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Attachment
F
Supporting
Statement for a Generic Information Collection Request (ICR)
Under
the
Paperwork Reduction Act (PRA)
EXECUTIVE SUMMARY
Identification of the Information Collection – Title and
Numbers
Title:
ICR
Numbers: EPA
ICR No.: XXXX.XX; OMB Control No.: XXXX-XXXX
Docket
ID No.: EPA-HQ-XXXX-XXXX-XXXX
Abstract
Explain the circumstances
that make the collection of information necessary.
Indicate how, by whom, and
for what purpose the information is to be used. Except for a new
collection, indicate the actual use the Agency has made of the
information received from the current collection
Describe whether, and to what extent, the
collection of information involves the use of automated, electronic,
mechanical, or other technological collection techniques or other
forms of information technology, e.g., permitting electronic
submission of responses.
Describe efforts to identify duplication.
If the collection of information impacts
small businesses or other small entities, describe the methods used
to minimize burden.
Describe the consequence to Federal program
or policy activities if the collection is not conducted or is
conducted less frequently, as well as any technical or legal
obstacles to reducing burden.
Explain any special circumstances that
require the collection to be conducted in a manner inconsistent with
OMB guidelines.
If applicable, provide a copy and identify
the date and page number of publication in the Federal Register of
the agency’s notice, required by 5CFR 320.8(d), soliciting
comments on the information collection prior to submission to OMB.
Summarize public comments received in response to that notice and
describe actions taken in response to the comments. Specifically
address comments received on cost and hour burden. Describe efforts
to consult with persons outside DOE to obtain their views on the
availability of data, frequency of collection, the clarity of
instructions and recordkeeping, disclosure, or reporting format (if
any), and on the data elements to be recorded, disclosed, or report.
Explain any decision to provide any payment
or gift to respondents, other than remuneration of contractors or
grantees.
Describe any assurance of confidentiality
provided to respondents and the basis for the assurance in statute,
regulation, or agency policy.
Provide additional justification for any
questions of a sensitive nature, such as sexual behavior and
attitudes, religious beliefs, and other matters that are commonly
considered private.
12. Provide estimates
of the hour burden of the collection of information.
13. Provide an estimate for the total annual cost burden to
respondents or recordkeepers resulting from the collection of
information.
14. Provide estimates of annualized cost to the Federal government.
Agency Activities
Unit Burden for Agency Activities
Total Agency Burden and Cost
15. Explain the
reasons for any program changes or adjustments reported in Items 13
(or 14) of OMB Form 83-I.
16. For collections
whose results will be published, outline the plans for tabulation and
publication.
If seeking approval to not display the
expiration date for OMB approval of the information collection,
explain the reasons why display would be inappropriate.
Explain each exception to the certification
statement identified in Item 19 of OMB Form 83-I.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | OMB Comments |
| File Modified | 0000-00-00 |
| File Created | 2021-12-03 |