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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: 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.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
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| Equal Opportunity Compliance Review Record |
0596-0215 |
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| DATE PREPARED |
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| November 29, 2021 |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
RECORDS |
RESPONDENT COST |
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TOTAL |
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FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
COST |
TOTAL |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
PER |
COST |
| REGS. |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
HOUR |
(Col. H x L) |
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RESPONDENT |
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KEEPER |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
(L) |
(M) |
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State, Local, Tribal Government - Pre-award and Post-award |
FS-1700-0006A |
1,000 |
2.00 |
2,000.00 |
1.000 |
2,000.00 |
2,000 |
0.017 |
33.40 |
37.22 |
$74,440.00 |
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Private Entity - Pre-Award and Post Award |
FS-1700-0006A |
8,200 |
2.00 |
16,400.00 |
1.000 |
16,400.00 |
16,400 |
0.017 |
273.88 |
40.53 |
$664,692.00 |
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Post-Award Recipient Employee |
FS-1700-0006B |
150 |
2.00 |
300.00 |
0.0830 |
24.90 |
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0.00 |
40.53 |
$1,009.20 |
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Post-Award Beneficiary |
FS-1700-0006C |
150 |
2.00 |
300.00 |
0.0830 |
24.90 |
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0.00 |
40.53 |
$1,009.20 |
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0.00 |
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0.00 |
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0.00 |
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$0.00 |
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0.00 |
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0.00 |
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0.00 |
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$0.00 |
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SUBTOTAL |
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19,000.00 |
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18,449.80 |
18,400.00 |
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307.28 |
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$741,150.39 |
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TOTAL OF ALL PAGES |
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19,000.00 |
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18,449.80 |
18,400.00 |
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307.28 |
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$741,150.39 |
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c |
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37,400.00 |
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18,757.08 |
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