| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| September 26, 2019 | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 116.2 | Food Waste Report | VS 13-17 | 0 | ||||||||||||
| Business | 1 | 1 | 1 | 0.08 | 1 | 0 | |||||||||
| State | 1 | 1 | 1 | 0.08 | 1 | 0 | |||||||||
| 116.10, 12 | Application for Licensing of Garbage Treatment Facility (Business) | VS 13-15 | 41 | 1 | 41 | 0.16 | 7 | 0 | |||||||
| 116.1(b) | Acknowledgement of Act and Regulations (Business) | 41 | 1 | 41 | 0.25 | 10 | 0 | ||||||||
| 116.13 | Garbage Treatment Facility Inspection | VS 13-16 | 0 | ||||||||||||
| Business | 1 | 1 | 1 | 1.00 | 1 | 0 | |||||||||
| State | 29 | 154 | 4,476 | 1.00 | 4,476 | 0 | |||||||||
| 166.10, 11, 12 | Request for Hearing (Business) | 1 | 1 | 1 | 1.00 | 1 | 0 | ||||||||
| 166.12 | Cancellation of License by Licensee or State | 0 | |||||||||||||
| Business | 4 | 1 | 4 | 0.25 | 1 | 0 | |||||||||
| State | 15 | 5 | 75 | 0.25 | 19 | 0 | |||||||||
| SUBTOTAL | 5,257 | 5,127 | 0.00 | 0 | |||||||||||
| TOTAL OF ALL PAGES | 931,654 | 1,703,801 | 31,245 | 11,735 | |||||||||||
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 15,150 | 962,899 | 1,715,536 | ||||||||||||
| \ | |||||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| September 26, 2019 | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 166.13 | Notification by Licensee of Sick or Dead Animals (Business) | 6 | 1.0 | 6 | 0.08 | 1 | 0 | ||||||||
| 166.15 | Swine Health Protection Program Inspection Summary (State) | VS 13-2 | 50 | 12.3 | 613 | 1.00 | 613 | 0 | |||||||
| 166.9 | Recordkeeping (Business) | 1,070 | 0.10 | 107 | |||||||||||
| 166.12 | Cooperative Agreement (Business) | 1 | 1.0 | 1 | 1.00 | 1 | |||||||||
| 71.19, 85.1, 85.5, 85.6, 85.11 | Permit to Move Restricted Animals | VS 1-27 | 0 | ||||||||||||
| Business | 1 | 1.0 | 1 | 0.25 | 1 | 0 | |||||||||
| Accredited Veterinarian | 1 | 1.0 | 1 | 0.50 | 1 | 0 | |||||||||
| State | 3 | 54.0 | 162 | 0.50 | 81 | 0 | |||||||||
| 85.6, 85.7 | Owner-Shipper Statement (Business) | 5 | 15.0 | 75 | 0.10 | 8 | 0 | ||||||||
| 85.1, 85.6, 85.7, 85.8 | Certificate of Veterinary Inspection | 0 | |||||||||||||
| Business | 1 | 1.0 | 1 | 0.25 | 1 | 0 | |||||||||
| Accredited Veterinarian | 8,000 | 10.0 | 80,000 | 0.25 | 20,000 | 0 | |||||||||
| State | 1 | 1.0 | 1 | 0.25 | 1 | 0 | |||||||||
| Business | 10 | 10.0 | 100.0 | 1.00 | 100 | 0 | |||||||||
| State | 10 | 10.0 | 100.0 | 0.25 | 25 | 0 | |||||||||
| SUBTOTAL | 80,442 | 20,218 | 1,070 | 107 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| September 26, 2019 | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 85.10, 85.11 | Accredited Veterinarian Statement: Embryo and Semen Shipments (Business) | 1 | 6784.0 | 6784.0 | 0.25 | 1696 | 0 | ||||||||
| 71.19(g) | Swine Production System Health Plan | 0 | |||||||||||||
| 71.19(g) | Swine Production System Health Plan -- Recordkeeping (Business) | 125 | 3.00 | 375 | |||||||||||
| 71.19(g) | Interstate Movement Report and Notification (Business) | 10 | 12.0 | 120.0 | 0.25 | 30 | 0 | ||||||||
| 71.19 | Annual Report of PRV Control and Eradication Activities (State) | VS 7-1 | 50 | 1.0 | 50.0 | 2.00 | 100 | 0 | |||||||
| 71.19 | Annual Report of PRV Control and Eradication Activities - Recordkeeping (State) | 50 | 0.033 | 2 | |||||||||||
| 52.3, 52.4 | Appraisal and Indemnity Claim Form | VS 1-23 | 0 | ||||||||||||
| Business | 2 | 1.0 | 2.0 | 0.25 | 1 | 0 | |||||||||
| State | 4 | 1.0 | 4.0 | 0.50 | 2 | 0 | |||||||||
| 52.5 | Herd Management Plan | 0 | |||||||||||||
| Business | 3 | 2.0 | 6.0 | 0.25 | 2 | 0 | |||||||||
| State | 3 | 2.0 | 6.0 | 0.50 | 3 | 0 | |||||||||
| 52.5 | Proceeds from Animals/Animal Products/Materials Sold for Slaughter (Business) | VS 1-24 | 2 | 1.0 | 2.0 | 0.25 | 1 | 0 | |||||||
| SUBTOTAL | 190.0 | 140 | 175 | 377 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| September 26, 2019 | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 52.5 | Appraisal Request for Affected Premises Using Contract Growers | VS 1-26 | 2 | 1.0 | 2.0 | 0.50 | 1 | 0 | |||||||
| 166.13 | Notification by Licensee of Changes to Name, Address, or Management (Business) | 1 | 1.0 | 1.0 | 0.25 | 1 | 0 | ||||||||
| 71.19€ | Recordkeeping for Buyers and Sellers of Swine Moved Interstate (Business) | 15,000 | 0.250 | 3,750 | |||||||||||
| 71.19(d) | Identification of Swine Moving Interstate | 0 | |||||||||||||
| Business | 15,000 | 55.0 | 825,000.0 | 2.00 | 1,650,000 | 0 | |||||||||
| Accredited Veterinarian | 100 | 5.0 | 500.0 | 2.00 | 1,000 | 0 | |||||||||
| State | 50 | 250.0 | 12,500.0 | 2.00 | 25,000 | 0 | |||||||||
| 71.19(d) | Identification of Swine Moving Interstate -- Recordkeeping (Business) | 15,000 | 0.500 | 7,500 | |||||||||||
| 71.19(h) | Cancellation of Withdrawal of a Swine Production System Health Plan | 0 | |||||||||||||
| Business | 1 | 1.00 | 1.0 | 1.00 | 1 | 0 | |||||||||
| State | 1 | 1.00 | 1.0 | 1.00 | 1 | 0 | |||||||||
| 71.21(a) | Application for Permit To Move Slaughter Swine from Originating Slaughter Facilities to Approved Destination Facilities | VS 1-38 | 0 | ||||||||||||
| Business | 1 | 1.00 | 1.0 | 2.00 | 2 | 0 | |||||||||
| State | 7 | 5.00 | 35.0 | 6.00 | 210 | 0 | |||||||||
| SUBTOTAL | 838,039.0 | 1,676,215 | 30,000 | 11,250 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| September 26, 2019 | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 71.19(h) | Appeal of Cancellation of a Swine Production System Health Plan (Business) | 1 | 1.0 | 1.0 | 10.00 | 10 | 0 | ||||||||
| 52.2 | Shipment to Slaughter Seal | 0 | |||||||||||||
| Accredited Veterinarian | 5 | 1.0 | 5.0 | 2.00 | 10 | 0 | |||||||||
| State | 25 | 5.0 | 125.0 | 2.00 | 250 | 0 | |||||||||
| New from 0579-0323 | |||||||||||||||
| 9 CFR 149.2(e)(2) | Temporary Withdrawal (Business) | 1 | 1.0 | 1.0 | 1.00 | 1 | 0 | ||||||||
| 9 CFR 149.2(e)(2) | Program Withdrawal (Business) | 1 | 1.0 | 1.0 | 1.00 | 1 | 0 | ||||||||
| 9 CFR 149.2(f) | Request for Review (Business) | 1 | 1.0 | 1.0 | 1.00 | 1 | 0 | ||||||||
| 9 CFR 149.2(a) | Request for Certification Site Audit (Business) | 16 | 1.0 | 16.0 | 0.10 | 2 | 0 | ||||||||
| 9 CFR 149.4 | Spot Audit (State) | 1 | 1.0 | 1.0 | 1.00 | 1 | 0 | ||||||||
| 9 CFR 149.3 | Trichinae Certification Audit Form | VS 7-9 | 0 | ||||||||||||
| Business | 1 | 1.0 | 1.00 | 1.00 | 1 | 0 | |||||||||
| State | 1 | 1.0 | 1.00 | 1.00 | 1 | 0 | |||||||||
| SUBTOTAL | 153.0 | 278 | 0 | 0 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| September 26, 2019 | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 9 CFR 149.7(a)(1) | Animal Disposal Plan and Recordkeeping (Business) | VS 7-11 | 1 | 1.0 | 1.0 | 1.0 | 1 | 1 | 1.00 | 1 | |||||
| 9 CFR 149.7(a)(2) | Animal Movement Record and Recordkeeping (Business) | VS 7-10 | 1 | 1.0 | 1.0 | 1.0 | 1 | 1 | 1.00 | 1 | |||||
| 9 CFR 149.7(a)(3) | Rodent Control Logbook and Recordkeeping (Business) | VS 7-12 | 1 | 1.0 | 1.0 | 1.0 | 1 | 1 | 1.00 | 1 | |||||
| 9 CFR 149.7(a)(4) | Trichinae Herd Certification Feed Mill Quality Assurance Affidavit and Recordkeeping (Business) | VS 7-13 | 1 | 1.0 | 1.0 | 1.0 | 1 | 1 | 1.00 | 1 | |||||
| 9 CFR 149.6(c)(5) | Records for Slaughter Testing and Recordkeeping (Business) | 1 | 1.00 | 1 | |||||||||||
| 9 CFR 166.5 | Inspection Report of Garbage Processing Equipment (Business) | VS 13-9 | 17 | 46.0 | 782.0 | 0.2 | 125 | 0 | |||||||
| SUBTOTAL | 786.0 | 129 | 5 | 5 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| DATE PREPARED | |||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||
| REPORTS | RECORDS | ||||||||||||||
| TOTAL | |||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | |||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | |||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | |||||||
| RESPONDENT | KEEPER | ||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | |||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |