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. |
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DOT/MARAD |
a. 2133-0030 |
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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 |
a. X Regular b. Emergency ‑ Approval requested by: ___/_____/___ c. Delegated
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a. X Three years from approval date b. Other Specify: __ _ |
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Supplementary Training Course Application |
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MA-823 |
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Human Resources Training, Vocational Education, Merchant Marine |
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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. |
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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 |
a. _ Voluntary b. P Required to obtain or retain benefits c. _ _ Mandatory |
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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 (+/‑) |
_________ __ |
f. Explanation of difference 1. Program change 2. Adjustment |
______________ |
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 |
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) _________ |
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Yes X No |
Name: _Rodney
McFadden
_ |
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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. |
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Signature of Senior Official or Designee
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Date |
OMB 83‑I (10/95)
File Type | application/msword |
File Title | Information Collection-Protection of Voluntarily Submitted Info |
Subject | There is an application requirement in the proposal which requires this document for justification to OMB. |
Author | JSMITH |
Last Modified By | xpprofile |
File Modified | 2007-11-15 |
File Created | 2007-11-15 |