| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.66(b)(1(iii), 3.6(c)(1(ii), 3.6(d) | Approval for less than minimum housing requirements for dogs and cats BUSINESS | None | 30 | 1.0000 | 30.00 | 1.0000 | 30.00 | 30 | 0.500 | 15.00 | ||||
| 3.8(b)(1)(2) | Proposal approved by research facility committee and attending veternarian BUSINESS | None | 750 | 1.0000 | 750.00 | 1.0000 | 750.00 | 0.00 | ||||||
| 3.8(c)(1) | Consultaton and review by the committee and attending veterinarian BUSINESS | None | 800 | 1.0000 | 800.00 | 1.0000 | 800.00 | 0.00 | ||||||
| 3.8(c)(3)(iii) | Written standard procedures (plan) for exercise and recording thereof BUSINESS | None | 3,000 | 1.0000 | 3,000.00 | 2.0000 | 6,000.00 | 3,000 | 1.000 | 3,000.00 | ||||
| 3.8(d)(1)(3) | Documentation for exercise exemption and recordkeeping BUSINESS | None | 500 | 5.0000 | 2,500.00 | 0.5000 | 1,250.00 | 500 | 1.000 | 500.00 | ||||
| 3.8(d)(2) | Review by committee, exemptions for dogs and cats BUSINESS | None | 200 | 10.0000 | 2,000.00 | 1.0000 | 2,000.00 | 0.00 | ||||||
| SUBTOTAL | 9,080.00 | 10,830.00 | 3,530.00 | 3,515.00 | ||||||||||
| TOTAL OF ALL PAGES | 11687 | 148,381.00 | 44,106.00 | 10,010.00 | 3,515.00 | |||||||||
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 11,783 | 172,177.00 | 50,245.00 | |||||||||||
| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.13(b), 3.86(b) | Consignment to carriers and intermediate handlers BUSINESS | None | 4,794 | 1.0000 | 4,794.00 | 0.1000 | 479.00 | 0.00 | ||||||
| Consignment to carriers and intermediate handlersSTATE/LOCAL | None | 206 | 1.0000 | 206.00 | 0.1000 | 21.00 | 0.00 | |||||||
| 3.13( c) (1)(2)(3)(4), 3.16(a), 3.86(c),(1)(2) (3)(4), 3.89(a) | Certification by consignor for transport consignor name and address, ID, tag number of tattoo, and each animal offered food and water (dogs, cats, primates) BUSINESS | None | 4,894 | 1.0000 | 4,894.00 | 0.2500 | 1,224.00 | 0.00 | ||||||
| Certification by consignor for transport consignor name and address, ID, tag number of tattoo, and each animal offered food and water (dogs, cats, primates) STATE/LOCAL | None | 206 | 1.0000 | 206.00 | 0.2500 | 52.00 | 0.00 | |||||||
| 3.13(c), 3.14(h), 3.16(b), 3.36(h), 3.61(g), 3.86(c) | Shipping documents and written instructions for food, water, medication, and special care attached to enclosure. Numbers accounted for under 3.113(g). BUSINESS | None | 5,385 | 1.0000 | 5,385.00 | 0.0500 | 269.00 | 0.00 | ||||||
| 3.61(g), 3.86(c) | Shipping documents and written instructions for food, water, medication, and special care attached to enclosure. Numbers accounted for under 3.113(g). STATE/LOCAL | None | 315 | 1.0000 | 315.00 | 0.0500 | 16.00 | 0.00 | ||||||
| SUBTOTAL | 15,800.00 | 2,061.00 | 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.137(f), 3.139(d), | Certification by consignor and attending veterinarian that animal is acclimated to temperatures outside requirements. BUSINESS 2050 | None | 2,050 | 15.0000 | 30,750.00 | 0.2500 | 7,688.00 | 0.00 | ||||||
| 3.13(e), 3.19(a)(3), 3.35(c), 3.37(g), 3.60(c), 3.62(g), 3.77(a), 3.78(a), 3.86(e), 3.92(a)(3), 3.112( c), 3.118(a)(2)(3) | Certification by consignor and attending veterinarian that animal is acclimated to temperatures outside requirements. STATE/LOCAL 50 | None | 50 | 15.0000 | 750.00 | 0.2500 | 188.00 | 0.00 | ||||||
| 3.60(c), 3.62(g), 3.77(a), 3.78(a), 3.86(e) | ||||||||||||||
| 3.86(c), 3.92(a)(3), 3.112(c), 3.118(a)(2)(3) | ||||||||||||||
| SUBTOTAL | 31,500.00 | 7,876.00 | 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.13(f), 3.35(d), 3.60(d), 3.86(f), | Attempt to notify consignee-recordkeeping. BUSINESS | 2,275 | 1.000 | 2,275.00 | ||||||||||
| 3.112(d), 3.86(f), 3.112(d), 3.136(d) | Attempt to notify consignee-recordkeeping. STATE/LOCAL | 25 | 1.000 | 25.00 | ||||||||||
| 3.14(a)(6), 3.19(b)(2), 3.36(g), 3.61(f) | Marking requirements for transport enclosure ("live animal") BUSINESS | None | 5,500 | 1.0000 | 5,500.00 | 0.0500 | 275.00 | 0.00 | ||||||
| 3.87(f), 3.113(f), 3.137(e), 3.92(b)(2) | Marking requirements for transport enclosure ("live animal") STATE/LOCAL | None | 500 | 1.0000 | 500.00 | 0.0500 | 25.00 | 0.00 | ||||||
| SUBTOTAL | 6,000.00 | 300.00 | 2,300 | 2,300.00 | ||||||||||
| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.77(f), 3.78(d), 3.103(c), 3.127(d) | Perimeter fencing variance from requirements BUSINESS | None | 150 | 1.0000 | 150.00 | 1.0000 | 150.00 | 0.00 | ||||||
| Perimeter fencing variance from requirements STATE/LOCAL | None | 30 | 1.0000 | 30.00 | 1.0000 | 30.00 | 0.00 | |||||||
| 3.28(c)(3), 3.53(c)(3), 3.80(b)(2)(iii) | Innovative housing approval (hamster, guinea pigs, rabbits, primates) BUSINESS | None | 39 | 1.0000 | 39.00 | 1.0000 | 39.00 | 0.00 | ||||||
| Innovative housing approval (hamster, guinea pigs, rabbits, primates) STATE/LOCAL | None | 1 | 1.0000 | 1.00 | 1.0000 | 1.00 | 0.00 | |||||||
| 3.80(c),3.83 | Review by Committee - exemptions for primates BUSINESS | None | 100 | 1.0000 | 100.00 | 1.0000 | 100.00 | 0.00 | ||||||
| 3.81 | Plan for environmental enhancement-recordkeeping BUSINESS | None | 886 | 1.0000 | 886.00 | 1.0000 | 886.00 | 1,086 | 1.000 | 1,086.00 | ||||
| Plan for environmental enhancement-recordkeeping STATE/LOCAL | None | 200 | 1.0000 | 200.00 | 1.0000 | 200.00 | 200 | 1.000 | 200.00 | |||||
| 3.8(d) | Committee approval for restraint devices for environmental enhancement BUSINESS | None | 200 | 1.0000 | 200.00 | 2.0000 | 400.00 | 0.00 | ||||||
| SUBTOTAL | 1,606.00 | 1,806.00 | 1,286 | 1,286.00 | ||||||||||
| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.81(e)(1)(2) (3) | Exemptions and recordkeeping for environmental enhancement BUSINESS | None | 886 | 1.0000 | 886.00 | 2.0000 | 1,772.00 | 1,086 | 1.000 | 1,086.00 | ||||
| Exemptions and recordkeeping for environmental enhancement STATE/LOCAL | None | 200 | 1.0000 | 200.00 | 2.0000 | 400.00 | 200 | 1.000 | 200.00 | |||||
| 3.100(g) | Research variance requests BUSINESS | None | 3 | 1.0000 | 3.00 | 1.0000 | 3.00 | 0.00 | ||||||
| 3.111(e)(5) | Written rules and instructions BUSINESS | None | 20 | 1.0000 | 20.00 | 1.0000 | 20.00 | 20 | 0.100 | 2.00 | ||||
| Written rules and instructions STATE/LOCAL | None | 10 | 1.0000 | 10.00 | 1.0000 | 10.00 | 10 | 0.100 | 1.00 | |||||
| 3.111(c)(8) | Written criteria for termination of interactive session BUSINESS | None | 20 | 1.0000 | 20.00 | 1.0000 | 20.00 | 20 | 0.100 | 2.00 | ||||
| Written criteria for termination of interactive session STATE/LOCAL | None | 10 | 1.0000 | 10.00 | 1.0000 | 10.00 | 10 | 0.100 | 1.00 | |||||
| 3.111(f)(3)(4) | Feeding, behavioral, water quality, and medical records for SWTD programs BUSINESS | None | 20 | 2190.0000 | 43,800.00 | 0.1000 | 4,380.00 | 20 | 0.200 | 4.00 | ||||
| Feeding, behavioral, water quality, and medical records for SWTD programs STATE/LOCAL | None | 10 | 2190.0000 | 21,900.00 | 0.1000 | 2,190.00 | 10 | 0.200 | 2.00 | |||||
| 3.111(f)(5) | SWTD program summary reports BUSINESS | None | 20 | 365.0000 | 7,300.00 | 0.2000 | 1,460.00 | 20 | 52.000 | 1,040.00 | ||||
| SWTD program summary reports STATE/LOCAL | None | 10 | 365.0000 | 3,650.00 | 0.2000 | 730.00 | 10 | 52.000 | 520.00 | |||||
| SUBTOTAL | 77,799.00 | 10,995.00 | 1,406 | 2,858.00 | ||||||||||
| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.111(f)(5) | SWTD program changes submitted to APHIS semiannually BUSINESS | None | 20 | 2.0000 | 40.00 | 0.5000 | 20.00 | 20 | 2.000 | 40.00 | ||||
| SWTD program changes submitted to APHIS semiannually STATE/LOCAL | None | 10 | 2.0000 | 20.00 | 0.5000 | 10.00 | 10 | 2.000 | 20.00 | |||||
| 3.101(a)(3) | Written protocol for cleaning enclosures surfaces BUSINESS | None | 31 | 1.0000 | 31.00 | 0.5000 | 14.00 | 100 | 0.100 | 3.00 | ||||
| Written protocol for cleaning enclosures surfaces STATE/LOCAL | None | 99 | 1.0000 | 99.00 | 0.5000 | 50.00 | 30 | 0.100 | 10.00 | |||||
| 3.101(b) | Written contingency plans BUSINESS | None | 31 | 1.0000 | 31.00 | 0.5000 | 16.00 | 100 | 1.000 | 100.00 | ||||
| Written contingency plans STATE/LOCAL | None | 99 | 1.0000 | 99.00 | 0.5000 | 50.00 | 30 | 1.000 | 30.00 | |||||
| SUBTOTAL | 320.00 | 160.00 | 290 | 203.00 | ||||||||||
| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.104(a)(1) | Written justificaiton to hold animals in noncompliant enclosures BUSINESS | None | 10 | 1.0000 | 10.00 | 1.0000 | 10.00 | 20 | 0.100 | 2.00 | ||||
| Written justificaiton to hold animals in noncompliant enclosures STATE/LOCAL | None | 20 | 1.0000 | 20.00 | 1.0000 | 20.00 | 10 | 0.100 | 1.00 | |||||
| 3.105(c) | Report inappetenance exceeding 24 hours; maintain feeding records for 1 year BUSINESS | None | 31 | 30.0000 | 930.00 | 0.2000 | 186.00 | 100 | 3.000 | 300.00 | ||||
| Report inappetenance exceeding 24 hours; maintain feeding records for 1 year STATE/LOCAL | None | 99 | 30.0000 | 2,970.00 | 0.2000 | 594.00 | 30 | 3.000 | 90.00 | |||||
| 3.106(b) | Water quality records BUSINESS | None | 31 | 52.0000 | 1,612.00 | 0.2000 | 322.00 | 100 | 5.200 | 161.00 | ||||
| Water quality records STATE/LOCAL | None | 99 | 52.0000 | 5,148.00 | 0.2000 | 1,030.00 | 30 | 5.200 | 515.00 | |||||
| 3.108(b) | Documentation of training for employees - participation and completion BUSINESS | None | 31 | 3.0000 | 93.00 | 0.2000 | 19.00 | 100 | 3.000 | 300.00 | ||||
| Documentation of training for employees - participation and completion STATE/LOCAL | None | 99 | 3.0000 | 297.00 | 0.2000 | 54.00 | 30 | 3.000 | 90.00 | |||||
| 3.109 | Written plans for animals housed separately BUSINESS | None | 11 | 1.0000 | 11.00 | 0.5000 | 5.00 | 20 | 0.500 | 5.00 | ||||
| Written plans for animals housed separately STATE/LOCAL | None | 39 | 1.0000 | 39.00 | 0.5000 | 20.00 | 10 | 0.500 | 20.00 | |||||
| 3.110(b) | Medical isolation BUSINESS | None | 5 | 1.0000 | 5.00 | 0.5000 | 3.00 | 15 | 0.500 | 8.00 | ||||
| Medical isolation STATE/LOCAL | None | 15 | 1.0000 | 15.00 | 0.5000 | 8.00 | 5 | 0.500 | 3.00 | |||||
| SUBTOTAL | 11,150.00 | 2,271.00 | 470 | 1,495.00 | ||||||||||
| 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.110(d), | Individual animal medical records BUSINESS | None | 31 | 8.0000 | 248.00 | 0.5000 | 124.00 | 100 | 0.500 | 15.00 | ||||
| Individual animal medical records STATE/LOCAL | None | 99 | 8.0000 | 792.00 | 0.5000 | 396.00 | 30 | 0.500 | 50.00 | |||||
| 3.110(e) | Veterinary care records for transport BUSINESS | None | 31 | 5.0000 | 155.00 | 0.2000 | 31.00 | |||||||
| Veterinary care records for transport STATE/LOCAL | None | 99 | 5.0000 | 495.00 | 0.2000 | 99.00 | ||||||||
| 3.110(f) | Exception from annual examination for cetaceans and sirenians BUSINESS | None | 10 | 2.0000 | 20.00 | 0.5000 | 10.00 | 15 | 0.200 | 3.00 | ||||
| Exception from annual examination for cetaceans and sirenians STATE/LOCAL | None | 10 | 2.0000 | 20.00 | 0.5000 | 10.00 | 5 | 0.200 | 1.00 | |||||
| 3.110(g), 3.111(g)(6) | Preliminary and final necropsy reports BUSINESS | None | 31 | 3.0000 | 93.00 | 1.0000 | 93.00 | 100 | 0.250 | 25.00 | ||||
| Preliminary and final necropsy reports STATE/LOCAL | None | 99 | 3.0000 | 297.00 | 1.0000 | 297.00 | 30 | 0.250 | 7.50 | |||||
| 3.111(f)(1) | Description of SWTD program submitted to APHIS, BUSINESS | APHIS 7002 | 20 | 1.0000 | 20.00 | 1.0000 | 20.00 | 20 | 0.100 | 2.00 | ||||
| Description of SWTD program submitted to APHIS, STATE/LOCAL | APHIS 7002 | 10 | 1.0000 | 10.00 | 1.0000 | 10.00 | 10 | 0.100 | 1.00 | |||||
| SUBTOTAL | 2,150.00 | 1,090.00 | 310 | 104.50 | ||||||||||
| 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. | ||||||||||||
| Animal Welfare -0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.111(f)(7) | Injury report within 24 hours, written report with 7 days STATE/LOCAL | None | 1 | 1.0000 | 1.00 | 1.0000 | 1.00 | 0.00 | ||||||
| 3.111(g)(3) | Dolphin profile - accounted for under 3.111(f)(3)(4) | None | 0 | 0.0000 | 0.00 | 0.00 | 0.00 | |||||||
| 3.111(g)(4) | Nutritional and repoductive status BUSINESS | None | 20 | 16.0000 | 320.00 | 0.2500 | 80.00 | 0.00 | ||||||
| Nutritional and repoductive status STATE/LOCAL | None | 10 | 16.0000 | 160.00 | 0.2500 | 40.00 | 0.00 | |||||||
| 3.111(g)(5) | Written assessment by veterinarian BUSINESS | None | 20 | 4.0000 | 80.00 | 0.5000 | 40.00 | 0.00 | ||||||
| Written assessment by veterinarian STATE/LOCAL | None | 10 | 4.0000 | 40.00 | 0.5000 | 20.00 | 0.00 | |||||||
| 3.112(a), 3.116(b)(4) | Health certificate for transport - marine mammals and primates BUSINESS | None | 350 | 6.0000 | 2,100.00 | 0.2000 | 420.00 | 0.00 | ||||||
| Health certificate for transport - marine mammals and primates STATE/LOCAL | None | 75 | 6.0000 | 450.00 | 0.2000 | 90.00 | 0.00 | |||||||
| 3.113( g), 3.118(a)(2) | Acclimation Certificate BUSINESS | None | 129 | 1.0000 | 129.00 | 0.1000 | 13.00 | 0.00 | ||||||
| SUBTOTAL | 3,280.00 | 704.00 | 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.116(a) | Transport plan - marine mammals BUSINESS | None | 31 | 5.0000 | 155.00 | 0.2000 | 31.00 | 0.00 | ||||||
| Transport plan - marine mammals STATE/LOCAL | None | 99 | 5.0000 | 495.00 | 0.2000 | 99.00 | 0.00 | |||||||
| 0.00 | ||||||||||||||
| 3.35(b), 3.60(b) | Certificate that shipping crate complies with Section 3.36 BUSINESS | APHIS 7020 & 7020A | 70 | 5.0000 | 350.00 | 0.1000 | 35.00 | 0.00 | ||||||
| 3.35 (c) , 3.37(g) | Acclimation Certification for Hamsters (Optional) BUSINESS | None | 20 | 10.0000 | 200.00 | 0.1000 | 20.00 | 0.00 | ||||||
| 3.60(c), 3.62(g) | Acclimation Certification for Rabbits (Optional) BUSINESS | None | 80 | 5.0000 | 400.00 | 0.1000 | 40.00 | 0.00 | ||||||
| 0 | 0.0000 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | ||||||||
| SUBTOTAL | 1,600.00 | 225.00 | 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. | ||||||||||||
| Animal Welfare - 0579-0093 | 0579-0093 | |||||||||||||
| 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) | ||||
| 3.35(d), 3.60(d) | Carrier or intermediate handler attempt to notify consignor BUSINESS | None | 0 | 0.0000 | 0.00 | 0.00 | 1,000 | 0.100 | 100.00 | |||||
| 3.36(g), 361(f) | Primary enclosure marked with letters "Live Animals" and arrows BUSINESS | None | 1,300 | 1.0000 | 1,300.00 | 0.0500 | 65.00 | 0.00 | ||||||
| 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 | 1,300.00 | 65.00 | 1,000 | 100.00 | ||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| 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 | ||||||||||||||
| RECORD- | ||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | KEEPING HOURS | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | (Col. I x J) | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | |||||||
| RESPONDENT | KEEPER | (K) | ||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | 0.00 | ||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||
| 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 | |||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |