Form OMB 83-I

2133-0030 Form OMB 83-I.doc

Supplementary Training Course Application

Form OMB 83-I

OMB: 2133-0030

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Please read the instructions before completing the form. For additional forms or assistance in completing this form, contact your agency's Paperwork Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 725 17th Street NW, Washington, DC 20503.

  1. Agency/Subagency originating request

DOT/MARAD

  1. OMB Control Number b. None

a. 2133-0030

  1. Type of information collection (check one)

a. New collection

b. Revision of a currently approved collection

c. X Extension of a currently approved collection

d. Reinstatement, without change, of a previously approved collection for which approval has expired

e. Reinstatement, with change, of a previously approved collection for which approval has expired

f. Existing collection in use without an OMB control number

For b‑f, note Item A2 of Supporting Statement instructions

  1. Type of review requested (check one)

a. X Regular

b. Emergency ‑ Approval requested by: ___/_____/___

c. Delegated



  1. Small entities
    Will this information collection have a significant economic impact on a substantial number of small entities?
    Yes No

  1. Requested expiration date

a. X Three years from approval date b. Other Specify: __ _

  1. Title

Supplementary Training Course Application

  1. Agency form number(s) (if applicable)

MA-823

  1. Keywords

Human Resources Training, Vocational Education, Merchant Marine

  1. Abstract

The supplementary Training Course Application form is needed to administer additional training of U.S. merchant seamen. Also on this form, marine firefighting students must sign a CONSENT/RELEASE statement which warns against participation without medical approval.

  1. Affected public (Mark primary with "P" and all others that apply with "X")

a. P_ Individuals or households d. ___ Farms

b. _ Business or other-for-profit e. ___ Federal Government

c. ___ Not-for-profit institutions f. _ State, Local, or Tribal Government

  1. Obligation to respond (Mark primary with "P" and all others that apply with "X")

a. _ Voluntary

b. P Required to obtain or retain benefits

c. _ _ Mandatory

  1. Annual Recordkeeping and reporting burden

  1. Annual reporting and recordkeeping cost burden (in thousands of dollars)

a. Number of respondents

__ 500_ __

a. Total annualized capital startup costs

______________

b. Total annual responses

1. Percentage of these responses collected electronically

__ 500 _

____ 0 _ %

b. Total annual cost (O&M)

______________

c. Total annual hours requested

_ 25 _________

c. Total annualized cost requested

______________

d. Current OMB inventory

_ 0__ ______

d. Current OMB inventory

______________

e. Difference (+/‑)

_____ 0 ___

e. Difference

______________

f. Explanation of difference

1. Program change (+/‑)

2. Adjustment (+/‑)


_____ _0___

_________ __

f. Explanation of difference

1. Program change

2. Adjustment


______________

______________

  1. Purpose of information collection (Mark primary with "P" and all others that apply with "X")

a. _P Application of benefits e. _x_ Program planning or management

b. _ X Program evaluation f. _ _ Research

c. ___ General purpose statistics g X Regulatory compliance

d. ___ Audit

  1. Frequency of recordkeeping or reporting (check all that apply)

a. Recordkeeping

b. Third party disclosures

c. Reporting

1. X On occasion 2. Weekly 3. Monthly

4. Quarterly 5. Semi‑annually 6. Annually

7. Biennially 8. Other (describe) _________

  1. Statistical methods
    Does this information collection employ statistical methods?

Yes X No

  1. Agency contact (person who can best answer questions regarding the content of this submission

Name: _Rodney McFadden _

Phone:
202-366-2647 __________


  1. Certification for Paperwork Reduction Act Submissions


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320..9.


NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b) (3), appear at the end of the instructions. The certification is to be made with reference to those regulatory provisions as set forth in the instructions.


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 terminology 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):


(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 (see note in Item 19 of the instructions);

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


(j) It makes appropriate use of information technology.


If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in Item 18 of the Supporting Statement.

Signature of Senior Official or Designee


Date


OMB 83‑I (10/95)

File Typeapplication/msword
File TitleInformation Collection-Protection of Voluntarily Submitted Info
SubjectThere is an application requirement in the proposal which requires this document for justification to OMB.
AuthorJSMITH
Last Modified Byxpprofile
File Modified2007-11-15
File Created2007-11-15

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