Aphis 71

2015 REV APHIS 71.xlsx

Importation of Peppers from Certain Central American Countries

APHIS 71

OMB: 0579-0274

Document [xlsx]
Download: xlsx | pdf















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.







Importation of Peppers from Certain Central American Countries 0579-0274




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)
319.56-40 Inspections (foreign government) None 6 95.00 570.00 2.00 1,140.00

0.00

Business
30 19.00 570.00 2.00 1,140.00

0.00
319.56-40 Phytosanitary Certificates (foreign government) (same respondents as foreign government inspections) None 6 45.00 270.00 1.00 270.00

0.00

Business = Requesting (same respondents as inspections)
30 9.00 270.00 1.00 270.00

0.00
319.56-40 Labeling of Boxes (Business) (same respondents as inspections) None 30 26240.00 787,200.00 0.00083 653.00

0.00
319-56-40) Monitoring Traps (foreign government)(same respondents as inspections) None 6 420.00 2,520.00 0.16 403.00

0.00
319.56-40 Trapping Records (foreign government) (same respondents as inspections) None

0.00
0.00 6 20.00 120.00
319.56-40 Bilateral Workplan (foreign government) (same respondents as inspectons) None 6 1.00 6.00 80.00 480.00

0.00



6
791,406.00
4,356.00 6.00
120.00

TOTAL OF ALL PAGES
36
791,472.00
4,434.00 6.00
120.00
TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c


791,478.00
4,554.00
















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.







Importation of Peppers from Certain Central American Countries 0579-0274




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)
319.56-40 Production Site Registrations (business) (same respondents as inspections) None 30 1.00 30.00 0.50 15.00

0.00

Foreign Government (same respondents as inspections) None 6 5.00 30.00 0.50 15.00

0.00
319.56-40 Quality Control Program (foreign government) (same respondents as inspections) None 6 1.00 6.00 8.00 48.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


66.00
78.00 0
0.00





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





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





















































TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.















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.








0581-




























DATE PREPARED


































ANNUAL BURDEN







IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





REPORTS RECORDS





















TOTAL






FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-

DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS






so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)
SECTION OF






RESPONDENT



KEEPER
REGS. (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)





0.00
0.00

0.00
(A)



0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00





0.00
0.00

0.00

SUBTOTAL


0.00
0.00 0
0.00






























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File Created0000-00-00

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