Burden Calculation Tables

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Overview

Instructions
Part 1
Part 2
Notes

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Sheet 1: Instructions

Instructions for using this ICR Submission Workbook
This Excel workbook is intended to replace many of the functionalities of the previous system (ICRAS) used to send Information Collection Requests (ICRs) to reviewers in the Office of Environmental Information, and mimics the online forms that must accompany ICR submissions to OMB.
**Please fill out the workbook using information from your completed ICR Supporting Statement.**
Step-by-Step Instructions:
1	If you are renewing or revising an existing approved ICR, go to http://www.reginfo.gov/public/do/PRASearch and find the record of your previous ICR submission. Sort results by “Current Expiration Date” to ensure that you pull up the most recent version of your ICR.
		http://www.reginfo.gov/public/do/PRASearch
2	Complete Part 1. This form gathers basic information about your ICR.
		Only fill out WHITE cells. Instructions will pop up when cell is selected.
3	Complete Part 2. This form requests specific details about the scope and burden of the information that you will be collecting. Your ICR may have several Part 2 forms to cover specific types of Information Collections (ICs). At minimum, the burden on different categories of respondents (i.e. Private sector, Individuals, State/Local/Tribal governments) must be divided into individual Part 2 IC forms. However, you may choose or need to break down your ICR burden further in order to clearly characterize different types of response.
		Consult RegInfo.gov to see how many ICs were used previously (if renewing or revising an ICR). Create as many copies of the blank Part 2 worksheet as needed before starting. (To do this, right-click on the “Part 2” tab, select “Move or Copy”, then check the “Create a copy” box before hitting “OK”.)
		Fill out the Part 2 IC form with information from your Supporting Statement. You may also reference RegInfo.gov to copy over information that will not be changing from your previous approved ICR.
		If renewing or revising an existing ICR, enter the currently approved total number of responses, burden and non-labor cost from RegInfo.gov into cells G78-G80. The rest of the “Burden Worksheet” section should be taken from your new supporting statement.
4	Use the “Notes” tab to capture any relevant information that could not be included on the Part 1 & 2 forms, or which would be useful to the OEI Desk Officers reviewing your package.
5	Save this workbook with a new filename reflecting the following format: “2060.07 Forms.xlsx” (e.g. for ICR #2060.07)
6	Email this completed workbook to your OEI Desk Officer along with all other supporting documents CLEARLY LABELED, such as:
		Supporting Statement A (and B, if required)
		Draft (unsigned) 2nd Federal Register Notice
		All reporting forms & instruments that you listed in Part 2
		Any Miscellaneous Supporting Documents (such as separate appendices)
		A copy of the Final Rule document (only for Final Rule ICRs being submitted to OMB in advance of rule publication)
Please contact your ICR Desk Officer if you have questions while filling out this workbook.
ICR Desk Officer List

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Sheet 2: Part 1

Basic Information about your ICR
Office:	OAR
Title of ICR:	NESHAP for Rubber Tire Manufacturing
EPA ICR Number	201903-2060-002
OMB Control Number	2060-0449
Type of Information Collection:	Revision (e.g. Rules, Renewal with Program Change)
Type of Review Requested:	Regular	If Emergency, please provide justification:
Requested expiration date:	Three years from approval date	If Other, please specify date or # of months from approval date:
Does this ICR contain surveys, censuses, or employ statistical methods?	No
Does the Supporting Statement serve as a Joint ICR and Privacy Impact Assessment per OMB Memorandum 03-22, Section II.D.?	No
Is this ICR related to the Affordable Care Act [PPACA, P.L. 111-148 & 111-152]?	No
Is this ICR related to the Dodd-Frank Act [Dodd-Frank Wall Street Reform and Consumer Protection Act, P.L. 111-203]?	No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?	No
Agency Contact
Name:	Korbin Smith
Email:	[email protected]
Phone:	(919) 541-2416
Abstract
Abstract:	Concurrent to the residual risk and technology reviews for the NESHAP, the EPA proposed amendments that remove exemptions for startup, shutdown, and malfunctions so that affected facilities would be subject to the emission standards at all times, and add electronic reporting requirements This ICR documents the reporting and recordkeeping requirements and burden imposed by the rule - both the requirements that were previously promulgated and retained, as well as the proposed amendments.
Legal Statutes
Authorizing Statute(s):	Clean Air Act (CAA)
If more than one statute applies, or the statute is not on list, enter name and legal citation: (otherwise leave blank)
Rulemaking
RIN	2060-AT07
Stage of Rulemaking:	Proposed Rule
Federal Register Notices & Public Comments		FR Citation
	Publication Date	Volume		Page Number
60-Day Notice:			FR
Did the Agency receive public comments on this ICR?
Annual Cost to Federal Government: $	$7,330.00
END OF PART 1. PLEASE PROCEED TO FILL OUT DETAILS OF BURDEN ON THE PART 2 WORKSHEET(S)

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Sheet 3: Part 2

Part 2 - Details of a specific Information Collection (IC)
IC Title:	Private sector - annual reporting
IC Status:	Modify Existing IC
Obligation to Respond:	Mandatory
CFR Citation(s)
Must enter at least one CFR citation, unless your collection does not have basis in a regulation.
If more than 10 citations, please record them in the "Notes" tab
Title		Part
40	CFR	63(XXXX)
	CFR
	CFR
	CFR
	CFR
	CFR
	CFR
	CFR
	CFR
	CFR
Information Collection Instruments (e.g. Reporting Forms, Surveys, Focus Group Scripts)
List individually any instruments used in this collection, and attach a copy of them (clearly titled) with your submission.
If more than 5 instruments, please record them in the "Notes" tab.
Document Type	Form Number	Form Name	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability	URL
Federal Enterprise Architecture Line of Business	Environmental Management - Pollution Prevention and Control
Privacy Act System of Records
Fill out ONLY if the information collected will be housed in a system subject to the Privacy Act. (rare)
Title:
FR Citation:
Burden Worksheet
Affected Public:
Frequency of Reporting:	(select as many as applicable)
Respondents
Total Number of Respondents:	21
Number of these which are small entities:	0
Percentage of Respondents Reporting Electronically: (%)	0%
Responses
Number of Responses per Respondent (per year):	1.6190476190
Total Annual Responses:	34.00
Burden Calculations
Enter burden and costs in "Annual" section below. Burden per response will be auto-calculated.
Burden per Response	Hours Per Response	Cost Per Response ($)
Reporting	13.47	$-
Recordkeeping	159.18	$-
Third-Party Disclosure	0.00	$-
TOTAL	172.65	$-
Annual Burden	Annual Time Burden (Hours)	Annual Non-Labor Cost ($)
Reporting	458.00	$-
Recordkeeping	5412.00	$-
Third-Party Disclosure	0.00	$-
TOTAL	5870.00	$-
Burden Summary and Reason for Change in Burden
Enter "Previously Approved" from last approval from RegInfo.gov. Then attribute the difference in burden by category if other than change in estimates.
		Change due to:
	Total Requested (from above)	New Statute	Agency Actions (New Rules, etc.)	Potential Violation of the PRA	Revised Estimates	Previously Approved
Annual Number of Responses	34				34	0
Annual Time Burden (Hour)	5870				5870	0
Annual Cost Burden (Dollars)	$-				$-	$-
Briefly explain the reason(s) for any changes from the previously approved estimates; that is, how the reduction or increase in burden was achieved.
changed number of major facilities from 23 to 21, and added additional time to become familiar with the rule, specifically electronic reporting templates.
END OF THIS PART 2 IC. IF YOUR ICR REQUIRES MORE THAN ONE PART 2 IC, PLEASE MAKE A COPY OF THIS WORKSHEET WITHIN THE WORKBOOK.

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Sheet 4: Notes

Add any notes or information that could not be entered on previous worksheets: