| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| Rural Community Development Inititive | 0575-0180 | |||||||||||||||
| DATE PREPARED | ||||||||||||||||
| Rev. 4/2/15 | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| NOTICE | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| Reporting Requirements - Forms | ||||||||||||||||
| Contents of Application | Certification Regarding Debarment, Suspension & Other Responsibility Matters - Primary Covered Transactions | AD-1047 or in writing | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | ||||||
| Certification Regarding Debarment, Ineligibility & Voluntary Exclusion - Lower Tier Covered Transactions | AD-1048 or in writing | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | |||||||
| Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - for Grantees other than Individuals | AD-1049 | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | |||||||
| Equal Opportunity Agreement | RD 400-1 (0575-0018 form app'd) | 110 | 1.00 | 110.00 | 0.17 | 18.70 | 0.00 | $65.00 | $1,215.50 | |||||||
| Assurance Agreement | RD 400-4 (0575-0018 form app'd) | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | |||||||
| Statement of Budget, Income and Equity | RD 442-2 (0575-0015 form app'd) | 110 | 1.00 | 110.00 | 2.50 | 275.00 | 0.00 | $65.00 | $17,875.00 | |||||||
| Balance Sheet | RD 442-3 (0575-0015 form app'd) | 110 | 1.00 | 110.00 | 1.00 | 110.00 | 0.00 | $65.00 | $7,150.00 | |||||||
| SUBTOTAL | 770.00 | 513.70 | 0.00 | 0.00 | $33,390.50 | |||||||||||
| TOTAL OF ALL PAGES | 4,400.00 | 5,556.20 | 0.00 | 0.00 | $361,153.00 | |||||||||||
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 4,400.00 | 5,556.20 | ||||||||||||||
| 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. | ||||||||||||||
| Rural Community Development Initiative | 0575-0180 | |||||||||||||||
| DATE PREPARED | ||||||||||||||||
| Rev. 4/2/15 | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| NOTICE | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| Reporting Requirements - Non-Forms Applicants | ||||||||||||||||
| Association or Relationship with Rural Development Employees | Written | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | |||||||
| Data Universal Number System (DUNS) and System for Award Management System (SAM) | Written | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | |||||||
| Contents of Application | Certification of Non-Lobbying Activities | Written | 110 | 1.00 | 110.00 | 0.25 | 27.50 | 0.00 | $65.00 | $1,787.50 | ||||||
| Application Narrative | Written | 110 | 1.00 | 110.00 | 10.00 | 1,100.00 | 0.00 | $65.00 | $71,500.00 | |||||||
| SUBTOTAL | 440.00 | 1,182.50 | $76,862.50 | |||||||||||||
| Reporting Requirements - Non-Forms Awardees/Grantees | ||||||||||||||||
| Grant Amounts | Modification of Application for Reduced Grant Amount | Written | 20 | 1.00 | 20.00 | 1.00 | 20.00 | 0.00 | $65.00 | $1,300.00 | ||||||
| Project Performance Report - Quarterly | Written | 105 | 4.00 | 420.00 | 1.00 | 420.00 | 0.00 | $65.00 | $27,300.00 | |||||||
| Financial Reporting | Written | 105 | 12.00 | 1,260.00 | 1.00 | 1,260.00 | 0.00 | $65.00 | $81,900.00 | |||||||
| Financial Management System | Written | 105 | 1.00 | 105.00 | 6.00 | 630.00 | 0.00 | $65.00 | $40,950.00 | |||||||
| SUBTOTAL | 1,805.00 | 2,330.00 | 0 | 0.00 | $151,450.00 | |||||||||||
| 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. | ||||||||||||||
| Rural Community Development Initiative | 0575-0180 | |||||||||||||||
| DATE PREPARED | ||||||||||||||||
| Rev. 4/2/15 | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| Reporting Req. - Non-Forms Awardees/Grantees cont'd | ||||||||||||||||
| Contents of Application | Audits (over $500,000) | Written | 20 | 1.00 | 20.00 | 3.00 | 60.00 | 0.00 | $65.00 | $3,900.00 | ||||||
| Data Collection by Race, Sex and National Origin -- Intermediaries - 35 -- Recipients & Benefciaries- 1,225 | Written | 1,260 | 1.00 | 1,260.00 | 1.00 | 1,260.00 | 0.00 | $65.00 | $81,900.00 | |||||||
| Final Project Performance Report | Written | 105 | 1.00 | 105.00 | 2.00 | 210.00 | 0.00 | $65.00 | $13,650.00 | |||||||
| SUBTOTAL | 1,385.00 | 1,530.00 | 0 | 0.00 | $99,450.00 | |||||||||||
| Reporting Req. - Form Burden Approved under other OMB Numbers | ||||||||||||||||
| Contents of Application | Application for Federal Assistance (Common Form - burden reported under RCF) | SF-424 (4040-0004) | 110 | 1.00 | 110.00 | 0.75 | 82.50 | 0.00 | $0.00 | |||||||
| Assurances -- Non-Construction Programs | SF-424-B (4040-0007) | 110 | 0.00 | 0.00 | 0.00 | $0.00 | ||||||||||
| Disclosure of Lobbying Activities | SF-LLL (4040-0013) | 110 | 0.00 | 0.00 | 0.00 | $0.00 | ||||||||||
| Grantee Req. | Request for Advance or Reimbursement | SF-270 (4040-0012) | 105 | 0.00 | 0.00 | 0.00 | $0.00 | |||||||||
| 0.00 | 0.00 | 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. | ||||||||||||||
| 0563-New | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | RESPONDENT COST | ||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | COST | TOTAL | ||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | ||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | ||||
| 0.00 | 0.00 | 0.00 | $0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | $0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | $0.00 | |||||||||||||
| 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 | $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. | ||||||||||||||
| 0563-New | ||||||||||||||||
| 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. | ||||||||||||||
| 0563-New | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | ||||||||||||||
| 0581- | ||||||||||||||||
| DATE PREPARED | ||||||||||||||||
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | |||||||||||||||
| REPORTS | RECORDS | |||||||||||||||
| TOTAL | ||||||||||||||||
| FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | TOTAL | NO. OF | ANNUAL | RECORD- | ||||||||
| SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | HOURS | RECORD- | HOURS PER | KEEPING HOURS | ||||||
| REGS. | so state) | PER | (Col. D x E) | RESPONSE | (Col. F x G) | KEEPERS | RECORD- | (Col. I x J) | ||||||||
| RESPONDENT | KEEPER | |||||||||||||||
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | ||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| 0.00 | 0.00 | 0.00 | ||||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | ||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |