2090-New State Reporting Burden Review

OMB Control No. 20XX-XXXX

Approval Expires XX/XX/XX

Attachment 1(A)

State Reporting Burden Review

STATE: POINT OF CONTACT: DATE:
Reporting Requirement (please specify):
Purpose (Please describe the intended purpose and use of the reporting requirement)
Type	□ Report □ Initiative □ Data □ Other (please specify) □ Measure
Source	□ Guidance (Regional) □ Grants □ Guidance (HQ) □ Regulation □ Statute (please reference) □ Other (please specify)
Transmission	□ Electronic (identify data base) □ Verbal □ Manual
Frequency (How often do you report this information?)
Nature of Burden (Please explain why this requirement is a burden to your state)	□ Administrative □ Data Collection □ Other (please specify)
Recommendation and rationale (Please explain)

The public reporting and recordkeeping burden for this collection of information is estimated to average 10 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Attachment 1(A)

Instructions for Completing the State Reporting Burden Review Form

Worksheet: To assist EPA in identifying specific reporting burdens, please list your state’s top 5 high-burden, low-value reporting requirements using the attached form. Each state should complete one form per reporting requirement for a total of five forms/state. There are 9 fields that must be filled out. Staff with the most expertise should complete the forms.

State/Point-of-Contact/Date: A point-of-contact is necessary in the event that EPA has questions or requires additional information.

Reporting Requirement: Identify the special reporting requirement in the space provided.

Purpose: Describe the state’s understanding of the intended purpose of the requirement and indicate why you believe it is a requirement. Describe how this data is used once it is reported.

Type: Identify whether the requirement is a report, measure, data, or initiative; if none applies, please explain what it is in the space provided.

Source: Indicate if the requirement is required by regional or EPA headquarters guidance, statute (include citation), regulation (include citation), grant workplan requirement, or other (including informal staff-level requests from the regions or headquarters). Specify or elaborate as necessary.

Transmission: Indicate mode of transmission for the requirement (whether electronically – in which case identify relevant data base, verbally, or manually).

Frequency: Indicate how often you have to report – yearly, monthly, biannually, or other.

Nature of Burden: Indicate whether the burden is the result of administrative, data collection, or other requirements. If other, please specify in the space provided. Also, briefly explain what is burdensome about this reporting requirement to your state.

Recommendation and Rationale: Indicate whether you recommend modifying or eliminating this requirement and provide appropriate rationale. Also, if you recommend modifying, please explain how you would change the requirement to decrease the reporting burden.

EPA Point-of-Contact: Please forward the State Reporting Burden Review Form to Pam Luttner by e-mail at luttner.pamela@epa.gov or by fax at 202-564-1545.