Special Use Administration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FS-2700-1 Inspection form for Special Uses	Form and Instruction	Unchanged	Available
Form FS-2700-6b Recreation Residence Self-Inspection Report	Form and Instruction	Unchanged	Repair queued
Form FS-2700-6b Special Use Administration - Compliance Reporting	Form and Instruction	Unchanged	Repair queued
Form FS-2700-38 Financing or Eligible for Financing of Telephone Facilities (Rural Utility Service required form)	Form and Instruction	Unchanged	Available
Form FS-2700-19a Fee Calculation for Ski Area Permits	Form and Instruction	Unchanged	Available
Form FS-2700-19 Fee Calculation for Concession Permits	Form and Instruction	Unchanged	Available
Form FS-2700-10a Communications Site Tenant/Customer Inventory	Form and Instruction	Unchanged	Available
Form FS-2700-8 Reconciliation of Gross Fixed Assets (GFA) to Booked Amounts	Form and Instruction	Unchanged	Available
Form FS-2700-7 Reconciliation of Sales for Fee Calculation	Form and Instruction	Unchanged	Available
Form FS-2700-7 Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Repair queued
Form FS-2700-27 Notice to Alaska Native Corporations Regarding Prospectus for Visitor Services	Form and Instruction	Unchanged	Available
Form Stanislaus FS-2300 Cherry Creek Self-Registration Permit	Form and Instruction	Unchanged	Available
Form Stanislaus FS-2300 Tuolumne Wild and Scenic River Permit	Form and Instruction	Unchanged	Available
Form FS-2700-32 Permit for Archeological Investigations	Form and Instruction	Unchanged	Available
Form FS-2700-31 Electric Transmission Line Easement	Form and Instruction	Unchanged	Repair queued
Form FS-2700-26b Category 5 Major Cost Recovery Agreement	Form and Instruction	Unchanged	Available
Form FS-2700-26 Category 6 Major Cost Recovery Agreement	Form and Instruction	Unchanged	Available
Form FS-2700-25 Temporary Special Use Permit	Form and Instruction	Unchanged	Available
Form FS-2700-23 Amendment for Special Use Authorization Cost Recovery Agreement	Form and Instruction	Unchanged	Available
Form FS-2700-10c Communications use Permit for Federal Agencies	Form and Instruction	Unchanged	Repair queued
Form FS-2700-10b Communications Use Lease	Form and Instruction	Unchanged	Available
Form FS-2700-9j Private Road Easement Issued Under The Federal Land Policy and Management Act	Form and Instruction	Unchanged	Repair queued
Form FS- 2700-9i Forest Road Easement issued under the Federal Land Policy and Management Act	Form and Instruction	Unchanged	Available
Form FS-2700-9h Private Road Easement Issued Under the National Forest Roads and Trails Act	Form and Instruction	Unchanged	Available
Form FS-2700-9g Forest Road Easement Issued Under the National Forest Roads & Trails act	Form and Instruction	Unchanged	Available
Form FS-2700-9f Public Road Easement	Form and Instruction	Unchanged	Available
Form FS-2700-9e Non-Cost Share Easement	Form and Instruction	Unchanged	Repair queued
Form FS-2700-9d Cost Share Easement	Form and Instruction	Unchanged	Available
Form FS-2700-9a Agricultural Irrigation and Livestock Watering System Easement	Form and Instruction	Unchanged	Available
Form FS-2700-5d Resort Supplement for Outfitting& Guiding	Form and Instruction	Unchanged	Available
Form FS-2700-5c Resort/Marina Term Special Use Permit	Form and Instruction	Unchanged	Available
Form FS-2700-5b Ski Area Term Special Use Permit	Form and Instruction	Unchanged	Available
Form FS-2700-5a-GI-Gran Term Special Use Permit for Recreation Residences on Grand Island	Form and Instruction	Unchanged	Repair queued
Form FS-2700-5a Term Special Use Permit for Recreation Residences	Form and Instruction	Unchanged	Available
Form FS-2700-5 Term Special Use Permit	Form and Instruction	Unchanged	Repair queued
Form FS-2700-4-Shawnee Special Use Permit for Equestrian Outfitting on the Shawnee National Forest	Form and Instruction	Unchanged	Available
Form FS-2700-4j Special Use Permit for a Federal Agencies Electric Transmission Line Permit	Form and Instruction	Unchanged	Repair queued
Form FS-2700-4i Special Use Permit for Outfitting & Guiding	Form and Instruction	Unchanged	Available
Form FS-2700-4h, Append Appendix G – Granger-Thye Fee Offset Claim Certification	Form and Instruction	Unchanged	Available
Form FS-2700-4h, Append Appendix F - Special Use Permit for Campground and Related Granger-Thye Concessions	Form and Instruction	Unchanged	Available
Form FS-2700-4h, Append Appendix B – Annual Granger-Thye Fee Offset Agreement	Form and Instruction	Unchanged	Available
Form FS-2700-4h Special Use Permit for Campground and Related Granger-Thye Concessions	Form and Instruction	Unchanged	Repair queued
Form FS-2700-4d Temporary Cost Share Agreement Road Special Use Permit	Form and Instruction	Unchanged	Repair queued
Form FS-2700-4c Private Road Special Use Permit	Form and Instruction	Unchanged	Available
Form FS-2700-4b Forest Road Special Use Permit	Form and Instruction	Unchanged	Repair queued
Form FS-2700-4 Special Use Permit	Form and Instruction	Unchanged	Available
Form FS-2700-4 Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Repair queued
Form FS-2700-40 Assumption of Risk, Waiver of Liability, and Indemnity Agreement for Good Samaritan Search and Recovery Missions	Form and Instruction	Modified	Available
Form FS-2700-14c Claim for In-Kind C0osideration Cost	Form and Instruction	Modified	Available
Form Fs-2700-14b In-Kind Consideration Agreement	Form and Instruction	Modified	Available
Form FS-2700-14a Prospectus for Leasing Administrative Sites	Form and Instruction	Modified	Available
Form FS-2700-14 Lease for Forest Service Administrative Sites	Form and Instruction	Modified	Available
Form FS-2700-13 Historic Property Lease	Form and Instruction	Modified	Available
Form FS-6500-25 Request for Verification	Form and Instruction	Modified	Available
Form FS-6500-24 Financial Statement	Form and Instruction	Modified	Available
Form FS-2700-34 Prospectus for Campground and Related Granger-Thye Concessions	Form and Instruction	Modified	Available
Form FS-2700-33 Insurance Endorsement Special Use Authorization	Form and Instruction	Modified	Available
Form FS-2700-30 Application for Permit for Archaeological Investigations	Form and Instruction	Modified	Available
Form FS-2700-12 Agreement Concerning Loan for Holder of Special Use Permit	Form and Instruction	Modified	Available
Form FS-2700-11 Agreement Concerning Small Business Administration Loan for Holder of Special Use Permit	Form and Instruction	Modified	Available
Form FS-2700-10 Technical Data – Communications Type Land Use	Form and Instruction	Modified	Available
Form FS-2700-3f Special Use Application & Temporary Permit for Outfitting and Guiding	Form and Instruction	Modified	Available
Form FS-2700-3e Special Use Application & Permit for Government Owned Buildings	Form and Instruction	Modified	Available
Form FS-2700-3c Special Use Application & Permit for Recreation Events	Form and Instruction	Modified	Available
Form FS-2700-3b Special Use Application & Permit for Noncommercial Group Use	Form and Instruction	Modified	Available
Form FS-2700-3a Holder Initiated Revocation of Existing Authorization, Request for a Special Use Permit	Form and Instruction	Modified	Available
Form W-9 (IRS) Request for Taxpayer Identification Number and Certification	Form and Instruction	Modified	Available
Form W-9 (IRS) Special Use Administration - General	Form and Instruction	Modified	Repair queued
JOC 0596-0082 Special Use Administration.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-02-17	Repair queued
Special Uses Administration ICR0596-0082_final.xlsx	Supplementary Document	Uploaded 2021-12-08	Repair queued
FRN Published May 29.pdf	Supplementary Document	Uploaded 2020-08-26	Repair queued
0596-0082 Supporting Statement A - 1203-2021_Final (1).docx	Supporting Statement A	Uploaded 2022-02-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250674	Special Use Administration - Compliance Reporting	Form and Instruction	Unchanged	Inspection form for Special Uses
250674	Special Use Administration - Compliance Reporting	Form and Instruction	Unchanged	Recreation Residence Self-Inspection Report
250674	Special Use Administration - Compliance Reporting	Form and Instruction	Unchanged
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Financing or Eligible for Financing of Telephone Facilities (Rural Utility Service required form)
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Fee Calculation for Ski Area Permits
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Fee Calculation for Concession Permits
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Communications Site Tenant/Customer Inventory
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Reconciliation of Gross Fixed Assets (GFA) to Booked Amounts
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged	Reconciliation of Sales for Fee Calculation
250673	Special Use Administration - Annual Financial Information	Form and Instruction	Unchanged
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Notice to Alaska Native Corporations Regarding Prospectus for Visitor Services
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Cherry Creek Self-Registration Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Tuolumne Wild and Scenic River Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Permit for Archeological Investigations
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Electric Transmission Line Easement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Category 5 Major Cost Recovery Agreement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Category 6 Major Cost Recovery Agreement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Temporary Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Amendment for Special Use Authorization Cost Recovery Agreement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Communications use Permit for Federal Agencies
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Communications Use Lease
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Private Road Easement Issued Under The Federal Land Policy and Management Act
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Forest Road Easement issued under the Federal Land Policy and Management Act
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Private Road Easement Issued Under the National Forest Roads and Trails Act
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Forest Road Easement Issued Under the National Forest Roads & Trails act
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Public Road Easement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Non-Cost Share Easement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Cost Share Easement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Agricultural Irrigation and Livestock Watering System Easement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Resort Supplement for Outfitting& Guiding
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Resort/Marina Term Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Ski Area Term Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Term Special Use Permit for Recreation Residences on Grand Island
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Term Special Use Permit for Recreation Residences
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Term Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Special Use Permit for Equestrian Outfitting on the Shawnee National Forest
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Special Use Permit for a Federal Agencies Electric Transmission Line Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Special Use Permit for Outfitting & Guiding
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Appendix G – Granger-Thye Fee Offset Claim Certification
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Appendix F - Special Use Permit for Campground and Related Granger-Thye Concessions
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Appendix B – Annual Granger-Thye Fee Offset Agreement
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Special Use Permit for Campground and Related Granger-Thye Concessions
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Temporary Cost Share Agreement Road Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Private Road Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Forest Road Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged	Special Use Permit
250672	Special Use Administration - Special Use Authorizations	Form and Instruction	Unchanged
250671	Special Use Administration - General	Form and Instruction	Modified	Assumption of Risk, Waiver of Liability, and Indemnity Agreement for Good Samaritan Search and Recovery Missions
250671	Special Use Administration - General	Form and Instruction	Modified	Claim for In-Kind C0osideration Cost
250671	Special Use Administration - General	Form and Instruction	Modified	In-Kind Consideration Agreement
250671	Special Use Administration - General	Form and Instruction	Modified	Prospectus for Leasing Administrative Sites
250671	Special Use Administration - General	Form and Instruction	Modified	Lease for Forest Service Administrative Sites
250671	Special Use Administration - General	Form and Instruction	Modified	Historic Property Lease
250671	Special Use Administration - General	Form and Instruction	Modified	Request for Verification
250671	Special Use Administration - General	Form and Instruction	Modified	Financial Statement
250671	Special Use Administration - General	Form and Instruction	Modified	Prospectus for Campground and Related Granger-Thye Concessions
250671	Special Use Administration - General	Form and Instruction	Modified	Insurance Endorsement Special Use Authorization
250671	Special Use Administration - General	Form and Instruction	Modified	Application for Permit for Archaeological Investigations
250671	Special Use Administration - General	Form and Instruction	Modified	Agreement Concerning Loan for Holder of Special Use Permit
250671	Special Use Administration - General	Form and Instruction	Modified	Agreement Concerning Small Business Administration Loan for Holder of Special Use Permit
250671	Special Use Administration - General	Form and Instruction	Modified	Technical Data – Communications Type Land Use
250671	Special Use Administration - General	Form and Instruction	Modified	Special Use Application & Temporary Permit for Outfitting and Guiding
250671	Special Use Administration - General	Form and Instruction	Modified	Special Use Application & Permit for Government Owned Buildings
250671	Special Use Administration - General	Form and Instruction	Modified	Special Use Application & Permit for Recreation Events
250671	Special Use Administration - General	Form and Instruction	Modified	Special Use Application & Permit for Noncommercial Group Use
250671	Special Use Administration - General	Form and Instruction	Modified	Holder Initiated Revocation of Existing Authorization, Request for a Special Use Permit
250671	Special Use Administration - General	Form and Instruction	Modified	Request for Taxpayer Identification Number and Certification
250671	Special Use Administration - General	Form and Instruction	Modified

ICR Details

OMB Control No: 0596-0082	ICR Reference No: 202202-0596-003
Status: Historical Active	Previous ICR Reference No: 202008-0596-001
Agency/Subagency: USDA/FS	Agency Tracking No:
Title: Special Use Administration
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/28/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/17/2022
Terms of Clearance: In accordance with 5 CFR 1320, the non-substantive change request is approved. The agency is reminded to include in the PRA burden statement whether it is a mandatory of voluntary collection and cite the authority to collect the information.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2024	12/31/2024	12/31/2024
Responses	104,962	0	104,962
Time Burden (Hours)	88,261	0	88,261
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is used by the Forest Service to evaluate and ensure that authorized uses of National Forest System (NFS) lands are in the public interest and are compatible with the Agency's mission. The information helps the agency identify environmental and social impacts of special uses for purposes of compliance with the National Environmental Policy Act (NEPA) and program administration.

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Authorizing Statute(s): US Code: 16 USC 497 Name of Law: The Act of March 4 1915
   US Code: 16 USC 6801-6814 Name of Law: Federal Lands Recreation Enhancement Act
   US Code: 16 USC 551 Name of Law: Organic Administration Act of 1897
   US Code: 16 USC 497b Name of Law: National Forest Ski Area Permit Act
   US Code: 43 USC 1761-1771 Name of Law: Title IV Federal Land Policy & Management Act of 1976
   US Code: 30 USC 185 Name of Law: Sec 28, Minerals Leasing Act
   US Code: 16 USC 532-538 Name of Law: National Forest Roads & Trails Act
   US Code: 16 USC 460l-6d Name of Law: Act of May 26, 2000
   US Code: 16 USC 1b Name of Law: Archaeological Resources Protection Act of 1979
   US Code: 43 USC 931c, 931d Name of Law: Act of September 3, 1954
   US Code: 16 USC 480d Name of Law: Sec 7, Granger-Thye Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 104	05/29/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 53318	08/28/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Special Use Administration - Annual Financial Information	FS-2700-7, FS-2700-8, FS-2700-10a, FS-2700-19, FS-2700-19a, FS-2700-38	Reconciliation of Sales for Fee Calculation ,   Reconciliation of Gross Fixed Assets (GFA) to Booked Amounts ,   Communications Site Tenant/Customer Inventory ,   Fee Calculation for Concession Permits ,   Fee Calculation for Ski Area Permits ,   Financing or Eligible for Financing of Telephone Facilities (Rural Utility Service required form)
Special Use Administration - Compliance Reporting	FS-2700-1, FS-2700-6b	Recreation Residence Self-Inspection Report ,   Inspection form for Special Uses
Special Use Administration - General	W-9 (IRS), FS-2700-3a, FS-2700-3b, FS-2700-3c, FS-2700-3e, FS-2700-3f, FS-2700-10, FS-2700-11, FS-2700-12, FS-2700-30, FS-2700-33, FS-2700-34, FS-6500-24, FS-6500-25, FS-2700-13, FS-2700-14, FS-2700-14a, Fs-2700-14b, FS-2700-14c, FS-2700-40	Request for Taxpayer Identification Number and Certification ,   Holder Initiated Revocation of Existing Authorization, Request for a Special Use Permit ,   Special Use Application & Permit for Noncommercial Group Use ,   Special Use Application & Permit for Recreation Events ,   Special Use Application & Permit for Government Owned Buildings ,   Special Use Application & Temporary Permit for Outfitting and Guiding ,   Technical Data – Communications Type Land Use ,   Agreement Concerning Small Business Administration Loan for Holder of Special Use Permit ,   Agreement Concerning Loan for Holder of Special Use Permit ,   Application for Permit for Archaeological Investigations  ,   Insurance Endorsement Special Use Authorization ,   Prospectus for Campground and Related Granger-Thye Concessions ,   Financial Statement ,   Request for Verification ,   Historic Property Lease ,   Lease for Forest Service Administrative Sites ,   Prospectus for Leasing Administrative Sites ,   In-Kind Consideration Agreement ,   Claim for In-Kind C0osideration Cost ,   Assumption of Risk, Waiver of Liability, and Indemnity Agreement for Good Samaritan Search and Recovery Missions
Special Use Administration - Special Use Authorizations	FS-2700-4b, FS-2700-4c, FS-2700-4d, FS-2700-4h, FS-2700-4h, Appendix B, FS-2700-4h, Appendix F, FS-2700-4h, Appendix G, FS-2700-4i, FS-2700-4j, FS-2700-4-Shawnee, FS-2700-5, FS-2700-5a, FS-2700-5a-GI-Grand Island, FS-2700-5b, FS-2700-5c, FS-2700-5d, FS-2700-9a, FS-2700-9d, FS-2700-9e, FS-2700-9g, FS-2700-9h, FS-2700-9j, FS-2700-10b, FS-2700-10c , FS-2700-23, FS-2700-25, FS-2700-26, FS-2700-26b, FS-2700-31, FS-2700-32, Stanislaus FS-2300-1A , Stanislaus FS-2300-1B, FS-2700-9f, FS- 2700-9i, FS-2700-27, FS-2700-4	Special Use Permit ,   Forest Road Special Use Permit ,   Private Road Special Use Permit ,   Temporary Cost Share Agreement Road Special Use Permit ,   Special Use Permit for Campground and Related Granger-Thye Concessions ,   Appendix B – Annual Granger-Thye Fee Offset Agreement ,   Appendix F - Special Use Permit for Campground and Related Granger-Thye Concessions ,   Appendix G – Granger-Thye Fee Offset Claim Certification ,   Special Use Permit for Outfitting & Guiding ,   Special Use Permit for a Federal Agencies Electric Transmission Line Permit ,   Special Use Permit for Equestrian Outfitting on the Shawnee National Forest ,   Term Special Use Permit ,   Term Special Use Permit for Recreation Residences ,   Term Special Use Permit for Recreation Residences on Grand Island ,   Ski Area Term Special Use Permit ,   Resort/Marina Term Special Use Permit ,   Resort Supplement for Outfitting& Guiding ,   Agricultural Irrigation and Livestock Watering System Easement ,   Cost Share Easement ,   Non-Cost Share Easement ,   Public Road Easement ,   Forest Road Easement Issued Under the National Forest Roads & Trails act ,   Private Road Easement Issued Under the National Forest Roads and Trails Act ,   Forest Road Easement issued under the Federal Land Policy and Management Act ,   Private Road Easement Issued Under The Federal Land Policy and Management Act ,   Communications Use Lease ,   Communications use Permit for Federal Agencies ,   Amendment for Special Use Authorization Cost Recovery Agreement ,   Temporary Special Use Permit ,   Category 6 Major Cost Recovery Agreement ,   Category 5 Major Cost Recovery Agreement ,   Electric Transmission Line Easement ,   Permit for Archeological Investigations ,   Tuolumne Wild and Scenic River Permit ,   Cherry Creek Self-Registration Permit ,   Notice to Alaska Native Corporations Regarding Prospectus for Visitor Services

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	104,962	104,962	0	0	0	0
Annual Time Burden (Hours)	88,261	88,261	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,973,475

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/17/2022

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