| 
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		| 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. | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| Select Agent Registration | 0579-0213 | 
 | 
	
		| 
 | 
 | 
	
		| 
 | 
 | 
	
		| DATE PREPARED | 
 | 
	
		| 
 | 
 | 
	
		| October 5, 2012 | 
	
		
	
		| 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) | 
	
		| 121.10, 331.10 | Request for Expedited Access Approval Review (business) | Letter | 2 | 1.00 | 2.00 | 3.00 | 6 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 1 | 1.00 | 1.00 | 3.00 | 3 | 
 | 
 | 0.00 | 
	
		| 121.7, 331.7 | Application for Registration for Possession, Use and Transfer of Select Agents and Toxins (business) + (not-for-profit) | APHIS/CDC 1 | 11 | 1.00 | 11.00 | 11.80 | 130 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 12 | 1.00 | 12.00 | 11.80 | 142 | 
 | 
 | 0.00 | 
	
		| 73.7; 121.7; and 331.7 | Amendment to the Application for Registration (Not-for-Profit) | 1 | 163 | 3.00 | 489.00 | 1.00 | 489 | 
 | 
 | 0.00 | 
	
		| 73.7; 121.7; and 331.7 | Amendment to the Application for Registration (Business) | 1 | 54 | 3.00 | 162.00 | 1.00 | 162 | 
 | 
 | 
 | 
	
		| 121.16, 331.16; 73.16; 121.16; and 331.16 | Request to Transfer Select Agents and Toxins (business) +  (not-for-profit) | APHIS/CDC 2 | 190 | 1.00 | 190.00 | 2.00 | 380 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 2 | 278 | 1.00 | 278.00 | 2.00 | 556 | 
 | 
 | 0.00 | 
	
		| 121.16 | Report of Transfer of Proficiency Test (business) + (not-for-profit) | None | 2 | 1.00 | 2.00 | 1.00 | 2 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 1 | 1.00 | 1.00 | 1.00 | 1 | 
 | 
 | 0.00 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | SUBTOTAL | 
 | 
 | 
 | 1,148.00 | 
 | 1,870 | 0.00 | 
 | 0.00 | 
	
		| 
 | TOTAL OF ALL PAGES | 
 | 
 | 
 | 4,458.00 | 
 | 12,220 | 296.00 | 
 | 148.00 | 
	
		| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 
 | 
 | 
 | 4,754.00 | 
 | 12,368 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
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 | 
	
		| 
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 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 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 | 0579-0213 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| Select Agent Registration | 
 | 
 | 
	
		| DATE PREPARED | 
 | 
	
		| 
 | 
 | 
	
		| October 5, 2012 | 
	
		
	
		| 
 | 
	
		
	
		| 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) | 
	
		| 121.19, 331.19 | Report of Theft, Loss, or Release of Select Agent and Toxins (business) + (not-for-profit) | APHIS/CDC 3 | 116 | 1.00 | 116.00 | 1.50 | 174 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 94 | 1.00 | 94.00 | 1.50 | 141 | 
 | 
 | 0.00 | 
	
		| 121.4.5.6.9,            331.5, 9 | Reporting the Identification of a Select Agent or Toxin in a Clinical/Diagnostic Specimen (business) + (not-for-profit) | APHIS/CDC 4 A, B, and C | 94 | 1.00 | 94.00 | 1.00 | 94 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 93 | 3.00 | 279.00 | 1.00 | 279 | 
 | 
 | 0.00 | 
	
		| 121.5, 331.5 | Request for Exemption of Select Agents and Toxins for Public Health or Agricultural Emergency or Investigational Product (business) + (not-for-profit) | APHIS CDC/5 | 2 | 1.00 | 2.00 | 1.00 | 2 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 1 | 1.00 | 1.00 | 1.00 | 1 | 
 | 
 | 0.00 | 
	
		| 121.8, 331.17 | Appeal of Registration Denial, Surrender of Registration Certificate (business) + (not-for-profit) | Letter | 2 | 1.00 | 2.00 | 1.00 | 2 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 1 | 1.00 | 1.00 | 1.00 | 1 | 
 | 
 | 0.00 | 
	
		| 121.9, 331.9 | Request of ID Select Agents or Toxins Contained in Specimens Presented for Diagnosis or Verification (business)+ (not-for-profit) | Letter | 4 | 1.00 | 4.00 | 1.00 | 4 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | 
 | 2 | 1.00 | 2.00 | 1.00 | 2 | 
 | 
 | 0.00 | 
	
		| 
 | SUBTOTAL | 
 | 
 | 
 | 595.00 | 
 | 700 | 
 | 
 | 0.00 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| INSTRUCTIONS:  Use this form when a single information collection document involves multiple reporting and recordkeeping requirements.  The totals of the figures in cols. should be entered in item 13 of OMB-83-1:                  cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b;         cols. H & K = 13c.                                                                                                                                                                                                                                                                                                       (F)Total/(D)Total = (E)Average     (H)Total/(F)Total = (G)Average     (K)Total/(I)Total = (J)Average NOTE:  The columns will calculate automatically.  If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
 
 | TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| Select Agent Registration | 0579-0213 | 
 | 
	
		| 
 | 
 | 
	
		| 
 | 
 | 
	
		| DATE PREPARED | 
 | 
	
		| 
 | 
 | 
	
		| October 5, 2012 | 
	
		
	
		| 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) | 
	
		| 121.17, 331.17 | Recordkeeping (business) | None | 
 | 
 | 0.00 | 
 | 0 | 169 | 0.500 | 85 | 
	
		| 121.17, 331.17 | Recordkeeping (State) | None | 
 | 
 | 0.00 | 
 | 0 | 127 | 0.500 | 64 | 
	
		| 121.18, 331.18 | Inspection of Facilities (business) + (not-for-profit) | None | 33 | cbsickles:
		1.00 | 33.00 | 8.00 | 264 | 
 | 
 | 0.00 | 
	
		| 
 | (State and local government) | None | 42 | 1.00 | 42.00 | 8.00 | 336 | 
 | 
 | 0.00 | 
	
		| 121.6 | Application for Permit to Import or Transport Controlled Material or Organisms or Vectors (business) | VS 16-3 | 941 | 1.00 | 941.00 | 1.60 | 1,506 | 
 | 
 | 0.00 | 
	
		| 121.16 | Additional Information for Cell Cultures and their Products (business) | VS 16-7 | 1 | 1.00 | 1.00 | 0.33 | 1 | 
 | 
 | 0.00 | 
	
		| 331.16 | Application and Permit to Move Live Plants or Noxious Weeds (business) | PPQ 526 | 18 | 1.00 | 18.00 | 0.17 | 3 | 
 | 
 | 
 | 
	
		| 73.11; 121.11; and 331.11 | Security Plan (State) | none | 163 | 1.00 | 163.00 | 5.00 | 815 | 
 | 
 | 0.00 | 
	
		| 73.11; 121.11; and 331.11 | Security Plan (Not-for-Profit) | none | 163 | 1.00 | 163.00 | 5.00 | 815 | 
 | 
 | 0.00 | 
	
		| 73.11; 121.11; and 331.11 | Security Plan (Business) | none | 54 | 1.00 | 54.00 | 5.00 | 270 | 
 | 
 | 0.00 | 
	
		| 
 | SUBTOTAL | 
 | 
 | 
 | 1,415.00 | 
 | 4,010 | 296 | 
 | 148.00 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| INSTRUCTIONS:  Use this form when a single information collection document involves multiple reporting and recordkeeping requirements.  The totals of the figures in cols. should be entered in item 13 of OMB-83-1:                  cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b;         cols. H & K = 13c.                                                                                                                                                                                                                                                                                                       (F)Total/(D)Total = (E)Average     (H)Total/(F)Total = (G)Average     (K)Total/(I)Total = (J)Average NOTE:  The columns will calculate automatically.  If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
 
 | TITLE OF INFORMATION COLLECTION DOCUMENT | Page | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 4 | 
	
		| Bioterrorism Protection Act of 2002; Bienniel Publication of the Select Agent and Toxin List; Regulatory Amendments | OMB NO. | 
 | 
	
		| 
 | 
 | 
	
		| 0579-0213 | 
 | 
	
		| DATE PREPARED | 
 | 
	
		| 
 | 
 | 
	
		| October 5, 2012 | 
	
		
	
		| 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) | 
	
		| 73.12; 121.12; and 331.12 | Biosafety/Biocontainment Plan (State) | none | 163 | 1.00 | 163.00 | 8.00 | 1,304 | 
 | 
 | 0.00 | 
	
		| 73.12; 121.12; and 331.12 | Biosafety/Biocontainment Plan (Not-for-Profit) | none | 163 | 1.00 | 163.00 | 8.00 | 1,304 | 
 | 
 | 0.00 | 
	
		| 73.12; 121.12; and 331.12 | Biosafety/Biocontainment Plan (Business) | none | 54 | 1.00 | 54.00 | 8.00 | 432 | 
 | 
 | 
 | 
	
		| 73.13; 121.13; and 331.13 | Request regarding a Restricted Experiment (State) | none | 69 | 1.00 | 69.00 | 2.00 | 138 | 
 | 
 | 0.00 | 
	
		| 73.13; 121.13; and 331.13 | Request regarding a Restricted Experiment (Not-for-Profit) | none | 69 | 1.00 | 69.00 | 2.00 | 138 | 
 | 
 | 0.00 | 
	
		| 73.13; 121.13; and 331.13 | Request regarding a Restricted Experiment (Business) | none | 22 | 1.00 | 22.00 | 2.00 | 44 | 
 | 
 | 
 | 
	
		| 73.14; 121.14; and 331.14 | Incident Response Plan (State) | none | 163 | 1.00 | 163.00 | 5.00 | 815 | 
 | 
 | 0.00 | 
	
		| 73.14; 121.14; and 331.14 | Incident Response Plan (Not-for-Profit) | none | 163 | 1.00 | 163.00 | 5.00 | 815 | 
 | 
 | 0.00 | 
	
		| 73.14; 121.14; and 331.14 | Incident Response Plan (Business) | none | 54 | 1.00 | 54.00 | 5.00 | 270 | 
 | 
 | 
 | 
	
		| 73.15; 121.15; and 331.15 | Training (State) | none | 163 | 1.00 | 163.00 | 1.00 | 163 | 
 | 
 | 0.00 | 
	
		| 73.15; 121.15; and 331.15 | Training (Not-for-Profit) | none | 163 | 1.00 | 163.00 | 1.00 | 163 | 
 | 
 | 0.00 | 
	
		| 73.15; 121.15; and 331.15 | Training (Business) | none | 54 | 1.00 | 54.00 | 1.00 | 54 | 
 | 
 | 
 | 
	
		| 
 | SUBTOTAL | 
 | 
 | 
 | 1,300.00 | 
 | 5640 | 0 | 
 | 0.00 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| INSTRUCTIONS:  Use this form when a single information collection document involves multiple reporting and recordkeeping requirements.  The totals of the figures in cols. should be entered in item 13 of OMB-83-1:                  cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b;         cols. H & K = 13c.                                                                                                                                                                                                                                                                                                       (F)Total/(D)Total = (E)Average     (H)Total/(F)Total = (G)Average     (K)Total/(I)Total = (J)Average NOTE:  The columns will calculate automatically.  If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
 
 | TITLE OF INFORMATION COLLECTION DOCUMENT | Page | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 5 | 
	
		| Bioterrorism Protection Act of 2002; Bienniel Publication of the Select Agent and Toxin List; Regulatory Amendments | OMB NO. | 
 | 
	
		| 0579-0213 | 
 | 
	
		| 
 | 
	
		| DATE PREPARED | 
 | 
	
		| 
 | 
 | 
	
		| October 5, 2012 | 
	
		
	
		| 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) | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
	
		| 
 | SUBTOTAL | 
 | 
 | 
 | 0.00 | 
 | 0.00 | 0.00 | 
 | 0.00 |