2732ws02

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Overview

INSTRUCTIONS
Part 1
Part 2-Water Systems
Part 2-Primacy Agencies
Notes

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Sheet 1: INSTRUCTIONS

Instructions for using this ICR Submission Workbook
This Excel workbook is intended to replace many of the functionalities of the previous system (ICRAS) used to send Information Collection Requests (ICRs) to reviewers in the Office of Environmental Information, and mimics the online forms that must accompany ICR submissions to OMB.
**Please fill out the workbook using information from your completed ICR Supporting Statement.**
Step-by-Step Instructions:
1	If you are renewing or revising an existing approved ICR, go use the search function at the RegInfo.gov Internet suite to find the record of your previous ICR submission. Sort results by “Current Expiration Date” to ensure that you pull up the most recent version of your ICR.
		http://www.reginfo.gov/public/do/PRASearch
2	Complete Part 1. This form gathers basic information about your ICR.
		Only fill out WHITE cells. Instructions will pop up when cell is selected.
3	Complete Part 2. This form requests specific details about the scope and burden of the information that you will be collecting. Be aware that your ICR may be made up of several separate Information Collections (ICs). At minimum, the burden on different categories of respondents (i.e. Private sector, Individuals, State/Local/Tribal governments) should be treated as individual ICs. If you need to record multiple ICs, create a new Part 2 tab for each one. This can be done by right clicking the Part 2 tab and selecting "Move or Copy" and then selecting the "Copy" checkbox near the bottom of the window before hitting "Okay."
		Consult RegInfo.gov to see how many ICs were used previously (if renewing or revising an ICR). Create as many copies of the blank Part 2 worksheet as needed before starting. (To do this, right-click on the “Part 2” tab, select “Move or Copy”, then check the “Create a copy” box before hitting “OK”.)
		Fill out the Part 2 IC form with information from your Supporting Statement. You may also reference RegInfo.gov to copy over information that will not be changing from your previous approved ICR.
		If renewing or revising an existing ICR, enter the currently approved total number of responses, burden and non-labor cost from RegInfo.gov into cells G78-G80. The rest of the “Burden Worksheet” section should be taken from your new supporting statement.
4	Use the “Notes” tab to capture any relevant information that could not be included on the Part 1 & 2 forms, or which would be useful to the OEI Desk Officers reviewing your package.
5	Save this workbook with a new filename reflecting the following format: “2060.07 Forms.xlsx” (e.g. for ICR #2060.07)
6	Email this completed workbook to your OEI Desk Officer along with all other supporting documents CLEARLY LABELED, such as:
		Supporting Statement A (and B, if required)
		Draft (unsigned) 2nd Federal Register Notice
		All reporting forms & instruments that you listed in Part 2
		An Action Information Sheet
		Any Miscellaneous Supporting Documents (such as separate appendices)
		A copy of the Final Rule document (only for Final Rule ICRs being submitted to OMB in advance of rule publication)

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Sheet 2: Part 1

Basic Information about your ICR
Office:	OW
Title of ICR:	Final PFAS National Primary Drinking Water Regulation
EPA ICR Number	2732.02
OMB Control Number	2040-0307
Type of Information Collection:	New Collection (Request for New OMB Control Number)
Type of Review Requested:	Regular	If Emergency, please provide justification:
Requested expiration date:	Three years from approval date	If Other, please specify date or # of months from approval date:
Does this ICR contain surveys, censuses, or employ statistical methods?	No
Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)?	No
Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))?	No
Is this ICR related to the Affordable Care Act [PPACA, P.L. 111-148 & 111-152]?	No
Is this ICR related to the Dodd-Frank Act [Dodd-Frank Wall Street Reform and Consumer Protection Act, P.L. 111-203]?	No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?	No
Agency Contact
Name:	Ryan Albert
Email:	albert.ryan@epa.gov
Phone:	202-564-2760
Abstract
Abstract:	The EPA is finalizing National Primary Drinking Water Regulations for six per- and polyfluoroalkyl substances (PFAS) including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), hexafluoropropylene oxide dimer acid (HFPO-DA, commonly known as GenX Chemicals), and perfluorobutane sulfonic acid (PFBS). The EPA is finalizing Maximum Contaminant Level Goals (MCLGs) for PFOA and PFOS at zero and the enforceable Maximum Contaminant Level (MCL) at 0.0000040 mg/L or 4.0 ppt for each of these contaminants. The EPA is also finalizing individual MCLGs and is promulgating individual MCLs for PFHxS, PFNA and HFPO-DA at 10 ppt. Lastly, the EPA is finalizing a Hazard Index (HI) of 1 (unitless) as the MCLG and MCL for any mixture containing two or more of PFHxS, PFNA, HFPO-DA and PFBS.
EO 13771 Designation
Is this ICR an EO 13771 deregulatory action (as defined by M-17-21)?	No
Legal Statutes
Authorizing Statute(s):	Safe Drinking Water Act (SDWA)
If more than one statute applies, or the statute is not on list, enter name and legal citation: (otherwise leave blank)
Rulemaking
RIN	2040-AG18
Stage of Rulemaking:	Interim Final or Final Rule
Federal Register Notices & Public Comments		FR Citation
	Publication Date	Volume		Page Number
60-Day Notice:	TBD		FR
Did the Agency receive public comments on this ICR?	Yes
Annual Cost to Federal Government: $	$94,086
END OF PART 1. PLEASE PROCEED TO FILL OUT DETAILS OF BURDEN ON THE PART 2 WORKSHEET(S)

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Sheet 3: Part 2-Water Systems

Part 2 - Details of a specific Information Collection (IC)
IC Title:	Public Water Systems
IC Status:	New IC
Obligation to Respond:	Mandatory
CFR Citation(s)
Must enter at least one CFR citation, unless your collection does not have basis in a regulation.
If more than 10 citations, please record them in the "Notes" tab
Title		Part
42	CFR	300j-9
42	CFR	300j-4(a)
42	CFR	300g-2(c)
42	CFR	300g-2(a)(1)
42	CFR	300g-2(b)(2)
	CFR
	CFR
	CFR
	CFR
	CFR
Information Collection Instruments (e.g. Reporting Forms, Surveys, Focus Group Scripts)
List individually any instruments used in this collection, and attach a copy of them (clearly titled) with your submission.
If more than 5 instruments, please record them in the "Notes" tab.
Document Type	Form Number	Form Name	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability	URL
Form	PH-SDWIS-022023	Safe Drinking Water Information System (SDWIS)	Yes	Yes	Fill Out & File electronically	https://sdwis.epa.gov/ords/sfdw_pub/f?p=108:200
Federal Enterprise Architecture Line of Business
Privacy Act System of Records
Fill out ONLY if the information collected will be housed in a system subject to the Privacy Act. (rare)
Title:
FR Citation:
Burden Worksheet
Affected Public:	Private Sector
Frequency of Reporting:	(select as many as applicable)
Respondents
Total Number of Respondents:	33594
Number of these which are small entities:	33538
Percentage of Respondents Reporting Electronically: (%)	100%
Responses
Number of Responses per Respondent (per year):	15.4796094541
Total Annual Responses:	520022.00
Burden Calculations
Enter burden and costs in "Annual" section below. Burden per response will be auto-calculated.
Burden per Response	Hours Per Response	Cost Per Response ($)
Reporting	2.86	$-
Recordkeeping	1.94	$-
Third-Party Disclosure	0.00	$-
TOTAL	4.79	$-
Annual Burden	Annual Time Burden (Hours)	Annual Non-Labor Cost ($)
Reporting	1485000.00	$-
Recordkeeping	1007000.00	$-
Third-Party Disclosure	0.00	$-
TOTAL	2492000.00	$-
Burden Summary and Reason for Change in Burden
Enter "Previously Approved" from last approval from RegInfo.gov. Then attribute the difference in burden by category if other than change in estimates.
		Change due to:
	Total Requested (from above)	New Statute	Agency Actions (New Rules, etc.)	Potential Violation of the PRA	Revised Estimates	Previously Approved
Annual Number of Responses	520022		506163		-528032	541891
Annual Time Burden (Hour)	2492000		2492000		-3568000	3568000
Annual Cost Burden (Dollars)	$-				$-	$-
Briefly explain the reason(s) for any changes from the previously approved estimates; that is, how the reduction or increase in burden was achieved.
The previous estimates included requirements for initial and quarterly sampling in the first three years, the new estimates include requirements for initial sampling only.
		Please categorize the burden increase due to Agency Actions
		Changing Regulations
END OF THIS PART 2 IC. IF YOUR ICR REQUIRES MORE THAN ONE PART 2 IC, PLEASE MAKE A COPY OF THIS WORKSHEET WITHIN THE WORKBOOK.

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Sheet 4: Part 2-Primacy Agencies

Part 2 - Details of a specific Information Collection (IC)
IC Title:	Water Systems and Drinking Water Primacy Agencies
IC Status:	New IC
Obligation to Respond:	Mandatory
CFR Citation(s)
Must enter at least one CFR citation, unless your collection does not have basis in a regulation.
If more than 10 citations, please record them in the "Notes" tab
Title		Part
42	CFR	300j-9
42	CFR	300j-4(a)
42	CFR	300g-2(c)
42	CFR	300g-2(a)(1)
42	CFR	300g-2(b)(2)
	CFR
	CFR
	CFR
	CFR
	CFR
Information Collection Instruments (e.g. Reporting Forms, Surveys, Focus Group Scripts)
List individually any instruments used in this collection, and attach a copy of them (clearly titled) with your submission.
If more than 5 instruments, please record them in the "Notes" tab.
Document Type	Form Number	Form Name	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability	URL
Form	PH-SDWIS-022023	Safe Drinking Water Information System (SDWIS)	Yes	Yes	Fill Out & File electronically	https://sdwis.epa.gov/ords/sfdw_pub/f?p=108:200
Federal Enterprise Architecture Line of Business
Privacy Act System of Records
Fill out ONLY if the information collected will be housed in a system subject to the Privacy Act. (rare)
Title:
FR Citation:
Burden Worksheet
Affected Public:
Frequency of Reporting:	(select as many as applicable)
Respondents
Total Number of Respondents:	56
Number of these which are small entities:	0
Percentage of Respondents Reporting Electronically: (%)	100%
Responses
Number of Responses per Respondent (per year):	2959.8750000000
Total Annual Responses:	165753.00
Burden Calculations
Enter burden and costs in "Annual" section below. Burden per response will be auto-calculated.
Burden per Response	Hours Per Response	Cost Per Response ($)
Reporting	0.44	$-
Recordkeeping	1.97	$-
Third-Party Disclosure	0.00	$-
TOTAL	2.41	$-
Annual Burden	Annual Time Burden (Hours)	Annual Non-Labor Cost ($)
Reporting	73000.00	$-
Recordkeeping	326000.00	$-
Third-Party Disclosure	0.00	$-
TOTAL	399000.00	$-
Burden Summary and Reason for Change in Burden
Enter "Previously Approved" from last approval from RegInfo.gov. Then attribute the difference in burden by category if other than change in estimates.
		Change due to:
	Total Requested (from above)	New Statute	Agency Actions (New Rules, etc.)	Potential Violation of the PRA	Revised Estimates	Previously Approved
Annual Number of Responses	165753		255675		-345597	255675
Annual Time Burden (Hour)	399000		274000		-149000	274000
Annual Cost Burden (Dollars)	$-				$-	$-
Briefly explain the reason(s) for any changes from the previously approved estimates; that is, how the reduction or increase in burden was achieved.
The previous estimates included requirements for primacy agencies review of initial and quarterly sampling in the first three years, the new estimates include requirements for initial sampling only.
		Please categorize the burden increase due to Agency Actions
		Changing Regulations
END OF THIS PART 2 IC. IF YOUR ICR REQUIRES MORE THAN ONE PART 2 IC, PLEASE MAKE A COPY OF THIS WORKSHEET WITHIN THE WORKBOOK.

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Sheet 5: Notes

Add any notes or information that could not be entered on previous worksheets: