| 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-I: 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. | ||||||||||||||
| Multiple Peril Crop Insurance | 0563-0053 | |||||||||||||||
| DATE PREPARED | ||||||||||||||||
| March 1, 2012 | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION: (DATA ELEMENT) | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| 7 CFR Part 457 508(h) and Pilot Policies | P05 - CIMS Request Record * - Insurance Sales Agent/Office Clerk | None | 0 | 0.00 | $19.85 | $0.00 | ||||||||||
| P09 - Fund Designation Record (per company)* - IT Staff | None | 16 | 0 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||||
| P10 - Policy Record (Company Application) - Farmer | None | 119,614 | 1.00 | 119,614 | 0.33 | 39,472.62 | 0.00 | $29.21 | $1,152,995.23 | |||||||
| - Insurance Sales Agent/Office Clerk | None | 18,213 | 6.57 | 119,659 | 0.33 | 39,487.61 | 0.00 | $19.85 | $783,828.97 | |||||||
| P11 - Acreage Record (Company Acreage Report) - Farmer | None | 530,408 | 2.10 | 1,113,857 | 0.75 | 835,392.60 | 0.00 | $29.21 | $24,401,817.85 | |||||||
| - Insurance Sales Agent/Office Clerk | None | 18,213 | 61.08 | 1,112,450 | 0.50 | 556,225.02 | 0.00 | $19.85 | $11,041,066.65 | |||||||
| P12 - Payment Record - Farmer | None | 636,045 | 1.00 | 636,045 | 0.10 | 63,604.50 | 0.00 | $29.21 | $1,857,887.45 | |||||||
| - Accountant | None | 16 | 39752.81 | 636,045 | 0.10 | 63,604.50 | 0.00 | $29.66 | $1,886,509.35 | |||||||
| P13 - Inventory Value Record - Farmer | None | 2,614 | 1.00 | 2,614 | 8.00 | 20,912.00 | 0.00 | $29.21 | $610,839.52 | |||||||
| - Insurance Sales Agent/Office Clerk | None | 2,614 | 1.00 | 2,614 | 0.50 | 1,307.00 | 0.00 | $19.85 | $25,943.95 | |||||||
| P14 - Insurance in Force Record * - IT Staff | None | 0 | 0.00 | 0 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| P15 - Yield History Record - Farmer | None | 530,408 | 2.10 | 1,113,857 | 1.00 | 1,113,856.80 | 0.00 | $29.21 | $32,535,757.13 | |||||||
| - Insurance Sales Agent/Office Clerk | None | 18,213 | 61.08 | 1,112,450 | 1.50 | 1,668,675.06 | 0.00 | $19.85 | $33,123,199.94 | |||||||
| P20 - Loss Total Record * - IT Staff | None | 0 | 0.00 | 0 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| SUBTOTAL | 5,969,205 | 4,402,537.70 | 0.00 | 0.00 | $107,419,846.02 | |||||||||||
| TOTAL OF ALL PAGES | 10,474,939 | 7,963,982.00 | 0.00 | 0.00 | $194,181,921.56 | |||||||||||
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 10,474,939 | 7,963,982.00 | ||||||||||||||
| 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. | ||||||||||||||
| Multiple Peril Crop Insurance | 0563-0053 | |||||||||||||||
| DATE PREPARED | ||||||||||||||||
| March 1, 2012 | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION: (DATA ELEMENT) | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| P21 - Loss Line Record (Company Claim for Indemnity) - Farmer | None | 159,122 | 2.10 | 334,156 | 2.50 | 835,390.50 | 0.00 | $29.21 | $24,401,756.51 | |||||||
| P21 - Loss Line Record - Insurance Sales Agent/Office Clerk/Claims Adjuster | None | 25,034 | 13.33 | 333,703 | 2.50 | 834,258.05 | 0.00 | $21.15 | $17,644,557.76 | |||||||
| P22 - Inventory Loss Record - Farmer | None | 121 | 1.00 | 121.00 | 2.50 | 302.50 | 0.00 | $29.21 | $8,836.03 | |||||||
| - Insurance Sales Agent/Office/Claims Adjuster | None | 121 | 1.00 | 121.00 | 2.50 | 302.50 | 0.00 | $21.15 | $6,397.88 | |||||||
| P27A - Land ID Record - Insurance Sales Agent/Office Clerk | None | 18,213 | 25.96 | 472,809.48 | 1.00 | 472,809.48 | 0.00 | $19.85 | $9,385,268.18 | |||||||
| P48 - Delete Record * - IT Staff | None | 0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| P49 - Policy Delete Record - Insurance Sales Agent/Office Clerk | None | 111,249 | 1.00 | 111,249.00 | 0.10 | 11,124.90 | 0.00 | $19.85 | $220,829.27 | |||||||
| P51 - Conflict of Interest Policy Reporting Record - Insurance Sales Agent/Claims Adjuster | None | 25,034 | 1.00 | 25,034.00 | 0.10 | 2,503.40 | 0.00 | $25.33 | $63,411.12 | |||||||
| P54 - Agency/Company Employee Data Record * - IT Staff | None | 0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| P55 - Agent Data Record * - IT Staff | None | 0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| P56 - Loan Adjuster Data Record * - IT Staff | None | 0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| P57 - Quality Control Reporting Record - Insurance Underwriter | None | 16 | 1.00 | 16.00 | 24.00 | 384.00 | 0.00 | $28.51 | $10,947.84 | |||||||
| SUBTOTAL | 1,277,209.90 | 2,157,075.33 | 0 | 0.00 | 51,742,004.57 | |||||||||||
| 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. | ||||||||||||||
| Multiple Peril Crop Insurance | 0563-0053 | |||||||||||||||
| DATE PREPARED | ||||||||||||||||
| March 1, 2012 | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION: (DATA ELEMENT) | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| P58 - Notice of Loss Reporting Record - Farmer | None | 159,122 | 2.10 | 334,156.20 | 0.10 | 33,415.62 | 0.00 | $29.21 | $976,070.26 | |||||||
| - Insurance Sales Agent/Office Clerk | None | 18,213 | 18.32 | 333,662.16 | 0.15 | 50,049.32 | 0.00 | $19.85 | $993,479.08 | |||||||
| Type 81 - Policy Holder Tracking Experience Inquiry Record * - IT Staff | None | 0 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | $45.28 | $0.00 | |||||||
| Additional information provided as needed - Insurance Sales Agent/Insurance Underwriter/Farmer/Agricultural Inspector | None | 25,000 | 1.00 | 25,000.00 | 0.33 | 8,250.00 | 0.00 | $25.06 | $206,745.00 | |||||||
| Reading Insurance Documents - Insurance Sales Agent/ Insurance Underwriter/Farmer | None | 556,408 | 1.00 | 556,408.00 | 0.50 | 278,204.00 | 0.00 | $26.73 | $7,436,392.92 | |||||||
| Record Retention - Farmer | None | 530,408 | 2.10 | 1,113,856.80 | 0.15 | 167,078.52 | 0.00 | $12.79 | $2,136,934.27 | |||||||
| Travel Time - Insurance Sales Agent/Claims Adjuster/ Farmer | None | 864,154 | 1.00 | 864,154.00 | 1.00 | 864,154.00 | 0.00 | $26.76 | $23,124,761.04 | |||||||
| * Crop insurance companies transmittal of data elements to RMA - IT Staff | None | 1,287 | 1.00 | 1,287.00 | 2.50 | 3,217.50 | 0.00 | $45.28 | $145,688.40 | |||||||
| SUBTOTAL | 3,228,524.16 | 1,404,368.96 | 0 | 0.00 | 35,020,070.97 | |||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| 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. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| 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) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |