1730om05part2

PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part II: Information Collection Detail

1. Title of Information Collection: New Source Performance Standards for Hospital/Medical/Infectious Waste Incinerators (40 CFR part 60, subpart Ec) (Proposed Rule)

2. Is this a common form?
Yes
No

(Select, Yes, to identify forms that EPA is willing to host for potential use by other Federal Agencies.)

3. Obligation to respond (check one):
Voluntary

Required to obtain or retain benefits

Mandatory

Only one selection may be made.
If multiple categories apply, you must create
additional ICs to account for the burden associated
with each category.

4. Frequency of reporting (only to be completed if there are reporting requirements, check all that apply):

Hourly

Daily

Weekly

Monthly

Quarterly

Semi-annually

Annually

Every Decade

Biennially

On Occasion

Once

5. CFR Citation(s) for the information collection under review (if applicable):

Title: Standards of Performance for Hospital/Medical/Infectious Waste Incinerators for Which Construction Is Commenced After June 20, 1996; Proposed Rule; Amendments Citation: 40 CFR part 60, subpart Ec

Title:         Citation:        
Title:        Citation:       
Title:        Citation:       

6. Information Collection Instruments/Forms (if applicable):
Form/Instrument must be submitted to OEI as a separate attachment.

Form Name	EPA Form #	URL (required if electronic)	Is this collection instrument/form available electronically?	If yes, can this collection instrument/form be submitted electronically?
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No

7. Federal Enterprise Architecture Business Reference Model

Line of Business (check one): Subfunction (check one):

None
Environmental Management	Environmental Monitoring and Forecasting Environmental Remediation Pollution Prevention and Control None
Health	Illness Prevention Immunization Management Public Health Monitoring Health Care Services Consumer Health and Safety None
Natural Resources	Water Resource Management Conservation, Marine and Land Management Recreational Resource Management and Tourism Agricultural Innovation and Services None

IMPORTANT: Part II must be completed for each Information Collection (IC) activity associated with the ICR. Please be sure that you copy this portion of the template as many times as necessary so that each IC has its own Part II submission. For more information on how to break your ICR into ICs, please see OMB’s ROCIS IC Q&A, located at: http://intranet.epa.gov/icrintra/download.html. In addition, please reference OEI’s ROCIS instructions at: http://intranet.epa.gov/icrintra/download.html

Note: Most EPA ICRs will be aligned with the Environmental Management FEA Line of Business. Other likely categories are also listed. For a full listing of the FEA Business Reference Model categories and definitions, see: http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_QuickGuide.pdf

8. Privacy Act System of Records (if applicable):

Title:       

Federal Register Citation: Volume:       Page number:       Publication date:      

9. Respondents

Total number: 4
Small entity number: 0
Percentage of responses collected electronically: 15

Affected Public (choose one):

Individuals or households
Private Sector (if private sector, check all that apply)
Business or other for-profit
Not-for-profit institutions
Farms
State, Local, or Tribal Governments
Federal Government

Only one selection may be made. If multiple categories apply, you must create additional ICs to account for the burden associated with each category. Note: Selecting multiple subcategories within the Private Sector will not affect the number of ICs required.

10. Frequency: How often on average will each respondent respond
to the Information Collection?

Number of Responses per Respondent: 7
Per (select the most appropriate time period for this collection)
Hour (24 per day, 8736 per year)
Business Hour (40 per week, 2080 per year)

Day ( 7 per week, 365 per year)

Business Day ( 5 per week, 260 per year)
Week (52 per year)
Month (12 per year)
Semi-Annual (2 per year)
Year
Decade (.1 per year)

Calculated: Annual Frequency = 7
(responses per respondent, per year)

Calculated: Annual Number of Responses = 28

11. Hour and Cost Burden - Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

	Hours per Response	Total Annual Hour Burden	Cost per Response (Capital/Startup and O&M Costs Only)	Total Annual Cost Burden (Capital/Startup and O&M Costs Only)
Reporting	23.38	658.00	$880.00	$24,748.00
Recordkeeping	47.84	1346.00	$875.00	$24,607.00
Third Party Disclosure	0.00	0.00	$0.00	$0.00
Total	71.22	2004.00	$1,754.00	$49,356.00

12. Allocate the change in Burden:

	Total Requested	Change Due to New Statute	Change Due to Agency Discretion	Due to Agency Estimate	Change due to Violation	Currently Approved
Annual Responses	45	     	0.00	     	     	45.00
Annual Hour Burden	4795.00	     	0.00	     	     	4795.00
Annual Cost Burden (Capital/Startup and O&M costs only)	$22,000.00	     	$0.00	     	     	$22,000.00

PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part II: Information Collection Detail

1. Title of Information Collection:     

2. Is this a common form?
Yes
No

(Select, Yes, to identify forms that EPA is willing to host for potential use by other Federal Agencies.)

3. Obligation to respond (check one):
Voluntary

Required to obtain or retain benefits

Mandatory

Only one selection may be made.
If multiple categories apply, you must create
additional ICs to account for the burden associated
with each category.

4. Frequency of reporting
(check all that apply):

Hourly

Daily

Weekly

Monthly

Quarterly

Semi-annually

Annually

Every Decade

Biennially

On Occasion

Once

5. CFR Citation(s) for the information collection under review (if applicable):

Title:         Citation:       

Title:         Citation:        
Title:        Citation:       
Title:        Citation:       

6. Information Collection Instruments/Forms (if applicable):
Form/Instrument must be submitted to OEI as a separate attachment.

Form Name	EPA Form #	URL (required if electronic)	Is this collection instrument/form available electronically?	If yes, can this collection instrument/form be submitted electronically?
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No

7. Federal Enterprise Architecture Business Reference Model

Line of Business (check one): Subfunction (check one):

None
Environmental Management	Environmental Monitoring and Forecasting Environmental Remediation Pollution Prevention and Control None
Health	Illness Prevention Immunization Management Public Health Monitoring Health Care Services Consumer Health and Safety None
Natural Resources	Water Resource Management Conservation, Marine and Land Management Recreational Resource Management and Tourism Agricultural Innovation and Services None

IMPORTANT: Part II must be completed for each Information Collection (IC) activity associated with the ICR. Please be sure that you copy this portion of the template as many times as necessary so that each IC has its own Part II submission. For more information on how to break your ICR into ICs, please see OMB’s ROCIS IC Q&A, located at: http://intranet.epa.gov/icrintra/download.html. In addition, please reference OEI’s ROCIS instructions at: http://intranet.epa.gov/icrintra/download.html

Note: Most EPA ICRs will be aligned with the Environmental Management FEA Line of Business. Other likely categories are also listed. For a full listing of the FEA Business Reference Model categories and definitions, see: http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_QuickGuide.pdf

8. Privacy Act System of Records (if applicable):

Title:       

Federal Register Citation: Volume:       Page number:       Publication date:    /   /  

9. Respondents

Total number:       
Small entity number:       
Percentage of responses collected electronically:      

Affected Public (choose one):

Individuals or households
Private Sector (if private sector, check all that apply)
Business or other for-profit
Not-for-profit institutions
Farms
State, Local, or Tribal Governments
Federal Government

Only one selection may be made. If multiple categories apply, you must create additional ICs to account for the burden associated with each category. Note: Selecting multiple subcategories within the Private Sector will not affect the number of ICs required.

10. Frequency: How often on average will each respondent respond
to the Information Collection?

Number of Responses per Respondent:         
Per (select the most appropriate time period for this collection)
Hour (24 per day, 8736 per year)
Business Hour (40 per week, 2080 per year)

Day ( 7 per week, 365 per year)

Business Day ( 5 per week, 260 per year)
Week (52 per year)
Month (12 per year)
Semi-Annual (.5 per year)
Year
Decade (.1 per year)

Calculated: Annual Frequency =      
(responses per respondent, per year)

Calculated: Annual Number of Responses =      

11. Hour and Cost Burden - Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

	Hours per Response	Total Annual Hour Burden	Cost per Response (Capital/Startup and O&M Costs Only)	Total Annual Cost Burden (Capital/Startup and O&M Costs Only)
Reporting	     	     	     	     
Recordkeeping	     	     	     	     
Third Party Disclosure	     	     	     	     
Total	     	     	     	     

12. Allocate the change in Burden:

	Total Requested	Change Due to New Statute	Change Due to Agency Discretion	Due to Agency Estimate	Change due to Violation	Currently Approved
Annual Responses	     	     	     	     	     	     
Annual Hour Burden	     	     	     	     	     	     
Annual Cost Burden (Capital/Startup and O&M costs only)	     	     	     	     	     	     

PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part II: Information Collection Detail

1. Title of Information Collection:      

2. Is this a common form?
Yes
No

(Select, Yes, to identify forms that EPA is willing to host for potential use by other Federal Agencies.)

3. Obligation to respond (check one):
Voluntary

Required to obtain or retain benefits

Mandatory

Only one selection may be made.
If multiple categories apply, you must create
additional ICs to account for the burden associated
with each category.

4. Frequency of reporting
(check all that apply):

Hourly

Daily

Weekly

Monthly

Quarterly

Semi-annually

Annually

Every Decade

Biennially

On Occasion

Once

5. CFR Citation(s) for the information collection under review (if applicable):

Title:         Citation:       

Title:         Citation:        
Title:        Citation:       
Title:        Citation:       

6. Information Collection Instruments/Forms (if applicable):
Form/Instrument must be submitted to OEI as a separate attachment.

Form Name	EPA Form #	URL (required if electronic)	Is this collection instrument/form available electronically?	If yes, can this collection instrument/form be submitted electronically?
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No

7. Federal Enterprise Architecture Business Reference Model

Line of Business (check one): Subfunction (check one):

None
Environmental Management	Environmental Monitoring and Forecasting Environmental Remediation Pollution Prevention and Control None
Health	Illness Prevention Immunization Management Public Health Monitoring Health Care Services Consumer Health and Safety None
Natural Resources	Water Resource Management Conservation, Marine and Land Management Recreational Resource Management and Tourism Agricultural Innovation and Services None

IMPORTANT: Part II must be completed for each Information Collection (IC) activity associated with the ICR. Please be sure that you copy this portion of the template as many times as necessary so that each IC has its own Part II submission. For more information on how to break your ICR into ICs, please see OMB’s ROCIS IC Q&A, located at: http://intranet.epa.gov/icrintra/download.html. In addition, please reference OEI’s ROCIS instructions at: http://intranet.epa.gov/icrintra/download.html

Note: Most EPA ICRs will be aligned with the Environmental Management FEA Line of Business. Other likely categories are also listed. For a full listing of the FEA Business Reference Model categories and definitions, see: http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_QuickGuide.pdf

8. Privacy Act System of Records (if applicable):

Title:       

Federal Register Citation: Volume:       Page number:       Publication date:    /   /  

9. Respondents

Total number:       
Small entity number:       
Percentage of responses collected electronically:      

Affected Public (choose one):

Individuals or households
Private Sector (if private sector, check all that apply)
Business or other for-profit
Not-for-profit institutions
Farms
State, Local, or Tribal Governments
Federal Government

Only one selection may be made. If multiple categories apply, you must create additional ICs to account for the burden associated with each category. Note: Selecting multiple subcategories within the Private Sector will not affect the number of ICs required.

10. Frequency: How often on average will each respondent respond
to the Information Collection?

Number of Responses per Respondent:         
Per (select the most appropriate time period for this collection)
Hour (24 per day, 8736 per year)
Business Hour (40 per week, 2080 per year)

Day ( 7 per week, 365 per year)

Business Day ( 5 per week, 260 per year)
Week (52 per year)
Month (12 per year)
Semi-Annual (.5 per year)
Year
Decade (.1 per year)

Calculated: Annual Frequency =      
(responses per respondent, per year)

Calculated: Annual Number of Responses =      

11. Hour and Cost Burden - Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

	Hours per Response	Total Annual Hour Burden	Cost per Response (Capital/Startup and O&M Costs Only)	Total Annual Cost Burden (Capital/Startup and O&M Costs Only)
Reporting	     	     	     	     
Recordkeeping	     	     	     	     
Third Party Disclosure	     	     	     	     
Total	     	     	     	     

12. Allocate the change in Burden:

	Total Requested	Change Due to New Statute	Change Due to Agency Discretion	Due to Agency Estimate	Change due to Violation	Currently Approved
Annual Responses	     	     	     	     	     	     
Annual Hour Burden	     	     	     	     	     	     
Annual Cost Burden (Capital/Startup and O&M costs only)	     	     	     	     	     	     

PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part II: Information Collection Detail

1. Title of Information Collection:      

2. Is this a common form?
Yes
No

(Select, Yes, to identify forms that EPA is willing to host for potential use by other Federal Agencies.)

3. Obligation to respond (check one):
Voluntary

Required to obtain or retain benefits

Mandatory

Only one selection may be made.
If multiple categories apply, you must create
additional ICs to account for the burden associated
with each category.

4. Frequency of reporting
(check all that apply):

Hourly

Daily

Weekly

Monthly

Quarterly

Semi-annually

Annually

Every Decade

Biennially

On Occasion

Once

5. CFR Citation(s) for the information collection under review (if applicable):

Title:         Citation:       

Title:         Citation:        
Title:        Citation:       
Title:        Citation:       

6. Information Collection Instruments/Forms (if applicable):
Form/Instrument must be submitted to OEI as a separate attachment.

Form Name	EPA Form #	URL (required if electronic)	Is this collection instrument/form available electronically?	If yes, can this collection instrument/form be submitted electronically?
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No
     	     	     	Yes No	Yes No

7. Federal Enterprise Architecture Business Reference Model

Line of Business (check one): Subfunction (check one):

None
Environmental Management	Environmental Monitoring and Forecasting Environmental Remediation Pollution Prevention and Control None
Health	Illness Prevention Immunization Management Public Health Monitoring Health Care Services Consumer Health and Safety None
Natural Resources	Water Resource Management Conservation, Marine and Land Management Recreational Resource Management and Tourism Agricultural Innovation and Services None

IMPORTANT: Part II must be completed for each Information Collection (IC) activity associated with the ICR. Please be sure that you copy this portion of the template as many times as necessary so that each IC has its own Part II submission. For more information on how to break your ICR into ICs, please see OMB’s ROCIS IC Q&A, located at: http://intranet.epa.gov/icrintra/download.html. In addition, please reference OEI’s ROCIS instructions at: http://intranet.epa.gov/icrintra/download.html

Note: Most EPA ICRs will be aligned with the Environmental Management FEA Line of Business. Other likely categories are also listed. For a full listing of the FEA Business Reference Model categories and definitions, see: http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_QuickGuide.pdf

8. Privacy Act System of Records (if applicable):

Title:       

Federal Register Citation: Volume:       Page number:       Publication date:    /   /  

9. Respondents

Total number:       
Small entity number:       
Percentage of responses collected electronically:      

Affected Public (choose one):

Individuals or households
Private Sector (if private sector, check all that apply)
Business or other for-profit
Not-for-profit institutions
Farms
State, Local, or Tribal Governments
Federal Government

Only one selection may be made. If multiple categories apply, you must create additional ICs to account for the burden associated with each category. Note: Selecting multiple subcategories within the Private Sector will not affect the number of ICs required.

10. Frequency: How often on average will each respondent respond
to the Information Collection?

Number of Responses per Respondent:         
Per (select the most appropriate time period for this collection)
Hour (24 per day, 8736 per year)
Business Hour (40 per week, 2080 per year)

Day ( 7 per week, 365 per year)

Business Day ( 5 per week, 260 per year)
Week (52 per year)
Month (12 per year)
Semi-Annual (.5 per year)
Year
Decade (.1 per year)

Calculated: Annual Frequency =      
(responses per respondent, per year)

Calculated: Annual Number of Responses =      

11. Hour and Cost Burden - Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.

	Hours per Response	Total Annual Hour Burden	Cost per Response (Capital/Startup and O&M Costs Only)	Total Annual Cost Burden (Capital/Startup and O&M Costs Only)
Reporting	     	     	     	     
Recordkeeping	     	     	     	     
Third Party Disclosure	     	     	     	     
Total	     	     	     	     

12. Allocate the change in Burden:

	Total Requested	Change Due to New Statute	Change Due to Agency Discretion	Due to Agency Estimate	Change due to Violation	Currently Approved
Annual Responses	     	     	     	     	     	     
Annual Hour Burden	     	     	     	     	     	     
Annual Cost Burden (Capital/Startup and O&M costs only)	     	     	     	     	     	     

12

Revised 9/1/2006