Agency for International Development
OMB NO: 0412-0004 EXPIRATION DATE: 09/30/2005
RESPS:850 HOURS:425 COSTS(000):$5
Application for Approval of Commodity Eligibility
FORMS: AID-11
OMB NO: 0412-0011 EXPIRATION DATE: 12/31/2003
RESPS:85 HOURS:1,020 COSTS(000):$0
Application for Assistance - American Schools and Hospitals
FORMS: AID-1010-2
OMB NO: 0412-0012 EXPIRATION DATE: 05/31/2004
RESPS:2,400 HOURS:1,200 COSTS(000):$0
Supplier's Certificate Agreement With the U.S. Agency for
International Development-In voice and contract abstract.
FORMS: AID-282
OMB NO: 0412-0017 EXPIRATION DATE: 06/30/2003
RESPS:216 HOURS:126 COSTS(000):$0
Contractor's Certificate with the Agency for International
Development--Contractor's Invoice--Contract Abstract
FORMS: FORM-AID-1440-3
OMB NO: 0412-0020 EXPIRATION DATE: 06/30/2003
RESPS:300 HOURS:196 COSTS(000):$0
Supplier's Certificate and Agreement with the Agency for
International Development for Project Commodities/Invoice--and--
Contract
FORMS: FORM-AID-1450-4
OMB NO: 0412-0035 EXPIRATION DATE: 07/31/2003
RESPS:442 HOURS:1,320 COSTS(000):$0
USAID FOrm 1550-2 Private and Voluntary Organization Annual
Return
FORMS: 1550-2
OMB NO: 0412-0506 EXPIRATION DATE: 10/31/2003
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Vendor Database (formerly known as ACRIS)
FORMS: AID-1420-50 (03/31/2002)
OMB NO: 0412-0510 EXPIRATION DATE: 04/30/2005
RESPS:1,100 HOURS:37,400 COSTS(000):$0
Administration of Assistance Awards to U.S. Non-Governmental
Organizations - 22 CFR 226 and USAID ADS Chapter 303
FORMS: NONE
OMB NO: 0412-0514 EXPIRATION DATE: 09/30/2003
RESPS:1,991 HOURS:869 COSTS(000):$0
AID Regulation 1-Rules and Procedures Applicable to Commodity
Transactions
FORMS: NONE
OMB NO: 0412-0520 EXPIRATION DATE: 09/30/2004
RESPS:53,270 HOURS:74,620 COSTS(000):$0
Information collection elements in the USAID Acquisition
Regulation (AIDAR), 48 CFR Chapter 7
FORMS: FORM-1420-17
OMB NO: 0412-0542 EXPIRATION DATE: 09/30/2004
RESPS:1,140 HOURS:2,280 COSTS(000):$0
Request for Advance or Reimbursement
FORMS: AID-1558-2
OMB NO: 0412-0543 EXPIRATION DATE: 09/30/2004
RESPS:760 HOURS:5,320 COSTS(000):$0
Exception to the Financial Status Report (SF-269) and Supplement
to the Financial Status Report (worksheet)
FORMS: 1558-1 1558-1A
OMB NO: 0412-0552 EXPIRATION DATE: 07/31/2005
RESPS:320 HOURS:800 COSTS(000):$133
Financial Status Report by Country
FORMS: NONE
OMB NO: 0412-0554 EXPIRATION DATE: 09/30/2004
RESPS:15,720 HOURS:2,630 COSTS(000):$0
Training Results and Information Network (TraiNet)
FORMS: NONE
OMB NO: 0412-0559 EXPIRATION DATE: 08/31/2003
RESPS:500 HOURS:4,800 COSTS(000):$235
Mexico City Police Certification
FORMS: NONE
OMB NO: 0412-0562 EXPIRATION DATE: 10/31/2003
RESPS:380 HOURS:30,600 COSTS(000):$0
Narrative/Time-Line (NTL) Report
FORMS: 1570-13
OMB NO: 0412-0563 EXPIRATION DATE: 10/31/2003
RESPS:1,120 HOURS:30,600 COSTS(000):$0
Report on Commodities (ROC)
FORMS: USAID-1570-14
OMB NO: 0412-0565 EXPIRATION DATE: 12/31/2005
RESPS:4,000 HOURS:1,500 COSTS(000):$93
Applicant's Certification that it Does not Support Terrorist
Organizations or Individuals
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
18 85,594 196,706 $466
Committee for Purchase from the Blind and Other Severely Handicapped
OMB NO: 3037-0001 EXPIRATION DATE: 03/31/2006
RESPS:77 HOURS:231 COSTS(000):$0
Annual Certification - Qualified Nonprofit Agency Serving People
Who are Blind
FORMS: 403
OMB NO: 3037-0002 EXPIRATION DATE: 03/31/2006
RESPS:565 HOURS:1,695 COSTS(000):$0
Annual Certification - Qualified Nonprofit Agency Serving People
who are Severly Disabled.
FORMS: 404
OMB NO: 3037-0003 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:50 COSTS(000):$0
Committee Form 402 -- Initial Certification - Qualified
Nonprofit Agency Serving People Who Are Severely Disabled
FORMS: 402
OMB NO: 3037-0004 EXPIRATION DATE: 03/31/2005
RESPS:5 HOURS:5 COSTS(000):$0
Committee form 401 -- Initial Certification - Qualified
Nonprofit Agency Serving Peiple Who Are Blind
FORMS: 401
OMB NO: 3037-0005 EXPIRATION DATE: 01/31/2005
RESPS:650 HOURS:3,250 COSTS(000):$0
Nonprofit Agency Responsibilities
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 1,347 5,231 $0
Corporation for National and Community Service
OMB NO: 3045-0004 EXPIRATION DATE: 10/31/2003
RESPS:100,000 HOURS:5,000 COSTS(000):$0
AmeriCorps National Referral Card
FORMS: NONE
OMB NO: 3045-0005 EXPIRATION DATE: 10/31/2004
RESPS:500 HOURS:1,000 COSTS(000):$0
AmericCorps*NCCC Team Leader Application
FORMS: NONE
OMB NO: 3045-0006 EXPIRATION DATE: 11/30/2003
RESPS:48,000 HOURS:5,600 COSTS(000):$0
Corporation for National Service, Enrollment Form
FORMS: NONE
OMB NO: 3045-0010 EXPIRATION DATE: 12/31/2003
RESPS:900 HOURS:7,200 COSTS(000):$108,000
AmeriCorps*National Civilian Community Corps Service Project
Application
FORMS: NONE
OMB NO: 3045-0014 EXPIRATION DATE: 06/30/2004
RESPS:55,000 HOURS:4,585 COSTS(000):$0
Voucher and Payment Request Form
FORMS: NONE
OMB NO: 3045-0015 EXPIRATION DATE: 11/30/2003
RESPS:48,000 HOURS:5,600 COSTS(000):$0
Corporation for National Service EXIT FORM
FORMS: NONE
OMB NO: 3045-0030 EXPIRATION DATE: 05/31/2005
RESPS:1,300 HOURS:2,166 COSTS(000):$0
Forbearance Request for National Service Form
FORMS: NONE
OMB NO: 3045-0033 EXPIRATION DATE: 05/31/2003
RESPS:2,104 HOURS:12,576 COSTS(000):$3
National Senior Service Corps Project Progress Report
FORMS: A-1020
OMB NO: 3045-0035 EXPIRATION DATE: 03/31/2005
RESPS:1,513 HOURS:2,027 COSTS(000):$0
National Senior Service Corps Grant Application
FORMS: 424-NSSC
OMB NO: 3045-0038 EXPIRATION DATE: 03/31/2005
RESPS:1,200 HOURS:7,200 COSTS(000):$10
AmeriCorps*VISTA 2003 Application Instructions
FORMS: NONE
OMB NO: 3045-0043 EXPIRATION DATE: 05/31/2005
RESPS:4,800 HOURS:9,600 COSTS(000):$0
AmeriCorps*VISTA Project Progress Report
FORMS: CNCS-1433
OMB NO: 3045-0045 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:2,250 COSTS(000):$0
The 2000 Application Guidelines for Learn and Serve America
School- and Community-Based Programs
FORMS: NONE
OMB NO: 3045-0047 EXPIRATION DATE: 03/31/2005
RESPS:2,000 HOURS:20,000 COSTS(000):$0
AmeriCorps National, State and Indian Tribes and U.S.
Territories 2003 Application Instructions
FORMS: NONE
OMB NO: 3045-0048 EXPIRATION DATE: 03/31/2004
RESPS:290,000 HOURS:11,667 COSTS(000):$0
AmeriCorps*VISTA Alumni Locator Card Part A, B, and C
FORMS: NONE
OMB NO: 3045-0053 EXPIRATION DATE: 05/31/2005
RESPS:13,000 HOURS:1,083 COSTS(000):$0
Interest Accrual Form (Interest Accrued During National SVC)
FORMS: NONE
OMB NO: 3045-0054 EXPIRATION DATE: 10/31/2005
RESPS:60,000 HOURS:45,000 COSTS(000):$0
AmeriCorps Member Application
FORMS: NONE
OMB NO: 3045-0065 EXPIRATION DATE: 03/31/2005
RESPS:300 HOURS:2,400 COSTS(000):$0
AmeriCorps Education Awards Program 2003 Application Instructions
FORMS: NONE
OMB NO: 3045-0067 EXPIRATION DATE: 05/31/2003
RESPS:1,304 HOURS:978 COSTS(000):$0
National Senior Service Corps (NSSC) Government Performance and
Results Act (GPRA) Project Data Report
FORMS: NONE
OMB NO: 3045-0068 EXPIRATION DATE: 06/30/2003
RESPS:319 HOURS:156 COSTS(000):$0
Evaluation of the Accomplishments and Outcomes of
AmeriCorps*NCCC Projects
FORMS: NONE
OMB NO: 3045-0070 EXPIRATION DATE: 08/31/2004
RESPS:3,337 HOURS:3,227 COSTS(000):$0
The Longitudinal Research on Member Outcomes
FORMS: NONE
OMB NO: 3045-0071 EXPIRATION DATE: 09/30/2003
RESPS:100 HOURS:1,000 COSTS(000):$2
Outreach to Individuals with a Disability to Increase their
Participation in National Service Application Guidelines
FORMS: NONE
OMB NO: 3045-0072 EXPIRATION DATE: 05/31/2004
RESPS:470 HOURS:470 COSTS(000):$0
Evaluation of the Effectiveness of Learn and Serve America
Grants in Promoting Institutuionalization of Service-Learning
FORMS: NONE
OMB NO: 3045-0073 EXPIRATION DATE: 05/31/2004
RESPS:90 HOURS:2,520 COSTS(000):$0
2001 AmeriCorps Promise Fellows Application Instructions
FORMS: NONE
OMB NO: 3045-0077 EXPIRATION DATE: 10/31/2005
RESPS:10,000 HOURS:500 COSTS(000):$0
Volunteer Service Hour Tracking Tool
FORMS: NONE
OMB NO: 3045-0078 EXPIRATION DATE: 11/30/2005
RESPS:11,700,000 HOURS:413,400 COSTS(000):$0
"Join Senior Service Now" Senior Service Web-based Recruitment
System
FORMS: NONE
OMB NO: 3045-0080 EXPIRATION DATE: 07/31/2005
RESPS:400 HOURS:200 COSTS(000):$0
Cross-sectional Study of AmeriCorps*VISTA Member and Supervisor
Training - Supervisor Survey
FORMS: NONE
OMB NO: 3045-0081 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:500 COSTS(000):$0
AmeriCorps Attrition Study
FORMS: NONE
OMB NO: 3045-0083 EXPIRATION DATE: 03/31/2005
RESPS:400 HOURS:4,000 COSTS(000):$0
Innovative and Demonstration Program 2003 Application
Instructions
FORMS: NONE
OMB NO: 3045-0084 EXPIRATION DATE: 07/31/2003
RESPS:187 HOURS:154 COSTS(000):$0
Study of Community, Higher Education, and School Partnership
(CHESP)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
29 12,346,225 572,059 $108,015
Equal Employment Opportunity Commission
OMB NO: 3046-0003 EXPIRATION DATE: 12/31/2003
RESPS:5,000 HOURS:10,000 COSTS(000):$0
Elementary-Secondary Staff Information (EEO-5)
FORMS: EEOC-168A
OMB NO: 3046-0006 EXPIRATION DATE: 05/31/2003
RESPS:3,000 HOURS:4,500 COSTS(000):$0
Local Union Report (EEO-3)
FORMS: 274
OMB NO: 3046-0007 EXPIRATION DATE: 12/31/2003
RESPS:170,000 HOURS:402,700 COSTS(000):$0
Employer Information Report (EEO-1)
FORMS: SF-100
OMB NO: 3046-0008 EXPIRATION DATE: 07/31/2003
RESPS:10,000 HOURS:40,000 COSTS(000):$0
State and Local Government (EEO-4)
FORMS: 164
OMB NO: 3046-0017 EXPIRATION DATE: 06/30/2003
RESPS:666,000 HOURS:1,450,000 COSTS(000):$0
Uniform Guidelines on Employee Selection Procedures
FORMS: NONE
OMB NO: 3046-0040 EXPIRATION DATE: 08/31/2003
RESPS:627,000 HOURS:16,677 COSTS(000):$0
Recordkeeping and Reporting under Title VII and the ADA
FORMS: NONE
OMB NO: 3046-0043 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:41,000 COSTS(000):$0
Waiver of Rights and Claims Under the Age Discrimination in
Employment Act (ADEA)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 1,481,001 1,964,877 $0
Export-Import Bank of the United States
OMB NO: 3048-0003 EXPIRATION DATE: 02/29/2004
RESPS:600 HOURS:1,200 COSTS(000):$0
U.S. Small Business Administration Export-Import Bank of the
United States Joint Application for Working Capital Guarantee
FORMS: EIB-SBAFORM84-1
OMB NO: 3048-0004 EXPIRATION DATE: 02/28/2005
RESPS:50 HOURS:50 COSTS(000):$0
Annual Competitiveness Report Survey of Exporters and Bankers
FORMS: 00-02
OMB NO: 3048-0005 EXPIRATION DATE: 10/31/2004
RESPS:960 HOURS:310 COSTS(000):$0
Ex-Im Bank Letter of Interest Application
FORMS: EIB-95-9
OMB NO: 3048-0009 EXPIRATION DATE: 10/31/2003
RESPS:2,219 HOURS:2,219 COSTS(000):$0
Application forms for export credit insurance program
FORMS: EIB-92-34 EIB-92-37 EIB-92-41 EIB-92-45 EIB-92-48 EIB-92-50
EIB-92-64 EIB-92-72 EIB-92-79
OMB NO: 3048-0012 EXPIRATION DATE: 08/31/2004
RESPS:2 HOURS:1,200 COSTS(000):$0
Foreign Content Aggregate/Cause Report
FORMS: EIB-FORM-01-02 EIB-FORM-01-02A
OMB NO: 3048-0013 EXPIRATION DATE: 11/30/2004
RESPS:225 HOURS:337 COSTS(000):$0
Export-Import Bank of the United States Preliminary Commitment
and Final Commitment
FORMS: 95-10
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
6 4,056 5,316 $0
Federal Emergency Management Agency
OMB NO: 3067-0298 EXPIRATION DATE: 04/30/2003
RESPS:5,550 HOURS:10,200 COSTS(000):$0
Mortgage abd Rental Assistance Program
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 5,550 10,200 $0
Appraisal Subcommittee of the FFIEC
OMB NO: 3139-0005 EXPIRATION DATE: 03/31/2006
RESPS:2 HOURS:120 COSTS(000):$0
Rules of Practice for Proceedings; 12 CFR Part 1102, subpart B
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2 120 $0
Federal Mediation and Conciliation Service
OMB NO: 3076-0001 EXPIRATION DATE: 01/31/2006
RESPS:250 HOURS:250 COSTS(000):$0
Arbitrator's Personal Data Questionnaire
FORMS: R-22
OMB NO: 3076-0002 EXPIRATION DATE: 02/28/2006
RESPS:18,000 HOURS:3,000 COSTS(000):$0
Request for Arbitration
FORMS: R-43
OMB NO: 3076-0003 EXPIRATION DATE: 01/31/2006
RESPS:2,500 HOURS:416 COSTS(000):$0
Arbitrator's Report and Fee Statement
FORMS: R-19
OMB NO: 3076-0004 EXPIRATION DATE: 01/31/2006
RESPS:21,000 HOURS:1,750 COSTS(000):$0
Notice to Mediation Agency
FORMS: F-7
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
4 41,750 5,416 $0
General Services Administration
OMB NO: 3090-0006 EXPIRATION DATE: 05/31/2005
RESPS:15,496 HOURS:15,496 COSTS(000):$0
Qualifications of Employees, GSAR Reference 537.110(b)
FORMS: GSA-176
OMB NO: 3090-0007 EXPIRATION DATE: 01/31/2005
RESPS:2,767 HOURS:6,917 COSTS(000):$0
Contractor's Qualifications and Financial Information
FORMS: GSA-527
OMB NO: 3090-0014 EXPIRATION DATE: 03/31/2005
RESPS:63,000 HOURS:18,900 COSTS(000):$0
Transfer Order - Surplus Personal Property and Continuation Sheet
FORMS: SF-123/123-A
OMB NO: 3090-0021 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:250 COSTS(000):$0
Profit and Loss Statement - Operating Statement
FORMS: GSA-2817
OMB NO: 3090-0023 EXPIRATION DATE: 05/31/2005
RESPS:12,000 HOURS:996 COSTS(000):$0
Surplus Personal Property Mailing List Application
FORMS: GSA-2170
OMB NO: 3090-0027 EXPIRATION DATE: 01/31/2005
RESPS:116,869 HOURS:7,830 COSTS(000):$0
GSAM, Part 542, Contract Administration - Part 546, Quality
Assurance
FORMS: GSA-1678 GSA-250 GSA-308
OMB NO: 3090-0040 EXPIRATION DATE: 06/30/2004
RESPS:3,000 HOURS:1,000 COSTS(000):$0
Application for Shipping Instructions and Notice of Availability
FORMS: GSA-1611
OMB NO: 3090-0043 EXPIRATION DATE: 01/31/2005
RESPS:1,300 HOURS:2,080 COSTS(000):$0
Appraisal of Fair Annual parking Rate Per Space for Standard
Level User Charge
FORMS: GSA-3357
OMB NO: 3090-0044 EXPIRATION DATE: 11/30/2005
RESPS:8,000 HOURS:400 COSTS(000):$0
Application/Permit for Use of Space in Public Buildings and
Grounds
FORMS: GSA-3453
OMB NO: 3090-0057 EXPIRATION DATE: 01/31/2005
RESPS:500 HOURS:125 COSTS(000):$0
Deposit Bond Individual - Sale of Government Personal Property
FORMS: SF-150
OMB NO: 3090-0058 EXPIRATION DATE: 01/31/2005
RESPS:1,000 HOURS:250 COSTS(000):$6,600
Deposit Bond - Annual Sale of Government Personal Property
FORMS: SF-151
OMB NO: 3090-0080 EXPIRATION DATE: 01/31/2005
RESPS:2,000 HOURS:200 COSTS(000):$0
General Services Administration Acquisition Manual (GSAM) Part
532, Contract Financing
FORMS: GSA-1142
OMB NO: 3090-0086 EXPIRATION DATE: 03/31/2005
RESPS:5,016 HOURS:25,183 COSTS(000):$0
GSA Form 1364, Proposal to Lease Space
FORMS: GSA-1364
OMB NO: 3090-0093 EXPIRATION DATE: 11/30/2004
RESPS:1,434 HOURS:1,434 COSTS(000):$0
Transportation Discrepancy Report, SF 361
FORMS: SF-361
OMB NO: 3090-0112 EXPIRATION DATE: 05/31/2005
RESPS:220 HOURS:330 COSTS(000):$0
State Agency Monthly Donation Report of Surplus Personal Property
FORMS: GSA-3040
OMB NO: 3090-0118 EXPIRATION DATE: 01/31/2005
RESPS:874 HOURS:291 COSTS(000):$0
Statement of Witness, Standard Form 94
FORMS: SF-94
OMB NO: 3090-0121 EXPIRATION DATE: 01/31/2005
RESPS:184,280 HOURS:1,530 COSTS(000):$0
GSAM, Part 538.2 Establishing and Administering Schedules
FORMS: GSA-72A
OMB NO: 3090-0163 EXPIRATION DATE: 11/30/2004
RESPS:172,500 HOURS:68,900 COSTS(000):$0
Information Specific to a Contract
FORMS: NONE
OMB NO: 3090-0197 EXPIRATION DATE: 01/31/2005
RESPS:6,722 HOURS:6,722 COSTS(000):$0
GSAR 537.110(a) (Insert 552.237-70, Qualification of Offerors)
FORMS: NONE
OMB NO: 3090-0200 EXPIRATION DATE: 01/31/2005
RESPS:10 HOURS:5 COSTS(000):$0
General Services Administration Acquisition Manual Part 514,
Sealed Bidding
FORMS: NONE
OMB NO: 3090-0204 EXPIRATION DATE: 02/28/2005
RESPS:10,305 HOURS:2,669 COSTS(000):$0
GSAR Part 552.211.-82 Notice of Shipment & Part 552.211-78
Commercial Delivery Schedule (Multiple Award Schedule)
FORMS: NONE
OMB NO: 3090-0221 EXPIRATION DATE: 01/31/2004
RESPS:55 HOURS:6 COSTS(000):$0
GSA Board of Contract Appeals Subpoena, GSA Board of Contract
Appeals Forms 4 and 5 (Certificates of Finality)
FORMS: GSA-9534
OMB NO: 3090-0228 EXPIRATION DATE: 08/31/2005
RESPS:220 HOURS:440 COSTS(000):$0
Nondiscrimination in Federal Financial Assistance Programs
FORMS: NONE
OMB NO: 3090-0235 EXPIRATION DATE: 04/30/2005
RESPS:19,094 HOURS:143,205 COSTS(000):$0
Price Reductions Clause
FORMS: NONE
OMB NO: 3090-0246 EXPIRATION DATE: 01/31/2005
RESPS:931,219 HOURS:7,760 COSTS(000):$0
General Services Administration Acquisition Regulation (GSAR)
Packing List Clause
FORMS: NONE
OMB NO: 3090-0248 EXPIRATION DATE: 09/30/2005
RESPS:5,380 HOURS:1,345 COSTS(000):$0
GSAR 516.506 Solicitation Provisions and Contracts, 552.216-72
Placement of orders, 552.216-73 Ordering Information
FORMS: NONE
OMB NO: 3090-0250 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Zero Burden Information Collection Reports
FORMS: NONE
OMB NO: 3090-0252 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:12,240 COSTS(000):$0
Preparation, Submission, and Neogtiation of Subcontracting Plans
FORMS: NONE
OMB NO: 3090-0259 EXPIRATION DATE: 08/31/2005
RESPS:25 HOURS:12 COSTS(000):$0
Market Research Questionnaire
FORMS: NONE
OMB NO: 3090-0262 EXPIRATION DATE: 03/31/2005
RESPS:9,200 HOURS:46,000 COSTS(000):$0
Idenfitication of Products with Environmental Attributes
FORMS: NONE
OMB NO: 3090-0270 EXPIRATION DATE: 05/31/2003
RESPS:100,000 HOURS:250,000 COSTS(000):$0
Access Certificates for Electronic Services (ACES)
FORMS: NONE
OMB NO: 3090-0271 EXPIRATION DATE: 04/30/2003
RESPS:23,400 HOURS:3,900 COSTS(000):$0
American Customer Satisfaction Index (ACSI)
FORMS: NONE
OMB NO: 3090-0273 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:50 COSTS(000):$0
Questionnaire: CD-ROM of the Ctalog of Federal Domestic
Assistance and Federal Assistance Award Data System
FORMS: NONE
OMB NO: 3090-0274 EXPIRATION DATE: 05/31/2003
RESPS:360 HOURS:90 COSTS(000):$2
Art-in-Architecture Program National Artist Registry
FORMS: GSA-7437
OMB NO: 3090-0275 EXPIRATION DATE: 10/31/2003
RESPS:50 HOURS:1,250 COSTS(000):$0
Child Care Subsidy Application - Main Provider
FORMS: GSA-3674A
OMB NO: 3090-0277 EXPIRATION DATE: 04/30/2003
RESPS:190 HOURS:230 COSTS(000):$0
Market Research Collection for the Office of Citizen Services
and Communications
FORMS: NONE
OMB NO: 3090-0278 EXPIRATION DATE: 06/30/2003
RESPS:2,250 HOURS:112 COSTS(000):$0
National Contact Center Customer Evaluation Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
37 1,699,739 628,149 $6,602
International Trade Commission
OMB NO: 3117-0016 EXPIRATION DATE: 06/30/2005
RESPS:5,216 HOURS:210,129 COSTS(000):$13,551
Information collections for import injury investigations
(producers, importers, purchasers, and foreign producer
questionnaires and institution notices for 5-year reviews)
FORMS: NONE
OMB NO: 3117-0188 EXPIRATION DATE: 12/31/2005
RESPS:600 HOURS:100 COSTS(000):$0
USITC Reader Satisfaction Survey
FORMS: NONE
OMB NO: 3117-0190 EXPIRATION DATE: 04/30/2003
RESPS:2,000 HOURS:66 COSTS(000):$0
ITC DataWeb: User Registration Forms
FORMS: NONE
OMB NO: 3117-0204 EXPIRATION DATE: 04/30/2003
RESPS:449 HOURS:3,592 COSTS(000):$0
Conditions of Competition in the US Mkt for Wood Structural
Building Components
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
4 8,265 213,887 $13,551
M.K. Udall Foundation U.S. Institute for Environmental Conflict Resolution
OMB NO: 3320-0001 EXPIRATION DATE: 06/30/2004
RESPS:80 HOURS:187 COSTS(000):$0
Application for National Roster of Environmental Dispute
Resolution and Consensus Building Professionals. Sub-Roster of
Transportation Mediators and Facilitors.
FORMS: NONE
OMB NO: 3320-0002 EXPIRATION DATE: 03/31/2005
RESPS:15 HOURS:160 COSTS(000):$0
Application for support from the US Institute for Environmental
Conflict Resolution for Environmental Conflict Resolution (ECR)
Participation Program
FORMS: NONE
OMB NO: 3320-0003 EXPIRATION DATE: 06/30/2005
RESPS:530 HOURS:103 COSTS(000):$0
Program Evaluation Instruments-Environmental Conflict Assessment
Services (Three Questionnaries)
FORMS: NONE
OMB NO: 3320-0004 EXPIRATION DATE: 06/30/2005
RESPS:5,445 HOURS:775 COSTS(000):$0
Program Evaluation Instruments--Environmental Conflict
Resolution Services (Six Questionaries)
FORMS: NONE
OMB NO: 3320-0005 EXPIRATION DATE: 06/30/2005
RESPS:492 HOURS:137 COSTS(000):$0
Program Evaluation Instruments-National Roster of Environmental
Dispute Resolution and Consensus Building Professionals (Five
Questionnaries)
FORMS: NONE
OMB NO: 3320-0006 EXPIRATION DATE: 06/30/2005
RESPS:24,450 HOURS:476 COSTS(000):$0
Program Evaluation Instruments-Environmental Conflict Resolution
Training (Five Questionnaires)
FORMS: NONE
OMB NO: 3320-0007 EXPIRATION DATE: 06/30/2005
RESPS:2,500 HOURS:382 COSTS(000):$0
Program Evaluation Instruments - Meeting Facilitation Services
(One Questionnaire)
FORMS: NONE
OMB NO: 3320-0008 EXPIRATION DATE: 10/31/2005
RESPS:155 HOURS:106 COSTS(000):$0
Application for National Roster of Environmental Dispute
Resolution and Consensus Building Professionals
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
8 33,667 2,326 $0
Merit Systems Protection Board
OMB NO: 3124-0009 EXPIRATION DATE: 12/31/2003
RESPS:9,000 HOURS:4,500 COSTS(000):$0
U.S. Merit Systems Protection Board Appeal Form (OF-283)
FORMS: NONE
OMB NO: 3124-0012 EXPIRATION DATE: 08/31/2004
RESPS:1,500 HOURS:375 COSTS(000):$0
Customer Surveys
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 10,500 4,875 $0
National Aeronautics and Space Administration
OMB NO: 2700-0003 EXPIRATION DATE: 01/31/2006
RESPS:10,200 HOURS:91,500 COSTS(000):$0
NASA Contractor Financial Management Reports
FORMS: NASA-533M NASA-533Q
OMB NO: 2700-0007 EXPIRATION DATE: 08/31/2005
RESPS:30 HOURS:29 COSTS(000):$0
Radioactive Material Transfer Receipt
FORMS: JSC-1625
OMB NO: 2700-0009 EXPIRATION DATE: 09/30/2004
RESPS:930 HOURS:895 COSTS(000):$0
AST-Technology Utilization
FORMS: NONE
OMB NO: 2700-0010 EXPIRATION DATE: 09/30/2003
RESPS:60 HOURS:30 COSTS(000):$0
Patent License Report
FORMS: NONE
OMB NO: 2700-0017 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:7,000 COSTS(000):$0
NASA Property in the Custody of Contractors
FORMS: NASA-1018
OMB NO: 2700-0039 EXPIRATION DATE: 09/30/2003
RESPS:80 HOURS:640 COSTS(000):$0
Application for a Patent License
FORMS: NONE
OMB NO: 2700-0047 EXPIRATION DATE: 08/31/2005
RESPS:28,596 HOURS:114,384 COSTS(000):$0
Property Management and Control, Grants
FORMS: NONE
OMB NO: 2700-0048 EXPIRATION DATE: 09/30/2003
RESPS:9,347 HOURS:17,276 COSTS(000):$0
Patents
FORMS: NONE
OMB NO: 2700-0049 EXPIRATION DATE: 10/31/2003
RESPS:37,696 HOURS:284,792 COSTS(000):$0
Financial Monitoring and Control, Grants
FORMS: NONE
OMB NO: 2700-0052 EXPIRATION DATE: 11/30/2004
RESPS:2,386 HOURS:7,276 COSTS(000):$0
NASA FAR Supplement, Part 1827, Patents, Data and Copyrights
FORMS: NONE
OMB NO: 2700-0054 EXPIRATION DATE: 08/31/2005
RESPS:176 HOURS:7,920 COSTS(000):$0
Contract Modifications, NASA FAR Supplement Part 18-43
FORMS: NONE
OMB NO: 2700-0057 EXPIRATION DATE: 05/31/2005
RESPS:30 HOURS:20 COSTS(000):$0
Application for Volunteer Program
FORMS: NONE
OMB NO: 2700-0063 EXPIRATION DATE: 05/31/2003
RESPS:75 HOURS:19 COSTS(000):$0
NASA Safety Reporting System
FORMS: NONE
OMB NO: 2700-0064 EXPIRATION DATE: 10/31/2003
RESPS:8,456 HOURS:702 COSTS(000):$0
Locator and Information Services Tracking System (LISTS) Form
FORMS: GSFC-24-27
OMB NO: 2700-0073 EXPIRATION DATE: 08/31/2005
RESPS:450 HOURS:5,400 COSTS(000):$0
Small Business and small disadvantaged business concerns and
related contract provisions, NASSA FAR Supplement Part 18-19, SF
295
FORMS: NONE
OMB NO: 2700-0078 EXPIRATION DATE: 09/30/2003
RESPS:96 HOURS:140 COSTS(000):$0
Small Business and Small Disadvantaged Business Concerns
FORMS: NONE
OMB NO: 2700-0080 EXPIRATION DATE: 09/30/2003
RESPS:650 HOURS:2,113 COSTS(000):$0
Uncompensated Overtime
FORMS: NONE
OMB NO: 2700-0085 EXPIRATION DATE: 11/30/2003
RESPS:1,496 HOURS:663,816 COSTS(000):$0
NASA Acquisition Process, bids and proposals for contracts with
an estimated value mor than $500,000.
FORMS: NONE
OMB NO: 2700-0086 EXPIRATION DATE: 11/30/2003
RESPS:250,865 HOURS:73,380 COSTS(000):$0
NASA Acquisition Process, Purchase orders for goods and services
with an estimated value of $100,000 or less
FORMS: NONE
OMB NO: 2700-0087 EXPIRATION DATE: 11/30/2003
RESPS:11,000 HOURS:2,790,000 COSTS(000):$0
NASA Acquisition Process, bids and proposals for contracts with
an estimated value less than $500,000.
FORMS: NONE
OMB NO: 2700-0088 EXPIRATION DATE: 05/31/2005
RESPS:38,460 HOURS:1,065,600 COSTS(000):$0
NASA Acquisition Process - Reports Required on Contracts Valued
at less than $500 K
FORMS: NONE
OMB NO: 2700-0089 EXPIRATION DATE: 11/30/2003
RESPS:76,160 HOURS:609,280 COSTS(000):$0
NASA Acquisiiton Process, reports required for contracts with an
estimated value more than $500,000.
FORMS: NONE
OMB NO: 2700-0092 EXPIRATION DATE: 05/31/2005
RESPS:658 HOURS:4,592 COSTS(000):$0
Cooperative Agreements with Commercial Firms
FORMS: NONE
OMB NO: 2700-0093 EXPIRATION DATE: 08/31/2005
RESPS:95 HOURS:485 COSTS(000):$0
Grants and Cooperative Agreements with State and Local
Governments
FORMS: NONE
OMB NO: 2700-0094 EXPIRATION DATE: 08/31/2005
RESPS:11 HOURS:506 COSTS(000):$0
Cost Reduction Proposals under the NASA FAR Supplement Shared
Savings Clause
FORMS: NONE
OMB NO: 2700-0095 EXPIRATION DATE: 06/30/2003
RESPS:200 HOURS:200 COSTS(000):$0
NASA Small Business Innovative Research Commercial Metrics
FORMS: NONE
OMB NO: 2700-0097 EXPIRATION DATE: 03/31/2006
RESPS:1,200 HOURS:3,130 COSTS(000):$0
Required Central Contractor Registration
FORMS: NONE
OMB NO: 2700-0099 EXPIRATION DATE: 07/31/2005
RESPS:8,000 HOURS:5,455 COSTS(000):$0
National Aviation Operations Monitoring Service
FORMS: NONE
OMB NO: 2700-0101 EXPIRATION DATE: 02/28/2005
RESPS:720 HOURS:180 COSTS(000):$0
NASA Procurement Customer Survey
FORMS: NONE
OMB NO: 2700-0102 EXPIRATION DATE: 01/31/2006
RESPS:10,000 HOURS:6,820 COSTS(000):$0
National Aviation Operations Monitoring Service - General
Aviation Pilots
FORMS: NONE
OMB NO: 2700-0103 EXPIRATION DATE: 11/30/2005
RESPS:40,000 HOURS:3,334 COSTS(000):$0
NASA Voluntary On-Line Job Applicant Racial and Ethnic Data
Collection
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
31 538,124 5,766,914 $0
National Archives and Records Administration
OMB NO: 3095-0002 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:7 COSTS(000):$0
Statistical Research in Archival Records Containing Personal
Information
FORMS: NONE
OMB NO: 3095-0007 EXPIRATION DATE: 02/29/2004
RESPS:1,925 HOURS:160 COSTS(000):$0
Customer Comment Form
FORMS: NA-14045
OMB NO: 3095-0012 EXPIRATION DATE: 11/30/2005
RESPS:25 HOURS:37.5 COSTS(000):$0
Application for Attendance at the Institute for the Editing of
Historical Documents
FORMS: NONE
OMB NO: 3095-0013 EXPIRATION DATE: 11/30/2005
RESPS:134 HOURS:7,636 COSTS(000):$0
National Historical Publications and Records Commission Grant
Program
FORMS: NONE
OMB NO: 3095-0014 EXPIRATION DATE: 11/30/2005
RESPS:9 HOURS:72 COSTS(000):$0
Applicatin for Archival Administration or Historical Documentary
Editing Fellowships
FORMS: NONE
OMB NO: 3095-0015 EXPIRATION DATE: 11/30/2005
RESPS:9 HOURS:153 COSTS(000):$0
Application for Host Institutions of Archival Administration or
Historical Documentary Editing Fellowships
FORMS: NONE
OMB NO: 3095-0016 EXPIRATION DATE: 06/30/2005
RESPS:27,273 HOURS:3,636 COSTS(000):$0
Researcher Application
FORMS: NA-14003
OMB NO: 3095-0017 EXPIRATION DATE: 05/31/2003
RESPS:1 HOURS:50 COSTS(000):$0
Request to Microfilm Records
FORMS: NONE
OMB NO: 3095-0021 EXPIRATION DATE: 02/29/2004
RESPS:36 HOURS:216 COSTS(000):$0
National Historical Publications and Records Commission (NHPRC)
Subvention Grant Guidelines and Aplications
FORMS: NONE
OMB NO: 3095-0022 EXPIRATION DATE: 12/31/2003
RESPS:36 HOURS:36 COSTS(000):$0
National Historical Publications & Records Commission (NHPRC)
Annual Sales Report for Subvention Grants
FORMS: NONE
OMB NO: 3095-0023 EXPIRATION DATE: 06/30/2003
RESPS:6,400 HOURS:533 COSTS(000):$0
NARA Class Evaluation Form
FORMS: NA-2019
OMB NO: 3095-0024 EXPIRATION DATE: 08/31/2004
RESPS:1,000 HOURS:333 COSTS(000):$0
Application and Permit for Use of Space in Presidential
FORMS: NA-16011
OMB NO: 3095-0025 EXPIRATION DATE: 06/30/2004
RESPS:2,816 HOURS:704 COSTS(000):$0
Item Approval Request List
FORMS: NA-14110 NA-14110A
OMB NO: 3095-0026 EXPIRATION DATE: 08/31/2004
RESPS:1,266 HOURS:63 COSTS(000):$0
Request for and Record of Pass
FORMS: NA-6006
OMB NO: 3095-0027 EXPIRATION DATE: 03/31/2005
RESPS:97,600 HOURS:16,267 COSTS(000):$0
Order Forms for Genealogical Reserach in the National Archives
FORMS: NATF-81 NATF-82 NATF-83 NATF-84 NATF-85 NATF-86
OMB NO: 3095-0029 EXPIRATION DATE: 09/30/2005
RESPS:552,500 HOURS:46,042 COSTS(000):$0
Request Pertaining to Military Records
FORMS: SF-180
OMB NO: 3095-0033 EXPIRATION DATE: 04/30/2003
RESPS:10,000 HOURS:1,667 COSTS(000):$0
National Archives Order for Land Entry Files
FORMS: NATF-84
OMB NO: 3095-0035 EXPIRATION DATE: 11/30/2004
RESPS:1 HOURS:15 COSTS(000):$0
Request to use Paper-to-Paper Copiers at the National Archives
at the College Park Facility
FORMS: NONE
OMB NO: 3095-0036 EXPIRATION DATE: 04/30/2005
RESPS:1 HOURS:31 COSTS(000):$1
Presidential Library Facilities
FORMS: NONE
OMB NO: 3095-0037 EXPIRATION DATE: 02/28/2006
RESPS:4,500 HOURS:375 COSTS(000):$0
Forms Relating to Civilian Service Records
FORMS: 13022 13064 13068
OMB NO: 3095-0038 EXPIRATION DATE: 12/31/2005
RESPS:5,000 HOURS:1,250 COSTS(000):$0
Court Order Requirements
FORMS: NA-13027
OMB NO: 3095-0039 EXPIRATION DATE: 12/31/2005
RESPS:79,800 HOURS:6,650 COSTS(000):$0
Forms Relating to Military Service Records
FORMS: NA-13036 NA-13042 NA-13075 NA-13055
OMB NO: 3095-0040 EXPIRATION DATE: 05/31/2003
RESPS:660 HOURS:110 COSTS(000):$0
Request to film, photograph, or videotape at a NARA facility for
news purposes
FORMS: NONE
OMB NO: 3095-0042 EXPIRATION DATE: 01/31/2006
RESPS:4,960 HOURS:827 COSTS(000):$0
Miitary Personnel Records (MPR) Customer Satisfaction Survey
FORMS: NONE
OMB NO: 3095-0043 EXPIRATION DATE: 05/31/2003
RESPS:52 HOURS:52 COSTS(000):$0
Request to use NARA facilities for events
FORMS: NA-16008
OMB NO: 3095-0045 EXPIRATION DATE: 10/31/2003
RESPS:13,300 HOURS:1,108 COSTS(000):$0
Applicant Background Survey
FORMS: NA-3035
OMB NO: 3095-0046 EXPIRATION DATE: 02/29/2004
RESPS:5,200 HOURS:867 COSTS(000):$0
Microfilm Order Form
FORMS: NATF-36
OMB NO: 3095-0047 EXPIRATION DATE: 04/30/2005
RESPS:130,000 HOURS:10,833 COSTS(000):$0
Customer Request for Information and Order Forms
FORMS: NA-14116
OMB NO: 3095-0052 EXPIRATION DATE: 10/31/2005
RESPS:5 HOURS:1 COSTS(000):$0
Use of NARA Official Seals
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
29 944,510 99,731 $1
National Commission on Libraries and Information Science
OMB NO: 3130-0005 EXPIRATION DATE: 04/30/2005
RESPS:325 HOURS:2 COSTS(000):$0
Assessment of NCLIS Sister Libraries Millennium project
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 325 2 $0
Institute of Museum and Library Services
OMB NO: 3137-0029 EXPIRATION DATE: 12/31/2003
RESPS:2,664 HOURS:36,432 COSTS(000):$0
Generic Clearance Grant Application Guidelines, Instructions and
Reporting Forms
FORMS: NONE
OMB NO: 3137-0040 EXPIRATION DATE: 01/31/2004
RESPS:1 HOURS:1,605 COSTS(000):$50,686
Technology Survey for Libraries and Museums
FORMS: NONE
OMB NO: 3137-0042 EXPIRATION DATE: 05/31/2004
RESPS:400 HOURS:78 COSTS(000):$0
Evaluation Professional Services Program
FORMS: NONE
OMB NO: 3137-0043 EXPIRATION DATE: 06/30/2004
RESPS:1 HOURS:2,250 COSTS(000):$33,533
Museum/School Program Research
FORMS: NONE
OMB NO: 3137-0044 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:135 COSTS(000):$0
Survey on the Partnerships in Museums in the Community Grant
Program
FORMS: NONE
OMB NO: 3137-0046 EXPIRATION DATE: 03/31/2004
RESPS:1 HOURS:116 COSTS(000):$0
Survey on User Need Assessments in Digitization Projects
FORMS: NONE
OMB NO: 3137-0047 EXPIRATION DATE: 03/31/2005
RESPS:1,500 HOURS:750 COSTS(000):$73,585
Evaluation of IMLS General Operating Support Grant Program for
Museums
FORMS: NONE
OMB NO: 3137-0048 EXPIRATION DATE: 08/31/2005
RESPS:900 HOURS:36,000 COSTS(000):$0
Learning Opportunity Grant Application and Guidelines
FORMS: NONE
OMB NO: 3137-0049 EXPIRATION DATE: 01/31/2005
RESPS:1 HOURS:4,800 COSTS(000):$0
Recuriting and Educating Librarians for the 21st Century
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 5,469 82,166 $157,804
National Endowment for the Arts
OMB NO: 3135-0094 EXPIRATION DATE: 08/31/2004
RESPS:40 HOURS:1,800 COSTS(000):$0
Application for Indemnification
FORMS: NONE
OMB NO: 3135-0098 EXPIRATION DATE: 08/31/2003
RESPS:271 HOURS:54 COSTS(000):$0
National Endowment for the Arts Panelist Profile Form
FORMS: NONE
OMB NO: 3135-0112 EXPIRATION DATE: 02/28/2005
RESPS:5,380 HOURS:129,152 COSTS(000):$0
FY 2004 - 2007 Blanket Justification for NEA Funding Application
Guidelines and Reporting Requirements
FORMS: NONE
OMB NO: 3135-0114 EXPIRATION DATE: 04/30/2005
RESPS:40 HOURS:550 COSTS(000):$0
Customer Service Information Collection
FORMS: NONE
OMB NO: 3135-0116 EXPIRATION DATE: 05/31/2003
RESPS:1,062 HOURS:2,124 COSTS(000):$0
Civil Rights Compliance and Section 504 Accessibility Checklists
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 6,793 133,680 $0
National Endowment for the Humanities
OMB NO: 3136-0134 EXPIRATION DATE: 06/30/2003
RESPS:20,569 HOURS:91,301 COSTS(000):$3,378
Generic Clearance Authority for the National Endowment for the
Humanities
FORMS: NONE
OMB NO: 3136-0137 EXPIRATION DATE: 11/30/2004
RESPS:1,224 HOURS:612 COSTS(000):$0
General Clearance Authority to Develop Evaluation Instruments
for the National Endowment for the Humanities
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 21,793 91,913 $3,378
National Mediation Board
OMB NO: 3140-0001 EXPIRATION DATE: 10/31/2005
RESPS:68 HOURS:17 COSTS(000):$0
Application for Investigation of Representation Dispute
FORMS: NONE
OMB NO: 3140-0002 EXPIRATION DATE: 09/30/2005
RESPS:70 HOURS:17 COSTS(000):$0
Application for Mediation Services
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 138 34 $0
National Science Foundation
OMB NO: 3145-0001 EXPIRATION DATE: 02/28/2005
RESPS:150 HOURS:262 COSTS(000):$0
Application for NATO Advanced Study Institutes Travel Award and
NATO Advanced Study Institutes Travel Award Report Form
FORMS: 192 250
OMB NO: 3145-0019 EXPIRATION DATE: 05/31/2003
RESPS:42,683 HOURS:14,228 COSTS(000):$0
Survey of Earned Doctorates
FORMS: NONE
OMB NO: 3145-0020 EXPIRATION DATE: 04/30/2003
RESPS:34,000 HOURS:14,167 COSTS(000):$0
2001 Survey of Doctorate Recipients (SDR)
FORMS: NONE
OMB NO: 3145-0023 EXPIRATION DATE: 07/31/2005
RESPS:13,000 HOURS:156,000 COSTS(000):$0
Fellowship Applications and Award Forms
FORMS: NONE
OMB NO: 3145-0027 EXPIRATION DATE: 01/31/2005
RESPS:31,200 HOURS:59,400 COSTS(000):$0
Survey of Industrial Research and Development, 2001-2004
FORMS: RD-1 RD-1A
OMB NO: 3145-0034 EXPIRATION DATE: 07/31/2004
RESPS:25 HOURS:12 COSTS(000):$0
Antarctic Conservation Act Application and Permit Form
FORMS: NONE
OMB NO: 3145-0035 EXPIRATION DATE: 07/31/2005
RESPS:137 HOURS:1,467 COSTS(000):$0
National Science Foundation Science Honor Awards
FORMS: NSF-1122 NSF-1123 NSF-1124
OMB NO: 3145-0058 EXPIRATION DATE: 08/31/2004
RESPS:30,000 HOURS:3,600,000 COSTS(000):$0
National Science Foundation Proposal/Award Information - Grant
Proposal Guide
FORMS: NONE
OMB NO: 3145-0060 EXPIRATION DATE: 03/31/2005
RESPS:96,000 HOURS:480,000 COSTS(000):$0
National Science Foundation Proposal Evaluation Process
FORMS: NSF-FORM-1 NSF-FORM-428
OMB NO: 3145-0062 EXPIRATION DATE: 05/31/2005
RESPS:11,793 HOURS:28,796 COSTS(000):$0
Survey of Graduate Students and Postdoctorates in Science and
Engineering
FORMS: NSF-811 NSF-812
OMB NO: 3145-0077 EXPIRATION DATE: 05/31/2004
RESPS:11,475 HOURS:5,737 COSTS(000):$0
2001 National Survey of Recent College Graduates
FORMS: NONE
OMB NO: 3145-0080 EXPIRATION DATE: 07/31/2003
RESPS:270 HOURS:56,010 COSTS(000):$0
Request for Proposals
FORMS: NONE
OMB NO: 3145-0096 EXPIRATION DATE: 08/31/2005
RESPS:5,000 HOURS:250 COSTS(000):$0
Applicant Survey
FORMS: NSF-1232
OMB NO: 3145-0100 EXPIRATION DATE: 07/31/2003
RESPS:646 HOURS:13,795 COSTS(000):$0
Survey of Research and Development Expenditures at Universities
and Colleges, FY 2002
FORMS: NSF-411
OMB NO: 3145-0136 EXPIRATION DATE: 11/30/2004
RESPS:16,423 HOURS:48,041 COSTS(000):$0
EHR Generic Clearance
FORMS: NONE
OMB NO: 3145-0153 EXPIRATION DATE: 04/30/2005
RESPS:364 HOURS:146 COSTS(000):$0
Impact on Industry of Interaction with Engineering Research
Centers
FORMS: NONE
OMB NO: 3145-0157 EXPIRATION DATE: 08/31/2005
RESPS:30,000 HOURS:5,000 COSTS(000):$0
National Science Foundation Surveys to Measure Customer
Satisfaction
FORMS: NONE
OMB NO: 3145-0161 EXPIRATION DATE: 07/31/2005
RESPS:14,040 HOURS:4,950 COSTS(000):$0
Cross-Project Evaluation of the National Science Foundation's
Local Systemic Change Through Teacher Enhancement Program (LSC)
FORMS: NONE
OMB NO: 3145-0174 EXPIRATION DATE: 12/31/2003
RESPS:1,620 HOURS:6,240 COSTS(000):$0
Generic Survey Clearance of the Science Resources Studies Survey
Improvement Projects and Quick Response Studies
FORMS: NONE
OMB NO: 3145-0175 EXPIRATION DATE: 11/30/2003
RESPS:1,040 HOURS:780 COSTS(000):$0
Evaluation of the NSF Summer Programs in Japan; NSF postdoctoral
Fellowships in Japan; and the NSF-CGP Fellowship Program.
FORMS: NONE
OMB NO: 3145-0176 EXPIRATION DATE: 04/30/2004
RESPS:500 HOURS:2,000 COSTS(000):$0
Generic Survey Clearance of the Science Resources Studies Quick
Response Capability
FORMS: NONE
OMB NO: 3145-0177 EXPIRATION DATE: 05/31/2004
RESPS:3,120 HOURS:29,617 COSTS(000):$0
Medical Clearance Process for Deployment to the Polar Regions
FORMS: 1421 1422 1423 1424 1425 1426 1427 1428 1429 1451
OMB NO: 3145-0178 EXPIRATION DATE: 05/31/2004
RESPS:3,750 HOURS:750 COSTS(000):$0
Information Technology Innovation Survey
FORMS: NONE
OMB NO: 3145-0180 EXPIRATION DATE: 08/31/2004
RESPS:12 HOURS:480 COSTS(000):$0
Response plan and educational materials for non-governmental
Antarctic expeditions.
FORMS: NONE
OMB NO: 3145-0182 EXPIRATION DATE: 07/31/2005
RESPS:880 HOURS:690 COSTS(000):$0
Cross-Site Analysis of the NSF Integrative Graduate Education
and Research Traineeships Program
FORMS: NONE
OMB NO: 3145-0183 EXPIRATION DATE: 07/31/2004
RESPS:150 HOURS:734 COSTS(000):$0
Evaluation of the Preparing Future Faculty (PFF) Program
FORMS: NONE
OMB NO: 3145-0184 EXPIRATION DATE: 02/28/2005
RESPS:6,500 HOURS:4,875 COSTS(000):$0
eRecruitment System
FORMS: NONE
OMB NO: 3145-0186 EXPIRATION DATE: 09/30/2005
RESPS:243 HOURS:121 COSTS(000):$0
Cross-Site Evaluation of USP Program
FORMS: NONE
OMB NO: 3145-0187 EXPIRATION DATE: 03/31/2005
RESPS:1 HOURS:1,253 COSTS(000):$0
Evaluation of NSF's Graduate teaching Fellows in K-12 Education
(GK-12)
FORMS: NONE
OMB NO: 3145-0188 EXPIRATION DATE: 04/30/2005
RESPS:150 HOURS:37 COSTS(000):$0
Survey of Colleges, Universities and Professional Development
Providers Regarding Evaluation Training Programs
FORMS: NONE
OMB NO: 3145-0189 EXPIRATION DATE: 05/31/2005
RESPS:1 HOURS:68 COSTS(000):$0
Outcomes and Impact of the NSF Minority Postdoctoral Research
Fellowships (MPRF) Program
FORMS: NONE
OMB NO: 3145-0190 EXPIRATION DATE: 05/31/2005
RESPS:795 HOURS:318 COSTS(000):$0
Evaluation of NSF's Louis Stokes Alliances for Minority
Participation (LSAMP) Program
FORMS: NONE
OMB NO: 3145-0191 EXPIRATION DATE: 08/31/2004
RESPS:560 HOURS:560 COSTS(000):$0
NSF Graduate Research Traineeships Program Followup Study
FORMS: NONE
OMB NO: 3145-0192 EXPIRATION DATE: 09/30/2004
RESPS:6,132 HOURS:6,952 COSTS(000):$0
Evaluation of the Adoption and use of the National Institutes of
Health Curriculum Supplements on Students' Scientific Knowledge
FORMS: NONE
OMB NO: 3145-0194 EXPIRATION DATE: 01/31/2006
RESPS:6 HOURS:600 COSTS(000):$0
Grantee Reporting Requirements for Science and Technology
Centers (STC): Integrative Partnerships
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
35 362,666 4,544,336 $0
National Transportation Safety Board
OMB NO: 3147-0001 EXPIRATION DATE: 08/31/2004
RESPS:2,100 HOURS:2,100 COSTS(000):$0
Pilot/Operator Aircraft Accident/Incident Report
FORMS: FORM-6120.1
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2,100 2,100 $0
Office of Government Ethics
OMB NO: 3209-0001 EXPIRATION DATE: 06/30/2003
RESPS:260 HOURS:780 COSTS(000):$0
Executive Branch Personnel Public Financial Disclosure Report
FORMS: 278
OMB NO: 3209-0002 EXPIRATION DATE: 12/31/2005
RESPS:222 HOURS:37 COSTS(000):$0
Request to Inspect or Receive Copies of SF 278 Executive Branch
Personnel Public Financial Disclosure Reports or Other Covered
Records
FORMS: OGE-201
OMB NO: 3209-0006 EXPIRATION DATE: 09/30/2005
RESPS:10 HOURS:15 COSTS(000):$0
Executive Branch Confidential Financial Disclosure Report
FORMS: 450
OMB NO: 3209-0007 EXPIRATION DATE: 03/31/2005
RESPS:294 HOURS:3,785 COSTS(000):$0
Executive Branch Qualified Trust Documents (see item #'s 1.-2.
of the Supporting Statement for precise title of all documents)
FORMS: NONE
OMB NO: 3209-0009 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:3 COSTS(000):$0
Public Financial Disclosure Access Customer Service Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 836 4,620 $0
Office of Management and Budget
OMB NO: 0348-0002 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-271: Outlay Report and Request for Reimbursement for
Construction Programs
FORMS: SF-271
OMB NO: 0348-0003 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-272 & 272A: Federal Cash Transactions Report
FORMS: SF-272 SF-272A
OMB NO: 0348-0004 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-270: Request for Advance or Reimbursement
FORMS: SF-270
OMB NO: 0348-0038 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-269A: Financial Status Report (Short Form)
FORMS: SF-269A
OMB NO: 0348-0039 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-269: Financial Status Report (Long Form)
FORMS: SF-269
OMB NO: 0348-0040 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-424B: Assurances - Nonconstruction Programs
FORMS: SF-424B
OMB NO: 0348-0041 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-424C: Budget Information - Construction Programs
FORMS: SF-424C
OMB NO: 0348-0042 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-424D: Assurances - Construction Programs
FORMS: SF-424D
OMB NO: 0348-0043 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-424: Application for Federal Assistance
FORMS: SF-424
OMB NO: 0348-0044 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
SF-424A: Budget Information - Nonconstruction Programs
FORMS: SF-424A
OMB NO: 0348-0046 EXPIRATION DATE: 07/31/2003
RESPS:300 HOURS:50 COSTS(000):$0
Disclosure of Lobbying Activities
FORMS: SF-LL
OMB NO: 0348-0057 EXPIRATION DATE: 12/31/2003
RESPS:60,000 HOURS:1,036,800 COSTS(000):$0
Data Collection Form for Reporting on Audits of States, Local
Governments, and Non-Profit Organizations
FORMS: SF-SAC
OMB NO: 0348-0058 EXPIRATION DATE: 06/30/2003
RESPS:141 HOURS:514 COSTS(000):$0
A-21 Facilities and Administrative Proposal
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
13 60,451 1,037,374 $0
Office of National Drug Control Policy
OMB NO: 3201-0007 EXPIRATION DATE: 12/31/2004
RESPS:1,000 HOURS:250 COSTS(000):$0
Community Drug Prevention Campaign Tracking Study
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 1,000 250 $0
Office of Personnel Management
OMB NO: 3206-0001 EXPIRATION DATE: 12/31/2003
RESPS:4,500 HOURS:750 COSTS(000):$0
Application for 10 point Veteran Preference
FORMS: SF-15
OMB NO: 3206-0005 EXPIRATION DATE: 12/31/2004
RESPS:252,310 HOURS:314,555 COSTS(000):$0
SF 85, Questionnaire for Non-Sensitive Positions; SF 85P,
Questionnaire for Public Trust Positions; SF 85PS, Supplemental
Questionnaire for Selected Positions, SF 86, Questionnaire for...
FORMS: SF-85 SF-85P SF-85PS SF-86 SF-86A SF-86C
OMB NO: 3206-0006 EXPIRATION DATE: 05/31/2003
RESPS:1,560 HOURS:3,120 COSTS(000):$2
Monthly Report of Federal Civilian Employment
FORMS: 113-A
OMB NO: 3206-0017 EXPIRATION DATE: 07/31/2005
RESPS:100 HOURS:17 COSTS(000):$0
Medicare Part B Certification
FORMS: RI-78-11
OMB NO: 3206-0032 EXPIRATION DATE: 11/30/2004
RESPS:14,000 HOURS:2,800 COSTS(000):$0
Self-Certification of Full-Time School Attendance
FORMS: RI-25-14
OMB NO: 3206-0033 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:250 COSTS(000):$0
Marital Status Certification
FORMS: RI-25-7
OMB NO: 3206-0034 EXPIRATION DATE: 09/30/2003
RESPS:21,000 HOURS:12,250 COSTS(000):$0
Annuitant's Report of Earned Income
FORMS: 30-2
OMB NO: 3206-0036 EXPIRATION DATE: 10/31/2005
RESPS:21,200 HOURS:75,800 COSTS(000):$0
Federal Wage System Data Collection forms
FORMS: DD-1918 DD-1919 DD-1919C
OMB NO: 3206-0040 EXPIRATION DATE: 08/31/2005
RESPS:500,000 HOURS:195,000 COSTS(000):$0
Occupational Questionnaire
FORMS: 1203-AW 1203-FX 1203-EZ
OMB NO: 3206-0042 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:1,250 COSTS(000):$0
Notice of Change in Student's Status
FORMS: RI-25-15
OMB NO: 3206-0061 EXPIRATION DATE: 11/30/2004
RESPS:50 HOURS:13 COSTS(000):$0
Application for Minimum Annuity
FORMS: RI-20-1
OMB NO: 3206-0076 EXPIRATION DATE: 02/29/2004
RESPS:10 HOURS:4 COSTS(000):$0
Application to be Listed Under the Voting Rights of 1965
FORMS: OPMFORM805 SERIES
OMB NO: 3206-0082 EXPIRATION DATE: 12/31/2003
RESPS:2,000 HOURS:4,000 COSTS(000):$0
Presidential Management Intern (PMI) Application
FORMS: OPM-1300
OMB NO: 3206-0095 EXPIRATION DATE: 10/31/2005
RESPS:100,000 HOURS:8,333 COSTS(000):$0
Applicnt Race and National Origin Questionnaire
FORMS: OPM-1386B
OMB NO: 3206-0099 EXPIRATION DATE: 08/31/2003
RESPS:1,200 HOURS:1,800 COSTS(000):$0
Initial Certification of Full-time School Attendance
FORMS: RI-25-41
OMB NO: 3206-0106 EXPIRATION DATE: 07/31/2004
RESPS:5,700 HOURS:570 COSTS(000):$0
Mail Reinterview Form
FORMS: IS-10
OMB NO: 3206-0121 EXPIRATION DATE: 09/30/2004
RESPS:3,000 HOURS:3,000 COSTS(000):$0
Application for Deferred Retirement (Separations before October
1, 1956) -- Application for Deferred Retirement (Separations on
or after October 1, 1956)
FORMS: OPM-1496 OPM-1496A
OMB NO: 3206-0128 EXPIRATION DATE: 07/31/2004
RESPS:60,990 HOURS:31,298 COSTS(000):$0
Application for Refund of Retirement Deductions (CSRS)
FORMS: SF-2802 SF-2802B
OMB NO: 3206-0134 EXPIRATION DATE: 05/31/2003
RESPS:150 HOURS:75 COSTS(000):$0
Application to Make Deposit or Redeposit (CSRS) Application to
Make Service Credit Payment for Civilian Service (FERS)
FORMS: SF-2803 SF-3108
OMB NO: 3206-0136 EXPIRATION DATE: 12/31/2003
RESPS:41,000 HOURS:10,250 COSTS(000):$0
Designation of Beneficiary: Federal Employees' Group Life
Insurance Program
FORMS: SF-2823
OMB NO: 3206-0138 EXPIRATION DATE: 09/30/2003
RESPS:200 HOURS:200 COSTS(000):$0
Reinstatement of Disability Annuity Previously Terminated
Because of Restoration to Earning Capacity
FORMS: RI-30-9
OMB NO: 3206-0140 EXPIRATION DATE: 03/31/2004
RESPS:12,730 HOURS:6,490 COSTS(000):$0
RI 20-7 - Representative Payee Application RI 30-3 - Information
Necessary for a Competency Determination
FORMS: RI-20-7 RI-30-3
OMB NO: 3206-0141 EXPIRATION DATE: 06/30/2005
RESPS:30,000 HOURS:16,667 COSTS(000):$0
Health Benefits Registration Form
FORMS: OPM-2809
OMB NO: 3206-0142 EXPIRATION DATE: 09/30/2004
RESPS:2,000 HOURS:500 COSTS(000):$0
Designation of Beneficiary (CSRS)
FORMS: SF-2808
OMB NO: 3206-0143 EXPIRATION DATE: 05/31/2004
RESPS:8,000 HOURS:8,000 COSTS(000):$0
Request to Disability Annuitant for Information on Physical
Condition and Employment
FORMS: RI-30-1
OMB NO: 3206-0144 EXPIRATION DATE: 06/30/2005
RESPS:3,000 HOURS:250 COSTS(000):$0
We Need the Social Security Number of the Person Named Below
FORMS: RI-38-45
OMB NO: 3206-0150 EXPIRATION DATE: 09/30/2004
RESPS:225,000 HOURS:18,750 COSTS(000):$0
Fingerprint Charts
FORMS: SF-87 SF-87A
OMB NO: 3206-0156 EXPIRATION DATE: 05/31/2005
RESPS:74,800 HOURS:56,100 COSTS(000):$0
Application for Death Benefits Under the Civil Service
Retirement System Documentation and Elections in Support of
Application for Death Benefits When the Deceased Was an Employee
at the Time of..
FORMS: SF-2800 SF-2800A
OMB NO: 3206-0160 EXPIRATION DATE: 09/30/2004
RESPS:9,000 HOURS:4,500 COSTS(000):$0
Employee Health Benefits Election Form
FORMS: SF-2809
OMB NO: 3206-0162 EXPIRATION DATE: 10/31/2004
RESPS:500 HOURS:750 COSTS(000):$0
Report of Medical Examination of Person Electing Survivor
Benefits Under the Civil Service Retirement System
FORMS: OPM-1530
OMB NO: 3206-0165 EXPIRATION DATE: 03/31/2005
RESPS:1,962,947 HOURS:162,924 COSTS(000):$0
Investigative Request for Employment Data & Supervisory
Information; Investigation Request for Personal Information;
Investigative Request for Educational Registrar and Dean of.....
FORMS: INV-41 INV-42 INV-43 INV-44
OMB NO: 3206-0167 EXPIRATION DATE: 08/31/2005
RESPS:2,081 HOURS:2,081 COSTS(000):$0
Financial Resources Questionnaire Notice of Amount Due Because
of Annuity Overpayment
FORMS: RI-34-1 RI-34-3
OMB NO: 3206-0168 EXPIRATION DATE: 06/30/2005
RESPS:200 HOURS:67 COSTS(000):$0
Alternative Annuity Election
FORMS: RI-20-80
OMB NO: 3206-0170 EXPIRATION DATE: 05/31/2005
RESPS:30,600 HOURS:9,633 COSTS(000):$0
Application for Refund of REtirement Deductions/Federal
Employees Retirement System (SF 3106) Current/Former Spouse's
Notification of Application for Refund of Retirement Deductions
Under the....
FORMS: SF-3106 SF-3106A
OMB NO: 3206-0172 EXPIRATION DATE: 12/31/2003
RESPS:8,061 HOURS:8,061 COSTS(000):$0
Application for Death Benefits/Federal Employees' Retirement
System Documentation and Elections in Support of Application for
Death Benefits when Deceased was an Employee at the Time of Death
FORMS: SF-3104 SF-3104B
OMB NO: 3206-0173 EXPIRATION DATE: 08/31/2005
RESPS:2,037 HOURS:509 COSTS(000):$0
Designation of Beneficiary (FERS)
FORMS: 3102
OMB NO: 3206-0174 EXPIRATION DATE: 06/30/2003
RESPS:2,400 HOURS:1,834 COSTS(000):$0
Survivor Annuity Election for a Spouse/Cover Letter for RI 20-63
Giving Information About the Cost to elect Less Than the Maximum
Survivor Annuity/Cover Letter for RI 20-63 Giving Information....
FORMS: RI-20-63 RI-20-116 RI-20-117
OMB NO: 3206-0179 EXPIRATION DATE: 07/31/2004
RESPS:2,500 HOURS:2,500 COSTS(000):$0
Disabled Dependent Questionnaire
FORMS: RI-30-10
OMB NO: 3206-0182 EXPIRATION DATE: 09/30/2003
RESPS:435,000 HOURS:108,750 COSTS(000):$0
Declaration for Federal Employment, Optional Form 306
FORMS: NONE
OMB NO: 3206-0187 EXPIRATION DATE: 02/28/2005
RESPS:8,000 HOURS:1,333 COSTS(000):$0
We Need More Information About Your Missing Payment
FORMS: RI-38-31
OMB NO: 3206-0190 EXPIRATION DATE: 08/31/2003
RESPS:1,272 HOURS:1,272 COSTS(000):$0
Application for Deferred or Postponed Retirement (FERS)
FORMS: RI-92-19 RI-92-19A
OMB NO: 3206-0193 EXPIRATION DATE: 02/28/2005
RESPS:360 HOURS:180 COSTS(000):$0
Campaign Results Report
FORMS: OPM-ONLINE-1417
OMB NO: 3206-0194 EXPIRATION DATE: 09/30/2003
RESPS:180 HOURS:45 COSTS(000):$0
Annuity Supplement Earnings Report
FORMS: RI-92-22
OMB NO: 3206-0197 EXPIRATION DATE: 05/31/2003
RESPS:25,400 HOURS:4,234 COSTS(000):$0
Verification of Who Is Getting Payments
FORMS: 38-107
OMB NO: 3206-0199 EXPIRATION DATE: 05/31/2005
RESPS:2,230 HOURS:262 COSTS(000):$0
Nonforeign Area COLA Price and Background Surveys
FORMS: NONE
OMB NO: 3206-0201 EXPIRATION DATE: 01/31/2004
RESPS:112,000 HOURS:18,666 COSTS(000):$0
Federal Employees Health Benefits (FEHB) Open Season Express
Interactive Voice Response (IVR) System
FORMS: NONE
OMB NO: 3206-0202 EXPIRATION DATE: 08/31/2004
RESPS:27,000 HOURS:20,250 COSTS(000):$0
Request to Change FEHB Enrollment or to receive Plan brochures
for Spouse Equity and Temporary Continuation of Coverage
Enrollees
FORMS: DPRS-2809
OMB NO: 3206-0204 EXPIRATION DATE: 03/31/2005
RESPS:19,000 HOURS:9,500 COSTS(000):$0
Court Orders Affecting Retirement Benefits - 5 CFR Sections
838.221, 838.421, and 838.721
FORMS: NONE
OMB NO: 3206-0206 EXPIRATION DATE: 06/30/2005
RESPS:250 HOURS:250 COSTS(000):$0
Evidence to Prove Dependency of a Child
FORMS: RI-25-37
OMB NO: 3206-0208 EXPIRATION DATE: 10/31/2003
RESPS:4,067 HOURS:1,356 COSTS(000):$0
Representative Payee Survey
FORMS: RI-38-115
OMB NO: 3206-0211 EXPIRATION DATE: 12/31/2003
RESPS:3,000 HOURS:350 COSTS(000):$0
Reemployment of Annuitants - 5 CFR Section 837.103
FORMS: NONE
OMB NO: 3206-0212 EXPIRATION DATE: 10/31/2004
RESPS:1,000 HOURS:500 COSTS(000):$0
Rollover Election
FORMS: RI-38-117 38-118 37-22
OMB NO: 3206-0213 EXPIRATION DATE: 07/31/2004
RESPS:2,600 HOURS:1,300 COSTS(000):$0
Marital Information Required of Refund Applicants
FORMS: RI-95-4
OMB NO: 3206-0215 EXPIRATION DATE: 12/31/2005
RESPS:10,000 HOURS:10,000 COSTS(000):$0
Verification of Full-Time School Attendance
FORMS: RS-25-49
OMB NO: 3206-0216 EXPIRATION DATE: 08/31/2004
RESPS:3,000 HOURS:250 COSTS(000):$0
We Need Important Information About Your Eligibility for Social
Security Disability Benefits, Our Records Show That You Have Not
Received a Decision From the Social Security Administration (SSA)
FORMS: RI-98-7
OMB NO: 3206-0218 EXPIRATION DATE: 10/31/2004
RESPS:1,850 HOURS:1,850 COSTS(000):$0
Death Benefit Payment Rollover Election Form
FORMS: RI-94-7
OMB NO: 3206-0219 EXPIRATION DATE: 08/31/2004
RESPS:431,600 HOURS:237,900 COSTS(000):$0
Applying for a Federal Job (OF 510) and Optional Application for
Federal Employment (OF 612)
FORMS: OF-510 OF-612
OMB NO: 3206-0226 EXPIRATION DATE: 12/31/2003
RESPS:45,500 HOURS:22,750 COSTS(000):$0
It's Time to Sign Up for Direct Deposit
FORMS: RI-38-128
OMB NO: 3206-0228 EXPIRATION DATE: 12/31/2003
RESPS:12,775 HOURS:12,775 COSTS(000):$0
CSRS/FERS Documentation in Support of Disability Retirement
Application
FORMS: SF-3112
OMB NO: 3206-0229 EXPIRATION DATE: 05/31/2005
RESPS:100 HOURS:17 COSTS(000):$0
Application for Federal Employee Commercial Garnishment
FORMS: OF-311
OMB NO: 3206-0230 EXPIRATION DATE: 05/31/2003
RESPS:100 HOURS:25 COSTS(000):$0
Life Insurance Election
FORMS: SF-2817
OMB NO: 3206-0232 EXPIRATION DATE: 06/30/2004
RESPS:100 HOURS:100 COSTS(000):$0
Procedures for Submitting Compensation and Leave Claims
FORMS: NONE
OMB NO: 3206-0233 EXPIRATION DATE: 10/31/2004
RESPS:34,800 HOURS:17,400 COSTS(000):$0
Civil Service Retirement System Survivor Annuitant Express Pay
Apkication for Death Benefits
FORMS: RI-25-51
OMB NO: 3206-0234 EXPIRATION DATE: 12/31/2004
RESPS:3,000 HOURS:750 COSTS(000):$0
Claim for Unpaid Compensation of Decreased Civilian Employee
FORMS: SF-1153
OMB NO: 3206-0235 EXPIRATION DATE: 03/31/2005
RESPS:30 HOURS:23 COSTS(000):$0
Survivor Annuity Election for a Former Spouse
FORMS: RI-20-64
OMB NO: 3206-0236 EXPIRATION DATE: 01/31/2006
RESPS:4,958,223 HOURS:704,794 COSTS(000):$0
Agency Generic Survey Plan
FORMS: NONE
OMB NO: 3206-0237 EXPIRATION DATE: 03/31/2005
RESPS:3,100 HOURS:2,325 COSTS(000):$0
Information and Instructions on Your Reconsideration Rights
FORMS: RI-38-47
OMB NO: 3206-0239 EXPIRATION DATE: 09/30/2004
RESPS:9,000 HOURS:4,500 COSTS(000):$0
Annuitant/OWCP Health Benefits Election Form
FORMS: SF-2809-1
OMB NO: 3206-0240 EXPIRATION DATE: 08/31/2004
RESPS:5,000 HOURS:833 COSTS(000):$0
Child Care Tuition Assistance Program-Provider Information
FORMS: OPM-1644
OMB NO: 3206-0245 EXPIRATION DATE: 04/30/2006
RESPS:5,000 HOURS:2,500 COSTS(000):$0
Request for Change to Unreduced Annuity
FORMS: RI-20-120
OMB NO: 3206-0246 EXPIRATION DATE: 08/31/2003
RESPS:200 HOURS:200 COSTS(000):$0
Scholarship For Service (SFP) Program Internet Website
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
71 9,570,564 2,152,191 $2
Office of Special Counsel
OMB NO: 3255-0002 EXPIRATION DATE: 08/31/2003
RESPS:2,246 HOURS:2,689 COSTS(000):$0
(a) Complaint of Possible Prohibited Personnel Practice or Other
Prohibited Activity; (b) Disclosure of Information
FORMS: OSC-11 OSC-12
OMB NO: 3255-0003 EXPIRATION DATE: 07/31/2005
RESPS:840 HOURS:323 COSTS(000):$0
3 OSC Surveys: 48a - Prohibited Personnel Practice or other
Prohibited activity; 48b - Hatch Act Advisory Opinion; 48c -
Whistleblower Disclosure
FORMS: 48A 48B 48C
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 3,086 3,012 $0
Office of the United States Trade Representative
OMB NO: 0350-0009 EXPIRATION DATE: 04/30/2003
RESPS:68 HOURS:136 COSTS(000):$0
Applications of inclusion on NAFTA Chapter 19 roster
FORMS: NONE
OMB NO: 0350-0011 EXPIRATION DATE: 11/30/2005
RESPS:500 HOURS:4,100 COSTS(000):$57,505
Questionnaire for Exclusion Requesters (Anniversary) under
Section 203 of the Trade Act
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 568 4,236 $57,505
Overseas Private Investment Corporation
OMB NO: 3420-0001 EXPIRATION DATE: 08/31/2004
RESPS:850 HOURS:425 COSTS(000):$0
Request for registration for political risk investment insurance
FORMS: OPIC-50
OMB NO: 3420-0004 EXPIRATION DATE: 10/31/2004
RESPS:25 HOURS:175 COSTS(000):$0
Project Information Report
FORMS: OPIC-71
OMB NO: 3420-0011 EXPIRATION DATE: 06/30/2003
RESPS:150 HOURS:975 COSTS(000):$0
Application for Political Risk Investment Insurance
FORMS: OPIC-52
OMB NO: 3420-0015 EXPIRATION DATE: 07/31/2004
RESPS:300 HOURS:900 COSTS(000):$0
Finance Application
FORMS: OPIC-115
OMB NO: 3420-0018 EXPIRATION DATE: 06/30/2003
RESPS:123 HOURS:735 COSTS(000):$0
Sponsor Disclosure Report in Support of an Application for
Financing
FORMS: OPIC-129
OMB NO: 3420-0019 EXPIRATION DATE: 07/31/2003
RESPS:200 HOURS:600 COSTS(000):$0
Self-Monitoring Questionnaire for Insurance and Finance Projects
FORMS: OPIC162
OMB NO: 3420-0020 EXPIRATION DATE: 08/31/2003
RESPS:30 HOURS:30 COSTS(000):$0
Expedited Screening Questionnaire -- Downstream Investments
FORMS: OPIC-168
OMB NO: 3420-0022 EXPIRATION DATE: 08/31/2003
RESPS:50 HOURS:200 COSTS(000):$0
Small Business Application for Political Risk Investment
Insurance
FORMS: OPIC-223
OMB NO: 3420-0023 EXPIRATION DATE: 07/31/2003
RESPS:190 HOURS:570 COSTS(000):$0
Self Monitoring Questionnaire for Investment Funds Projects
FORMS: OPIC-217
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 1,918 4,610 $0
Peace Corps
OMB NO: 0420-0001 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:2,500 COSTS(000):$27,062
National Agency Check Questionnaire for Peace Corps Volunteer
Background Investigation
FORMS: PC-5
OMB NO: 0420-0005 EXPIRATION DATE: 04/30/2005
RESPS:30,000 HOURS:240,000 COSTS(000):$104,954
Peace Corps Volunteer Application Form
FORMS: PC-1502
OMB NO: 0420-0006 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:13,692 COSTS(000):$151
Peace Corps Reference Form
FORMS: PC-1532
OMB NO: 0420-0007 EXPIRATION DATE: 04/30/2005
RESPS:35,000 HOURS:1,021 COSTS(000):$0
Request for Information Card
FORMS: PC-1741
OMB NO: 0420-0510 EXPIRATION DATE: 02/29/2004
RESPS:12,500 HOURS:4,625 COSTS(000):$16
Health Status Review/Report of Medical Exam
FORMS: PC-1789 PC-1790
OMB NO: 0420-0513 EXPIRATION DATE: 07/31/2005
RESPS:16,000 HOURS:1,833 COSTS(000):$9,000
Teacher Enrollment Form; Volunteer Enrollment Form; Teacher
Survey
FORMS: WWS-PCV-2000 WWS/ED-2000 WWS-TEACHER
OMB NO: 0420-0525 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:250 COSTS(000):$1,984
Peace Corps Fellows/ USA Program Alumni Questionnaire
FORMS: NONE
OMB NO: 0420-0529 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:8,100 COSTS(000):$55
Peace Corps Day Brochure
FORMS: NONE
OMB NO: 0420-0531 EXPIRATION DATE: 04/30/2005
RESPS:5,000 HOURS:150 COSTS(000):$8,900
Peace Corps Career Information Consultants (CIC) Waiver Form
FORMS: CIC-11/00-RVS15
OMB NO: 0420-0533 EXPIRATION DATE: 08/31/2003
RESPS:1,000 HOURS:83 COSTS(000):$0
Peace Corps - Crisis Corps Application
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
10 99,504 272,254 $152,122
Pension Benefit Guaranty Corporation
OMB NO: 1212-0009 EXPIRATION DATE: 01/31/2005
RESPS:45,900 HOURS:2,540 COSTS(000):$9,657
Payment of Premiums (29 CFR Part 4007), Disclosure to
Participants (29 CFR Part 4011)
FORMS: FORM-1 FORM-1-EZ FORM-1-ES
OMB NO: 1212-0013 EXPIRATION DATE: 04/30/2003
RESPS:305 HOURS:1,249 COSTS(000):$187
Reportable Events
FORMS: 10 10-ADVANCE
OMB NO: 1212-0017 EXPIRATION DATE: 10/31/2004
RESPS:6 HOURS:72 COSTS(000):$72
Liability for Termination of Single-Employer Plans
FORMS: NONE
OMB NO: 1212-0020 EXPIRATION DATE: 11/30/2004
RESPS:1,411 HOURS:23 COSTS(000):$9
Termination of Multiemployer Plans (29 CFR Part 4041A)
FORMS: NONE
OMB NO: 1212-0021 EXPIRATION DATE: 11/30/2004
RESPS:24 HOURS:1 COSTS(000):$3
Variances for Sale of Assets (29 CFR Part 4204)
FORMS: NONE
OMB NO: 1212-0022 EXPIRATION DATE: 11/30/2004
RESPS:35 HOURS:8 COSTS(000):$5
Mergers and Transfers Between Multiemployer Plans (29 CFR Part
4231)
FORMS: NONE
OMB NO: 1212-0023 EXPIRATION DATE: 11/30/2004
RESPS:1 HOURS:1 COSTS(000):$3
Extension of Special Withdrawal Liability Rules (29 CFR Part
4203)
FORMS: NONE
OMB NO: 1212-0030 EXPIRATION DATE: 01/31/2006
RESPS:44 HOURS:41 COSTS(000):$0
Survey of Nonparticipating Single-Premium Group Annuity Rates
FORMS: NONE
OMB NO: 1212-0031 EXPIRATION DATE: 11/30/2004
RESPS:3 HOURS:1 COSTS(000):$0
Procedures for PBGC Approval of Plan Amendments (29 CFR Part
4220)
FORMS: NONE
OMB NO: 1212-0032 EXPIRATION DATE: 11/30/2004
RESPS:23,357 HOURS:1 COSTS(000):$115
Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part
4281)
FORMS: NONE
OMB NO: 1212-0033 EXPIRATION DATE: 11/30/2004
RESPS:838 HOURS:1 COSTS(000):$1
Notice of Insolvency (29 CFR Part 4245)
FORMS: NONE
OMB NO: 1212-0034 EXPIRATION DATE: 11/30/2004
RESPS:179 HOURS:4 COSTS(000):$5
Notice, Collection, and Redetermination of Withdrawal Liability
(29 CFR Part 4219)
FORMS: NONE
OMB NO: 1212-0035 EXPIRATION DATE: 11/30/2004
RESPS:5 HOURS:10 COSTS(000):$0
Allocating Unfunded Vested Benefits (29 CFR Part 4211)
FORMS: NONE
OMB NO: 1212-0036 EXPIRATION DATE: 05/31/2004
RESPS:1,564 HOURS:2,246 COSTS(000):$1,865
Termination of Single Employer Plans
FORMS: 500 501 600 601 602 SCHEDULES-EA-S REP-S EA-D MP
OMB NO: 1212-0039 EXPIRATION DATE: 11/30/2004
RESPS:2,001 HOURS:250 COSTS(000):$200
Reduction or Waiver of Partial Withdrawal Liability (29 CFR Part
4208)
FORMS: NONE
OMB NO: 1212-0041 EXPIRATION DATE: 01/31/2006
RESPS:30 HOURS:64 COSTS(000):$12
Notice of Failure to Make Required Contributions
FORMS: 200
OMB NO: 1212-0044 EXPIRATION DATE: 11/30/2004
RESPS:201 HOURS:25 COSTS(000):$20
Reduction or Waiver of Complete Withdrawal Liability (29 CFR
Part 4207)
FORMS: NONE
OMB NO: 1212-0049 EXPIRATION DATE: 03/31/2005
RESPS:70 HOURS:552 COSTS(000):$700
Annual Financial and Actuarial Information Reporting (29 CFR
Part 4010)
FORMS: NONE
OMB NO: 1212-0050 EXPIRATION DATE: 11/30/2004
RESPS:3,331 HOURS:8,878 COSTS(000):$355
Disclosure to Participants
FORMS: NONE
OMB NO: 1212-0053 EXPIRATION DATE: 06/30/2003
RESPS:9,500 HOURS:2,500 COSTS(000):$0
Customer Service Focus Groups and Surveys
FORMS: NONE
OMB NO: 1212-0054 EXPIRATION DATE: 08/31/2003
RESPS:300 HOURS:104 COSTS(000):$119
Qualified Domestic Relations Orders Submitted to the PBGC
FORMS: NONE
OMB NO: 1212-0055 EXPIRATION DATE: 04/30/2003
RESPS:133,750 HOURS:71,000 COSTS(000):$45
Locating and Paying Participants
FORMS: NONE
OMB NO: 1212-0057 EXPIRATION DATE: 12/31/2004
RESPS:37,700 HOURS:3,859 COSTS(000):$2,553
Annual Information Return/Report
FORMS: 5500-SERIES
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
23 260,555 93,430 $15,926
Railroad Retirement Board
OMB NO: 3220-0002 EXPIRATION DATE: 07/31/2003
RESPS:19,100 HOURS:11,634 COSTS(000):$0
Application for Employee Annuity Under the Railroad Retirement
Act
FORMS: AA-1 AA-1CERT AA-1D G-204
OMB NO: 3220-0005 EXPIRATION DATE: 08/31/2004
RESPS:2,968 HOURS:474 COSTS(000):$0
Employer Reporting
FORMS: AA-12 G-88A.1 G.88A.2 BA-6A
OMB NO: 3220-0007 EXPIRATION DATE: 08/31/2004
RESPS:1,150 HOURS:382 COSTS(000):$0
Appeal Under the Railroad Retirement and Railroad Unemployment
Insurance Act
FORMS: HA-1
OMB NO: 3220-0008 EXPIRATION DATE: 02/28/2005
RESPS:1,028 HOURS:37,980 COSTS(000):$0
Railroad Service and Compensation Reports
FORMS: BA-3A BA-4
OMB NO: 3220-0012 EXPIRATION DATE: 03/31/2006
RESPS:2,200 HOURS:917 COSTS(000):$0
Employer's Quarterly Report of Contributions Under the RUIA
FORMS: DC-1
OMB NO: 3220-0014 EXPIRATION DATE: 07/31/2003
RESPS:65 HOURS:33 COSTS(000):$0
Employee Representatives' Status and Compensation Reports
FORMS: DC-2A DC-2
OMB NO: 3220-0016 EXPIRATION DATE: 05/31/2005
RESPS:3,600 HOURS:360 COSTS(000):$0
Certification of Relinquishment of Rights
FORMS: G-88
OMB NO: 3220-0021 EXPIRATION DATE: 01/31/2006
RESPS:1,100 HOURS:196 COSTS(000):$0
Evidence of Marital Relationship - Living with Requirements
FORMS: G-124 G-124A G-237 G-238 G-238A
OMB NO: 3220-0022 EXPIRATION DATE: 06/30/2003
RESPS:78,700 HOURS:8,617 COSTS(000):$0
Application and Claim for Unemployment Benefits and Employment
Service
FORMS: UI-1 UI-3
OMB NO: 3220-0025 EXPIRATION DATE: 11/30/2003
RESPS:7,905 HOURS:1,622 COSTS(000):$0
RUIA Investigations and Continuing Entitlement
FORMS: UI-9 UI-23 ID-4F ID-4U ID-4X ID-4Y ID-20-1 ID-20-2 ID-20-4
ID-5I.........
OMB NO: 3220-0030 EXPIRATION DATE: 03/31/2004
RESPS:4,137 HOURS:1,718 COSTS(000):$0
Application for Survivor Insurance Annuities
FORMS: AA-17 AA-17B AA-17CERT AA-18 AA-19 AA-19A AA-20
OMB NO: 3220-0031 EXPIRATION DATE: 03/31/2006
RESPS:20,600 HOURS:5,150 COSTS(000):$0
Application for Survivor Death Benefits
FORMS: AA-21 AA-21-CERT G-273A AA-11A G-131
OMB NO: 3220-0032 EXPIRATION DATE: 06/30/2003
RESPS:8,000 HOURS:1,391 COSTS(000):$0
Survivor Questionnaire
FORMS: RL-94-F
OMB NO: 3220-0034 EXPIRATION DATE: 08/31/2005
RESPS:400 HOURS:40 COSTS(000):$0
Statement of Authority to Act for Employee
FORMS: SI-10
OMB NO: 3220-0036 EXPIRATION DATE: 02/28/2005
RESPS:28,500 HOURS:1,691 COSTS(000):$0
Supplemental Information on Accident and Insurance
FORMS: SI-1C SI-5 ID-3S ID-3S-1 ID-3U ID-30K ID-30K-1
OMB NO: 3220-0038 EXPIRATION DATE: 11/30/2005
RESPS:29,950 HOURS:12,417 COSTS(000):$0
Medical Reports
FORMS: G-3EMP G-250 G-250A G-260 RL-11B RL-11D
OMB NO: 3220-0039 EXPIRATION DATE: 02/29/2004
RESPS:271,900 HOURS:27,971 COSTS(000):$0
Railroad Unemployment Insurance Act Applications
FORMS: SI-1A SI-1B SI-3 SI-7 SI-8 ID-7H ID-11A ID-11B
OMB NO: 3220-0042 EXPIRATION DATE: 07/31/2003
RESPS:8,500 HOURS:4,714 COSTS(000):$0
Application for Spouse Annuity Under the Railroad Retirement Act
FORMS: AA-3 AA-3CERT
OMB NO: 3220-0052 EXPIRATION DATE: 03/31/2004
RESPS:20,300 HOURS:16,350 COSTS(000):$0
Railroad Retirement Act Continuing Entitlement
FORMS: AA-5 G-478 RB-5
OMB NO: 3220-0055 EXPIRATION DATE: 12/31/2005
RESPS:200 HOURS:23 COSTS(000):$0
Application and Claim for RUIA Benefits Due at Death
FORMS: UI-63
OMB NO: 3220-0057 EXPIRATION DATE: 07/31/2004
RESPS:27,000 HOURS:1,494 COSTS(000):$0
Placement Service
FORMS: ES-2 ES-20A ES-20B ES-21 ES-21C UI-35
OMB NO: 3220-0070 EXPIRATION DATE: 10/31/2004
RESPS:3,000 HOURS:400 COSTS(000):$0
Employer Service and Compensation Reports
FORMS: UI-41 UI-41A
OMB NO: 3220-0079 EXPIRATION DATE: 08/31/2004
RESPS:2,900 HOURS:487 COSTS(000):$0
Certification Regarding Rights to Unemployment Benefits
FORMS: UI-45
OMB NO: 3220-0082 EXPIRATION DATE: 12/31/2005
RESPS:1,040 HOURS:165 COSTS(000):$0
Medicare
FORMS: AA-6 AA-7 AA-8 RL-311-F
OMB NO: 3220-0083 EXPIRATION DATE: 11/30/2003
RESPS:290 HOURS:121 COSTS(000):$0
Evidence for Application of Overall Minimum
FORMS: G-319 G-320
OMB NO: 3220-0086 EXPIRATION DATE: 07/31/2005
RESPS:50 HOURS:8 COSTS(000):$0
Application for Reimbursement for Hospital Services in Canada
FORMS: AA-104
OMB NO: 3220-0089 EXPIRATION DATE: 02/28/2006
RESPS:1,515 HOURS:203 COSTS(000):$0
Pension Plan Reports
FORMS: G-88P G-88R G-88R.1
OMB NO: 3220-0097 EXPIRATION DATE: 10/31/2004
RESPS:750 HOURS:63 COSTS(000):$0
Pay Rate Report
FORMS: UI-LE
OMB NO: 3220-0099 EXPIRATION DATE: 06/30/2005
RESPS:100 HOURS:259 COSTS(000):$0
Statement Regarding contributions and Support
FORMS: G-134
OMB NO: 3220-0100 EXPIRATION DATE: 01/31/2006
RESPS:4,100 HOURS:1,025 COSTS(000):$0
Request for Review of Part B Medicare Claim
FORMS: G-790 G-791
OMB NO: 3220-0107 EXPIRATION DATE: 02/28/2006
RESPS:300 HOURS:150 COSTS(000):$0
Request to Non-Railroad Employer for Information About
Annuitant's Work and Earnings
FORMS: RL-231-F
OMB NO: 3220-0123 EXPIRATION DATE: 11/30/2003
RESPS:1,230 HOURS:121 COSTS(000):$0
Student Beneficiary Monitoring
FORMS: G-315 G-315A G-315A.1
OMB NO: 3220-0127 EXPIRATION DATE: 05/31/2005
RESPS:1,200 HOURS:1,700 COSTS(000):$0
Financial Disclosure Statement
FORMS: G-423
OMB NO: 3220-0131 EXPIRATION DATE: 10/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
Request for Medicare Payment
FORMS: G-740S CMS-1500
OMB NO: 3220-0132 EXPIRATION DATE: 04/30/2003
RESPS:556 HOURS:345 COSTS(000):$0
Gross Earnings Report
FORMS: BA-11
OMB NO: 3220-0136 EXPIRATION DATE: 03/31/2004
RESPS:2,700 HOURS:475 COSTS(000):$0
Public Service Pension Questionnaires
FORMS: G-208 G-212
OMB NO: 3220-0138 EXPIRATION DATE: 04/30/2004
RESPS:600 HOURS:415 COSTS(000):$0
Self-Employment Questionnaire
FORMS: AA-4
OMB NO: 3220-0140 EXPIRATION DATE: 11/30/2005
RESPS:5,400 HOURS:450 COSTS(000):$0
Employee's Certification
FORMS: G-346
OMB NO: 3220-0141 EXPIRATION DATE: 11/30/2003
RESPS:6,000 HOURS:3,045 COSTS(000):$0
Vocational Report
FORMS: G-251
OMB NO: 3220-0145 EXPIRATION DATE: 06/30/2003
RESPS:1,500 HOURS:750 COSTS(000):$0
Nonresident Questionnaire
FORMS: RRB-1001
OMB NO: 3220-0149 EXPIRATION DATE: 07/31/2004
RESPS:25,000 HOURS:1 COSTS(000):$0
Withholding Certificate for Railroad Retirement Monthly Annuity
Payments
FORMS: RRBW-4P
OMB NO: 3220-0151 EXPIRATION DATE: 10/31/2004
RESPS:6,535 HOURS:2,032 COSTS(000):$0
Representative Payee Monitoring
FORMS: G-99A G-99C
OMB NO: 3220-0154 EXPIRATION DATE: 07/31/2005
RESPS:500 HOURS:55 COSTS(000):$0
Employee Noncovered Service Pension Questionnaire
FORMS: G-209
OMB NO: 3220-0155 EXPIRATION DATE: 07/31/2004
RESPS:100 HOURS:17 COSTS(000):$0
Supplement to Claim of Person Outside the United States
FORMS: G-45
OMB NO: 3220-0156 EXPIRATION DATE: 06/30/2003
RESPS:4,000 HOURS:133 COSTS(000):$0
Employer's Deemed Service Month Questionnaire
FORMS: GL-99
OMB NO: 3220-0164 EXPIRATION DATE: 06/30/2005
RESPS:7,600 HOURS:1,085 COSTS(000):$0
Availability for Work
FORMS: UI-38 UI-38S ID-8K
OMB NO: 3220-0169 EXPIRATION DATE: 06/30/2003
RESPS:300 HOURS:25 COSTS(000):$0
Repayment of Debt
FORMS: G-421F
OMB NO: 3220-0171 EXPIRATION DATE: 06/30/2005
RESPS:18,600 HOURS:460 COSTS(000):$0
RUIA Claims Notification System
FORMS: ID-4K
OMB NO: 3220-0173 EXPIRATION DATE: 05/31/2005
RESPS:1,009 HOURS:1,262 COSTS(000):$0
Railroad Separation Allowance or Severance Pay Report
FORMS: BA-9
OMB NO: 3220-0175 EXPIRATION DATE: 02/28/2005
RESPS:239 HOURS:219 COSTS(000):$0
Sick Pay and Miscellaneous Payments Report
FORMS: BA-10
OMB NO: 3220-0176 EXPIRATION DATE: 05/31/2005
RESPS:1,850 HOURS:154 COSTS(000):$0
Representative Payee Parental Custody Monitoring
FORMS: G-99D
OMB NO: 3220-0179 EXPIRATION DATE: 11/30/2005
RESPS:1,000 HOURS:250 COSTS(000):$0
Annual Earnings Questionnaire for Annuitants in Last Pre-Retire-
ment Non-Railroad Employment
FORMS: G-19L
OMB NO: 3220-0183 EXPIRATION DATE: 10/31/2003
RESPS:900 HOURS:225 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: G-93
OMB NO: 3220-0184 EXPIRATION DATE: 10/31/2004
RESPS:1,500 HOURS:200 COSTS(000):$0
Earnings Information Request
FORMS: G-19-F
OMB NO: 3220-0185 EXPIRATION DATE: 11/30/2004
RESPS:600 HOURS:100 COSTS(000):$0
Report of Medicaid State Office on Beneficiary's Buy-In Status
FORMS: RL-380-F
OMB NO: 3220-0187 EXPIRATION DATE: 10/31/2005
RESPS:3,000 HOURS:748 COSTS(000):$0
Continuing Disability Report
FORMS: G-254 G-254A
OMB NO: 3220-0192 EXPIRATION DATE: 09/30/2003
RESPS:3,330 HOURS:945 COSTS(000):$0
Voluntary Customer Surveys in Accordance with E.O. 12862
FORMS: G-201 T-15 T-16
OMB NO: 3220-0193 EXPIRATION DATE: 11/30/2003
RESPS:430 HOURS:144 COSTS(000):$0
Job Information Report
FORMS: G-251A G-251B
OMB NO: 3220-0195 EXPIRATION DATE: 05/31/2005
RESPS:500 HOURS:500 COSTS(000):$0
Statement Regarding Contributions and Support of Children
FORMS: G-139
OMB NO: 3220-0196 EXPIRATION DATE: 08/31/2004
RESPS:80 HOURS:13 COSTS(000):$0
Investigation of Claim for Possible Days of Employment
FORMS: ID-5S(SUP)
OMB NO: 3220-0197 EXPIRATION DATE: 11/30/2004
RESPS:90 HOURS:180 COSTS(000):$0
Verification of Supplement Annuity
FORMS: G-88P.1 G-88P.2
OMB NO: 3220-0198 EXPIRATION DATE: 02/29/2004
RESPS:10,000 HOURS:541 COSTS(000):$0
Request for Internet Services
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
62 657,698 154,646 $0
Selective Service System
OMB NO: 3240-0002 EXPIRATION DATE: 07/31/2005
RESPS:601,418 HOURS:20,047 COSTS(000):$0
Selective Service Registration Form
FORMS: SSS-1 SSS-1M
OMB NO: 3240-0003 EXPIRATION DATE: 08/31/2005
RESPS:729,878 HOURS:24,305 COSTS(000):$0
SSS Change of Information, SSS Registration Status Form, SSS
Acknowledgement and Correction/Change Form
FORMS: SSS-2 SSS-3A SSS-3B SSS-3C
OMB NO: 3240-0005 EXPIRATION DATE: 11/30/2004
RESPS:900 HOURS:225 COSTS(000):$0
Potential Board Member Information
FORMS: SSS-404
OMB NO: 3240-0006 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Registrant Claim Form
FORMS: SSS-9
OMB NO: 3240-0010 EXPIRATION DATE: 08/31/2005
RESPS:2,705 HOURS:89 COSTS(000):$0
Uncompensated Registrar Appointment
FORMS: SSS-402
OMB NO: 3240-0014 EXPIRATION DATE: 05/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Registrant Travel Reimbursement Request
FORMS: SSS-350
OMB NO: 3240-0015 EXPIRATION DATE: 05/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Application for Voluntary Induction
FORMS: SSS-254
OMB NO: 3240-0017 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Application by Alien for Relief from Training and Service in the
Armed Forces of the United States
FORMS: SSS-130
OMB NO: 3240-0018 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Student Certificate
FORMS: SSS-109
OMB NO: 3240-0022 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Alien or Dual National
FORMS: SSS=26
OMB NO: 3240-0023 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Minister of Religion
FORMS: SSS-25
OMB NO: 3240-0024 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Hardship to Dependents
FORMS: SSS-24
OMB NO: 3240-0025 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Administrative
FORMS: SSS-21
OMB NO: 3240-0026 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form - Divinity Student
FORMS: SSS-23
OMB NO: 3240-0027 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Postponement of Induction
FORMS: SSS-27
OMB NO: 3240-0028 EXPIRATION DATE: 05/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form-Conscientious Objector
FORMS: SSS-FORM-22
OMB NO: 3240-0029 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Worker Travel Reimubursement Request
FORMS: SSS-164
OMB NO: 3240-0030 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Claim for Reimbursement for Emergency Medical Care
FORMS: SSS-166
OMB NO: 3240-0031 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
employer data sheet
FORMS: SSS-153
OMB NO: 3240-0032 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Skills Questionnaire
FORMS: SSS-156
OMB NO: 3240-0033 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Job Data Form
FORMS: SSS-157
OMB NO: 3240-0034 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Request for Overseas Job Assignment
FORMS: SSS-160
OMB NO: 3240-0035 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
employment verification form
FORMS: SSS-163
OMB NO: 3240-0036 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
alternative service employement agreement
FORMS: SSS-152
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
24 1,334,921 44,686 $0
Small Business Administration
OMB NO: 3245-0007 EXPIRATION DATE: 08/31/2003
RESPS:195,930 HOURS:53,375 COSTS(000):$0
Surety Bond Guarantee Assistance
FORMS: SBA-FORMS-990 991 994 994B 994C 994F 994H
OMB NO: 3245-0009 EXPIRATION DATE: 06/30/2004
RESPS:4,200 HOURS:700 COSTS(000):$0
Size Status Declaration
FORMS: SBA-FORM-480
OMB NO: 3245-0012 EXPIRATION DATE: 05/31/2005
RESPS:5,000 HOURS:5,000 COSTS(000):$0
Requests from borrowers (Financial Statements)
FORMS: 770
OMB NO: 3245-0016 EXPIRATION DATE: 11/30/2004
RESPS:60,000 HOURS:1,200,000 COSTS(000):$0
Applications for Business Loans
FORMS: FORM-4 SCH.-A FORM-4-1 FORM-4-L
OMB NO: 3245-0017 EXPIRATION DATE: 05/31/2004
RESPS:11,540 HOURS:28,821 COSTS(000):$111
Disaster Business Loan Application
FORMS: FORM-5 FORM-739A FORM-1368
OMB NO: 3245-0018 EXPIRATION DATE: 09/30/2003
RESPS:53,975 HOURS:80,963 COSTS(000):$0
Disaster Home Loan Application
FORMS: SBA-FORM-5C SBA-FORM-739
OMB NO: 3245-0063 EXPIRATION DATE: 07/31/2004
RESPS:1,040 HOURS:16,480 COSTS(000):$0
SBIC Financial Reports
FORMS: FORM-468
OMB NO: 3245-0071 EXPIRATION DATE: 04/30/2005
RESPS:5,200 HOURS:11,700 COSTS(000):$0
U.S. Small Business Administration Application for Section 504
Loan
FORMS: FORM-1244
OMB NO: 3245-0074 EXPIRATION DATE: 12/31/2003
RESPS:270 HOURS:7,560 COSTS(000):$108
CDC Annual Report Guide
FORMS: 1253 1253A
OMB NO: 3245-0076 EXPIRATION DATE: 05/31/2005
RESPS:486,000 HOURS:487,600 COSTS(000):$0
Notice to New SBA Borrowers
FORMS: 793
OMB NO: 3245-0078 EXPIRATION DATE: 07/31/2004
RESPS:2,100 HOURS:420 COSTS(000):$0
Portfolio Financing Report
FORMS: FORM-1031
OMB NO: 3245-0081 EXPIRATION DATE: 07/31/2005
RESPS:125 HOURS:110 COSTS(000):$0
25-Model Corp. Resol. or GP Certif., 33-Model Letter to Selling
Agent 34-Bank ID, 1065 Appl. Lic. Assure. of Compliance
FORMS: 25 33 34 1065
OMB NO: 3245-0084 EXPIRATION DATE: 06/30/2003
RESPS:53,478 HOURS:13,370 COSTS(000):$0
Disaster Home/Business Loan Inquiry Record
FORMS: SBA-FORM-700
OMB NO: 3245-0096 EXPIRATION DATE: 12/31/2005
RESPS:469 HOURS:1,876 COSTS(000):$0
Nomination for the Small Business Prime Contractor & Nomination
of the Small Business Subcontractor of the Year Award
FORMS: 1375 883
OMB NO: 3245-0108 EXPIRATION DATE: 04/30/2004
RESPS:264,000 HOURS:132,000 COSTS(000):$0
SBDC Counseling Record
FORMS: FORM-1062
OMB NO: 3245-0109 EXPIRATION DATE: 05/31/2004
RESPS:2,160 HOURS:2,160 COSTS(000):$0
Request for Information Concerning Portfolio Financing
FORMS: 857
OMB NO: 3245-0116 EXPIRATION DATE: 05/31/2004
RESPS:1,500 HOURS:750 COSTS(000):$0
Financial Institution Confirmation Form
FORMS: 860
OMB NO: 3245-0118 EXPIRATION DATE: 11/30/2005
RESPS:400 HOURS:187 COSTS(000):$0
Disclosure Statement, Leveraged Licenses and Disclosure
Statement Non-Leveaged Licensees
FORMS: SBA-856 SBA-856A
OMB NO: 3245-0121 EXPIRATION DATE: 06/30/2003
RESPS:57 HOURS:1,140 COSTS(000):$0
Governor's Request for Disaster Declaration
FORMS: NONE
OMB NO: 3245-0124 EXPIRATION DATE: 03/31/2004
RESPS:500 HOURS:83 COSTS(000):$0
U.S. Small Business Administration Advisory Committee
Membership- Nominee Information
FORMS: SBAFORM898
OMB NO: 3245-0132 EXPIRATION DATE: 03/31/2005
RESPS:5,000 HOURS:5,000 COSTS(000):$0
Lender Transcript of Account
FORMS: FORM-1149
OMB NO: 3245-0136 EXPIRATION DATE: 05/31/2004
RESPS:4,000 HOURS:332 COSTS(000):$0
Disaster Survey Worksheet
FORMS: SBA-FORM-987
OMB NO: 3245-0140 EXPIRATION DATE: 08/31/2004
RESPS:477 HOURS:34,191 COSTS(000):$0
SBA Form 1222-Notice of Award SBA Form 1224 Grant/Cooperative
Agreement Cost Sharing Proposal
FORMS: FORM-1222 FORM-1224
OMB NO: 3245-0141 EXPIRATION DATE: 10/31/2003
RESPS:63 HOURS:1,020 COSTS(000):$0
Prime Contracts Program Quarterly Report Part A and Part B
FORMS: 843A 843B
OMB NO: 3245-0169 EXPIRATION DATE: 09/30/2003
RESPS:114 HOURS:7,524 COSTS(000):$0
SBDC Program & Financial Reports
FORMS: SF-269 SF-272
OMB NO: 3245-0172 EXPIRATION DATE: 06/30/2004
RESPS:600 HOURS:600 COSTS(000):$0
Stockholder's Confirmation (Corporation); Ownership Confirmation
(Partnership)
FORMS: SBA-FORM-1405
OMB NO: 3245-0178 EXPIRATION DATE: 09/30/2003
RESPS:55,000 HOURS:13,750 COSTS(000):$0
Statement of Personal History
FORMS: SBA-FORM-912
OMB NO: 3245-0185 EXPIRATION DATE: 03/31/2004
RESPS:12,500 HOURS:46,875 COSTS(000):$0
Secondary Participation Guaranty Agreement
FORMS: SBA-FORM-1086
OMB NO: 3245-0188 EXPIRATION DATE: 11/30/2004
RESPS:187,027 HOURS:280,608 COSTS(000):$0
Personal Financial Statement
FORMS: SBA-FORM-413
OMB NO: 3245-0193 EXPIRATION DATE: 05/31/2005
RESPS:4,200 HOURS:4,200 COSTS(000):$0
Servicing Agent Agreement
FORMS: 1506
OMB NO: 3245-0200 EXPIRATION DATE: 03/31/2005
RESPS:39,988 HOURS:29,991 COSTS(000):$0
Settlement Sheet
FORMS: FORM-1050
OMB NO: 3245-0201 EXPIRATION DATE: 05/31/2005
RESPS:115,000 HOURS:9,584 COSTS(000):$0
7(a) Loan Closing Forms
FORMS: 159 160 160A
OMB NO: 3245-0212 EXPIRATION DATE: 12/31/2005
RESPS:5,000 HOURS:7,500 COSTS(000):$0
Secondary Market Assignment and Disclosure Form
FORMS: 1088
OMB NO: 3245-0213 EXPIRATION DATE: 08/31/2004
RESPS:475 HOURS:1,425 COSTS(000):$63
Application For Pool of Guaranteed Interest Certificates
FORMS: FORM-1454
OMB NO: 3245-0225 EXPIRATION DATE: 12/31/2003
RESPS:300 HOURS:2,400 COSTS(000):$0
Small Business Administration Application for Certificate of
Competency
FORMS: 1531
OMB NO: 3245-0270 EXPIRATION DATE: 12/31/2005
RESPS:13,884 HOURS:13,884 COSTS(000):$0
Representatives Used and Compensation Paid for Services in
Connection with Obtaining Federal Contracts
FORMS: 1790
OMB NO: 3245-0298 EXPIRATION DATE: 08/31/2003
RESPS:1,806 HOURS:68 COSTS(000):$0
Business Information Center Customer Satisfaction Survey
FORMS: FORM-1916(9-94)
OMB NO: 3245-0301 EXPIRATION DATE: 07/31/2004
RESPS:293 HOURS:586 COSTS(000):$0
Financing Eligibility statement - social disadvantaged -
Economic Disadvantaged
FORMS: FORM-1941A FORM-1941B FORM-1941C
OMB NO: 3245-0312 EXPIRATION DATE: 01/31/2004
RESPS:33 HOURS:8 COSTS(000):$0
Survey of Job Creation and Retention in the DELTA Program
FORMS: SEB-1989
OMB NO: 3245-0313 EXPIRATION DATE: 12/31/2003
RESPS:200 HOURS:183 COSTS(000):$0
Federal Agency Appraisal Form
FORMS: 1993
OMB NO: 3245-0314 EXPIRATION DATE: 06/30/2005
RESPS:11,038 HOURS:2,760 COSTS(000):$0
Voluntary Customer Surveys in accordance with E.O. 12862
FORMS: NONE
OMB NO: 3245-0320 EXPIRATION DATE: 02/28/2006
RESPS:10,000 HOURS:10,000 COSTS(000):$0
HUBZone Internet Application Form
FORMS: 2103
OMB NO: 3245-0324 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:60,000 COSTS(000):$0
Entrepreneurial Development Management Information System (EDMIS)
FORMS: SBA-641 SBA-641A
OMB NO: 3245-0326 EXPIRATION DATE: 12/31/2003
RESPS:2,500 HOURS:5,000 COSTS(000):$0
Pre-Disaster Mitigation Small Business Loan Application
FORMS: SBA-FORM-5M
OMB NO: 3245-0327 EXPIRATION DATE: 12/31/2003
RESPS:1 HOURS:1,244 COSTS(000):$0
Value of Worker Training Programs to Small Business
FORMS: NONE
OMB NO: 3245-0328 EXPIRATION DATE: 12/31/2003
RESPS:500 HOURS:250 COSTS(000):$0
7(j) Management and Technical Assistance Program Sponsored
Training Impact and Longitudinal Studies
FORMS: 2167 2168 2169 2170 2171
OMB NO: 3245-0329 EXPIRATION DATE: 05/31/2004
RESPS:500 HOURS:40,000 COSTS(000):$0
PRIME (Program for Investment in Microentrepreneurs)
FORMS: NONE
OMB NO: 3245-0330 EXPIRATION DATE: 01/31/2004
RESPS:2,500 HOURS:5,000 COSTS(000):$0
Military Reservist Economic Injury Disaster Loan Application
FORMS: SBA-FORM-5R
OMB NO: 3245-0331 EXPIRATION DATE: 07/31/2004
RESPS:6,103 HOURS:21,460 COSTS(000):$0
8(a)/SDB Paper and Electronic Application
FORMS: 1010 1010B 2065 1010C
OMB NO: 3245-0332 EXPIRATION DATE: 09/30/2005
RESPS:1,131 HOURS:13,925 COSTS(000):$2,699
New Markets Venture Capital (NMVC) Program Application, Funding
and Reporting
FORMS: SFS-269/270 272/424 SBA-34/159/468 480/1031/2184 2185/2207-2211
2219
OMB NO: 3245-0333 EXPIRATION DATE: 09/30/2004
RESPS:81 HOURS:4,200 COSTS(000):$0
BusinessLINC Program
FORMS: 01-1
OMB NO: 3245-0334 EXPIRATION DATE: 08/31/2004
RESPS:58 HOURS:29 COSTS(000):$0
Other Funding Under the SBDC Umbrella
FORMS: FORM-2186
OMB NO: 3245-0336 EXPIRATION DATE: 10/31/2004
RESPS:130 HOURS:120 COSTS(000):$0
Evaluation of State Efforts to Review and Alleviate State
Regulatory Burdens on Small Businesses
FORMS: NONE
OMB NO: 3245-0338 EXPIRATION DATE: 07/31/2005
RESPS:38 HOURS:91 COSTS(000):$37
NMVC Program Applicant Interview Questions: SSBIC Applicant
Tech, Proposal: Request for Approval of Management Services Fees
FORMS: 2215 2216 2217
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
54 1,628,485 2,668,103 $3,018
Social Security Administration
OMB NO: 0960-0001 EXPIRATION DATE: 04/30/2004
RESPS:18,000 HOURS:4,500 COSTS(000):$0
Certification of Support
FORMS: SSA-760-F4
OMB NO: 0960-0002 EXPIRATION DATE: 06/30/2005
RESPS:3,000 HOURS:1,500 COSTS(000):$0
Statement Regarding the Inferred Death of an Individual by
Reason of Continued and Unexplained Absence
FORMS: SSA-723
OMB NO: 0960-0003 EXPIRATION DATE: 11/30/2005
RESPS:5,000 HOURS:12,500 COSTS(000):$0
Application for Mother's or Father's Insurance Benefits - 20 CFR
404 Subparts D and G
FORMS: SSA-5-F6
OMB NO: 0960-0004 EXPIRATION DATE: 10/31/2003
RESPS:288,580 HOURS:72,145 COSTS(000):$0
Application for Widow(er)'s Benefits, 20 CFR 404.335 - 404.338,
404.603
FORMS: SSA-10-BK
OMB NO: 0960-0007 EXPIRATION DATE: 04/30/2004
RESPS:1,460,692 HOURS:255,621 COSTS(000):$0
Application for Retirement Insurance Benefits
FORMS: SSA-1-F6
OMB NO: 0960-0008 EXPIRATION DATE: 02/28/2006
RESPS:700,000 HOURS:175,000 COSTS(000):$0
Application for Wife's or Husband's Insurance Benefits - 20 CFR,
Subpart D, 404.330-.333; Subpart G, 404.603
FORMS: SSA-2-F6
OMB NO: 0960-0009 EXPIRATION DATE: 11/30/2005
RESPS:180,000 HOURS:15,000 COSTS(000):$0
Marriage Certification - 20 CFR 404 Subpart H
FORMS: SSA-3-F6
OMB NO: 0960-0010 EXPIRATION DATE: 04/30/2004
RESPS:1,740,000 HOURS:372,417 COSTS(000):$0
Application for Child's Insurance Benefits
FORMS: SSA-4-BK
OMB NO: 0960-0012 EXPIRATION DATE: 02/28/2006
RESPS:1,400 HOURS:350 COSTS(000):$0
Application for Parent's Insurance Benefits,, 20 CFR 404.370 -
.374, .601 - .603
FORMS: SSA-7-F6
OMB NO: 0960-0013 EXPIRATION DATE: 01/31/2004
RESPS:877,000 HOURS:146,167 COSTS(000):$0
Application for Lump Sum Death Payment
FORMS: SSA-8
OMB NO: 0960-0014 EXPIRATION DATE: 06/30/2003
RESPS:2,121,686 HOURS:371,295 COSTS(000):$0
Request to be Selected as Payee
FORMS: SSA-11-BK
OMB NO: 0960-0015 EXPIRATION DATE: 09/30/2003
RESPS:100,000 HOURS:8,333 COSTS(000):$0
Request for Withdrawal of Application
FORMS: SSA-521
OMB NO: 0960-0016 EXPIRATION DATE: 08/31/2005
RESPS:1,200 HOURS:200 COSTS(000):$0
Statement Regarding Date of Birth and Citizenship
FORMS: SSA-702
OMB NO: 0960-0017 EXPIRATION DATE: 05/31/2005
RESPS:40,000 HOURS:6,000 COSTS(000):$0
Statement Regarding Marriage
FORMS: SSA-753
OMB NO: 0960-0019 EXPIRATION DATE: 04/30/2004
RESPS:14,000 HOURS:2,333 COSTS(000):$0
Certificate of Responsibility for Welfare and Care of Child Not
in Applicant's Custody
FORMS: SSA-781
OMB NO: 0960-0020 EXPIRATION DATE: 06/30/2005
RESPS:30,000 HOURS:8,500 COSTS(000):$0
Statement Regarding Contributions
FORMS: SSA-783
OMB NO: 0960-0024 EXPIRATION DATE: 03/31/2004
RESPS:120,000 HOURS:20,000 COSTS(000):$0
Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits
FORMS: SSA-787
OMB NO: 0960-0025 EXPIRATION DATE: 03/31/2006
RESPS:12,350 HOURS:6,175 COSTS(000):$0
Partnership Questionnaire - 20 CFR, Subpart K, 404.1080-.1082
FORMS: SSA-7104
OMB NO: 0960-0029 EXPIRATION DATE: 10/31/2004
RESPS:375,000 HOURS:62,500 COSTS(000):$0
Request for Correction of Earnings Record
FORMS: SSA-7008
OMB NO: 0960-0030 EXPIRATION DATE: 05/31/2003
RESPS:925,000 HOURS:308,333 COSTS(000):$0
Statement of Employer
FORMS: SSA-7011
OMB NO: 0960-0034 EXPIRATION DATE: 03/31/2006
RESPS:150,000 HOURS:100,000 COSTS(000):$0
Letter to Employer Requesting Information About Wages Earned by
Beneficiary, 20 CFR 404703 and .801
FORMS: SSA-L725
OMB NO: 0960-0036 EXPIRATION DATE: 10/31/2004
RESPS:125,000 HOURS:37,500 COSTS(000):$0
Statement of Agricultural Employer (Year Prior to 1988);
Statement of Agricultural Employer (1988 & Later)
FORMS: SSA-1002 SSA-1003
OMB NO: 0960-0037 EXPIRATION DATE: 05/31/2004
RESPS:500,000 HOURS:1,000,000 COSTS(000):$0
Request for Waiver of Overpayment Recovery or Change in
Repayment Notice
FORMS: SSA-632-BK
OMB NO: 0960-0038 EXPIRATION DATE: 02/28/2006
RESPS:30,000 HOURS:15,000 COSTS(000):$0
Statement of Marital Relationship (By One of the Parties) 20
CFR, 404.726
FORMS: SSA-754
OMB NO: 0960-0040 EXPIRATION DATE: 01/31/2004
RESPS:47,500 HOURS:19,792 COSTS(000):$0
Employment Relationship Questionnaire
FORMS: SSA-7160
OMB NO: 0960-0041 EXPIRATION DATE: 01/31/2006
RESPS:10 HOURS:1 COSTS(000):$0
Wage and Contributions Paid Prior to 1987 - 20 CFR, Subpart M,
404.1237 and .1249
FORMS: NONE
OMB NO: 0960-0045 EXPIRATION DATE: 08/31/2003
RESPS:305,500 HOURS:76,375 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: SSA-795
OMB NO: 0960-0046 EXPIRATION DATE: 11/30/2003
RESPS:5,000 HOURS:417 COSTS(000):$0
Statement of Self-Employment Income
FORMS: SSA-766
OMB NO: 0960-0049 EXPIRATION DATE: 04/30/2003
RESPS:230,000 HOURS:24,167 COSTS(000):$0
Report to U.S. SSA by Person Receiving Benefits for a Child or
Adult Unable to Handle Funds; & Report to U.S. SSA
FORMS: SSA-7161-OCR-SM SSA-7162-OCR-SM
OMB NO: 0960-0050 EXPIRATION DATE: 02/29/2004
RESPS:20,000 HOURS:4,000 COSTS(000):$0
Questionnaire About Employment of Self-Employment Outside the
United States
FORMS: SSA-7163
OMB NO: 0960-0051 EXPIRATION DATE: 09/30/2003
RESPS:35,000 HOURS:2,917 COSTS(000):$0
Supplement to claim of Person Outside the United States
FORMS: SSA-221
OMB NO: 0960-0052 EXPIRATION DATE: 10/31/2004
RESPS:750,000 HOURS:375,000 COSTS(000):$0
Medical Report (General)
FORMS: SSA-3826-F4
OMB NO: 0960-0058 EXPIRATION DATE: 12/31/2005
RESPS:50,000 HOURS:30,000 COSTS(000):$0
Report on Individual with Mental Impairment - 20 CFR, Subparts O
& I
FORMS: SSA-824
OMB NO: 0960-0059 EXPIRATION DATE: 04/30/2003
RESPS:300,000 HOURS:225,000 COSTS(000):$0
Work Activity Report--Employee
FORMS: SSA-821-BK
OMB NO: 0960-0060 EXPIRATION DATE: 01/31/2006
RESPS:1,513,677 HOURS:504,559 COSTS(000):$0
Application for Disability Insurance
