|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| National Management Information System - pg 1 of 4 |
0579-0335 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| August 9, 2012 |
| 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) |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management (individual) |
12A/12A Addendum |
3,613 |
1.0000 |
3,613.00 |
0.0590 |
213 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management (Private Sector) |
12A/12A Addendum |
27,540 |
1.0000 |
27,540.00 |
0.0590 |
1,625 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management (State, Local or Tribal Group) |
12A/12A Addendum |
6,461 |
1.0000 |
6,461.00 |
0.0590 |
381 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management (Multiple Resource Owners) (individual) |
12B/12B Addendum |
55 |
1.0000 |
55.00 |
0.0380 |
2 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management (Multiple Resource Owners) (Private Sector) |
12B/12B Addendum |
427 |
1.0000 |
427.00 |
0.0380 |
16 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management (Multiple Resource Owners) (State, Local or Tribal Group) |
12B/12B Addendum |
99 |
1.0000 |
99.00 |
0.0380 |
4 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management on Urban Properties (Indivual) |
12C |
1,358 |
1.0000 |
1,358.00 |
0.0210 |
29 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management on Urban Properties (Private Sector) |
12C |
10,357 |
1.0000 |
10,357.00 |
0.0210 |
217 |
|
|
0.00 |
| 426; 426b |
Work Initiation Document for Wildlife Damage Management on Urban Properties (State, Local or Tribal Group) |
12C |
2,432 |
1.0000 |
2,432.00 |
0.0210 |
51 |
|
|
0.00 |
| 426b; 426c |
Pocatello Supply Depot Order Form (Individual) |
17 |
77 |
1.0000 |
77.00 |
0.0650 |
5 |
|
|
0.00 |
|
SUBTOTAL |
|
52,419 |
|
52,419.00 |
|
2,543 |
0 |
|
0.00 |
|
TOTAL OF ALL PAGES |
|
|
|
117,772 |
|
5,448 |
0.00 |
|
0.00 |
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c |
|
|
|
117,772 |
|
5,448 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
|
|
|
|
| National Management Information System - pg 2 of 4 |
0579-0335 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| August 9, 2012 |
| 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) |
| 426b; 426c |
Pocatello Supply Depot Order Form (Private Sector) |
17 |
592 |
1.0000 |
592.00 |
0.0650 |
38 |
|
|
0.00 |
| 426b; 426c |
Pocatello Supply Depot Order Form (State, Local or Tribal Group) |
17 |
138 |
1.0000 |
138.00 |
0.0650 |
9 |
|
|
0.00 |
| 426; 426b |
Project Report (Individual) |
14 |
24 |
1.0000 |
24.00 |
0.0440 |
1 |
|
|
0.00 |
| 426; 426b |
Project Report (Private Sector) |
14 |
173 |
1.0000 |
173.00 |
0.0440 |
8 |
|
|
0.00 |
| 426; 426b |
Project Report (State, Local or Tribal Group) |
14 |
39 |
1.0000 |
39.00 |
0.0440 |
2 |
|
|
0.00 |
| 426b |
Control Materials Sales Records (Individual) |
18 |
49 |
1.0000 |
49.00 |
0.0630 |
3 |
|
|
0.00 |
| 426b |
Control Materials Sales Records (Private Sector) |
18 |
365 |
1.0000 |
365.00 |
0.0630 |
23 |
|
|
0.00 |
| 426b |
Control Materials Sales Records (State, Local or Tribal Group) |
18 |
77 |
1.0000 |
77.00 |
0.0630 |
5 |
|
|
0.00 |
| 426; 426b |
Wildlife Services Assistance Request (Individual) |
30 |
21,738 |
1.0000 |
21,738.00 |
0.0350 |
761 |
|
|
0.00 |
| 426; 426b |
Wildlife Services Assistance Request (Private Sector) |
30 |
28,013 |
1.0000 |
28,013.00 |
0.0350 |
980 |
|
|
0.00 |
| 426; 426b |
Wildlife Services Assistance Request (State, Local or Tribal Group) |
30 |
8,003 |
1.0000 |
8,003.00 |
0.0350 |
280 |
|
|
0.00 |
|
SUBTOTAL |
|
59,211 |
|
59,211 |
|
2,110 |
0 |
|
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. |
|
|
|
|
|
|
|
|
| National Management Information System pg. 3 of 4 |
0579-0335 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| August 9, 2012 |
| 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) |
| 426b; 522a |
WS Resource Values Survey (Private Sector) |
45 |
52 |
1.0000 |
52.00 |
0.0530 |
3 |
|
|
0.00 |
| 426; 426b |
Report of Injury or Death to Non-target Animals (Private Sector) |
35 |
1 |
1.0000 |
1.00 |
0.3800 |
1 |
|
|
0.00 |
| 426; 426b |
Migratory Bird Damage Project Report (Individual) |
37 |
579 |
1.0000 |
579.00 |
0.1300 |
75 |
|
|
0.00 |
| 426; 426b |
Migratory Bird Damage Project Report (Private Sector) |
37 |
4,410 |
1.0000 |
4,410.00 |
0.1300 |
573 |
|
|
0.00 |
| 426; 426b |
Migratory Bird Damage Project Report (State, Local or Tribal Group) |
37 |
1,034 |
1.0000 |
1,034.00 |
0.1300 |
134 |
|
|
0.00 |
| 426 |
Nuisance Wildlife Permit (Louisiana) (Individual) |
66 |
6 |
1.0000 |
6.00 |
0.0610 |
1 |
|
|
0.00 |
| 426 |
Nuisance Wildlife Permit (Louisiana) (Private Sector) |
66 |
46 |
1.0000 |
46.00 |
0.0610 |
3 |
|
|
0.00 |
| 426 |
Nuisance Wildlife Permit (Louisiana) (State, Local or Tribal Group) |
66 |
10 |
1.0000 |
10.00 |
0.0610 |
1 |
|
|
0.00 |
| 426; 426b |
Wildlife Services Abatement Program Assignment of U.S. Government Property (Private Sector) |
68 |
0 |
1.0000 |
0.00 |
0.0195 |
0 |
|
|
0.00 |
|
Cleared under 4040-0005 (Common Form) |
SF 424 |
4 |
1.0000 |
4.00 |
0.7500 |
3.00 |
|
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SUBTOTAL |
|
6,142 |
|
6,142 |
|
795 |
0 |
|
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. |
|
|
|
|
|
|
|
|
| National Management Information System pg. 4 of 4 |
0579-0335 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| August 9, 2012 |
| 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) |
|
smharris:
Cooperative Agreement Forms Family ** These figures were not added to the total |
SF 424, 424A, 424b, SF LLL |
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
Cleared under 0348-0044 |
SF 424a |
4 |
1.0000 |
4.00 |
3.0000 |
12.00 |
|
|
0.00 |
|
Cleared under 0348-0040 |
SF 424B |
4 |
1.0000 |
4.00 |
0.2500 |
1.00 |
|
|
0.00 |
|
Cleared under 0348-0046 |
SF LLL |
0 |
1.0000 |
0.00 |
0.5000 |
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
0 |
|
0.00 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
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|
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|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
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|
0581- |
|
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|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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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. |
|
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|
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|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
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|
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|
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|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
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|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
|
0581- |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
|
|
|
|
0.00 |
|
0.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
0.00 |
|
0.00 |
0 |
|
0.00 |