| 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. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| February 13, 2017 | |||||||||||||||
| 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) | |||||
| 116.2 | Food Waste Report | VS 13-17 | 0 | ||||||||||||
| Business | 50 | 1 | 50 | 0.08 | 4 | 0 | |||||||||
| State | 50 | 1 | 50 | 0.08 | 4 | 0 | |||||||||
| 116.10, 12 | Application for Licensing of Garbage Treatment Facility (Business) | VS 13-15 | 106 | 1 | 106 | 0.16 | 17 | 0 | |||||||
| 116.1(b) | Acknowledgement of Act and Regulations (Business) | 106 | 1 | 106 | 0.25 | 27 | 0 | ||||||||
| 116.13 | Garbage Treatment Facility Inspection | VS 13-16 | 0 | ||||||||||||
| Business | 1,410 | 5 | 7,050 | 1.00 | 7,050 | 0 | |||||||||
| State | 50 | 70 | 3,500 | 1.00 | 3,500 | 0 | |||||||||
| 166.10, 11, 12 | Request for Hearing (Business) | 1 | 1 | 1 | 1.00 | 1 | 0 | ||||||||
| 166.12 | Cancellation of License by Licensee or State | 0 | |||||||||||||
| Business | 4 | 1 | 4 | 0.25 | 1 | 0 | |||||||||
| State | 2 | 1 | 2 | 0.25 | 1 | 0 | |||||||||
| SUBTOTAL | 10,869 | 10,605 | 0.00 | 0 | |||||||||||
| TOTAL OF ALL PAGES | 1,101,204 | 1,672,131 | 46,585.00 | 15518 | |||||||||||
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c | 15,000 | 1,147,789 | 1,687,650 | ||||||||||||
| \ | |||||||||||||||
| 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. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| February 13, 2017 | |||||||||||||||
| 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) | |||||
| 166.13 | Notification by Licensee of Sick or Dead Animals (Business) | 6 | 1.0 | 6 | 0.08 | 1 | 0 | ||||||||
| 166.15 | Swine Health Protection Program Inspection Summary (State) | VS 13-2 | 50 | 12.0 | 600 | 1.00 | 600 | 0 | |||||||
| 166.9 | Recordkeeping (Business) | 1,410 | 0.10 | 141 | |||||||||||
| Form 0579-0137 | |||||||||||||||
| 85.5 | Permit to Move Restricted Animals | VS 1-27 | 0 | ||||||||||||
| Business | 25 | 75.0 | 1,875 | 0.25 | 469 | 0 | |||||||||
| Accredited Veterinarian | 5 | 1.0 | 5 | 0.50 | 3 | 0 | |||||||||
| State | 20 | 1.0 | 20 | 0.50 | 10 | 0 | |||||||||
| 85.6, 85.7 | Owner-Shipper Statement (Business) | 300 | 20.0 | 6,000 | 0.10 | 600 | 0 | ||||||||
| 85.1, 85.6, 85.7, 85.8 | Certificate of Veterinary Inspection | 0 | |||||||||||||
| Business | 4,500 | 30.0 | 135,000 | 0.25 | 33,750 | 0 | |||||||||
| Accredited Veterinarian | 12,000 | 12.0 | 144,000 | 0.25 | 36,000 | 0 | |||||||||
| State | 50 | 150.0 | 7,500 | 0.25 | 1,875 | 0 | |||||||||
| SUBTOTAL | 295,006 | 73,308 | 1,410 | 141 | |||||||||||
| 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. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| February 13, 2017 | |||||||||||||||
| 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) | |||||
| 85.10, 85.11 | Accredited Veterinarian Statement: Embryo and Semen Shipments (Business) | 10 | 5.0 | 50.0 | 0.25 | 13 | 0 | ||||||||
| 71.19 | Swine Production System Health Plan | 0 | |||||||||||||
| Business | 100 | 1.0 | 100.0 | 1.00 | 100 | 0 | |||||||||
| State | 25 | 5.0 | 125.0 | 0.25 | 31 | 0 | |||||||||
| 71.19 | Swine Production System Health Plan -- Recordkeeping (Business) | 125 | 3.00 | 375 | |||||||||||
| 71.19 | Interstate Movement Report and Notification (Business) | 100 | 12.0 | 1200.0 | 0.25 | 300 | 0 | ||||||||
| 71.19 | Annual Report of PRV Control and Eradication Activities (State) | VS 7-1 | 50 | 1.0 | 50.0 | 2.00 | 100 | 0 | |||||||
| 71.19 | Annual Report of PRV Control and Eradication Activities -- Recordkeeping (State) | 50 | 0.033 | 2 | |||||||||||
| 52.3, 52.4 | Appraisal and Indemnity Claim Form | VS 1-23 | 0 | ||||||||||||
| Business | 15 | 1.0 | 15.0 | 0.25 | 4 | 0 | |||||||||
| State | 5 | 2.0 | 10.0 | 0.50 | 5 | 0 | |||||||||
| 52.2 | Herd Management Plan | 0.00 | |||||||||||||
| Business | 15 | 1.0 | 15.0 | 0.25 | 4 | 0 | |||||||||
| State | 5 | 2.0 | 10.0 | 0.50 | 5 | 0 | |||||||||
| SUBTOTAL | 1575.0 | 561 | 175 | 377 | |||||||||||
| 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. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| February 13, 2017 | |||||||||||||||
| 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) | |||||
| 52.5 | Proceeds from Animals/Animal Products/Materials Sold for Slaughter (Business) | VS 1-24 | 5 | 1.0 | 5.0 | 0.25 | 1 | 0.00 | |||||||
| NEW | |||||||||||||||
| Appraisal Request for Affected Premises Using Contract Growers | VS 1-26 | 2 | 1.0 | 2.0 | 0.50 | 1 | 0.00 | ||||||||
| 166.13 | Notification by Licensee of Changes to Name, Address, or Management (Business) | 2 | 1.0 | 2 | 0.25 | 1 | 0 | ||||||||
| 71.19 | Recordkeeping for Buyers and Sellers of Swine Moved Interstate (Business) | 30,000 | 0.250 | 7500 | |||||||||||
| 71.19 | Identification of Swine Moving Interstate | 0 | |||||||||||||
| Business | 15,000 | 52.0 | 780000.0 | 2.00 | 1560000 | 0 | |||||||||
| Accredited Veterinarian | 100 | 5.0 | 500.0 | 2.00 | 1000 | 0 | |||||||||
| State | 50 | 260.0 | 13000.0 | 2.00 | 26000 | 0 | |||||||||
| 71.19 | Identification of Swine Moving Interstate -- Recordkeeping (Business) | 15,000 | 0.500 | 7500 | |||||||||||
| 71.19 | Cancellation of Withdrawal of a Swine Production System Health Plan | 0.00 | |||||||||||||
| Business | 2 | 1.00 | 2.0 | 1.00 | 2 | 0.00 | |||||||||
| State | 2 | 1.00 | 2.0 | 1.00 | 2 | 0.00 | |||||||||
| SUBTOTAL | 793513.0 | 1587007 | 45000 | 15000 | |||||||||||
| 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. | |||||||||||||
| Swine Health Protection | 0579-0065 | ||||||||||||||
| DATE PREPARED | |||||||||||||||
| February 13, 2017 | |||||||||||||||
| 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) | |||||
| 71.19 | Appeal of Cancellation of a Swine Production System Health Plan (Business) | 1 | 1.0 | 1.0 | 10.00 | 10 | 0 | ||||||||
| 71.21(a) | Application for Permit To Move Slaughter Swine from Originating Slaughter Facilities to Approved Destination Facilities | VS 1-38 | 0.0 | 0 | 0.00 | ||||||||||
| Business | 20 | 2.00 | 40.0 | 2.00 | 80 | 0.00 | |||||||||
| State | 5 | 8.00 | 40.0 | 6.00 | 240 | 0.00 | |||||||||
| 52.2 | Shipment to Slaughter Seal | ||||||||||||||
| Accredited Veterinarian | 10 | 1.0 | 10.0 | 2.00 | 20 | ||||||||||
| State | 30 | 5.0 | 150.0 | 2.00 | 300 | 0.00 | |||||||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0.00 | |||||||||||||||
| SUBTOTAL | 241.0 | 650 | 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 | OMB NO. | |||||||||||||
| 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) | |||||
| 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 | |||||||||||
| 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. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| 0.00 | |||||||||||||||
| 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. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 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 | OMB NO. | |||||||||||||
| 0581- | |||||||||||||||
| 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) | |||||
| 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 | |||||||||||||
| 0.00 | 0.00 | 0.00 | |||||||||||||
| SUBTOTAL | 0.00 | 0.00 | 0 | 0.00 | |||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |