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-I: 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.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
0560-0260 |
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| Measurement Service Records |
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| DATE PREPARED |
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| December 15, 2021 |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
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RECORDS |
RESPONDENT COST |
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TOTAL BURDEN HOURS |
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TOTAL |
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FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
(Col. F x G) |
NO. OF |
ANNUAL |
RECORD- |
COST |
TOTAL |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
(H) |
RECORD- |
HOURS PER |
KEEPING HOURS |
PER |
COST |
| REGS. |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
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KEEPERS |
RECORD- |
(Col. I x J) |
HOUR |
(Col. H x L) |
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RESPONDENT |
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EXEMPT |
NON-EXEMPT |
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KEEPER |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
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(I) |
(J) |
(K) |
(L) |
(M) |
| N/A |
Measurement Service Records |
FSA-409 and FSA-409A |
135,000 |
1 |
135,000 |
0.25 |
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33,750 |
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$50.08 |
1,690,200 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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SUBTOTAL |
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135,000 |
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0 |
33,750 |
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0.00 |
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1,690,200 |
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TOTAL OF ALL PAGES |
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135,000 |
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33,750 |
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0.00 |
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1,690,200 |
| TOTAL - COLUMNS "F" AND "I" = OMB 83-I, 13b; COLUMNS "H" AND "K" = OMB 83-I, 13c |
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135,000 |
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33,750 |
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