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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. |
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| Federal and Non-Federal Financial Assistance Instruments |
0596-0217 |
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| DATE PREPARED |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
RECORDS |
RESPONDENT COST |
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TOTAL |
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FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
COST |
TOTAL |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
PER |
COST |
| REGS. |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
HOUR |
(Col. H x L) |
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RESPONDENT |
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KEEPER |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
(L) |
(M) |
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Modification Form |
FS-1500-19 |
7,893 |
1.00 |
7,893 |
0.30 |
2,368 |
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0.00 |
0.00 |
$0.00 |
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Cooperator Performance Report (Optional Template) |
FS-1500-23 |
4,293 |
2.00 |
8,586 |
2.00 |
17,172 |
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0.00 |
0.00 |
$0.00 |
| NEW |
Grant or Agreement Award Face Sheet |
FS-1500-100 |
1,016 |
1.00 |
1,016 |
3.00 |
3,048 |
1,249.68 |
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By using a single form FS-1500-100 the agency hopes to eliminate duplicate collection when G&A Specialists must change forms when the wrong instrument type is completed by a partner/FS Program Manager. The Agency has sucessfully tested the new 1500-100 form and the goal in the upcoming years will to use the FS-1500-100 as the single form for all our Grants and Agreements. |
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Total |
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13,202 |
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17,495 |
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22,588 |
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0.00 |
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$0.00 |
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FEDERAL FINANCIAL ASSISTANCE TEMPLATES |
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0.00 |
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$0.00 |
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Cooperative Agreement |
Award Letter |
175 |
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- |
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- |
$41,178.48 |
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0.00 |
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$0.00 |
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Domestic Grant |
Award Letter |
761 |
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- |
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- |
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0.00 |
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$0.00 |
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International Cooperative Agreement |
Award Letter |
12 |
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- |
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- |
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0.00 |
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$0.00 |
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International Grant |
Award Letter |
16 |
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- |
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- |
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0.00 |
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$0.00 |
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SUB TOTAL: |
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964 |
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- |
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- |
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NEW FORMS AND COLLECTIONS |
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| NEW |
Certification Regarding Lobbying (Required for all awards over $100K) |
FS-1500-35 |
318 |
1.00 |
318 |
0.15 |
48 |
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| NEW |
Financial Capability Questionnaire |
FS-1500-22 |
200 |
1.00 |
200 |
1.00 |
200 |
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| NEW |
Financial Capability Checklist |
FS-1500-22A |
550 |
1.00 |
550 |
0.50 |
275 |
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| NEW |
Financial Capability Checklist (States ONLY) |
FS-1500-22B |
50 |
1.00 |
50 |
0.50 |
25 |
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| NEW |
Equipment Justification and Certification Statement |
FS-1500-34 |
25 |
1.00 |
25 |
0.42 |
11 |
558 |
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STANDARD FORM: Common |
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| 4040-0002 |
Application for Federal Assistance (Mandatory) |
SF-424 |
820 |
1.00 |
820.00 |
1.00 |
820.00 |
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| 4040-0005 |
Application for Federal Assistance (Individual) |
SF-424 |
10 |
1.00 |
10.00 |
3.00 |
30.00 |
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| 4040-0001 |
Application for Federal Assistance – Research |
SF-424 RR |
134 |
1.00 |
134.00 |
58.00 |
7,772.00 |
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TOTAL |
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964 |
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964.00 |
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8,622.00 |
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STANDARD FORM: Burden accounted for under another information collection number |
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| 4040-0013 |
Disclosure of Lobbying Activities |
SF-LLL & SF-LLLa |
150 |
1.00 |
150.00 |
0.17 |
25.00 |
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| 4040-0012 |
Request for Advance or Reimbursement |
SF-270 |
939 |
2.50 |
2,347.50 |
1.00 |
2,347.50 |
is 4040-0012. Grants.gov is carrying the burden for using this form. |
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| 4040-0011 |
Outlay Report and Request for Reimbursement for Construction Programs |
SF-271 |
25 |
2.50 |
62.50 |
1.00 |
62.50 |
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| 4040-0006 |
Budget Information – Non-Construction Programs |
SF-424A |
939 |
1.00 |
939.00 |
3.00 |
2,817.00 |
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| 4040-0007 |
Assurances – Non-Construction Programs |
SF-424B |
939 |
1.00 |
939.00 |
0.25 |
234.75 |
SF-424B is approved under 4040-0007 – Grants.gov carries the burden |
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| 4040-0008 |
Budget Information - Construction Programs |
SF-424C |
25 |
1.00 |
25.00 |
3.00 |
75.00 |
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| 4040-0009 |
Assurances – Construction Program |
SF-424D |
25 |
1.00 |
25.00 |
0.25 |
6.25 |
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| 4040-0014 |
Federal Financial Report |
SF-425 |
2,750 |
2.00 |
5,500.00 |
1.50 |
8,250.00 |
SF-425 and 425A – approved under 4040-0014 – Grants. Gov carries the burden. |
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| 3090-0289 |
Tangible Personal Property |
SF-428 |
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Annual Report |
SF-428-A |
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Final Report Form and Instructions |
SF-428-B |
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Disposition Request/Report |
SF-428-C |
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Supplemental Form and Instructions |
SF-428-S |
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| 3090-0296 |
Real Property Status Repot |
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| 9000-0045 |
Payment Bond |
SF-25A |
5 |
1.00 |
5.00 |
0.42 |
2.08 |
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TOTAL: |
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9,832 |
21 |
13,064 |
75 |
13,820 |
* |
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NONFEDERAL FINANCIAL ASSISTANCE TEMPLATES |
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COOPERATIVE FIRE AGREEMENTS |
FS-1500-7 |
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SUB TOTAL: |
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225 |
1.00 |
225.00 |
3.00 |
675.00 |
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LAW ENFORCEMENT AGREEMENTS |
FS-1500-8 |
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Cooperative Law Enforcement Annual Operating Plan and Financial Plan |
FS-1500-8A |
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SUB TOTAL: |
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174 |
1.00 |
174 |
3.00 |
522 |
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ROADS AGREEMENTS |
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Cooperative Forest Road Agreement |
FS-1500-9 |
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Road Project Agreement |
FS-1500-9A |
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SUB TOTAL: |
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205 |
1.00 |
205 |
4.00 |
820 |
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CHALLENGE COST SHARE AGREEMENTS |
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Challenge Cost-Share Agreement |
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Replaces FS-1500-10 through 10C |
Replaced |
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SUB TOTAL: |
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357 |
1.00 |
357 |
4.00 |
1,428 |
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COLLECTION AGREEMENTS |
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Collection Agreement |
FS-1500-11 |
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Reimbursable Collection Agreement, Rocky Mountain Elk Foundation |
FS-1500-11A |
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Advance Collection Agreement, Rocky Mountain Elk Foundation |
FS-1500-11B |
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Collection Agreement- FERC |
FS-1500-11C |
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Collection Agreement Financial Plan (Optional) |
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FS-1500-18 |
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SUB TOTAL: |
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975 |
1.00 |
975 |
4.00 |
3,900 |
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RESEARCH AND DEVELOPMENT (R&D) AGREEMENTS |
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Cost-Reimbursable Agreement |
Replaced |
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Cooperative Research and Development Agreements |
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Replaces FS-1500-13 through 13B |
Replaced |
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Nondisclosure Agreement |
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Joint Venture Agreement |
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Replaces FS-1500-14 through 14A |
Replaced |
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SUB TOTAL: |
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158 |
1.00 |
158 |
4.00 |
632 |
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MEMORANDUM OF UNDERSTANDING |
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Memorandum of Understanding |
FS-1500-15 |
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Memorandum of Understanding for Cooperative Frequency Usage |
FS-1500-15A |
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SUB TOTAL: |
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299 |
1.00 |
299 |
3.00 |
897 |
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PARTICIPATING AGREEMENTS |
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Replaces FS-1500-16 through 1500-16G |
Replaced |
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Master Stewardship Agreement |
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FS 1500-21 |
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Stewardship Agreement Supplemental Project Agreement |
FS-1500-21A |
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Stewardship Agreement Financial Plan |
FS-1500-21B |
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Stewardship Agreement |
FS-1500-21C |
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Stewardship Agreement (Short Form) |
FS-1500-21D |
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Agreements Financial Plan (Long) Optional |
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FS-1500-17A |
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Agreements Financial Plan (Short) Optional |
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FS-1500-17B |
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Agreements Financial Plan (Medium Form) Optional |
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FS-1500-17C |
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Collection Agreement Financial Plan Optional |
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FS-1500-18 |
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SUB TOTAL: |
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481 |
1.00 |
481 |
4.00 |
1,924 |
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| GOOD NEIGHBOR AGREEMENTS |
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Replaced |
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Good Neighbor Agreement |
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FS-1500-36 |
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Master Good Neighbor Agreement |
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FS-1500-36A |
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Supplemental Good Neighbor Agreement |
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FS-1500-36B |
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Good Neighbor Agreement (Road Work and Other Activities) |
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FS-1500-37 |
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SUB TOTAL: |
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20 |
1.00 |
20 |
4.45 |
89 |
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TOTAL: |
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2,894 |
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2,894 |
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10,887 |
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Reports |
Recordkeeping |
Cost |
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% |
No. Resp |
AveResp |
Burden |
AveTime |
Burden |
AveCost* |
Burden |
Cost to Partner |
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| TOTAL: Estimated PRIVATE burden |
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58% |
15,038 |
8.68 |
130,533 |
1.00 |
15,038 |
$40.53 |
145,571 |
$5,899,986 |
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| TOTAL: Estimated GOVERNMENT Burden |
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41% |
10,631 |
8.68 |
92,273 |
1.00 |
10,631 |
$40.53 |
102,904 |
$4,170,680 |
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| TOTAL: Estimated INDIVIDUAL Burden |
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1% |
259 |
8.68 |
2,251 |
1.00 |
259 |
$40.53 |
2,510 |
$101,724 |
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100% |
25,928 |
8.68 |
225,056 |
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25,928 |
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250,984 |
$10,172,390 |
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