Supplemental Supporting Statement / Cover Sheet

Contest Template.doc

Contests, Challenges, and Awards

Supplemental Supporting Statement / Cover Sheet

OMB: 3041-0151

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SUPPLEMENTAL SUPPORTING STATEMENT FOR

THE CPSC GENERIC CLEARANCE OF

CONTESTS, CHALLENGES, AND AWARDS UNDER THE PRA



TITLE OF CONTEST:


[ ] VIDEO [ ] ESSAY [ ] POSTER [ ] OTHER ( )


DESCRIPTION OF THIS SPECIFIC COLLECTION

  1. Basic contest description:


  1. Objective for the contest:


  1. Data elements to be collected:


  1. Dates for the contest:


  1. Eligible entrants/participants:


  1. Number of winners expected:


  1. Selection criteria for winner:


  1. Prize” or planned recognition for winner:


  1. Other notes:


BURDEN HOUR COMPUTATION1


Category of Respondent

No. of Respondents

Participation Time

Burden

Hours







REQUESTED APPROVAL DATE:

NAME OF CONTACT PERSON:

TELEPHONE NUMBER:

NAME OF OFFICE/PROGRAM:

1 (Number of responses) x (estimated time in minutes) / 60 = annual burden hours

1

File Typeapplication/msword
File TitleOMBMemoMERCPtP
SubjectMERC OMB MEP
AuthorHillabrant
Last Modified Bylglatz
File Modified2011-08-12
File Created2011-08-11

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