Spreadsheet for Breakout of Burden

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-83-1: 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.

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

Community Outreach and Assistance Partnership Program

0563-0066

DATE PREPARED

November 5, 2010

IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT

ANNUAL BURDEN

REPORTS

RECORDS

TOTAL

FORMS NO (S)

NO. OF

NO OF

TOTAL ANNUAL

HOURS

TOTAL

NO. OF

ANNUAL

RECORD-

SECTION OF

DESCRIPTION

(If "none"

RESPONDENTS

RESPONSES

RESPONSES

PER

HOURS

RECORD-

HOURS PER

KEEPING HOURS

REGS.

so state)

PER

(Col. D x E)

RESPONSE

(Col. F x G)

KEEPERS

RECORD-

(Col. I x J)

RESPONDENT

KEEPER

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J)

(K)

Narrative Title Page

None

120

1.00

120.00

0.3300

39.60

0.00

Narrative

None

120

1.00

120.00

2.1600

259.20

0.00

Delivery Plan

None

120

1.00

120.00

2.1600

259.20

0.00

Statement of Work

None

120

1.00

120.00

4.0000

480.00

0.00

Budget Narrative

None

120

1.00

120.00

1.0000

120.00

0.00

Certification Regarding Debarment, Suspension, and other Responsibility Matters - Primary Covered Transactions

AD-1047

120

1.00

120.00

0.1600

19.20

Certification Regarding Drug-Free Workplace Requirements (Grants)

AD-1049

120

1.00

120.00

0.1600

19.20

Disclosure of Lobbying Activities (form approved under 0348-0046)

SF-LLL

120

1.00

120.00

0.1600

19.20

SUBTOTAL

960.00

1,215.60

0.00

0.00

TOTAL OF ALL PAGES

960.00

1,215.60

0.00

0.00

TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c

960.00

1,215.60

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-83-1: 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.

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

Community Outreach and Assistance Partnership Program

0583-0066

DATE PREPARED

November 5, 2010

IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT

ANNUAL BURDEN

REPORTS

RECORDS

TOTAL

FORMS NO (S)

NO. OF

NO OF

TOTAL ANNUAL

HOURS

TOTAL

NO. OF

ANNUAL

RECORD-

SECTION OF

DESCRIPTION

(If "none"

RESPONDENTS

RESPONSES

RESPONSES

PER

HOURS

RECORD-

HOURS PER

KEEPING HOURS

REGS.

so state)

PER

(Col. D x E)

RESPONSE

(Col. F x G)

KEEPERS

RECORD-

(Col. I x J)

RESPONDENT

KEEPER

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J)

(K)

Forms & burden approved under other OMB numbers

0.00

0.00

0.00

Application for Federal Assistance (4040-0004)

SF 424

120

1.0000

120.00

1.5000

180.00

0.00

Budget Information Non-Construction Programs (4040-0006)

SF 424A

120

1.0000

120.00

6.0000

720.00

0.00

Assurances Non-Construction Programs (4040-0007)

SF 424B

120

1.0000

120.00

0.2500

30.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

SUBTOTAL

360.00

930.00

0

0.00