2025 Supporting Statement - Long Term Contracting 2-27-2025

Supporting Statement 0578-0013

USDA-NRCS

2025 Supporting Statement

Long Term Contracting

OMB No. 0578-0013

1. Explain the circumstances that make the collection of information necessary. Identify

any legal or administrative requirements that necessitate the collection. Attach a copy

of the appropriate section of each statute and regulation mandating or authorizing the

collection of information:

This is an extension of a currently approved information collection request. The primary objective of NRCS is to work in partnership with the American people and the farming and ranching community to protect, conserve and sustain our nation’s natural resources on privately owned land. The purpose of the LTC information collection is to allow for programs to provide Federal technical and financial cost-sharing assistance through long term contracts to eligible producers, landowners, and entities. These long-term contracts provide for making land use changes and installing conservation measures and practices to protect, conserve, develop, and use the soil, water, and related natural resources on private lands. Under the terms of the agreement, the participant agrees to apply, or arrange to apply, the conservation treatment specified in the conservation plan. In return for this agreement, Federal financial assistance payments are made to the land user, or third party, upon successful application of the conservation treatment. Additionally, NRCS purchases easements for the long-term protection of the property and provides for the protection and management of the property for the life of the easement.

The authorizations listed above, direct the Secretary of Agriculture to formulate and carry out conservation program LTC activities. These forms are needed to administer NRCS LTC programs as authorized. NRCS regulations listed above in Table A; require the collection of information on these forms to ensure proper utilization of program funds.

The Long-Term Contracting (LTR) regulations at 7 CFR Part 630, and the Conservation Program regulations identified in Table A below set forth the basic policies, program provisions, and eligibility requirements for owners and operators to enter into and carry out long-term conservation program contracts and conservation easements with technical and financial assistance under the various programs. These programs are administered by the Natural Resources Conservation Service (NRCS).

The programs in this information collection that continue to be subject to the requirements of the Paperwork Reduction Act of 1995 are listed in Table A. The forms included in this collection are to accommodate the conservation programs identified in Table A below.

Status of the Rules:

TABLE A: Identifies the Programs and the Associated Regulations in the Current Package

Program	Regulation	Source	Date
Long Term Contracting (LTC)	7 CFR 630	40 FR 53370	November 18, 1975
Emergency Conservation Program (ECP)	7 CFR 701	45 FR 49522 69 FR 10302 69 FR 22377 71 FR 30265	July 25, 1980 March 4, 2004 April 26, 2004 May 26, 2006
Emergency Watershed Protection Program (EWP)	7 CFR 624	46 FR 56577 70 FR 16926	November 17, 1981 April 4, 2005
Healthy Forest Reserve Program (HFRP)	7 CFR 625	71 FR 28547 75 FR 6539	May 17, 2006 February 10, 2010

The regulations listed above implemented the provisions for LTC authorized by the following Public Laws:

Program	Authority	U.S. Code Citation
Conservation Technical Assistance (CTA)	The Soil Conservation and Domestic Allotment Act (Pub. L. 74-46), as amended	16 U.S.C. 590a-f
Emergency Conservation Program (ECP)	Agricultural Credit Act of 1978 (Pub. L. 95–334), as amended	16 U.S.C. 2201–2205
Emergency Watershed Protection Program (EWP)	Flood Control Act of 1938 (Pub. L. 81–516); Agricultural Credit Act of 1978 (Pub. L. 95–334), as amended	33 U.S.C. 70lb–1; 16 U.S.C. 2203; 5 U.S.C. 301
Healthy Forests Reserve Program (HFRP)	Title V of the Healthy Forests Restoration Act (Pub. L. 108-148), as amended	16 U.S.C. 6571-6578
Resource Conservation and Development Program (RC&D)	Section 1528 of the Agriculture and Food Act of 1981 (Pub. L. 97-98), as amended	16 U.S.C. 3451 et seq.
Watershed Prevention & Flood Protection Program (WPFPP)	Watershed Protection and Flood Prevention Act of 1954 (Pub. L. 83-566) as amended; Flood Control Act of 1944 (Pub. L. 78-534)	16 U.S.C. 1001, et seq.; 33 U.S.C. 701-1

2. Indicate how, by whom, how frequently, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection:

the information reporting requirements and burden related to this clearance request package includes reporting requirements associated with the following LTC items:

TABLE B: Identifies the current forms and provides a brief description

Form	Description
AD-1153	Application
AD-1154	Long-Term Contract/Agreement for NRCS Financial Assistance Programs
AD-1155; AD-1155A	Schedule of Operations (Practices/Cost and signature sheet)
AD-1156	Modification of Schedule of Operations
AD-1157	Option Agreement to Purchase
AD-1157A	Option Agreement to Purchase Amendment
AD-1158	Subordination Agreement and Limited Lien Waiver
AD-1159	Notice of Intent to Continue
AD-1160	Compatible Use Agreement
AD-1161	Practice Approval and Payment Application
NRCS-CPA-68	Conservation Plan
NRCS-LTP-13	Status/Contract Review
NRCS-LTP-020; NRCS-CPA-260	Warranty Easement Deed, Conservation Easement Deed
NRCS-LTP-70	Agreement for the Purchase of Conservation Easement (Healthy Forests Reserve Program)
NRCS-LTP-80	Agreement for the Purchase of Conservation Easement (Emergency Watershed Program Floodplain Easement)
NRCS-LTP-151	Notice of Agreement or Contract Violation
NRCS-LTP-152	Transfer Agreement
NRCS-LTP-153	Agreement Covering Non-Compliance with Provisions of the Contract

The Conservation Programs that utilize the forms included in this collection are described in the following table. This also serves as a key to the program abbreviations used in other areas of this package.

TABLE C: Conservation Programs subject to the requirements of the Paperwork Reduction

Act

Program	Description
Emergency Conservation Program (ECP) (7 CFR part 701)	USDA Farm Service Agency’s ECP provides emergency funding and technical assistance for farmers and ranchers to rehabilitate farmland damaged by natural disasters and for carrying out emergency water conservation measures in periods of severe drought. Funding for ECP is appropriated by Congress.
Emergency Watershed Program (EWP) (7 CFR part 624).	The EWP was initiated in 1950 and is administered by NRCS. It provides technical and financial assistance to local institutions for the removal of storm and flood debris from stream channels and for the restoration of stream channels and levees to reduce the threat to life and property. The program also provides for establishing permanent easements in floodplains with private landowners.
Healthy Forests Reserve Program (HFRP) (7 CFR part 625).	HFRP is a voluntary program established for the purpose of restoring and enhancing forest ecosystems to: 1) Promote the recovery of threatened and endangered species; 2) improve biodiversity; and 3) enhance carbon sequestration. The HFRP was signed into law as part of the Healthy Forests Restoration Act of 2003 and amended by the 2008 Act. The Agricultural Act of 2014 made minor changes to HFRP land eligibility and funding.
Resource Conservation and Development Program (RC&D)	The RC&D was initiated in 1962 and was administered by NRCS. Through this program, NRCS assisted multi-county areas in enhancing conservation, water quality, wildlife habitat, recreation, and rural development. The program provided technical and limited financial assistance for the planning and installation of approved projects.
Watershed Protection and Flood Prevention Program (WPFPP) (7 CFR Part 622)	The WPFPP, otherwise known as P.L. 566, was initiated in 1954, and is administered by the NRCS. It assists State and local units of government in flood prevention, watershed protection, and water management. Part of this effort involves the establishment of conservation practices on private lands to reduce erosion, sedimentation, and runoff.

The information collected on LTC forms is obtained from conservation program participants manually and electronically for use by NRCS, other USDA agencies, and local conservation districts as follows: The Number Submitted Annually provides the number of forms completed by respondents and the approximate number of hours to complete each form. The response time is taken from the forms themselves as identified in the OMB Disclosure Statement where available.

TABLE D: Burden for required programs under the Paperwork Reduction Act

Form	Purpose	Program(s)	Form Description	Who Completes	*Number Submitted Annually & Burden Hours
AD-1153	Application	EWP WPFPP HFRP	The basic document used by program participants to request assistance through the local USDA Service Centers (7 CFR Parts 622.20, 624.9, and 625.5.) Used by NRCS to evaluate and prioritize application and to verify eligibility.	Program Applicants with assistance from agency personnel.	750 Estimated time per participant is .30 per response. Burden Hours = 225.0
AD-1154	Contract or Agreement	EWP HFRP	Document is used by NRCS to enter into a contract or agreement with the program participant (7 CFR Parts 622.3, 624.10, and 625.10. Includes Special Contract/Agreement Provisions.	Executed by the agency, with concurrence and acceptance (signature) of the participant.	150 Estimated time per participant is .37 per response. Burden Hours = 55.5
AD-1155; AD-1155A	Schedule of Practices/ Costs and signature sheet	EWP WPFPP HFRP	Practices to be installed are described, scheduled for year of installation, and cost outlays are presented. (7 CFR Parts 622.3(c); 624.3(b); 624.10; 632.21; 634.23; 625.10 701.16; 701.40; 633; and 1410.22.) Summary of schedule and cost outlays included in the schedule of practices and costs with signature blocks. (7 CFR Parts 622.3(c); 624.3(b); 632.21; 634.23; 636.7; 701.16; 701.40; 633; and 1410.22.)	Developed by the agency. Participant must read and agree to the terms. Agency, Conservation District Official, and participant must sign.	300 Estimated time per participant is .373 per response. Burden Hours = 111.9
AD-1156	Schedule Modification	EWP WPFPP HFRP	Document is used by the agency to modify, as needed, a participant’s schedule of practices and costs. (7 CFR Parts 622.3(c); 624.3(b);624.10; 632.21; 634.23; 625.10; 701.16; 701.40; 633; and 1410.22.)	Developed by the agency. Participant must read and agree to the terms. Agency, Conservation District Official, and Participant must sign.	25 Estimated time per participant is .375 per response. Burden Hours = 9.375
AD-1157	Option Agreement to Purchase	EWP HFRP	Form is used by program participants as the equivalent of a real estate option to purchase. (7 CFR Part 624 and 625).	Developed by the agency. Participant must read and agree to the terms through signature.	170 Estimated time per participant is .40 per response. Burden Hours = 68
AD-1157A	Option Agreement to Purchase Amendment	EWP HFRP	Form is used by program participants as the equivalent of a real estate option to purchase. (7 CFR Parts 624 and 625).	Developed by the agency. Participant must read and agree to the terms through signature.	170 Estimated time per participant is .40 per response. Burden Hours = 68
AD-1158	Subordination Agreement and Limited Lien Waiver	EWP HFRP	Form is used by program participants to subordinate mortgages and obtain limited lien waivers, when applicable, to the United States with respect to any and all interests of the subordinating party in, or related to the easement area. (7 CFR Parts 624 and 625).	Developed by the agency. Participant must read and agree to the terms through signature.	100 Estimated time per participant is .495 per response. Burden Hours = 49.5
AD-1159	Notice of Intent to Continue	Not used by any non-exempt programs
AD-1160	Compatible Use Application	EWP HFRP	Used by the program participants to request authorization from NRCS to use the easement area for specified purposes. Informs the participant that the authorization does not vest any right of any kind with the landowner. This agreement includes a plan developed by NRCS describing the compatible use of the land, frequency, timing, intensity, and duration of the use. (7 CFR Parts 624 and 625).	Developed by the agency. Participant must read and agree to the terms through signature.	200 Estimated time per participant is .40 per response. Burden Hours = 80
AD-1161	Application for Payment	EWP HFRP	Used by program participants to transmit bills and certify completion of the contracted item.	Developed by the agency. Participant must read and agree to the terms through signature.	200 Estimated time per participant is .30 per response. Burden Hours = 60
NRCS-CPA-68	Conservation Plan	CTA EWP HFRP	Practices planned are described and scheduled for the year of installation. The conservation plan is developed whether there is financial assistance provided or not.	Developed by the agency. Participant must read and agree and sign.	2700 Estimated time per participant is .75 per response. Burden Hours = 2,025
NRCS-LTP-13	Status/ Contract Review	EWP WPFPP HFRP	Participant progress in contract or agreement implementation is recorded. (7 CFR Parts 622.3; 624.4; 632.24; 634.27(i); 625.10; 701.24; 701.43; 633; and 1410.55.)	NRCS employees conduct a review. Participant may or may not participate in the documentation process. Final review must be signed by the participant.	250 Estimated time per participant is .375 per response. Burden Hours = 93.75
NRCS-LTP-20 NRCS-CPA-260	Warranty Easement Deed Conservation Easement Deed	EWP HFRP	Form used by the program participant to grant and convey NRCS and easement with appurtenant rights of access to the easement area(s). (7 CFR Parts 624 and 625).	Developed by the agency. Participant must read and agree to the terms through signature.	170 Estimated time per participant is .295 per response. Burden Hours = 50.1
NRCS-LTP-70	Agreement for the Purchase of Conservation Easement	HFRP	Form is used by program participants as the equivalent of a real estate option to purchase. (7 CFR Part 625).	Developed by the agency. Participant must read and agree to the terms through signature.	50 Estimated time per participant is .69 per response. Burden Hours = 34.5
NRCS-LTP-80	Agreement for the Purchase of Conservation Easement	EWP	Form is used by program participants as the equivalent of a real estate option to purchase. (7 CFR Part 624).	Developed by the agency. Participant must read and agree to the terms through signature.	120 Estimated time per participant is .69 per response. Burden Hours = 82.8
NRCS-LTP-151	Contract Violation Notification	EWP HFRP	Used by the agency to notify a program participant of the indication of a contract or agreement violation. (7 CFR Parts; 632.42(b) (1, 2); 634.29; 625.16 and 633).	This form is completed by the NRCS.	20 Estimated time per participant is .495 per response. Burden Hours = 9.9
NRCS-LTP-152	Transfer Agreement	EWP HFRP	Used by the agency and participant when the program participant loses control of all or part of the right and interest in the land. (7 CFR Parts; 624.10; 625.15; 632.22(f); and 633)	Completed jointly by NRCS and the participant.	5 Estimated time per participant is .495 per response. Burden Hours = 2.475
NRCS-LTP-153	Agreement Covering Non-Compliance With Provisions of the Contract	EWP HFRP	This form is used to indicate non-compliance with the contract or agreement. (7 CFR Parts; 624.10; 625.16; 632.41; 634.29; and 633).	Completed by NRCS employee.	10 Estimated time per participant is 1.5 hour per response. Burden Hours = 15

2. Describe whether, and to what extent, the collection of information involves the use of

automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also, describe any consideration of using information technology to reduce burden:

NRCS makes every effort to comply with the E-Government Act of 2002. The LTC conservation program forms are all available electronically, however they are not all currently being processed using automated methods. Certain information will still need to be collected manually such as the participant’s personally identifiable information and signature. NRCS is still actively participating in the Departmental e-Forms Initiative. Program participants currently have electronic access to the forms, instructions, and the program special provisions and can fill out the forms electronically; NRCS’ goal is that participants will eventually be able to sign and submit to the agency for consideration electronically. Currently, 25% of this data collection is collected electronically.

2. Describe efforts to identify duplication. Show specifically why any similar information

already available cannot be used or modified for use for the purpose described in item 2 above:

There is no similar data collection available. The agency has reviewed its reporting requirements and has made every effort as possible to combine forms and eliminate duplication. The information required for data collection is not currently reported to any other agency on a regular basis in a standardized form.

2. If the collection of information impacts small businesses or other small entities, describe

any methods used to minimize burden:

There is no additional reporting requirements created specifically for small businesses to meet the requirements.

2. Describe the consequence to Federal program or policy activities if the collection is not

conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden:

Contracting forms are filed at the time of the voluntary application phase or when a revision of the information is required.  NRCS reviews contract forms with the participant annually for the duration of the contract to ensure contract compliance and to determine if changes are needed through the annual status review procedure (NRCS-LTP-013; NRCS-CPA-013.)  Participants do not report based on these forms.  If the information is not reviewed, NRCS would not be able to perform its responsibilities in administering the conservation program Long-Term Contracting Activities.

7. Explain any special circumstances that would cause an information collecti­on to be

con­ducted in a manner:

• requiring respondents to report informa­tion to the agency more often than quarterly;

• requiring respondents to prepare a writ­ten response to a collection of infor­ma­tion in fewer than 30 days after receipt of it;

• requiring respondents to submit more than an original and two copies of any docu­ment.

• requiring respondents to retain re­cords, other than health, medical, governm­ent contract, grant-in-aid, or tax records for more than three years;

• in connection with a statisti­cal sur­vey, that is not de­signed to produce valid and reli­able results that can be general­ized to the uni­verse of study;

• requiring the use of a statis­tical data classi­fication that has not been re­vie­wed and approved by OMB;

• that includes a pledge of confiden­tiali­ty that is not supported by au­thority estab­lished in statute or regu­la­tion, that is not sup­ported by dis­closure and data security policies that are consistent with the pledge, or which unneces­sarily impedes shar­ing of data with other agencies for com­patible confiden­tial use; or

• requiring respondents to submit propri­etary trade secret, or other confidential information unless the agency can demon­strate that it has instituted procedures to protect the information's confidentiality to the extent permit­ted by law.

The collection of information is conducted in a manner consistent with the guidelines in 5 CFR 1320.5.

8. If applicable, provide a copy and identify the date and page number of publication in

the Federal Register of the agency's notice, soliciting comments on the information

collection prior to submission to OMB. Summarize public comments received in

response to that notice and describe actions taken by the agency in response to these

comments:

• Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and

recordkeeping, disclosure, or reporting form, and on the data elements to be

recorded, disclosed, or reported.

A 60-day Notice in the Federal Register on December 12, 2024, at 89 FR 100463-100464. No comments were received.

M. Maggart

500 S. Front Street

Suite 250

Columbus, OH 43215

G. Wagner

105 West Veterans Parkway

Yorkville, IL 60560

A Meuleners

699 Walnut Street

Suite 2000

Des Moines, IA 50309

The contact persons we reached out to either did not provide feedback or provided the following:

1. would you be willing to allow NRCS to provide your name and contact information to OMB as one of the people we reached out to for information relative to this exercise? (While we think it is highly unlikely OMB would contact you directly, there is a chance they might, and we want you to be aware.) Yes, no issue with sharing my contact information.

2. the amount of time it took for you to read the form. Approx. 10 minutes

3. is the form reasonable for the purpose it serves?  Yes.  The terms are generally consistent with what we expect to see in a conservation easement deed.

4. Is the form straight-forward?  Yes.  The paragraph headings are generally clear and the information is organized in a logical format.   This form is considerably shorter than similar instruments I encounter from private entities (e.g., wetland mitigation banking easements). 

5. Is the form commensurate for its purpose?  The form seems sufficient to accomplish its intended purpose.  It could go further to better clarify the responsibilities and limitations of the landowner (see below).  

6. Do you have any other comments or feedback you would like to provide relative to the form?  

   1. It might be beneficial to have a more explicit statement regarding Landowner’s obligations for boundary defense/3^rd party violations enforcement and trespass in connection with the Landowner’s reserved rights and reporting requirements. Similarly, it might be beneficial to clarify the scope of the Landowner’s liability for injury to property beyond their control – e.g., fire, storm, flood, earth movement.

   2. It might be helpful to make the Easement Term its own paragraph, to specifically highlight the perpetual nature.  Although landowners presumably understand this at the time of execution, this is an important term for successors, and could receive greater emphasis.

   3. I would suggest including language regarding the right of the United States to ingress/egress across the Easement Area to other adjoining USDA easements.  This would be beneficial for future expansion of wetland complexes.

   4. There is some redundancy between the language in the granting paragraph and Part VI, but seems appropriate to underscore the significant impact of the easement on the landowner’s reserved property rights. 

   5. There appears to be a typo in Part V.D.2 – “To access all expenses incurred by the United States [….]” – should this be “To assess all expenses incurred by the United States [….]” ?

After considering the consultations, NRCS did not make any changes based on the outside consultations.

9. Explain any decision to provide any payment or gift to respondents, other than

remuneration of contractors or grantees:

LTC payments are only disbursed to participants or third parties who earned the payments by complying with the terms and conditions of the conservation program LTC.

10. Describe any assurance of confidentiality provided to respondents and the basis for the

assurance in statute, regulation, or agency policy:

These forms are handled according to established NRCS procedures implementing the Long-Term Contracting (LTR) regulations at 7 CFR Part 630 provide for programs to extend cost-sharing and technical assistance through long-term contracts to landowners and others for making land use changes and to install measures to conserve, develop, and utilize the soil, water, and related natural resources on their lands.

Confidentiality is ensured under 7 U.SC. 879, (Section 1619 of the Food, Conservation and Energy of 2008) which prohibits the disclosure of certain geospatial and farm-level data collected from producer. The information protected such as farm plans, land assessments, conservation practices and geospatial data identified as private from release under the Freedom of Information Act. 7 CFR 630 Protects landowner records related to conservation planning, soil surveys, and technical assistance.

Permissible disclosures of all information collected are treated as confidential and conform with System of Records Notices (SORN) USDA/NRCS-1:Conservation Programs Systems governs the authorized access to the personally identifiable information collection (PII). Request for and/or disclosure of PII from this information collection is subject to the provisions of The Privacy Act of 1974, as amended, 5 U.S.C. § 552a, and the routine uses of the SORN as mentioned above.

The Senior Government Information Specialist, Samantha Jones, reviewed and approved this package on February 21, 2025.

11. Provide additional justification for any questions of a sensitive nature, such as sexual

behavior or attitudes, religious beliefs, and other matters that are commonly considered

private. This justification should include the reasons why the agency considers the

questions necessary, the specific uses to be made of the information, the explanation to

be given to persons from whom the information is requested, and any steps to be taken

to obtain their consent:

No data is collected that may be considered sensitive or personal in nature.

12. Provide estimates of the hour burden of the collection of information. The statement

should:

• Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

• Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories.

NRCS anticipates the total number of respondents will be 5,390. NRCS estimates that the total burden hours will be 3,058.7 hours. The estimated burden per response depends upon the specific form. This burden amount is identified by form in Table E and ranges from .30 of an hour to 1.5 hour per respondent.

NRCS employees generally complete the remainder of the forms in the collection and review the documents with the program participant for concurrence and acceptance.

The burden was estimated based on a projected average of documents to be filed annually based on the funding level for the authorized conservation programs. There was a decrease of 170 respondents and 26.30 in burden hours due to phasing out form AD-1159.

Total annual cost to the respondents is $80,413.22. This figure is computed based on 3,058.70 burden hours times a wage of $26.29 per hour rate derived from the U.S. Bureau of Labor Statistics, My 2023 National Industry-Specific Occupation Employment and Wage Estimates (https://www.bls.gov/oes/current/oessrci.htm); there is no recordkeeping or third party disclosure.

13. Provide estimates of the total annual cost burden to respondents or record keepers

resulting from the collection of information, (do not include the cost of any hour burden

shown in items 12 and 14). The cost estimates should be split into two components: (a) a

total capital and start-up cost component annualized over its expected useful life; and

(b) a total operation and maintenance and purchase of services component:

There will not be any capital, start-up, or operation and maintenance costs.

14. Provide estimates of annualized cost to the Federal government. Also, provide a

description of the method used to estimate cost and any other expense that would not

have been incurred without this collection of information:

The estimated cost to the Federal Government is $233,333.10. This amount is estimated as follows:

Cost Item	Total Responses No.	Cost Factor/Form ($)	Total Cost ($)
Cost of the Forms, Development and Storage	5,390	7.34	$39,562.60
Work Hour Costs	5,390	34.76	$193,770.50
Total Costs			$233,333.10

Work hour costs associated with NRCS employees is an estimate that employees may spend an average of 60 minutes per response, collecting, filing, and processing data on the form. The average hourly wage of an NRCS employee (GS11) is $34.76 derived from the OPM.Gov Salary Table 2025-GS Effective 2025.

15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14

of the OMB Form 83-1:

There is no change of burden in this package.

16. For collections of information whose results are planned to be published, outline plans

for tabulation and publication:

The information collected through conservation program long term contracting allows the Agency to evaluate performance of the Agency’s functions in administering the programs, and will not be tabulated or published in any way.

17. If seeking approval to not display the expiration date for OMB approval of the

information collection, explain the reasons that display would be inappropriate:

While the cost of developing, printing, distributing, and storing the forms is estimated at $7.34 per form, any funds expended on this should remain available for use in any future LTC opportunities. Therefore, the Agency is requesting approval to not be required to display the expiration date for OMB approval.

18. Explain each exception to the certification statement identified in Item 19 "Certification

for Paperwork Reduction Act."

There are no exceptions to the 83-1 certification statement.

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