Department of Agriculture
Office of Chief Financial Officer
OMB NO: 0505-0001 EXPIRATION DATE: 02/28/2006
RESPS:1,644 HOURS:823 COSTS(000):$0
Advisory Committee and Research and Promotion Board Membership
Background Information
FORMS: AD-755
OMB NO: 0505-0007 EXPIRATION DATE: 09/30/2005
RESPS:7,542 HOURS:7,542 COSTS(000):$0
Debt Collection
FORMS: NONE
OMB NO: 0505-0011 EXPIRATION DATE: 07/31/2003
RESPS:600 HOURS:150 COSTS(000):$0
Maximum Workweek - Construction Schedule
FORMS: NONE
OMB NO: 0505-0013 EXPIRATION DATE: 07/31/2003
RESPS:3,200 HOURS:112,000 COSTS(000):$0
Instructions for the Preparation of Technical and Business
Proposals
FORMS: NONE
OMB NO: 0505-0014 EXPIRATION DATE: 07/31/2003
RESPS:45,170 HOURS:4,517 COSTS(000):$0
Brand Name or Equal Provision and Clause
FORMS: NONE
OMB NO: 0505-0015 EXPIRATION DATE: 07/31/2003
RESPS:200 HOURS:200 COSTS(000):$0
Procurement: Key Personnel Clause
FORMS: NONE
OMB NO: 0505-0016 EXPIRATION DATE: 07/31/2003
RESPS:2,400 HOURS:3,600 COSTS(000):$0
Progress Reporting Clause
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 60,756 128,832 $0
Office of Civil Rights
OMB NO: 0508-0004 EXPIRATION DATE: 05/31/2003
RESPS:40,000 HOURS:3,334 COSTS(000):$0
USDA Minority Farm Register
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 40,000 3,334 $0
Agricultural Research Service
OMB NO: 0518-0003 EXPIRATION DATE: 11/30/2004
RESPS:75 HOURS:225 COSTS(000):$0
Patent License Application
FORMS: AD-761
OMB NO: 0518-0013 EXPIRATION DATE: 10/31/2005
RESPS:120 HOURS:10 COSTS(000):$0
USDA Biological Shipment Record - Beneficial Organisms
FORMS: 941 942 943
OMB NO: 0518-0024 EXPIRATION DATE: 11/30/2004
RESPS:220 HOURS:53 COSTS(000):$0
Use of facilities or the performance of photography/
cinematography at the U.S. National Arboretum
FORMS: NONE
OMB NO: 0518-0027 EXPIRATION DATE: 02/28/2006
RESPS:3,300 HOURS:725 COSTS(000):$0
Information Collection For Document Delivery Services
FORMS: NONE
OMB NO: 0518-0028 EXPIRATION DATE: 09/30/2003
RESPS:4,360 HOURS:4,601 COSTS(000):$0
Peer Review-Related Forms for the Office of Scientific Quality
Review
FORMS: ARS-199A ARS-200-PA ARS-202PA ARS-203PA ARS-209P ARS-211P
ARS-223P ARS-225P ARS-227P
OMB NO: 0518-0029 EXPIRATION DATE: 08/31/2005
RESPS:200 HOURS:50 COSTS(000):$0
Utilization of Food and Nutrition Information Center (FNIC)
Resources by Personnel at schools receiving USDA funds for Child
Nutrition Programs
FORMS: NONE
OMB NO: 0518-0031 EXPIRATION DATE: 01/31/2005
RESPS:50 HOURS:16 COSTS(000):$0
Food Stamp Nutrition Connection Resource Sharing Form
FORMS: NONE
OMB NO: 0518-0032 EXPIRATION DATE: 02/28/2006
RESPS:11,450 HOURS:572 COSTS(000):$0
Web Order Forms for Research Data, Materials, Models, and
Publications, Speaker Bureau and Conference, Event, and Study
Registration Services.
FORMS: NONE
OMB NO: 0518-0033 EXPIRATION DATE: 02/28/2006
RESPS:100 HOURS:8 COSTS(000):$0
Meeting the Information Requirements of the Animal Welfare Act
Workshop Registration Form
FORMS: NONE
OMB NO: 0518-0034 EXPIRATION DATE: 06/30/2003
RESPS:288 HOURS:48 COSTS(000):$0
Fluoride Content of the US Tap Water Supply
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
10 20,163 6,308 $0
Cooperative State Research, Education, and Extension Service
OMB NO: 0524-0025 EXPIRATION DATE: 10/31/2004
RESPS:960 HOURS:2,472 COSTS(000):$0
Grant Application Forms for the Small Business Innovation
Research Grants Program
FORMS: CSREES-667 CSREES-668
OMB NO: 0524-0026 EXPIRATION DATE: 08/31/2003
RESPS:150 HOURS:600 COSTS(000):$0
Assurance of Compliance with the Department of Agriculture
Regulations Assuring Civil Rights Compliance "Organizational
Information"
FORMS: CSREES-665 CSREES-666
OMB NO: 0524-0034 EXPIRATION DATE: 03/31/2006
RESPS:60 HOURS:30 COSTS(000):$0
Application for Authorization to Use the 4-H Name and/or Emblem
FORMS: CSREES-01
OMB NO: 0524-0038 EXPIRATION DATE: 04/30/2003
RESPS:117 HOURS:457 COSTS(000):$0
Section 1449 Matching Funds Requirement for Research and
Extension Activities at Eligible Institutions
FORMS: CSREES-2103
OMB NO: 0524-0039 EXPIRATION DATE: 03/31/2006
RESPS:59,550 HOURS:156,813 COSTS(000):$0
Cooperative State Research, Education, and Extension Application
Kit for Research and Extension Programs
FORMS: CSREES-2002 CSREES-2003 CSREES-2004 CSREES-2005 CSREES-2006
CSREES-2007 CSREES-2008 CSREES-2010
OMB NO: 0524-0040 EXPIRATION DATE: 02/28/2006
RESPS:75,000 HOURS:12,500 COSTS(000):$0
Questionnaire for Potential Reviewers
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
6 135,837 172,872 $0
National Agricultural Statistical Service
OMB NO: 0535-0001 EXPIRATION DATE: 11/30/2004
RESPS:9,747 HOURS:4,362 COSTS(000):$0
Cold Storage
FORMS: NONE
OMB NO: 0535-0002 EXPIRATION DATE: 12/31/2004
RESPS:436,474 HOURS:122,344 COSTS(000):$0
Field Crops Production
FORMS: NONE
OMB NO: 0535-0003 EXPIRATION DATE: 12/31/2004
RESPS:49,655 HOURS:9,564 COSTS(000):$0
Agricultural Prices
FORMS: NONE
OMB NO: 0535-0004 EXPIRATION DATE: 10/31/2005
RESPS:17,609 HOURS:3,133 COSTS(000):$0
Egg, Chicken, and Turkey Surveys
FORMS: NONE
OMB NO: 0535-0005 EXPIRATION DATE: 07/31/2005
RESPS:52,280 HOURS:12,137 COSTS(000):$0
Livestock Slaughter
FORMS: NONE
OMB NO: 0535-0007 EXPIRATION DATE: 02/28/2006
RESPS:49,132 HOURS:14,580 COSTS(000):$0
Stocks Reports
FORMS: NONE
OMB NO: 0535-0020 EXPIRATION DATE: 09/30/2004
RESPS:177,688 HOURS:24,223 COSTS(000):$0
Milk and Milk Products
FORMS: NONE
OMB NO: 0535-0037 EXPIRATION DATE: 04/30/2003
RESPS:17,896 HOURS:3,071 COSTS(000):$0
Vegetables
FORMS: NONE
OMB NO: 0535-0039 EXPIRATION DATE: 11/30/2004
RESPS:43,782 HOURS:8,794 COSTS(000):$0
Fruit, Nuts and Specialty Crops
FORMS: NONE
OMB NO: 0535-0088 EXPIRATION DATE: 10/31/2005
RESPS:6,795 HOURS:2,696 COSTS(000):$0
Field Crops Objective Yield
FORMS: NONE
OMB NO: 0535-0093 EXPIRATION DATE: 04/30/2003
RESPS:14,600 HOURS:6,532 COSTS(000):$0
Floriculture Survey
FORMS: NONE
OMB NO: 0535-0109 EXPIRATION DATE: 02/28/2006
RESPS:64,570 HOURS:10,859 COSTS(000):$0
Agricultural Labor
FORMS: NONE
OMB NO: 0535-0140 EXPIRATION DATE: 10/31/2003
RESPS:325,000 HOURS:22,500 COSTS(000):$0
List Sampling Frame Survey
FORMS: NONE
OMB NO: 0535-0150 EXPIRATION DATE: 04/30/2003
RESPS:3,300 HOURS:861 COSTS(000):$0
Acquaculture Survey
FORMS: NONE
OMB NO: 0535-0153 EXPIRATION DATE: 09/30/2003
RESPS:7,278 HOURS:2,492 COSTS(000):$0
Honey Survey
FORMS: NONE
OMB NO: 0535-0209 EXPIRATION DATE: 02/29/2004
RESPS:50 HOURS:150 COSTS(000):$0
Supplemental Qualifications Statement
FORMS: NONE
OMB NO: 0535-0212 EXPIRATION DATE: 06/30/2005
RESPS:359 HOURS:58 COSTS(000):$0
Mink Survey
FORMS: NONE
OMB NO: 0535-0213 EXPIRATION DATE: 01/31/2004
RESPS:526,955 HOURS:143,472 COSTS(000):$0
Agricultural Surveys Program
FORMS: NONE
OMB NO: 0535-0217 EXPIRATION DATE: 02/28/2005
RESPS:21,000 HOURS:1,700 COSTS(000):$0
Wildlife Damage Survey
FORMS: NONE
OMB NO: 0535-0218 EXPIRATION DATE: 12/31/2003
RESPS:65,775 HOURS:24,093 COSTS(000):$0
Agricultural Resource Management, Chemical Use, and Post-harvest
Chemical Use Surveys
FORMS: NONE
OMB NO: 0535-0220 EXPIRATION DATE: 03/31/2004
RESPS:10,417 HOURS:1,065 COSTS(000):$0
Cotton Ginnings
FORMS: NONE
OMB NO: 0535-0226 EXPIRATION DATE: 10/31/2004
RESPS:2,358,026 HOURS:1,354,204 COSTS(000):$0
2002 Census of Agriculture
FORMS: 02-A0101 02-A0114 02-A01 02-A0201 02-A0215 02-A02(I) 02-A04
02-A04(L1) 02-A1(CMNI) 02-A1(PR)
OMB NO: 0535-0235 EXPIRATION DATE: 04/30/2005
RESPS:46,450 HOURS:10,635 COSTS(000):$0
Childhood Injury and Adult Occupational Injury Survey
FORMS: NONE
OMB NO: 0535-0241 EXPIRATION DATE: 10/31/2003
RESPS:21,720 HOURS:3,658 COSTS(000):$0
Monthly Hog Survey
FORMS: NONE
OMB NO: 0535-0244 EXPIRATION DATE: 01/31/2004
RESPS:4,874 HOURS:3,229 COSTS(000):$0
Nursery and Greenhouse Production Survey and Nursery and
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
25 4,331,432 1,790,412 $0
Economic Research Service
OMB NO: 0536-0043 EXPIRATION DATE: 09/30/2005
RESPS:57,000 HOURS:7,126 COSTS(000):$0
Food Security Supplement to the Current Population Survey
FORMS: NONE
OMB NO: 0536-0052 EXPIRATION DATE: 03/31/2004
RESPS:1,312 HOURS:729 COSTS(000):$0
The Use of Food Safety Practices in Meat and Poultry
FORMS: NONE
OMB NO: 0536-0053 EXPIRATION DATE: 11/30/2003
RESPS:37,278 HOURS:5,110 COSTS(000):$0
Study of Program Access and Declining Food Stamp Participation
FORMS: NONE
OMB NO: 0536-0055 EXPIRATION DATE: 02/29/2004
RESPS:2,052 HOURS:817 COSTS(000):$0
Assesment of WIC Cost-Containment Practices
FORMS: NONE
OMB NO: 0536-0056 EXPIRATION DATE: 05/31/2004
RESPS:424 HOURS:3,400 COSTS(000):$0
Summer Food Service Program Implementation Study
FORMS: NONE
OMB NO: 0536-0057 EXPIRATION DATE: 08/31/2004
RESPS:4,870 HOURS:1,212 COSTS(000):$0
Emergency Food Assistance System Client Survey
FORMS: NONE
OMB NO: 0536-0058 EXPIRATION DATE: 09/30/2004
RESPS:53 HOURS:1,244 COSTS(000):$0
CACFP Administrative Cost Reimbursement Study
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 102,989 19,638 $0
Foreign Agricultural Service
OMB NO: 0551-0001 EXPIRATION DATE: 12/31/2003
RESPS:440 HOURS:270 COSTS(000):$0
Title Dairy Tariff-Rate Import Quota Licensing Regulation
FORMS: 923 923A 923B 924A 924B
OMB NO: 0551-0004 EXPIRATION DATE: 02/28/2006
RESPS:22,758 HOURS:11,415 COSTS(000):$0
CCC's Export Credit Guarantee Program (GSM-102), Intermediate
Credit Guarantee Program (GSM-103) Supplier Credit Guarantee
Program (SCGP)
FORMS: NONE
OMB NO: 0551-0005 EXPIRATION DATE: 08/31/2003
RESPS:205 HOURS:423 COSTS(000):$0
Regulations - Financing Commercial Sales of Agricultural
Commodities Under Title I, P.L. 480 - Recordkeeping and
Reporting Requirements
FORMS: NONE
OMB NO: 0551-0007 EXPIRATION DATE: 07/31/2004
RESPS:50,260 HOURS:24,523 COSTS(000):$0
Export Sales of U.S. Agricultural Commodities
FORMS: FAS-97 FAS-98 FAS-99 FAS-100
OMB NO: 0551-0008 EXPIRATION DATE: 06/30/2005
RESPS:36 HOURS:9 COSTS(000):$0
Request for Vessel Approval
FORMS: CCC-105
OMB NO: 0551-0009 EXPIRATION DATE: 08/31/2003
RESPS:89 HOURS:23 COSTS(000):$0
Declaration of Sale
FORMS: FAS-359
OMB NO: 0551-0014 EXPIRATION DATE: 02/29/2004
RESPS:1,200 HOURS:200 COSTS(000):$0
Certificate for Quota Eligibility
FORMS: FAS-961
OMB NO: 0551-0015 EXPIRATION DATE: 12/31/2004
RESPS:977 HOURS:4,377 COSTS(000):$0
Sugar imported to be re-exported in refined form, in sugar-
containing products, or used in production of certain polyhydric
alcohols.
FORMS: NONE
OMB NO: 0551-0024 EXPIRATION DATE: 06/30/2003
RESPS:1,800 HOURS:1,010 COSTS(000):$0
Buyer Alert
FORMS: FAS-964
OMB NO: 0551-0025 EXPIRATION DATE: 02/28/2005
RESPS:20 HOURS:40 COSTS(000):$0
Specialty Sugar Certificates
FORMS: NONE
OMB NO: 0551-0026 EXPIRATION DATE: 04/30/2003
RESPS:2,134 HOURS:43,748 COSTS(000):$0
FAS/Cooperator Foreign Market Development Program
FORMS: NONE
OMB NO: 0551-0027 EXPIRATION DATE: 06/30/2003
RESPS:2,670 HOURS:62,830 COSTS(000):$0
Market Access Program
FORMS: NONE
OMB NO: 0551-0028 EXPIRATION DATE: 09/30/2003
RESPS:3,063 HOURS:1,803 COSTS(000):$0
CCC's Export Enhancement Program (EEP) and CCC's Export
Incentive Program (DEIP)
FORMS: NONE
OMB NO: 0551-0032 EXPIRATION DATE: 04/30/2004
RESPS:66 HOURS:256 COSTS(000):$2,000
CCC's Facility Guarantee Program (FGP)
FORMS: NONE
OMB NO: 0551-0033 EXPIRATION DATE: 12/31/2005
RESPS:2 HOURS:46 COSTS(000):$0
Emergency Relief from Duty-Free Imports of Perishable Products
under the Andean Trade Promotion and Drug Eradication Act
(ATPDEA)
FORMS: NONE
OMB NO: 0551-0035 EXPIRATION DATE: 02/29/2004
RESPS:3,510 HOURS:38,827 COSTS(000):$0
Foreign Donation of Agricultural Commodities
FORMS: NONE
OMB NO: 0551-0037 EXPIRATION DATE: 02/29/2004
RESPS:2,495 HOURS:1,166 COSTS(000):$0
CCC's Supplier Credit Guarantee Program (SCGP)
FORMS: NONE
OMB NO: 0551-0038 EXPIRATION DATE: 04/30/2003
RESPS:100 HOURS:640 COSTS(000):$0
Technical Assisstance for Specialty Crops
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
18 91,825 191,606 $2,000
Farm Service Agency
OMB NO: 0560-0025 EXPIRATION DATE: 04/30/2003
RESPS:112,820 HOURS:197,435 COSTS(000):$0
Farm Reconstitution -- 7 CFR Part 718
FORMS: FSA-155
OMB NO: 0560-0026 EXPIRATION DATE: 09/30/2004
RESPS:4,000 HOURS:6,000 COSTS(000):$0
Application for payment of amounts due persons who have died,
disappeared or have been declared incompetent.
FORMS: FSA-325
OMB NO: 0560-0040 EXPIRATION DATE: 01/31/2004
RESPS:13,401 HOURS:25,946 COSTS(000):$0
Regulations for Cooperative Marketing Associations, 7 CFR Part
1425
FORMS: CCC-719 726 727 732 734 736 846 846-1 COTTON-G COTTON-G4
OMB NO: 0560-0052 EXPIRATION DATE: 10/31/2003
RESPS:9,680 HOURS:484,410 COSTS(000):$0
Standards for Approval of Waraehouses-7 CFR 1421, 1423, and 1427
FORMS: CCC-25 25ADDEN.1 25-1(SUPP)/29-1 25-2/29 823-1A/823-1T
29-3/20/24/560 49/24-1/29/ 29ADDEN.1/823 33/33-A/34/34-1
KC-14/40/227
OMB NO: 0560-0058 EXPIRATION DATE: 09/30/2004
RESPS:1,403,207 HOURS:1,501,734 COSTS(000):$0
Tobacco Marketing Quotas and Price Support (7 CFR Parts 711,
723, and 1464).
FORMS: MQ-25 MQ-32 MQ-38 MQ-38BUR MQ-53 MQ-71 MQ-72-2 MQ-76 MQ-77
OMB NO: 0560-0074 EXPIRATION DATE: 01/31/2005
RESPS:96,122 HOURS:45,246 COSTS(000):$0
7 CFR 1427-Regulations Governing CCC Nonrecourse Cotton Loan
Programs for 1996 and Subsequent Crops
FORMS: CCC-COTTON-A CCC-COTTON-A-1 CCC-COTTON-A-5 CCC-605 CCC-605-1
CCC-605-2 CCC-809 CCC-810 CCC-877 CCC-879
OMB NO: 0560-0082 EXPIRATION DATE: 10/31/2005
RESPS:251,000 HOURS:187,667 COSTS(000):$0
7 CFR Part 701 - Conservation and Environmental Programs
FORMS: AD-245 FSA-18
OMB NO: 0560-0087 EXPIRATION DATE: 03/31/2005
RESPS:1,858,515 HOURS:552,324 COSTS(000):$0
General Regulations Governing Commodity Loans for 1996 and
Subsequent Crops
FORMS: CCC-64/CCC-601 CCC-638/CCC-665 CCC-666/CCC-677 CCC-679/CCC-685
CCC-699 CCC-681-A CCC-681-1 CCC-678 CCC-6811 CCC-156
OMB NO: 0560-0092 EXPIRATION DATE: 09/30/2004
RESPS:2,131,523 HOURS:2,664,404 COSTS(000):$0
Forms for Participation in a 7-year Production Flexibility
Contract
FORMS: CCC-478 CCC-478B CCC-505
OMB NO: 0560-0096 EXPIRATION DATE: 06/30/2003
RESPS:351,960 HOURS:626,727 COSTS(000):$0
Payment Limitation and Determination of Eligibility of Foreign
Individuals or Entities to Receive Program Benefits
FORMS: CCC-501A CCC-501B CCC-502A CCC-502B CCC-502C CCC-502D CCC-502EZ
CCC-502CONTINUA TION
OMB NO: 0560-0097 EXPIRATION DATE: 10/31/2003
RESPS:4,375 HOURS:1,108 COSTS(000):$0
Agricultural Foreign Investment Disclosure Act Report
FORMS: FSA-153
OMB NO: 0560-0120 EXPIRATION DATE: 08/31/2005
RESPS:25,265 HOURS:10,452 COSTS(000):$0
Warehouse Regulations Under USWA and As applicable Standards for
Approval of Warehouses
FORMS: WA-50/WA-51-2 WA-53/WA-70 WA-80/WA-81 WA-82/WA-83 WA/84/WA-85
WA-86/WA-87 WA-88/WA-105 WA-125/WA-139 WA-140/WA-141 WA-141-1
OMB NO: 0560-0129 EXPIRATION DATE: 03/31/2004
RESPS:6,105,000 HOURS:3,825,000 COSTS(000):$0
Loan Deficiency Payments
FORMS: CCC-633-LDP CCC-709
OMB NO: 0560-0138 EXPIRATION DATE: 10/31/2004
RESPS:1,381 HOURS:18,429 COSTS(000):$0
Sugar Program
FORMS: CCC-80 CCC-831 CCC-832 CCC-833 CCC-835 CCC-836 CCC-837 CCC-838
OMB NO: 0560-0146 EXPIRATION DATE: 03/31/2006
RESPS:250 HOURS:125 COSTS(000):$0
Debt Settlement Policies and Procedures
FORMS: CCC-279
OMB NO: 0560-0151 EXPIRATION DATE: 06/30/2003
RESPS:25,927 HOURS:4,520 COSTS(000):$0
End-Use Certificate Program
FORMS: FSA-750 FSA-751
OMB NO: 0560-0154 EXPIRATION DATE: 09/30/2004
RESPS:74,225 HOURS:159,562 COSTS(000):$0
7 CFR 1924 B Management Advice To Individuals Borrowers and
Applicants
FORMS: FSA-431-2 FSA-1924-22 FSA-1924-23 FSA-1924-24 FSA-1924-27
OMB NO: 0560-0155 EXPIRATION DATE: 03/31/2004
RESPS:293,676 HOURS:228,074 COSTS(000):$0
Guaranteed Farm Loans
FORMS: FSA-1980-25 1980-28 1980-64 1980-24 1980-15 1980-22 1980-38
1980-19 1980-41 1980-43
OMB NO: 0560-0157 EXPIRATION DATE: 01/31/2004
RESPS:312 HOURS:63 COSTS(000):$0
Insured Farm Ownership Loan Policies, Procedures, and
Authorizations
FORMS: FSA-440-35
OMB NO: 0560-0158 EXPIRATION DATE: 07/31/2005
RESPS:14,080 HOURS:6,753 COSTS(000):$0
7 CFR 1965-A, Servicing of Real Estate Security for Farmer
Program Loans and Certain Note-Only Cases
FORMS: RD-465-1 RD-443-16 FSA-440-26 FMHA-440-9 FMHA-1965-11
FMHA-1965-13 RD-465-5
OMB NO: 0560-0159 EXPIRATION DATE: 01/31/2004
RESPS:16,938 HOURS:14,223 COSTS(000):$0
7 CFR 1945-D, Emergency Loan Policies, Procedures and
Authorizations
FORMS: 1945-22 1940-38
OMB NO: 0560-0160 EXPIRATION DATE: 03/31/2005
RESPS:200 HOURS:800 COSTS(000):$0
7 CFR 1951-L, Servicing Cases Where Unauthorized Loan or Other
Assistance was Received
FORMS: NONE
OMB NO: 0560-0161 EXPIRATION DATE: 03/31/2004
RESPS:26,963 HOURS:13,109 COSTS(000):$0
Farm Loan Programs Account Servicing Policies
FORMS: FSA-1951-39
OMB NO: 0560-0162 EXPIRATION DATE: 02/29/2004
RESPS:51,466 HOURS:6,176 COSTS(000):$0
7 CFR 1941-A, Operating Loan Policies, Procedures and
Authorizations
FORMS: 1940-51 1940-53 1940-55 2940-56 441-8 441-18 441-25 441-10
441-13
OMB NO: 0560-0164 EXPIRATION DATE: 04/30/2003
RESPS:21,629 HOURS:12,233 COSTS(000):$0
Disaster Set-Aside Program -- 7 CFR 1951 Subpart T
FORMS: NONE
OMB NO: 0560-0165 EXPIRATION DATE: 02/29/2004
RESPS:125 HOURS:775 COSTS(000):$0
Certified Mediation Program
FORMS: NONE
OMB NO: 0560-0166 EXPIRATION DATE: 06/30/2005
RESPS:48,312 HOURS:12,078 COSTS(000):$0
Verification of Debts and Assets
FORMS: FSA-440-32
OMB NO: 0560-0167 EXPIRATION DATE: 02/28/2006
RESPS:48,321 HOURS:96,642 COSTS(000):$0
Request for Direct Loan Assistance
FORMS: FSA-410-1
OMB NO: 0560-0170 EXPIRATION DATE: 06/30/2003
RESPS:2,236 HOURS:988 COSTS(000):$0
Disaster Assistance - General (7 CFR Part 1945-A)
FORMS: NONE
OMB NO: 0560-0171 EXPIRATION DATE: 03/31/2005
RESPS:83,050 HOURS:20,531 COSTS(000):$0
Agreement for the Use of Proceeds/Release of Chattel Security
FORMS: 1962-1
OMB NO: 0560-0175 EXPIRATION DATE: 09/30/2003
RESPS:3,564,000 HOURS:4,618,346 COSTS(000):$0
Noninsured Crop Disaster Assistance Program
FORMS: CCC-451 CCC-576 CCC-441 CCC-576-1 CCC-452
OMB NO: 0560-0176 EXPIRATION DATE: 03/31/2005
RESPS:24,000 HOURS:8,000 COSTS(000):$0
Request for Aerial Photography
FORMS: FSA-441
OMB NO: 0560-0177 EXPIRATION DATE: 09/30/2005
RESPS:37,763 HOURS:6,758 COSTS(000):$0
Offer Forms
FORMS: 156 269 327 324 366 332 331 334 337 333
OMB NO: 0560-0178 EXPIRATION DATE: 10/31/2004
RESPS:75,489 HOURS:122,538 COSTS(000):$0
7 CFR 1910-A, Receiving and Processing Applications
FORMS: NONE
OMB NO: 0560-0179 EXPIRATION DATE: 02/28/2005
RESPS:3,000 HOURS:5,000 COSTS(000):$0
Certification of Livestock Losses for Eligible Disaster
FORMS: CCC-661
OMB NO: 0560-0185 EXPIRATION DATE: 06/30/2003
RESPS:206,250 HOURS:251,153 COSTS(000):$0
Highly Erodible Land Conservation and Wetland Conservation (7
CFR Part 12)
FORMS: AD-1026 AD-1026B AD-1026C AD-1026D AD-1068 AD-1069 CCC-21
FSA-492
OMB NO: 0560-0194 EXPIRATION DATE: 10/31/2005
RESPS:14 HOURS:14 COSTS(000):$0
Standard Operating Agreement Governing Intermodal Transportation
FORMS: NONE
OMB NO: 0560-0195 EXPIRATION DATE: 10/31/2005
RESPS:99 HOURS:99 COSTS(000):$0
Standard Rules Tender Governing Motor Carrier Transportation
FORMS: NONE
OMB NO: 0560-0201 EXPIRATION DATE: 01/31/2004
RESPS:1,860 HOURS:930 COSTS(000):$0
ELS Cotton Competitiveness Payment Program
FORMS: CCC-1045-A CCC-1045A-2
OMB NO: 0560-0203 EXPIRATION DATE: 02/29/2004
RESPS:1,039,306 HOURS:20,786 COSTS(000):$0
Facsimile Signature Authorization and Verification
FORMS: FSA-237
OMB NO: 0560-0204 EXPIRATION DATE: 01/31/2004
RESPS:280,000 HOURS:90,600 COSTS(000):$0
Farm Storage Facility Loan Program
FORMS: CCC-185 CCC-186 CCC-186-1 CCC-190 CCC-191 CCC-193 CCC-194
CCC-296 CCC-297 CCC-298
OMB NO: 0560-0207 EXPIRATION DATE: 11/30/2003
RESPS:1,100 HOURS:1,286 COSTS(000):$0
Bioenergy Program (7 CFR Part 1424)
FORMS: CCC-850-A SF-LLL SF-3881 ATF-F-5110.74 ATF-F-5110.75
ATF-F-5110.41
OMB NO: 0560-0214 EXPIRATION DATE: 10/31/2004
RESPS:1,000 HOURS:250 COSTS(000):$15,000
Total Quality Systems Audit
FORMS: 1TQ 3TQ
OMB NO: 0560-0215 EXPIRATION DATE: 09/30/2005
RESPS:207,500 HOURS:120,350 COSTS(000):$0
Representations for CCC and FSA Loans and Authorization to File
a Financing Statement
FORMS: CCC-10
OMB NO: 0560-0216 EXPIRATION DATE: 09/30/2005
RESPS:836 HOURS:2,539 COSTS(000):$0
Storage of Honey Forfeited to CCC by Honey Producers
FORMS: CCC-56 56-1 56-2 55
OMB NO: 0560-0219 EXPIRATION DATE: 10/31/2005
RESPS:1,100,000 HOURS:1,331,000 COSTS(000):$0
USDA Registration Formto Request Electronic Access Code
FORMS: AD-2016
OMB NO: 0560-0221 EXPIRATION DATE: 04/30/2003
RESPS:2,000 HOURS:1,258 COSTS(000):$0
Horse Breeder Loan Program
FORMS: 410-1 431-2 440-32 1910-5 1940-38 1927-9 1927-10
OMB NO: 0560-0224 EXPIRATION DATE: 02/28/2006
RESPS:113 HOURS:113 COSTS(000):$0
Brokerage Agreement for the Transportation of USDA Commodities
FORMS: NONE
OMB NO: 0560-0227 EXPIRATION DATE: 09/30/2003
RESPS:2,860 HOURS:321 COSTS(000):$0
National Nonprofit Humanitarian Program 501(3)(3)
FORMS: CCC-330 CCC-330A
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
49 19,623,149 17,304,875 $15,000
Federal Crop Insurance Corporation
OMB NO: 0563-0053 EXPIRATION DATE: 02/28/2005
RESPS:3,345,415 HOURS:1,194,316 COSTS(000):$67,750
Multiple Peril Crop Insurance
FORMS: NONE
OMB NO: 0563-0055 EXPIRATION DATE: 03/31/2006
RESPS:156 HOURS:78 COSTS(000):$0
General Administrative Regulations; Interpretations of Statutory
and Regulatory Provisions
FORMS: NONE
OMB NO: 0563-0057 EXPIRATION DATE: 04/30/2003
RESPS:14,880 HOURS:5,394 COSTS(000):$0
New-Crop Insurance Programs (Pilot and Private Crop Insurance
FORMS: NONE
OMB NO: 0563-0058 EXPIRATION DATE: 08/31/2004
RESPS:30,970 HOURS:37,257 COSTS(000):$0
Dairy Options Pilot Program (DOPP), Round III
FORMS: CCC-320 CCC-320-1 CCC-321 CCC-322 CCC-323
OMB NO: 0563-0060 EXPIRATION DATE: 02/28/2005
RESPS:55,760 HOURS:32,526 COSTS(000):$0
Specialty Crop Producer Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 3,447,181 1,269,571 $67,750
Rural Business-Cooperative Service
OMB NO: 0570-0006 EXPIRATION DATE: 11/30/2003
RESPS:775 HOURS:1,848 COSTS(000):$0
7 CFR 4284-F, Rural Cooperative Development Grant
FORMS: NONE
OMB NO: 0570-0007 EXPIRATION DATE: 04/30/2004
RESPS:2,649 HOURS:2,404 COSTS(000):$0
Annual Survey of Farmer Cooperatives
FORMS: NONE
OMB NO: 0570-0012 EXPIRATION DATE: 06/30/2003
RESPS:2,276 HOURS:7,742 COSTS(000):$0
Rural Economic Development Loan and Grant Program
FORMS: RD-1703-1
OMB NO: 0570-0014 EXPIRATION DATE: 06/30/2005
RESPS:1 HOURS:1 COSTS(000):$0
7 CFR 1980-E, Business and Industrial Loan Program
FORMS: RD-449-1 RD-449-2
OMB NO: 0570-0015 EXPIRATION DATE: 06/30/2005
RESPS:4,185 HOURS:11,235 COSTS(000):$0
7 CFR 1951-R-Rural Development Loan Servicing
FORMS: RD-1951-4
OMB NO: 0570-0016 EXPIRATION DATE: 04/30/2003
RESPS:19,548 HOURS:10,019 COSTS(000):$0
Servicing Business and Industry Guaranteed Loans -- 7 CFR 4287-B
FORMS: RD-1980-41 RD-1980-44
OMB NO: 0570-0017 EXPIRATION DATE: 04/30/2003
RESPS:8,875 HOURS:20,813 COSTS(000):$0
Guaranteed Loanmaking; Business and Industry Loans -- 7 CFR
4279-B
FORMS: RD-4279-1 RD-4279-2 RD-4279-3 RD-4279-4 RD-4279-6
OMB NO: 0570-0018 EXPIRATION DATE: 04/30/2003
RESPS:1,147 HOURS:1,749 COSTS(000):$0
Business and Industry Guaranteed Loanmaking (General) -- 7 CFR
4279-A
FORMS: RD-4279-8
OMB NO: 0570-0020 EXPIRATION DATE: 02/28/2005
RESPS:127 HOURS:127 COSTS(000):$0
Annual Survey of Cooperative Involvement in International Markets
FORMS: NONE
OMB NO: 0570-0021 EXPIRATION DATE: 09/30/2003
RESPS:3,802 HOURS:16,930 COSTS(000):$0
Intermediary Relending Program
FORMS: RD-4274-1 4274-3 4274-4 4274-5
OMB NO: 0570-0022 EXPIRATION DATE: 10/31/2003
RESPS:21,172 HOURS:38,334 COSTS(000):$0
7 CFR 1942-G "Rural Business Enterprise Grants and Television
Demonstration Grants"
FORMS: NONE
OMB NO: 0570-0024 EXPIRATION DATE: 06/30/2004
RESPS:866 HOURS:8,044 COSTS(000):$0
CFR Part 4284-G, Rural Business Opportunity Grants
FORMS: NONE
OMB NO: 0570-0027 EXPIRATION DATE: 04/30/2003
RESPS:8 HOURS:1,382 COSTS(000):$0
Rural Empowerment Zones and Enterprise Communities
FORMS: NONE
OMB NO: 0570-0028 EXPIRATION DATE: 02/29/2004
RESPS:240 HOURS:1,140 COSTS(000):$0
Research on Rural Cooperative Opportunities and Problems
FORMS: NONE
OMB NO: 0570-0039 EXPIRATION DATE: 10/31/2004
RESPS:1,596 HOURS:19,452 COSTS(000):$0
Value-Added Agricultural Product Market Development Grant
Program (Independent Producers)
FORMS: NONE
OMB NO: 0570-0040 EXPIRATION DATE: 06/30/2005
RESPS:48 HOURS:628 COSTS(000):$0
Agricultural Product Market Development Grant Program (Resource
Center)
FORMS: NONE
OMB NO: 0570-0041 EXPIRATION DATE: 03/31/2006
RESPS:297 HOURS:762 COSTS(000):$0
1890 Land Grant Institutions: Rural Entrepreneurial Program
Outreach Initiative
FORMS: NONE
OMB NO: 0570-0042 EXPIRATION DATE: 02/29/2004
RESPS:490 HOURS:113 COSTS(000):$0
Survey of Cooperatives on Selecting Director Candidates for
Director Elections
FORMS: NONE
OMB NO: 0570-0043 EXPIRATION DATE: 04/30/2003
RESPS:50 HOURS:300 COSTS(000):$0
National Rural Development Partnership
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
19 68,152 143,023 $0
Rural Utilities Service
OMB NO: 0572-0003 EXPIRATION DATE: 10/31/2005
RESPS:1,422 HOURS:38,394 COSTS(000):$0
Accounting Requirements for RUS Electric and Telecommunications
Borrowers
FORMS: NONE
OMB NO: 0572-0015 EXPIRATION DATE: 03/31/2006
RESPS:10,020 HOURS:14,820 COSTS(000):$0
Advance of Loan Funds and Budgetary Control and Other Related
Burdens
FORMS: RUS-219 RUS-595
OMB NO: 0572-0019 EXPIRATION DATE: 06/30/2003
RESPS:6,750 HOURS:10,125 COSTS(000):$0
Inventory of Work Orders
FORMS: RUS-FORM-219
OMB NO: 0572-0020 EXPIRATION DATE: 04/30/2003
RESPS:5 HOURS:15 COSTS(000):$0
Request for Approval to Sell Capital Assets
FORMS: 369
OMB NO: 0572-0023 EXPIRATION DATE: 05/31/2003
RESPS:3,680 HOURS:3,660 COSTS(000):$0
7 CFR 1744-C, Advance and Disbursement of Funds -
Telecommunications
FORMS: RUS-FORM-481
OMB NO: 0572-0025 EXPIRATION DATE: 04/30/2003
RESPS:253 HOURS:1,012 COSTS(000):$0
Review Rating Summary
FORMS: 300
OMB NO: 0572-0031 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:3,200 COSTS(000):$0
Financial and Statistical Report for Telecommunications Borrowers
FORMS: RUS-FORM-479
OMB NO: 0572-0032 EXPIRATION DATE: 02/28/2005
RESPS:4,415 HOURS:65,673 COSTS(000):$0
RUS Electric Loan Application and Related Reporting Burdens
FORMS: RUS-726 RUS-740C RUS-740G 7 12 325 266 SF-100 SF-LLL AD-1047
OMB NO: 0572-0041 EXPIRATION DATE: 08/31/2003
RESPS:75 HOURS:206 COSTS(000):$0
Request for Release of Lien and/or Approval of Sale
FORMS: RUS-FORM-793
OMB NO: 0572-0051 EXPIRATION DATE: 09/30/2005
RESPS:905 HOURS:226 COSTS(000):$0
RUS Form 87, Request for Mail List Data
FORMS: FORM-87
OMB NO: 0572-0074 EXPIRATION DATE: 06/30/2003
RESPS:665 HOURS:67 COSTS(000):$0
Certification of Authority
FORMS: RUS-FORM-675
OMB NO: 0572-0079 EXPIRATION DATE: 09/30/2003
RESPS:406 HOURS:3,621 COSTS(000):$0
Preloan Procedures and Requirements for Telecommunications
Program
FORMS: FORM-490 494 495 507 567 569
OMB NO: 0572-0088 EXPIRATION DATE: 08/31/2003
RESPS:30 HOURS:62 COSTS(000):$0
7 CFR Part 1786, "Prepayment of RUS Guaranteed and Insured Loans
to Electric and Telephone Borrowers"
FORMS: NONE
OMB NO: 0572-0089 EXPIRATION DATE: 01/31/2004
RESPS:110 HOURS:660 COSTS(000):$0
RUS Form 444, "Wholesale Power Contracts"
FORMS: RUS-FORM-444
OMB NO: 0572-0095 EXPIRATION DATE: 04/30/2003
RESPS:3,872 HOURS:20,374 COSTS(000):$0
7 CFR 1773, Policy on Audits of RUS Borrowers
FORMS: NONE
OMB NO: 0572-0096 EXPIRATION DATE: 08/31/2003
RESPS:6,900 HOURS:17,741 COSTS(000):$0
Distance Learning and Telemedicine Loan and Grant Program (7 CFR
1703, Subpart D, E, F and G)
FORMS: NONE
OMB NO: 0572-0097 EXPIRATION DATE: 05/31/2003
RESPS:40 HOURS:140 COSTS(000):$0
7 CFR Part 1703-H, Deferments of RUS Loan Payments for Rural
Development Projects
FORMS: NONE
OMB NO: 0572-0098 EXPIRATION DATE: 04/30/2003
RESPS:25 HOURS:238 COSTS(000):$0
7 CFR 1744-E, Borrower Investments-Telecommunications Loan
Program
FORMS: NONE
OMB NO: 0572-0099 EXPIRATION DATE: 10/31/2003
RESPS:1,000 HOURS:750 COSTS(000):$0
7 CFR 1792, Subpart C - Seismic Safety of New Building
Construction
FORMS: NONE
OMB NO: 0572-0100 EXPIRATION DATE: 04/30/2003
RESPS:42 HOURS:69 COSTS(000):$0
Lien Accommodations and Subordinations 7 CFR Part 1717, Subparts
R and S
FORMS: NONE
OMB NO: 0572-0104 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:350 COSTS(000):$0
State Telecommunications Modernization Plan
FORMS: NONE
OMB NO: 0572-0107 EXPIRATION DATE: 10/31/2005
RESPS:3,908 HOURS:85 COSTS(000):$0
7 CFR 1726, Electric System Construction Policies and
Procedures- Electric
FORMS: 168B/168C/187 198/200/213 224/231/238 254/257/307 786/790/792B
830
OMB NO: 0572-0109 EXPIRATION DATE: 09/30/2004
RESPS:1 HOURS:9 COSTS(000):$0
7 CFR 1777, Section 306C Water and Waste Disposal (WWD) Loans &
Grants
FORMS: NONE
OMB NO: 0572-0112 EXPIRATION DATE: 05/31/2003
RESPS:1,375 HOURS:4,168 COSTS(000):$0
7 CFR 1775, Technical Assistance Program
FORMS: NONE
OMB NO: 0572-0114 EXPIRATION DATE: 04/30/2003
RESPS:142 HOURS:184 COSTS(000):$0
Mergers and Consolidations of Electric Borrowers -- 7 CFR 1717
Subpart D
FORMS: NONE
OMB NO: 0572-0115 EXPIRATION DATE: 04/30/2003
RESPS:6 HOURS:12 COSTS(000):$0
Use of Consultants Funded by Borrowers -- 7 CFR Part 1789
FORMS: NONE
OMB NO: 0572-0116 EXPIRATION DATE: 06/30/2003
RESPS:1 HOURS:3,000 COSTS(000):$0
7 CFR 1717 Subpart Y, Settlement of Debt Owed by Electric
Borrowers
FORMS: NONE
OMB NO: 0572-0117 EXPIRATION DATE: 03/31/2004
RESPS:1,872 HOURS:450,200 COSTS(000):$0
Environmental Policies and Procedures (7 CFR Part 1794)
FORMS: NONE
OMB NO: 0572-0118 EXPIRATION DATE: 03/31/2006
RESPS:161 HOURS:161 COSTS(000):$0
7 CFR Part 1724, Electric Engineering Architectural Services and
Design Policies and Procedures
FORMS: 211 220 236
OMB NO: 0572-0121 EXPIRATION DATE: 06/30/2003
RESPS:50,650 HOURS:134,240 COSTS(000):$0
7 CFR 1780, Water and Waste Disposal Loan and Grant Program
FORMS: NONE
OMB NO: 0572-0122 EXPIRATION DATE: 01/31/2004
RESPS:110 HOURS:858 COSTS(000):$0
Water and Waste Disposal Programs Guaranteed Loans
FORMS: NONE
OMB NO: 0572-0123 EXPIRATION DATE: 12/31/2004
RESPS:180 HOURS:784 COSTS(000):$0
Extensions of Payments of Principal and Interest
FORMS: NONE
OMB NO: 0572-0124 EXPIRATION DATE: 09/30/2004
RESPS:120 HOURS:345 COSTS(000):$0
Weather Radio Transmitter Grant Program
FORMS: NONE
OMB NO: 0572-0125 EXPIRATION DATE: 06/30/2005
RESPS:30 HOURS:1,005 COSTS(000):$0
Local Dial-Up Internet Grant Program
FORMS: NONE
OMB NO: 0572-0126 EXPIRATION DATE: 01/31/2005
RESPS:45 HOURS:23 COSTS(000):$0
7 CFR Part 1744, Subpart B, Lien Accommodations and
Subordination Policy
FORMS: NONE
OMB NO: 0572-0127 EXPIRATION DATE: 03/31/2004
RESPS:310 HOURS:48,010 COSTS(000):$0
Broadband Pilot Grant Program
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
36 99,528 824,487 $0
Rural Housing Service
OMB NO: 0575-0015 EXPIRATION DATE: 06/30/2003
RESPS:33,230 HOURS:61,076 COSTS(000):$0
7 CFR 1942-A, Community Facility Loans
FORMS: 442-7 442-3 1942-19 1942-8 1942-46 1942-47 1942-9 442-20 442-21
442-22
OMB NO: 0575-0018 EXPIRATION DATE: 04/30/2005
RESPS:74,516 HOURS:555,692 COSTS(000):$0
7 CFR 1901-3, Civil Rights Compliance Requirements
FORMS: RD-4001/4/6/7/8 HUD-932.5 CC-257
OMB NO: 0575-0033 EXPIRATION DATE: 10/31/2004
RESPS:2,382,265 HOURS:2,143,740 COSTS(000):$0
7 CFR 1930-C, Management and Supervision of Multiple Family
Housing Borrowers and Grant Recipients
FORMS: 1930-5 1930-7 1930-8 1944-8 1944-25 1944-27 1944-29 1951-29
444-27A
OMB NO: 0575-0042 EXPIRATION DATE: 10/31/2003
RESPS:291,631 HOURS:94,924 COSTS(000):$0
7 CFR 1924-A, "Planning and Performing Construction and Other
Development"
FORMS: 1924-1 2 3 4 5 6 7 9 10 11
OMB NO: 0575-0043 EXPIRATION DATE: 04/30/2003
RESPS:3,043 HOURS:3,095 COSTS(000):$0
"Self-Help Technical Assistance Grants" -- 7 CFR 1944-I
FORMS: NONE
OMB NO: 0575-0045 EXPIRATION DATE: 05/31/2004
RESPS:780 HOURS:8,524 COSTS(000):$0
7 CFR 1944-D, Farm Labor Housing Loan and Grant Policies,
Procedures, and Authorization
FORMS: NONE
OMB NO: 0575-0046 EXPIRATION DATE: 10/31/2004
RESPS:200 HOURS:82 COSTS(000):$0
7 CFR 1944-L, Tenant Grievance and Appeals Procedure
FORMS: NONE
OMB NO: 0575-0047 EXPIRATION DATE: 06/30/2003
RESPS:5,102 HOURS:28,246 COSTS(000):$0
7 CFR 1944-E, Rural Rental and Cooperative Housing Loan
Policies, Procedures, and Authorizations
FORMS: RD-1944-7 RD-1944-30 RD-1944-31 RD-1944-33 RD-1944-34 RD-1944-35
RD-1944-38
OMB NO: 0575-0064 EXPIRATION DATE: 07/31/2005
RESPS:4 HOURS:2 COSTS(000):$0
7 CFR 1901-K, "Certificates of Beneficial Ownership and Insured
Notes"
FORMS: RD-471-7
OMB NO: 0575-0066 EXPIRATION DATE: 04/30/2003
RESPS:158 HOURS:118 COSTS(000):$0
7 CFR 1951-E, "Servicing of Community and Direct Business
Programs Loans and Grants"
FORMS: 1951-15 1951-33
OMB NO: 0575-0071 EXPIRATION DATE: 03/31/2006
RESPS:6 HOURS:36 COSTS(000):$0
7 CFR 1822-G, Rural Housing Site Loans, Policies, Procedures and
Authorizations
FORMS: NONE
OMB NO: 0575-0075 EXPIRATION DATE: 06/30/2003
RESPS:110 HOURS:28 COSTS(000):$0
7 CFR 1951-A, "Account Servicing Policies"
FORMS: NONE
OMB NO: 0575-0078 EXPIRATION DATE: 09/30/2003
RESPS:411,004 HOURS:154,250 COSTS(000):$0
7 CFR 1980-D, Rural Housing Loans
FORMS: RD-1980-11 1980-12 1980-13 1980-16 1980-17 1980-18 1980-20
1980-21 1980-80 1980-81
OMB NO: 0575-0082 EXPIRATION DATE: 07/31/2003
RESPS:5,250 HOURS:1,350 COSTS(000):$0
7 CFR 1924-F, Complaints and Compensation for Construction
FORMS: RD-FORM-1924-4
OMB NO: 0575-0087 EXPIRATION DATE: 11/30/2004
RESPS:8,765 HOURS:4,895 COSTS(000):$0
7 CFR Part 1806-A - Real Property Insurance
FORMS: FORM-RD-426-2
OMB NO: 0575-0088 EXPIRATION DATE: 10/31/2004
RESPS:57,800 HOURS:28,900 COSTS(000):$0
Form RD 1940-59, Settlement Statement
FORMS: 1940-59
OMB NO: 0575-0091 EXPIRATION DATE: 04/30/2003
RESPS:85,569 HOURS:28,238 COSTS(000):$0
"Applicant Reference Letter (A Request for Credit Reference)" --
Form RD 410-8
FORMS: RD-410-8
OMB NO: 0575-0093 EXPIRATION DATE: 08/31/2003
RESPS:25,047 HOURS:75,361 COSTS(000):$0
7 CFR 1951-F, Analyzing Credit Needs and Graduation of Borrower
FORMS: NONE
OMB NO: 0575-0094 EXPIRATION DATE: 08/31/2003
RESPS:5,220 HOURS:15,320 COSTS(000):$0
7 CFR 1940 Subpart G Environmental Program
FORMS: RD-1940-G
OMB NO: 0575-0100 EXPIRATION DATE: 10/31/2003
RESPS:945 HOURS:1,587 COSTS(000):$0
7 CFR 1965-B Security Servicing for Multiple Family Housing
Loans.
FORMS: 1944-33A 1944-34A 1944-35A 1965-16
OMB NO: 0575-0104 EXPIRATION DATE: 09/30/2004
RESPS:700 HOURS:800 COSTS(000):$0
7 CFR 1951-N, Sercicing Cases Where Unauthorized Loan or Other
Financial Assistance Was Received--Multiple Family Housing
FORMS: NONE
OMB NO: 0575-0110 EXPIRATION DATE: 01/31/2005
RESPS:292 HOURS:136 COSTS(000):$0
7 CFR, Part 1955-B-Management of Property
FORMS: RD-1955-20
OMB NO: 0575-0114 EXPIRATION DATE: 10/31/2004
RESPS:25 HOURS:2,000 COSTS(000):$0
Rural Housing Demonstration Program - Section 502
FORMS: NONE
OMB NO: 0575-0115 EXPIRATION DATE: 04/30/2003
RESPS:10,555 HOURS:10,814 COSTS(000):$0
"Housing Preservation Grant Program" -- 7 CFR 1944-N
FORMS: NONE
OMB NO: 0575-0118 EXPIRATION DATE: 07/31/2004
RESPS:2,900 HOURS:24,650 COSTS(000):$0
7 CFR 1956-B, Debt Settlement-Farm Programs and Multiple Family
Housing
FORMS: RD-1956-1
OMB NO: 0575-0120 EXPIRATION DATE: 09/30/2004
RESPS:2,921 HOURS:6,482 COSTS(000):$0
7 CFR 1942-C, "Fire and Rescue Loans"
FORMS: 1942-52 1942-53 1942-54
OMB NO: 0575-0124 EXPIRATION DATE: 10/31/2003
RESPS:92 HOURS:880 COSTS(000):$0
7 CFR 1956-C, Debt Settlement - Community and Business Programs
FORMS: NONE
OMB NO: 0575-0137 EXPIRATION DATE: 02/28/2006
RESPS:58,819 HOURS:89,530 COSTS(000):$0
7 CFR 3575-A, Community Programs Guaranteed Loans
FORMS: 449-14 449-30 449-35 449-36 1980-19 1980-43 3575-1
OMB NO: 0575-0147 EXPIRATION DATE: 05/31/2004
RESPS:174,000 HOURS:41,296 COSTS(000):$0
7 CFR 1927-B, "Real Estate Title Clearance and Loan Closing"
FORMS: RD1927-5 RD1927-8 RD1927-9 RD1927-10 RD1927-11 RD1927-12
RD1927-15 RD1927-16 RD1927-19 RD1927-20
OMB NO: 0575-0155 EXPIRATION DATE: 10/31/2003
RESPS:920 HOURS:687 COSTS(000):$0
"Prepayment and Displacement Prevention of Multiple Family
Housing Loans" -- 7 CFR 1965-E
FORMS: NONE
OMB NO: 0575-0157 EXPIRATION DATE: 04/30/2003
RESPS:800 HOURS:900 COSTS(000):$0
Housing Application Packaging Grants -- 7 CFR 1944-B
FORMS: NONE
OMB NO: 0575-0158 EXPIRATION DATE: 01/31/2005
RESPS:62,000 HOURS:26,260 COSTS(000):$0
7 CFR 1902-A, Supervised Bank Accounts
FORMS: RD-402-1
OMB NO: 0575-0172 EXPIRATION DATE: 02/28/2006
RESPS:1,714,622 HOURS:513,872 COSTS(000):$0
7 CFR 3550 - Direct Single Family Housing Loan and Grant
Programs, HB-1-3550, and HB-2-3550
FORMS: NONE
OMB NO: 0575-0173 EXPIRATION DATE: 06/30/2004
RESPS:1,078 HOURS:859 COSTS(000):$0
7 CFR 3570-B, Community Facilities Grant Program
FORMS: FORM-RD-3570-3
OMB NO: 0575-0174 EXPIRATION DATE: 10/31/2005
RESPS:3,005 HOURS:1,581 COSTS(000):$0
7 CFR Part 3565, "Guaranteed Rural Rental Housing Program" and
its supporting handbook
FORMS: 3565-1 3565-2 3565-3 1980-24
OMB NO: 0575-0179 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:1 COSTS(000):$0
Guaranteed Rural Housing Loan Program -- 7 CFR Part 3555
FORMS: 1980-11 1980-13 1980-16 1980-20 1980-21
OMB NO: 0575-0180 EXPIRATION DATE: 05/31/2004
RESPS:843 HOURS:1,702 COSTS(000):$0
Notice of Funds Availability (NOFA) Inviting Applications for
the Rural Community Development Initiative (RCDI)
FORMS: NONE
OMB NO: 0575-0181 EXPIRATION DATE: 06/30/2004
RESPS:147 HOURS:175.5 COSTS(000):$0
Farm Labor Housing Technical Assistance Grants
FORMS: NONE
OMB NO: 0575-0184 EXPIRATION DATE: 04/30/2005
RESPS:1,200 HOURS:600 COSTS(000):$0
RD 3550-28, "Authorization Agreement for Preauthorization
Payments", RD 1951-65, "Customer Initiated Payments (CIP)", and
RD 1951-66, "Fedwire Worksheet"
FORMS: RD-3550-28 RD-1951-65 RD-1951-66
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
39 5,425,565 3,928,689 $0
Natural Resources Conservation Service
OMB NO: 0578-0007 EXPIRATION DATE: 05/31/2003
RESPS:768 HOURS:936 COSTS(000):$0
Agriculture and Urban Flood Damage Surveys
FORMS: NRCS-ECN-001 ECN-002 ECN-003 ECN-004 ECN-005 ECN-006
OMB NO: 0578-0013 EXPIRATION DATE: 06/30/2003
RESPS:235,043 HOURS:160,311 COSTS(000):$0
Long Term Contracting
FORMS: CCC-1250 1251 1252 1252A 1252B 1253 1255 1255A 1256 1257
OMB NO: 0578-0018 EXPIRATION DATE: 06/30/2004
RESPS:35,540 HOURS:20,731 COSTS(000):$0
Application for Payment
FORMS: CCC-1202 NRCS-FNM-141
OMB NO: 0578-0024 EXPIRATION DATE: 03/31/2006
RESPS:50,420 HOURS:1,016 COSTS(000):$0
Volunteer Program - Earth Team
FORMS: NRCS-PER-001 NRCS-PER-002 NRCS-PER-003 NRCS-PER-004
OMB NO: 0578-0028 EXPIRATION DATE: 01/31/2005
RESPS:5,000 HOURS:2,917 COSTS(000):$0
Risk Protection Programs
FORMS: CCC-1200 CCC-1245
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 326,771 185,911 $0
Animal and Plant Health Inspection Service
OMB NO: 0579-0007 EXPIRATION DATE: 04/30/2003
RESPS:48,135 HOURS:7,451 COSTS(000):$0
National Poultry Improvement Plan (NPIP)
FORMS: VS-9-2 VS-9-3 VS-9-5
OMB NO: 0579-0008 EXPIRATION DATE: 09/30/2005
RESPS:20 HOURS:10 COSTS(000):$0
Application for Inspection and Certification of Animal Byproducts
FORMS: VS-16-24
OMB NO: 0579-0010 EXPIRATION DATE: 02/29/2004
RESPS:35,050 HOURS:1,445 COSTS(000):$0
National Agricultural Pest Information System
FORMS: PPQ-391
OMB NO: 0579-0013 EXPIRATION DATE: 03/31/2005
RESPS:19,472 HOURS:51,177 COSTS(000):$0
Virus-Serum-Toxin Act and Regulations in 9 CFR, Subchapter E,
Parts 101-124
FORMS: 2001 2003 2005 2007 2008 2008A 2015 2020
OMB NO: 0579-0015 EXPIRATION DATE: 03/31/2005
RESPS:51,171 HOURS:17,830 COSTS(000):$0
Importation of Restricted and Controlled Animal and Poultry
Products and Byproducts, Organisms, and Vectors into the US.
FORMS: VS-16-3 VS-16-25 VS-16-26
OMB NO: 0579-0020 EXPIRATION DATE: 08/31/2004
RESPS:42,067 HOURS:21,009 COSTS(000):$0
U.S. Origin Health Certificate
FORMS: VS-17-140
OMB NO: 0579-0032 EXPIRATION DATE: 04/30/2003
RESPS:171,024 HOURS:52,190 COSTS(000):$0
Veterinary Accreditation Program -- 9 CFR 160-162
FORMS: VS-1-36A 4-24 4-26 4-33 4-54 17-145
OMB NO: 0579-0036 EXPIRATION DATE: 04/30/2003
RESPS:119,426 HOURS:95,720 COSTS(000):$0
Animal Welfare
FORMS: APHIS-7001 7001A 7003 7003A 7005 7006 7006A 7009 7011 7019
OMB NO: 0579-0040 EXPIRATION DATE: 04/30/2003
RESPS:2,537,098 HOURS:64,200 COSTS(000):$0
Importation of Animal & Poultry, Animal/Poultry Products,
Certain Animal Embryos, Semen, and Zoological Animals
FORMS: VS17-8 VS17-23 VS-17-135A VS-17-128 VS-17-29 VS-17-129 VS-10-4
VS-17-65C VS-17-65A VS-17-65B
OMB NO: 0579-0047 EXPIRATION DATE: 02/28/2006
RESPS:527,486 HOURS:17,681 COSTS(000):$0
Brucellosis Program Cooperative Agreements - Title 9, CFR Parts
50, 51, 53, 54, 71, 76 and 78
FORMS: 1-23 1-23A 1-27 1-68 4-1 4-1D 4-6 4-59 4-108/4-108A
4-108B/4-108C
OMB NO: 0579-0048 EXPIRATION DATE: 02/28/2005
RESPS:21,000 HOURS:10,500 COSTS(000):$0
Certificate for poultry and hatching eggs for export
FORMS: VS-17-6
OMB NO: 0579-0049 EXPIRATION DATE: 02/28/2006
RESPS:289,440 HOURS:91,138 COSTS(000):$0
Foreign Quarantine Notices
FORMS: 368 546 564 587 588 585
OMB NO: 0579-0051 EXPIRATION DATE: 08/31/2003
RESPS:9,717 HOURS:740 COSTS(000):$0
Permit for Movement of Restricted Animals
FORMS: VS-1-27
OMB NO: 0579-0052 EXPIRATION DATE: 06/30/2005
RESPS:759,992 HOURS:539,681 COSTS(000):$0
Phytosanitary Export Certification
FORMS: 572 577 578 579
OMB NO: 0579-0054 EXPIRATION DATE: 06/30/2003
RESPS:46,974 HOURS:38,133 COSTS(000):$0
Federal Plant Pest and Noxious Weeds Regulations
FORMS: PPQ-FORMS-525A 526 526-1 519
OMB NO: 0579-0055 EXPIRATION DATE: 08/31/2004
RESPS:360 HOURS:90 COSTS(000):$0
Request for Credit Account Approval for Reimbursable Services
FORMS: APHIS-192
OMB NO: 0579-0065 EXPIRATION DATE: 03/31/2005
RESPS:860 HOURS:584 COSTS(000):$0
Swine Health Protection
FORMS: VS-13-2 VS-13-15 VS-13-16 VS-13-7
OMB NO: 0579-0070 EXPIRATION DATE: 02/28/2005
RESPS:80,250 HOURS:5,092 COSTS(000):$0
9 CFR 85 Psuedoriabies
FORMS: 7-1 1-27
OMB NO: 0579-0071 EXPIRATION DATE: 03/31/2005
RESPS:1,070 HOURS:1,070 COSTS(000):$0
Foreign Animal Disease (Emerging Disease Investigation (FAD/EDI)
Database
FORMS: VS-12-27
OMB NO: 0579-0072 EXPIRATION DATE: 02/28/2006
RESPS:23 HOURS:9 COSTS(000):$0
7 CFR 319.76 Exotic Bee Diseases and Parasites, 7 CFR 322
Honeybees and Honeybee Semen
FORMS: 368
OMB NO: 0579-0076 EXPIRATION DATE: 08/31/2005
RESPS:31,933 HOURS:4,738 COSTS(000):$0
Endangered Species Regulations and Forfeiture Procedures
FORMS: 368 621 625 623 626
OMB NO: 0579-0084 EXPIRATION DATE: 10/31/2005
RESPS:53,539 HOURS:17,372 COSTS(000):$0
CFR 50& 77 Tuberculosis
FORMS: 1-23 1-24 1-68 6-22 6-22A 6-22B 6-22C 6-22D 6-35 6-38
OMB NO: 0579-0085 EXPIRATION DATE: 04/30/2005
RESPS:3,464 HOURS:2,984 COSTS(000):$0
7 CFR 340-Intro of Organisms and Products Altered or Produced
Through Genetic Engineering
FORMS: 2000 2050 2051 2052 2053 2054
OMB NO: 0579-0088 EXPIRATION DATE: 07/31/2005
RESPS:1,059,954 HOURS:87,647 COSTS(000):$0
Domestic Quarantines
FORMS: 527 530 537 540 543 586
OMB NO: 0579-0090 EXPIRATION DATE: 09/30/2003
RESPS:30,290 HOURS:15,149 COSTS(000):$0
Specimen Submission
FORMS: VS-10-4
OMB NO: 0579-0092 EXPIRATION DATE: 03/31/2006
RESPS:2,250 HOURS:260 COSTS(000):$0
Animal Welfare, Part 3, Subparts B and C, Guinea Pigs, Hamsters,
and Rabbits
FORMS: 7020 7020A
OMB NO: 0579-0093 EXPIRATION DATE: 06/30/2003
RESPS:72,585 HOURS:44,313 COSTS(000):$0
Animal Welfare Act, Part 3, Subparts A and D, Dogs, cats, Pri-
mates
FORMS: NONE
OMB NO: 0579-0094 EXPIRATION DATE: 10/31/2005
RESPS:223,562 HOURS:7,640 COSTS(000):$0
User Fee Regulations, 7 CFR 354 and 9 CFR 130
FORMS: VS-FORM-16-7 16-3 PPQ-FORM-250 577 578 579
OMB NO: 0579-0101 EXPIRATION DATE: 10/31/2004
RESPS:732,185 HOURS:81,526 COSTS(000):$0
Scrapie Flock Certification, Animal Identification and
Indemnification Procedures
FORMS: VS-5-18 VS-5-19 VS-5-20 VS-5-24 VS-1-23 VS-1-27
OMB NO: 0579-0102 EXPIRATION DATE: 09/30/2005
RESPS:12,224 HOURS:5,078 COSTS(000):$0
Imported Fire Ant
FORMS: 523 518
OMB NO: 0579-0104 EXPIRATION DATE: 06/30/2005
RESPS:240 HOURS:20 COSTS(000):$0
Gypsy Moth Identification Worksheet
FORMS: PPQ-305
OMB NO: 0579-0115 EXPIRATION DATE: 09/30/2005
RESPS:27,398 HOURS:15,607 COSTS(000):$0
Animal Welfare, 9 CFR, Part 3 Marine Mammals
FORMS: APHIS-7002
OMB NO: 0579-0116 EXPIRATION DATE: 01/31/2005
RESPS:57 HOURS:34 COSTS(000):$0
Exotic newcastle disease in birds and poultry; chlamydiosis in
poultry
FORMS: NONE
OMB NO: 0579-0117 EXPIRATION DATE: 03/31/2005
RESPS:3,000 HOURS:1,500 COSTS(000):$0
Environmental Monitoring Form
FORMS: APHIS-2060
OMB NO: 0579-0122 EXPIRATION DATE: 02/28/2005
RESPS:315 HOURS:132 COSTS(000):$0
Asian Lonhorned Beetle Regulations
FORMS: PPQ-527 PPQ-537 PPQ-530 PPQ-540
OMB NO: 0579-0123 EXPIRATION DATE: 04/30/2004
RESPS:2,746 HOURS:327 COSTS(000):$0
Fruit from Hawaii
FORMS: PPQ-519 PPQ-530 PPQ-540
OMB NO: 0579-0124 EXPIRATION DATE: 04/30/2004
RESPS:30,000 HOURS:11,345 COSTS(000):$0
Imported Seed and Screening
FORMS: PPQ-925 PPQ-519
OMB NO: 0579-0127 EXPIRATION DATE: 10/31/2004
RESPS:1,075,003 HOURS:98,156 COSTS(000):$0
9 CFR 75 Communicable Diseases in Horses
FORMS: 10-11 10-12
OMB NO: 0579-0128 EXPIRATION DATE: 11/30/2004
RESPS:500 HOURS:501 COSTS(000):$0
Importation of Fruits and Vegetables
FORMS: NONE
OMB NO: 0579-0129 EXPIRATION DATE: 01/31/2005
RESPS:630 HOURS:743 COSTS(000):$0
Hass Avocado
FORMS: PPQ-587 PPQ-519
OMB NO: 0579-0130 EXPIRATION DATE: 03/31/2005
RESPS:87 HOURS:300 COSTS(000):$0
Export Certification, Accreditation on Non-Government Facilities
FORMS: NONE
OMB NO: 0579-0131 EXPIRATION DATE: 02/28/2005
RESPS:2,448 HOURS:1,704 COSTS(000):$0
Importation of Tomatoes from France, Morocco, Western Sahara,
Chile, Spain
FORMS: NONE
OMB NO: 0579-0132 EXPIRATION DATE: 11/30/2004
RESPS:100 HOURS:120 COSTS(000):$0
Mexicali Valley - Karnal Bunt
FORMS: NONE
OMB NO: 0579-0135 EXPIRATION DATE: 09/30/2005
RESPS:850,000 HOURS:73,950 COSTS(000):$0
Wood Packing Material from China
FORMS: NONE
OMB NO: 0579-0136 EXPIRATION DATE: 05/31/2005
RESPS:1,834 HOURS:1,343 COSTS(000):$0
7 CFR Part 319 - Importation of Fruits and Vegetables
FORMS: PPQ-587(MD)
OMB NO: 0579-0138 EXPIRATION DATE: 03/31/2005
RESPS:40 HOURS:40 COSTS(000):$0
9 CFR part 94 importation of Pork from Yucatan and Sonora, Mexico
FORMS: NONE
OMB NO: 0579-0141 EXPIRATION DATE: 08/31/2003
RESPS:204 HOURS:30 COSTS(000):$0
Poultry Imports and Export
FORMS: NONE
OMB NO: 0579-0142 EXPIRATION DATE: 02/28/2006
RESPS:2,230 HOURS:81 COSTS(000):$0
Importation of Gypsy Moth Host Materials from Canada
FORMS: NONE
OMB NO: 0579-0144 EXPIRATION DATE: 10/31/2005
RESPS:40 HOURS:40 COSTS(000):$0
Importation of Poultry Meat and other Poultry products from
Sinaloa and Sonora, Mexico
FORMS: NONE
OMB NO: 0579-0145 EXPIRATION DATE: 10/31/2005
RESPS:780 HOURS:572 COSTS(000):$0
Poultry and Pork Products Transiting the United States
FORMS: NONE
OMB NO: 0579-0146 EXPIRATION DATE: 08/31/2003
RESPS:2,216 HOURS:766 COSTS(000):$0
Tuberculosis (Docket 99-038-1, TB in Cattle, Bison, and Goats)
Addendum 1
FORMS: VS-6-38 VS-6-22 VS-6-22C VS-6-22D
OMB NO: 0579-0147 EXPIRATION DATE: 06/30/2003
RESPS:162,500 HOURS:2,808 COSTS(000):$0
Conifer Solid Wood Packing Material to China, Export
Certification
FORMS: PPQ-553
OMB NO: 0579-0148 EXPIRATION DATE: 04/30/2003
RESPS:325 HOURS:13 COSTS(000):$0
Johne's Disease in Domestic Animals, Interstate Movement, 9 CFR
80
FORMS: VS-1-27
OMB NO: 0579-0152 EXPIRATION DATE: 07/31/2003
RESPS:95 HOURS:75 COSTS(000):$0
Spanish Pure Breed Horses From Spain
FORMS: NONE
OMB NO: 0579-0153 EXPIRATION DATE: 05/31/2003
RESPS:256 HOURS:192 COSTS(000):$0
Fuji Apples
FORMS: NONE
OMB NO: 0579-0155 EXPIRATION DATE: 07/31/2003
RESPS:1,214,885 HOURS:10,305 COSTS(000):$0
Iradiation Phytosanitary Treatment of Fresh Fruits and Vegetables
FORMS: NONE
OMB NO: 0579-0156 EXPIRATION DATE: 07/31/2004
RESPS:900 HOURS:75 COSTS(000):$0
Interstate Movement of Certain Tortoises
FORMS: APHIS-7001
OMB NO: 0579-0158 EXPIRATION DATE: 03/31/2004
RESPS:11,400 HOURS:11,400 COSTS(000):$0
Importation of Fruits and Vegetables
FORMS: NONE
OMB NO: 0579-0159 EXPIRATION DATE: 05/31/2004
RESPS:12 HOURS:2 COSTS(000):$0
Plum Pox Compensation
FORMS: PPQ-651
OMB NO: 0579-0160 EXPIRATION DATE: 01/31/2004
RESPS:100,100 HOURS:5,008 COSTS(000):$0
Commercial Transportation of Equines to Slaughter
FORMS: VS-10-13
OMB NO: 0579-0161 EXPIRATION DATE: 02/29/2004
RESPS:12,000 HOURS:2,600 COSTS(000):$0
Interstate Movement of Swine Within A Production System
FORMS: NONE
OMB NO: 0579-0162 EXPIRATION DATE: 09/30/2004
RESPS:840 HOURS:945 COSTS(000):$0
West Nile Virus Surveillance Report
FORMS: WNV-1 WNV-2
OMB NO: 0579-0163 EXPIRATION DATE: 05/31/2004
RESPS:65 HOURS:15 COSTS(000):$0
Citrus Canker: Commercial citrus tree replacement program
FORMS: PPQ-652
OMB NO: 0579-0165 EXPIRATION DATE: 10/31/2004
RESPS:136 HOURS:34 COSTS(000):$0
Importation of horses, ruminants, swine, and dogs; inspection
and treatment for screwworm
FORMS: NONE
OMB NO: 0579-0166 EXPIRATION DATE: 04/30/2004
RESPS:200 HOURS:40 COSTS(000):$0
District of Columbia Plant Health Certificate
FORMS: PPQ-571
OMB NO: 0579-0167 EXPIRATION DATE: 01/31/2004
RESPS:9,000 HOURS:153 COSTS(000):$0
Veterinary Services User Fees; Fees for Permit Applications
FORMS: NONE
OMB NO: 0579-0168 EXPIRATION DATE: 01/31/2004
RESPS:65 HOURS:10 COSTS(000):$0
Citrus Canker Payments for Recovery of Lost Production
FORMS: NONE
OMB NO: 0579-0169 EXPIRATION DATE: 02/28/2006
RESPS:32 HOURS:16 COSTS(000):$0
Animal Welfare Licensing and Inspection Requirements for Dealers
of Dogs Intended for Hunting, Breeding, or Security Purpose
FORMS: 7001 7001A 7002 7003 7003A 7005 7006
OMB NO: 0579-0170 EXPIRATION DATE: 09/30/2004
RESPS:37 HOURS:37 COSTS(000):$0
West Indian Fruit Fly
FORMS: FORM-540
OMB NO: 0579-0172 EXPIRATION DATE: 03/31/2004
RESPS:40 HOURS:40 COSTS(000):$0
Importation of Mangoes from the Philippines
FORMS: NONE
OMB NO: 0579-0173 EXPIRATION DATE: 05/31/2004
RESPS:10 HOURS:10 COSTS(000):$0
Importation of Unshu Oranges
FORMS: PPQ-203
OMB NO: 0579-0175 EXPIRATION DATE: 10/31/2004
RESPS:1,455 HOURS:1,373 COSTS(000):$0
Bluetongue Surveillance Pilot Program (BSPP)
FORMS: VS-11-3 VS-11-4 VS-11-5 VS-11-6A VS-11-6B VS-11-7 VS-11-8
VS-11-9
OMB NO: 0579-0176 EXPIRATION DATE: 05/31/2004
RESPS:100 HOURS:25 COSTS(000):$0
Importation of Artifically Dwarfed Plants
FORMS: NONE
OMB NO: 0579-0182 EXPIRATION DATE: 08/31/2004
RESPS:340 HOURS:170 COSTS(000):$0
Karmal Bunt, Compensation for the 1999-2000 Crop Season and
Subsequent Seasons
FORMS: PPQ-926 PPQ-927
OMB NO: 0579-0183 EXPIRATION DATE: 11/30/2004
RESPS:9,000 HOURS:1,494 COSTS(000):$0
BSE - Certificate of Orgin
FORMS: VS-16-3
OMB NO: 0579-0185 EXPIRATION DATE: 10/31/2004
RESPS:4 HOURS:1 COSTS(000):$0
Brucellosis in sheep, goats, horses; Payment of indemnity
FORMS: VS-1-27
OMB NO: 0579-0186 EXPIRATION DATE: 11/30/2004
RESPS:8 HOURS:32 COSTS(000):$0
Black Stem Rust; Identification Requirements and Addition of
Rust-Resistant Varieties
FORMS: NONE
OMB NO: 0579-0188 EXPIRATION DATE: 01/31/2005
RESPS:10,731 HOURS:9,090 COSTS(000):$0
National Animal Health Monitoring System Sheep 2001 Study
FORMS: NAHMS-120 NAHMS-121 NAHMS-123 NAHMS-124 NAHMS-125 NAHMS-126
NAHMS-127 NAHMS-128 NAHMS-122
OMB NO: 0579-0189 EXPIRATION DATE: 09/30/2005
RESPS:10 HOURS:10 COSTS(000):$0
CWD in cervids; Payment of indemnity
FORMS: VS1-23
OMB NO: 0579-0190 EXPIRATION DATE: 03/31/2005
RESPS:20 HOURS:10 COSTS(000):$0
Update of the Nursery Stock Regulation
FORMS: PPQ-203
OMB NO: 0579-0191 EXPIRATION DATE: 09/30/2005
RESPS:16,642 HOURS:1,227 COSTS(000):$0
Phytopthora Ramorum; Quarantine and Regulations
FORMS: PPQ-540 PPQ-519
OMB NO: 0579-0192 EXPIRATION DATE: 09/30/2005
RESPS:697 HOURS:2,934 COSTS(000):$0
ISA-Payment of Indemnity
FORMS: VS-1-22 VS-1-23
OMB NO: 0579-0193 EXPIRATION DATE: 09/30/2004
RESPS:590 HOURS:875 COSTS(000):$0
TB Payments to El Paso Texas
FORMS: VS-1-27
OMB NO: 0579-0195 EXPIRATION DATE: 10/31/2005
RESPS:10,000 HOURS:2,000 COSTS(000):$0
Foot-and-Mouth Disease; Prohibition on Importation of Farm
Equipment
FORMS: NONE
OMB NO: 0579-0196 EXPIRATION DATE: 06/30/2005
RESPS:300 HOURS:50 COSTS(000):$0
Self Certification Medical Statement (SCMS)
FORMS: MRP-5
OMB NO: 0579-0197 EXPIRATION DATE: 07/31/2005
RESPS:85 HOURS:35 COSTS(000):$0
Interstate Movement of Gardenia from Hawaii
FORMS: 530 540 519
OMB NO: 0579-0198 EXPIRATION DATE: 07/31/2005
RESPS:5,380 HOURS:315 COSTS(000):$0
Fruit and Vegetables from Hawaii
FORMS: 519 530 540
OMB NO: 0579-0199 EXPIRATION DATE: 09/30/2005
RESPS:1 HOURS:1 COSTS(000):$0
Foot-and-Mouth Disease Payment of Indemnity; Update of Provisions
FORMS: VS1-23
OMB NO: 0579-0203 EXPIRATION DATE: 10/31/2005
RESPS:8,003,200 HOURS:113,200 COSTS(000):$0
Importation of Clementines from Spain
FORMS: NONE
OMB NO: 0579-0205 EXPIRATION DATE: 12/31/2005
RESPS:8,405 HOURS:6,680 COSTS(000):$0
National Animal Health Monitoring System Dairy 2002
FORMS: 129 139 131 132 133 134 135 136
OMB NO: 0579-0206 EXPIRATION DATE: 12/31/2005
RESPS:1,080 HOURS:495 COSTS(000):$0
Center for Animal Health Monitoring Catfish 2003
FORMS: 138 139
OMB NO: 0579-0208 EXPIRATION DATE: 04/30/2003
RESPS:1,600 HOURS:1,600 COSTS(000):$0
Low Pathogenic AI Payment of Indemnity
FORMS: VS-1-20 VS-1-21 VS-1-23
OMB NO: 0579-0209 EXPIRATION DATE: 02/28/2006
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Viruses, Serums, Toxins, and Analogous Products; Records and
Reports
FORMS: NONE
OMB NO: 0579-0211 EXPIRATION DATE: 02/28/2006
RESPS:168 HOURS:198 COSTS(000):$0
Safeguarding System Definition Project
FORMS: NONE
OMB NO: 0579-0213 EXPIRATION DATE: 08/31/2003
RESPS:9,801 HOURS:25,460 COSTS(000):$0
Select Agent Registeration
FORMS: VS-16-3 VS-16-7 PPQ-526 APHIS-2041 APHIS-2043 VS-16-2 APHIS-2040
APHIS-2042 APHIS-2044
OMB NO: 0579-0215 EXPIRATION DATE: 07/31/2003
RESPS:722 HOURS:462 COSTS(000):$0
Mexican Fruit Fly; Treatments
FORMS: PPQ-519
OMB NO: 0579-0216 EXPIRATION DATE: 08/31/2003
RESPS:108 HOURS:804 COSTS(000):$0
Field Testing of Plants Engineered to Produce Pharmaceutical and
Industrial Compounds
FORMS: 2000
OMB NO: 0579-0220 EXPIRATION DATE: 09/30/2003
RESPS:60,000 HOURS:960 COSTS(000):$0
TB in Cattle and Bison, State Designations; California
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
98 18,636,834 1,694,047 $0
Grain Inspection, Packers and Stockyards Administration
OMB NO: 0580-0013 EXPIRATION DATE: 12/31/2004
RESPS:2,494,098 HOURS:396,937 COSTS(000):$0
Reporting and Recordkeeping Requirements (US Grain Standards Act
and Agricultural Marketing Act of 1946)
FORMS: NONE
OMB NO: 0580-0014 EXPIRATION DATE: 02/28/2005
RESPS:4 HOURS:80 COSTS(000):$0
Guidelines for Preparation of Research Proposal
FORMS: NONE
OMB NO: 0580-0015 EXPIRATION DATE: 09/30/2004
RESPS:25,015 HOURS:304,253 COSTS(000):$0
Regulations and Related Reporting and Recordkeeping
Requirements- Packers and Stockyards Programs
FORMS: 116 116-1 1 333 23 315 316 5 131 135
OMB NO: 0580-0016 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:12 COSTS(000):$0
"Clear Title" Regulations to Implement Section 1324 of the Food
Security Act of 1985
FORMS: NONE
OMB NO: 0580-0018 EXPIRATION DATE: 05/31/2003
RESPS:1,874 HOURS:313 COSTS(000):$0
Survey of Customers of the Official Grain Inspection and
Weighing System
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 2,520,992 701,595 $0
Agricultural Marketing Service
OMB NO: 0581-0004 EXPIRATION DATE: 06/30/2005
RESPS:304 HOURS:278 COSTS(000):$0
Tobacco Report
FORMS: TB-26 TB-39
OMB NO: 0581-0005 EXPIRATION DATE: 08/31/2005
RESPS:3,864 HOURS:129 COSTS(000):$0
Grain Market News and Molasses Market News Reports
FORMS: NONE
OMB NO: 0581-0006 EXPIRATION DATE: 04/30/2003
RESPS:3,663,030 HOURS:120,964 COSTS(000):$0
Fruit and Vegetable Market News Reports
FORMS: FV-29 FV-498-1 FV-498-2
OMB NO: 0581-0008 EXPIRATION DATE: 05/31/2004
RESPS:1,697 HOURS:119 COSTS(000):$0
Cotton Classing, Testing, and Standards
FORMS: 246 357 383
OMB NO: 0581-0009 EXPIRATION DATE: 05/31/2004
RESPS:2,417 HOURS:226 COSTS(000):$0
Cotton Classification and Market News Service
FORMS: CN-59
OMB NO: 0581-0026 EXPIRATION DATE: 03/31/2004
RESPS:17,697 HOURS:37,215 COSTS(000):$0
Federal Seed Act Program
FORMS: NONE
OMB NO: 0581-0031 EXPIRATION DATE: 09/30/2004
RESPS:40,609 HOURS:155,138 COSTS(000):$0
Reporting and Recordkeeping Requirements Under Regulations
(Other than Rules of Practice) Under the Persihable Agricultural
Commodities Act, 1930
FORMS: FV-211 FV-231 FV-231-2A
OMB NO: 0581-0032 EXPIRATION DATE: 09/30/2004
RESPS:20,026 HOURS:21,397 COSTS(000):$0
Report Forms Under Milk Marketing Order Programs (From Milk
Handlers and Milk Marketing Cooperatives)
FORMS: DA-24 DA-25
OMB NO: 0581-0033 EXPIRATION DATE: 06/30/2004
RESPS:212,740 HOURS:17,657 COSTS(000):$0
Poultry Market News Report
FORMS: PY-90
OMB NO: 0581-0050 EXPIRATION DATE: 09/30/2005
RESPS:18,720 HOURS:624 COSTS(000):$0
Plan for Estimating Daily Livestock Slaughter Under Federal
Inspection
FORMS: NONE
OMB NO: 0581-0055 EXPIRATION DATE: 04/30/2003
RESPS:1,760 HOURS:1,691 COSTS(000):$0
Application for Plant Variety Protection Certificate and
FORMS: ST-470 ST-470-E
OMB NO: 0581-0056 EXPIRATION DATE: 05/31/2004
RESPS:13,504 HOURS:5,569 COSTS(000):$0
Reporting and Recordkeeping Requirements for 7 CFR, Part 29
FORMS: TB-87 TB-92
OMB NO: 0581-0065 EXPIRATION DATE: 02/29/2004
RESPS:1,323 HOURS:162 COSTS(000):$0
Marketing Order Regulating the Handling of Spearmint Oil
Produced in the Far West, M.O. 985
FORMS: FV-57 FV-58 FV-60 FV-63 FV-63A
OMB NO: 0581-0071 EXPIRATION DATE: 07/31/2005
RESPS:7,446 HOURS:2,445 COSTS(000):$0
Almonds Grown in California
FORMS: FV-176 FV-177 FV-178 FV-179 FV-180
OMB NO: 0581-0093 EXPIRATION DATE: 07/31/2004
RESPS:4,389,973 HOURS:344,801 COSTS(000):$0
National Research, Promotion and Consumer Information Program
(HONEY-FINAL RULE)
FORMS: CV-100 DA-15/19/19-1 20/20-1/ FV-182/229/258 261/265
LS-25/26/26-1 35/45R/46/46-1 48/49/50/81/82 PY-1 MAS-735
OMB NO: 0581-0110 EXPIRATION DATE: 03/31/2006
RESPS:487 HOURS:1,388 COSTS(000):$0
Regulations governing the inspection and grading of manufactured
or processed dairy products -- Recordkeeping
FORMS: NONE
OMB NO: 0581-0113 EXPIRATION DATE: 03/31/2006
RESPS:5,988 HOURS:1,749 COSTS(000):$0
Regulations for Inspection of Eggs
FORMS: PY-76 PY-155 PY-156 PY-222 PY-518-1
OMB NO: 0581-0123 EXPIRATION DATE: 04/30/2005
RESPS:23,347 HOURS:1,292 COSTS(000):$0
Reporting Requirements under the Regulations Governing
Inspection and Certification of Processed Fruits and Vegetables
and Related Products
FORMS: FV-159 FV-356 FV-468
OMB NO: 0581-0124 EXPIRATION DATE: 09/30/2003
RESPS:24,000 HOURS:406 COSTS(000):$0
7 CFR Part 54 - Meats, Prepared Meats, and Meat Products
(Grading, Certification, and Standards)
FORMS: LS-313 LS-315
OMB NO: 0581-0125 EXPIRATION DATE: 02/29/2004
RESPS:212,306 HOURS:6,416 COSTS(000):$0
Regulations Governing Inspection, Certification, and Standards
for Fresh Fruits, Vegetables and Other Products -- 7 CFR 51
FORMS: FV-24 FV-202 FV-237 FV-292
OMB NO: 0581-0126 EXPIRATION DATE: 08/31/2003
RESPS:11,991 HOURS:551 COSTS(000):$0
Reporting Requirements under Regulations Governing the
Inspection and Grading Services of Manufactured or Processed
Dairy Products- FINAL RULE
FORMS: DA-132 DA-155 DA-156 DA-162 DA-201B
OMB NO: 0581-0127 EXPIRATION DATE: 06/30/2004
RESPS:22,978 HOURS:1,781 COSTS(000):$0
7 CFR Part 70, Regulations for Voluntary Grading of Poultry
Products and Rabbit Products
FORMS: PY-32 PY-33 PY-210 PY-212
OMB NO: 0581-0128 EXPIRATION DATE: 07/31/2005
RESPS:22,702 HOURS:5,608 COSTS(000):$0
Regulations Governing the Voluntary Grading of Shell Eggs
FORMS: PY-100 PY-157 PY0240
OMB NO: 0581-0140 EXPIRATION DATE: 05/31/2004
RESPS:1,568 HOURS:392 COSTS(000):$0
Seed Service Program
FORMS: NONE
OMB NO: 0581-0142 EXPIRATION DATE: 09/30/2003
RESPS:10,434 HOURS:2,947 COSTS(000):$0
Olives Grown in California
FORMS: COC-149 COC-150
OMB NO: 0581-0143 EXPIRATION DATE: 05/31/2004
RESPS:445 HOURS:2,204 COSTS(000):$0
Export Fruit Regulations--Export Apple Act (7 CFR Part 33) and
Export Grape and Plum Act (7 CFR Part 35)
FORMS: NONE
OMB NO: 0581-0154 EXPIRATION DATE: 02/28/2005
RESPS:234,000 HOURS:7,020 COSTS(000):$0
Livestock and Meat Market News Reports
FORMS: NONE
OMB NO: 0581-0164 EXPIRATION DATE: 06/30/2005
RESPS:190,407,995 HOURS:1,699,596 COSTS(000):$0
Recordkeeping Requirements for Certified Applicators of
Federally Restricted Use Pesticides (7 CFR Part 110)
FORMS: STD-8 STD-8-1
OMB NO: 0581-0167 EXPIRATION DATE: 05/31/2003
RESPS:9,600 HOURS:1,632 COSTS(000):$0
Specified Commodities Imported into the United States Exempt
from Import Requirements, 7 CFR Parts 944, 980, and 999
FORMS: FV-6 FV-7
OMB NO: 0581-0169 EXPIRATION DATE: 03/31/2004
RESPS:1,430 HOURS:358 COSTS(000):$0
Farmer's Market Questionnaire
FORMS: TM-6
OMB NO: 0581-0177 EXPIRATION DATE: 02/29/2004
RESPS:4,649 HOURS:852 COSTS(000):$0
Tart Cherries Grown in the States of Michigan, New York,
Pennsylvania, Oregon, Utah, Washington, and Wisconsin
FORMS: FV-43 FV-43A FV-44 FV-45 FV-45A FV-46 FV-47 FV-48 FV-49
OMB NO: 0581-0178 EXPIRATION DATE: 04/30/2004
RESPS:122,737 HOURS:9,356 COSTS(000):$0
Vegetable and Specialty Crops
FORMS: NONE
OMB NO: 0581-0182 EXPIRATION DATE: 10/31/2004
RESPS:8,400 HOURS:700 COSTS(000):$0
Customer Service Survey for USDA-Donated Food Products
FORMS: AMS-11A 11B 11C
OMB NO: 0581-0183 EXPIRATION DATE: 04/30/2003
RESPS:132 HOURS:3,531 COSTS(000):$0
7 CFR Part 37 - Program to Accredit Organic Certifying Agencies
FORMS: LS-314
OMB NO: 0581-0186 EXPIRATION DATE: 10/31/2004
RESPS:135,824 HOURS:24,414 COSTS(000):$0
Livestock Mandatory Reporting Act of 1999
FORMS: LS-113-126 LS-128 LS-129
OMB NO: 0581-0189 EXPIRATION DATE: 07/31/2004
RESPS:38,736 HOURS:10,717 COSTS(000):$0
Generic OMB Fruit Crops, Marketing Order Administration Branch
FORMS: FV-304
OMB NO: 0581-0190 EXPIRATION DATE: 02/29/2004
RESPS:13,100 HOURS:3,275 COSTS(000):$0
Pricing Pilot Program
FORMS: Q-P Q-C Q-H
OMB NO: 0581-0191 EXPIRATION DATE: 01/31/2004
RESPS:321,635 HOURS:574,877 COSTS(000):$0
National Organic Program - Final Rule
FORMS: N/A
OMB NO: 0581-0192 EXPIRATION DATE: 07/31/2003
RESPS:18,000 HOURS:3,000 COSTS(000):$0
Federal-State Shipping Point Inspection Program Customer Service
Survey
FORMS: FV-600
OMB NO: 0581-0193 EXPIRATION DATE: 06/30/2003
RESPS:428 HOURS:36 COSTS(000):$0
Customer Service Survey (Meat Grading and Certification
Services).
FORMS: NONE
OMB NO: 0581-0194 EXPIRATION DATE: 06/30/2003
RESPS:109,500 HOURS:11,120 COSTS(000):$0
Pork Promotion, Research, and Consumer Information Program:
Procedures for the Conduct of Referendum
FORMS: NONE
OMB NO: 0581-0195 EXPIRATION DATE: 02/29/2004
RESPS:50 HOURS:50 COSTS(000):$0
Marketing Order Committee/Board Interview
FORMS: NONE
OMB NO: 0581-0197 EXPIRATION DATE: 10/31/2004
RESPS:12,903 HOURS:6,134 COSTS(000):$0
Hass Avocados National Research, Promotion and Consumer
Information Program
FORMS: NONE
OMB NO: 0581-0198 EXPIRATION DATE: 08/31/2004
RESPS:185,178 HOURS:67,601 COSTS(000):$0
Lamb Promotion, Reserarch and Information Program - Final Rule
FORMS: LS-78 LS-81 LS-82 LS-83 LS-84 LS-85 AD-755
OMB NO: 0581-0201 EXPIRATION DATE: 07/31/2005
RESPS:1,443 HOURS:250 COSTS(000):$0
California Prune/Plum Tree Removal Program - Section 32 (as
amended 7 USC 622c) -- Final Rule
FORMS: 298 299
OMB NO: 0581-0202 EXPIRATION DATE: 01/31/2005
RESPS:4,504 HOURS:1,304 COSTS(000):$0
Beef Promotion and Research Act of 1985 - Proposed Rule
FORMS: NONE
OMB NO: 0581-0207 EXPIRATION DATE: 03/31/2006
RESPS:672 HOURS:336 COSTS(000):$0
National Research and Promotion Board, Council, and Committee
Membership Background Information
FORMS: AMS-755 AMS-755-PM
OMB NO: 0581-0208 EXPIRATION DATE: 02/28/2006
RESPS:24 HOURS:6 COSTS(000):$0
Dried Prunes Produced in California - Handler Compensation Survey
FORMS: NONE
OMB NO: 0581-0209 EXPIRATION DATE: 02/28/2006
RESPS:173 HOURS:6 COSTS(000):$0
Mango Promotion, Research, and Information Order
FORMS: NONE
OMB NO: 0581-0210 EXPIRATION DATE: 02/28/2006
RESPS:80 HOURS:4 COSTS(000):$0
AMS Research and Promotion Customer Service Survey
FORMS: AMS-13
OMB NO: 0581-0211 EXPIRATION DATE: 02/28/2006
RESPS:15 HOURS:4 COSTS(000):$0
Dried Prunes Produced in California-Prune Dehydrator Survey
FORMS: NONE
OMB NO: 0581-0214 EXPIRATION DATE: 09/30/2003
RESPS:66 HOURS:5 COSTS(000):$0
Sweet Cherries Grown in Designated Counties in Washington, M.O.
923
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
52 200,362,630 3,159,333 $0
Food Safety and Inspection Service
OMB NO: 0583-0082 EXPIRATION DATE: 03/31/2004
RESPS:11,490 HOURS:1,091 COSTS(000):$0
Application for Inspection, Sanitation, Accredited Laboratories
FORMS: 10-600-1 10-110-4 10-110-2 6200-18 5200-8 5200-2 5200-2 PY-38
PY-32
OMB NO: 0583-0092 EXPIRATION DATE: 09/30/2004
RESPS:858 HOURS:119,005 COSTS(000):$0
Marking, Labeling, and Packaging Material
FORMS: FORM-7234-1
OMB NO: 0583-0094 EXPIRATION DATE: 04/30/2003
RESPS:2,201,058 HOURS:168,711 COSTS(000):$0
Exportation, Transportation, and Importation of Meat and Poultry
Products
FORMS: 9060-1 7350-1 9540-1 9510-1
OMB NO: 0583-0103 EXPIRATION DATE: 02/29/2004
RESPS:70,182,657 HOURS:8,559,292 COSTS(000):$243
Pathogen Reduction/Hazard Analysis and Critical Control Point
(HACCP) Systems
FORMS: NONE
OMB NO: 0583-0124 EXPIRATION DATE: 07/31/2003
RESPS:307,500 HOURS:392,100 COSTS(000):$0
E. coli contamination in beef products
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 72,703,563 9,240,199 $243
Food and Nutrition Service
OMB NO: 0584-0002 EXPIRATION DATE: 04/30/2003
RESPS:2,976 HOURS:95,232 COSTS(000):$0
Report of School Program Operations
FORMS: FNS-10
OMB NO: 0584-0005 EXPIRATION DATE: 01/31/2006
RESPS:3,368,061 HOURS:702,767 COSTS(000):$0
7 CFR Part 215 - Special Milk Program for Children
FORMS: NONE
OMB NO: 0584-0006 EXPIRATION DATE: 05/31/2004
RESPS:2,210,854 HOURS:9,462,622 COSTS(000):$0
7 CFR Part 210 National School Lunch Program
FORMS: FNS-66 FNS-640 FNS-67
OMB NO: 0584-0008 EXPIRATION DATE: 05/31/2003
RESPS:40,190 HOURS:9,447 COSTS(000):$0
Food Stamp Program - Store Applications
FORMS: FNS-252 FNS-252-2
OMB NO: 0584-0009 EXPIRATION DATE: 08/31/2004
RESPS:5,700 HOURS:17,100 COSTS(000):$0
Food coupon Accountability Report
FORMS: FNS-250
OMB NO: 0584-0012 EXPIRATION DATE: 05/31/2004
RESPS:1,283,639 HOURS:4,895,796 COSTS(000):$0
7 CFR Part 220 School Breakfast Program
FORMS: NONE
OMB NO: 0584-0015 EXPIRATION DATE: 12/31/2004
RESPS:800 HOURS:67 COSTS(000):$0
Food Stamp Mail Issuance Report
FORMS: FNS-259
OMB NO: 0584-0022 EXPIRATION DATE: 09/30/2004
RESPS:1,326 HOURS:663 COSTS(000):$0
Requisition for Food Coupon Books
FORMS: FNS-260
OMB NO: 0584-0025 EXPIRATION DATE: 05/31/2003
RESPS:2,939 HOURS:6,595 COSTS(000):$0
Civil Rights Title VI-Collection Reports-FNS-191 and FNS-101
FORMS: FNS-191 FNS-101
OMB NO: 0584-0026 EXPIRATION DATE: 08/31/2004
RESPS:12,193,997 HOURS:1,021,272 COSTS(000):$0
7 CFR 245, Determining Eligibility for F & RP Meals and Free Milk
FORMS: NONE
OMB NO: 0584-0034 EXPIRATION DATE: 05/31/2003
RESPS:33,178 HOURS:101,049 COSTS(000):$0
Negative Quality Control Review Schedule; Status of Sample
Selection and Completion; Statistical Summary of Sample
Disposition
FORMS: FNS-245 FNS-247 FNS-248
OMB NO: 0584-0037 EXPIRATION DATE: 03/31/2005
RESPS:100 HOURS:97 COSTS(000):$0
Report of Coupon Issuance & Commodity Distribution for Disaster
Relief
FORMS: FNS-292
OMB NO: 0584-0041 EXPIRATION DATE: 06/30/2003
RESPS:1,590 HOURS:1,193 COSTS(000):$0
Summer Food Service Program Claim for Reimbursement
FORMS: FNS-143
OMB NO: 0584-0043 EXPIRATION DATE: 01/31/2004
RESPS:26,149,238 HOURS:2,734,330 COSTS(000):$0
WIC Program Regulations - Reporting and Recordkeeping Burden
FORMS: NONE
OMB NO: 0584-0045 EXPIRATION DATE: 07/31/2005
RESPS:17 HOURS:4,660 COSTS(000):$0
WIC Financial Management and Participation Report with Addendum
FORMS: FNS-798 FNS-798A
OMB NO: 0584-0052 EXPIRATION DATE: 03/31/2005
RESPS:30,000 HOURS:7,500 COSTS(000):$0
Affidavit of Return or Exchange of Food Coupons
FORMS: FNS-135
OMB NO: 0584-0053 EXPIRATION DATE: 06/30/2003
RESPS:111,312 HOURS:12,127 COSTS(000):$0
Coupon Account and Destruction Report
FORMS: FNS-471
OMB NO: 0584-0055 EXPIRATION DATE: 12/31/2003
RESPS:4,804,928 HOURS:5,093,852 COSTS(000):$0
7 CFR Part 226 Child and Adult Care Food Program
FORMS: FNS-82 341 342 344 345 430 431 433
OMB NO: 0584-0064 EXPIRATION DATE: 01/31/2006
RESPS:149,135,163 HOURS:29,422,927 COSTS(000):$0
Food Stamp Forms: Applications, Periodic Reporting, Notices
FORMS: NONE
OMB NO: 0584-0067 EXPIRATION DATE: 09/30/2005
RESPS:2,052 HOURS:12,922 COSTS(000):$0
7 CFR Part 235 State Administrative Expense Funds
FORMS: FNS-74 FNS-525
OMB NO: 0584-0069 EXPIRATION DATE: 05/31/2003
RESPS:212 HOURS:742 COSTS(000):$0
Status of Claims Against Households
FORMS: FNS-209
OMB NO: 0584-0074 EXPIRATION DATE: 11/30/2003
RESPS:54,663 HOURS:491,967 COSTS(000):$0
Worksheet for Food Stamp Program Quality Control Reveiws, FNS-380
FORMS: FNS-380
OMB NO: 0584-0075 EXPIRATION DATE: 10/31/2004
RESPS:54 HOURS:4,320 COSTS(000):$0
Annual Report of State Revenue Matching
FORMS: FNS-13
OMB NO: 0584-0078 EXPIRATION DATE: 04/30/2003
RESPS:1,908 HOURS:5,724 COSTS(000):$0
Report of the Child and Adult Care Food Program
FORMS: FNS-44
OMB NO: 0584-0080 EXPIRATION DATE: 10/31/2004
RESPS:2,808 HOURS:22,416 COSTS(000):$0
Issuance Reconciliation Report
FORMS: FNS-46
OMB NO: 0584-0081 EXPIRATION DATE: 11/30/2003
RESPS:636 HOURS:4,542 COSTS(000):$0
Form FNS-388, State Issuance and Participation Estimates
FORMS: FNS-388
OMB NO: 0584-0083 EXPIRATION DATE: 12/31/2005
RESPS:253 HOURS:2,932 COSTS(000):$0
Operating Guidelines, Forms and Waivers
FORMS: 366-A 366-B
OMB NO: 0584-0085 EXPIRATION DATE: 02/28/2005
RESPS:6,797,351 HOURS:135,947 COSTS(000):$0
Food Stamp Redemption Certificate
FORMS: FNS-278B FNS-278-4
OMB NO: 0584-0124 EXPIRATION DATE: 11/30/2003
RESPS:3,951,516 HOURS:21,250 COSTS(000):$0
Food Stamp Program Identification Cards
FORMS: NONE
OMB NO: 0584-0280 EXPIRATION DATE: 04/30/2003
RESPS:347,641 HOURS:316,005 COSTS(000):$0
Summer Food Service Program -- 7 CFR Part 225
FORMS: FNS-19-1 FNS-19-2 FNS-80 FNS-81 FNS-81-1 FNS-418 FNS-688
OMB NO: 0584-0284 EXPIRATION DATE: 04/30/2003
RESPS:5,200 HOURS:7,540 COSTS(000):$0
Monthly claim for Reimbursement
FORMS: FNS-806
OMB NO: 0584-0293 EXPIRATION DATE: 06/30/2003
RESPS:918,593 HOURS:1,154,581 COSTS(000):$0
Food Distribution Forms
FORMS: FNS-7 52 53 57 152 153 155 586A 586B 663
OMB NO: 0584-0299 EXPIRATION DATE: 10/31/2003
RESPS:54,663 HOURS:58,686 COSTS(000):$0
Quality Control Review Schedule
FORMS: FNS-380-1
OMB NO: 0584-0303 EXPIRATION DATE: 08/31/2004
RESPS:4,326 HOURS:3,830 COSTS(000):$0
Food Stamp Program Regulations, Part 275 - Quality Control
FORMS: NONE
OMB NO: 0584-0314 EXPIRATION DATE: 09/30/2004
RESPS:136,534 HOURS:1,327 COSTS(000):$0
Food Coupon Deposit Document
FORMS: FNS-521
OMB NO: 0584-0320 EXPIRATION DATE: 04/30/2003
RESPS:4,163 HOURS:3,122 COSTS(000):$0
Child Nutrition Labeling Program
FORMS: NONE
OMB NO: 0584-0332 EXPIRATION DATE: 05/31/2003
RESPS:100 HOURS:25 COSTS(000):$0
WIC Federal and State Agreement
FORMS: FNS-339
OMB NO: 0584-0336 EXPIRATION DATE: 03/31/2006
RESPS:6 HOURS:60 COSTS(000):$0
Disaster Food Stamp Program
FORMS: NONE
OMB NO: 0584-0339 EXPIRATION DATE: 12/31/2004
RESPS:3,386,325 HOURS:190,541 COSTS(000):$0
Employment and Training (E&T) Program Report
FORMS: FNS-583
OMB NO: 0584-0385 EXPIRATION DATE: 04/30/2003
RESPS:275 HOURS:963 COSTS(000):$0
Report of the Emergency Food Assistance Program (TEFAP)
Administrative
FORMS: FNS-667
OMB NO: 0584-0401 EXPIRATION DATE: 09/30/2004
RESPS:1 HOURS:1,778 COSTS(000):$0
The Integrity Profile
FORMS: FNS-698 FNS-699 FNS-700
OMB NO: 0584-0431 EXPIRATION DATE: 02/28/2005
RESPS:1 HOURS:15 COSTS(000):$0
WIC Local Agency Directory Report
FORMS: FNS-648
OMB NO: 0584-0446 EXPIRATION DATE: 04/30/2003
RESPS:843,623 HOURS:71,803 COSTS(000):$0
Federal Collection; Methods for Food Stamp Program Recipient
Claims
FORMS: N/A
OMB NO: 0584-0447 EXPIRATION DATE: 02/28/2005
RESPS:2,009 HOURS:4,912 COSTS(000):$0
WIC Farmers' Market Nutrition Program (FMNP) Forms: 683, 203 &
Regulations
FORMS: FNS-683 FNS-203
OMB NO: 0584-0474 EXPIRATION DATE: 05/31/2003
RESPS:1,850 HOURS:148 COSTS(000):$0
A National Hunger Clearinghouse Data Base Form
FORMS: NONE
OMB NO: 0584-0479 EXPIRATION DATE: 08/31/2005
RESPS:69 HOURS:1,380 COSTS(000):$0
Waivers Under Section 6(0) of the Food Stamp Act
FORMS: NONE
OMB NO: 0584-0492 EXPIRATION DATE: 11/30/2004
RESPS:1,536,129 HOURS:162,560 COSTS(000):$0
Repayment Demand and Program Disqualification
FORMS: NONE
OMB NO: 0584-0494 EXPIRATION DATE: 02/28/2005
RESPS:100 HOURS:2,500 COSTS(000):$0
Child Nutrition Database
FORMS: FNS-709 FNS-710
OMB NO: 0584-0496 EXPIRATION DATE: 09/30/2004
RESPS:135 HOURS:256 COSTS(000):$0
Food Stamp Program: State agency options
FORMS: NONE
OMB NO: 0584-0501 EXPIRATION DATE: 05/31/2003
RESPS:800 HOURS:66 COSTS(000):$0
Supplemental Form for Collecting Taxpayer Identifying Numbers
FORMS: FNS-711
OMB NO: 0584-0505 EXPIRATION DATE: 03/31/2004
RESPS:15,942 HOURS:7,817 COSTS(000):$0
Evaluation of the School Breakfast Pilot Program
FORMS: NONE
OMB NO: 0584-0512 EXPIRATION DATE: 05/31/2005
RESPS:505 HOURS:30,000 COSTS(000):$0
Uniform Grant Application for Non-Entitlement Discretionary
Grants
FORMS: FNS-728
OMB NO: 0584-0513 EXPIRATION DATE: 06/30/2003
RESPS:630 HOURS:274 COSTS(000):$0
14 State Summer Food Service Program Pilot Project
FORMS: NONE
OMB NO: 0584-0515 EXPIRATION DATE: 03/31/2004
RESPS:1,113 HOURS:672 COSTS(000):$0
Case Study of NSLP Verification outcomes in large metropplitan
ares
FORMS: NONE
OMB NO: 0584-0516 EXPIRATION DATE: 10/31/2003
RESPS:3,216 HOURS:2,308 COSTS(000):$0
Evaluation of the NSLP Application and Verification and Pilot
Program
FORMS: NONE
OMB NO: 0584-0517 EXPIRATION DATE: 09/30/2003
RESPS:6,186 HOURS:3,532 COSTS(000):$0
Nutrition Education Materials for Food and Nutrition Service
Population Groups
FORMS: NONE
OMB NO: 0584-0521 EXPIRATION DATE: 03/31/2006
RESPS:7,500 HOURS:1,250 COSTS(000):$0
Interactive Healthy eating Index Questionnaire
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
57 217,465,096 56,320,009 $0
Forest Service
OMB NO: 0596-0003 EXPIRATION DATE: 04/30/2003
RESPS:7,200 HOURS:2,950 COSTS(000):$0
Grazing Permit Administration Forms
FORMS: R1-FS-2200-5 R2-2200-6 R#-FS-2200-1 R8-2200-23 FS-220-1/2/12
13/15/16/17
OMB NO: 0596-0009 EXPIRATION DATE: 03/31/2004
RESPS:2,919 HOURS:199 COSTS(000):$0
Residential Fuelwood and Post Assessment, Any State, Year
FORMS: NONE
OMB NO: 0596-0010 EXPIRATION DATE: 06/30/2003
RESPS:2,909 HOURS:2,369 COSTS(000):$0
Forest Industries Data Collection System
FORMS: NONE
OMB NO: 0596-0015 EXPIRATION DATE: 05/31/2003
RESPS:988 HOURS:248 COSTS(000):$0
Airplane Pilot Qualifications and Approval Record, Helicopter
Pilot Qualifications and Approval Record, Airplane Data Record,
and Helicopter Data Record.
FORMS: FS-5700-20 FS-5700-20A FS-5700-21 FS-5700-21A
OMB NO: 0596-0016 EXPIRATION DATE: 07/31/2003
RESPS:2,000 HOURS:500 COSTS(000):$0
Use of Roads by Order
FORMS: FS-7700-40
OMB NO: 0596-0017 EXPIRATION DATE: 04/30/2004
RESPS:20 HOURS:20 COSTS(000):$0
Timber Purchasers' Cost and Sales Data
FORMS: NONE
OMB NO: 0596-0019 EXPIRATION DATE: 11/30/2003
RESPS:320,000 HOURS:16,000 COSTS(000):$0
Recreation Fee Permit and Visitor Registration Card
FORMS: FS-2300-30 FS-2300-32
OMB NO: 0596-0022 EXPIRATION DATE: 07/31/2005
RESPS:4,208 HOURS:13,174 COSTS(000):$0
36 CFR Part 228, Subpart A-Locatable Minerals
FORMS: FS-2800-5
OMB NO: 0596-0025 EXPIRATION DATE: 05/31/2004
RESPS:50 HOURS:25 COSTS(000):$0
Annual Wildfire Summary Report
FORMS: FS-3100-8
OMB NO: 0596-0066 EXPIRATION DATE: 05/31/2003
RESPS:1,600 HOURS:38,672 COSTS(000):$0
Bid for Advertised Timber
FORMS: FS-2400-42A FS-2400-14
OMB NO: 0596-0078 EXPIRATION DATE: 12/31/2004
RESPS:10,000 HOURS:2,500 COSTS(000):$0
National Woodland Owner Survey
FORMS: NONE
OMB NO: 0596-0080 EXPIRATION DATE: 04/30/2004
RESPS:58,100 HOURS:14,525 COSTS(000):$0
Volunteer Application for Natural Resource Agencies
FORMS: FORM-301
OMB NO: 0596-0081 EXPIRATION DATE: 05/31/2004
RESPS:3,000 HOURS:7,500 COSTS(000):$0
36 CFR Part 228, Subpart C-Disposal of Mineral Materials
FORMS: FS-2800-9
OMB NO: 0596-0082 EXPIRATION DATE: 04/30/2003
RESPS:56,940 HOURS:75,875 COSTS(000):$0
Special Use Administration
FORMS: NONE
OMB NO: 0596-0084 EXPIRATION DATE: 09/30/2003
RESPS:18,000 HOURS:6,000 COSTS(000):$0
Youth Conservation Corps Application & Medical History Forms.
FORMS: FS-1800-3 FS-1800-18
OMB NO: 0596-0085 EXPIRATION DATE: 03/31/2005
RESPS:27,750 HOURS:41,366 COSTS(000):$0
Forest Products Free Use Permit, Forest Products Removal Permit
and Cash Receipt, and Forest Products Sale Permit and Cash
Receipt
FORMS: FS-2400-8 FS-2400-1 FS-2400-4
OMB NO: 0596-0086 EXPIRATION DATE: 01/31/2004
RESPS:3,750 HOURS:1,875 COSTS(000):$0
Operating Plans
FORMS: NONE
OMB NO: 0596-0087 EXPIRATION DATE: 03/31/2004
RESPS:40 HOURS:20 COSTS(000):$0
Commercial Use of Woodsy Owl Symbol-36 CFR Part 272
FORMS: NONE
OMB NO: 0596-0089 EXPIRATION DATE: 11/30/2003
RESPS:25 HOURS:6 COSTS(000):$0
Application for Prospecting Permit
FORMS: FS-2800-14
OMB NO: 0596-0099 EXPIRATION DATE: 12/31/2003
RESPS:6,500 HOURS:1,083 COSTS(000):$0
Application for the Senior Communitry Service Employment Program
FORMS: FS-1800-21B
OMB NO: 0596-0105 EXPIRATION DATE: 06/30/2003
RESPS:200 HOURS:200 COSTS(000):$0
Agreement to Initiate (ATI) and Exchange Agreement (EA)
FORMS: NONE
OMB NO: 0596-0106 EXPIRATION DATE: 04/30/2003
RESPS:400,000 HOURS:20,000 COSTS(000):$0
Recreation Fee Permit Envelope
FORMS: FS-2300-26
OMB NO: 0596-0108 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:416 COSTS(000):$0
Baseline and Trend Information on Wilderness Use and Users
FORMS: NONE
OMB NO: 0596-0110 EXPIRATION DATE: 04/30/2003
RESPS:57,000 HOURS:9,917 COSTS(000):$0
Customer and Use Survey Techniques for Operations, Management,
Evaluation, and Research
FORMS: NONE
OMB NO: 0596-0127 EXPIRATION DATE: 10/31/2003
RESPS:40,000 HOURS:13,333 COSTS(000):$0
National Survey on Recreation and the Environment
FORMS: NONE
OMB NO: 0596-0129 EXPIRATION DATE: 03/31/2006
RESPS:600 HOURS:150 COSTS(000):$0
Day Use on the National Forests of Southern California
FORMS: NONE
OMB NO: 0596-0141 EXPIRATION DATE: 05/31/2005
RESPS:80 HOURS:320 COSTS(000):$0
Small Business Timber Set-Aside Program: Appeal Procedures on
Recompution of Shares
FORMS: NONE
OMB NO: 0596-0146 EXPIRATION DATE: 09/30/2005
RESPS:15,000 HOURS:1,000 COSTS(000):$0
How Are We Doing? Customer Service Comment Card
FORMS: FS-1300-5
OMB NO: 0596-0149 EXPIRATION DATE: 03/31/2004
RESPS:9,250 HOURS:3,043 COSTS(000):$0
Public Information Survey for the Recreation Fee Demonstration
Programs at Sedona, AZ on the Coconino National Forest and the
Pacific Northwest Region
FORMS: NONE
OMB NO: 0596-0158 EXPIRATION DATE: 10/31/2003
RESPS:1,210 HOURS:12,100 COSTS(000):$0
National Forest System Land and Resource Management Planning
FORMS: NONE
OMB NO: 0596-0161 EXPIRATION DATE: 04/30/2004
RESPS:20,000 HOURS:1,667 COSTS(000):$0
Forest Stewarship and Stewardship Incentive Program Participant
Demographics
FORMS: NONE
OMB NO: 0596-0162 EXPIRATION DATE: 08/31/2004
RESPS:1,600 HOURS:800 COSTS(000):$0
Improve Management of the Tongass National Forest and Service to
Southeast Alaska Residents
FORMS: NONE
OMB NO: 0596-0163 EXPIRATION DATE: 07/31/2004
RESPS:22,000 HOURS:1,833 COSTS(000):$0
Title Publication Comment Card
FORMS: NONE
OMB NO: 0596-0164 EXPIRATION DATE: 08/31/2004
RESPS:1,500 HOURS:1,250 COSTS(000):$0
Health Screen Questionarie (HSQ)
FORMS: FS-5100-30 FS-5100-31
OMB NO: 0596-0167 EXPIRATION DATE: 04/30/2003
RESPS:25 HOURS:50 COSTS(000):$0
Urgent Removal of Timber
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
35 1,095,464 290,986 $0
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
479 546,557,927 97,375,727 $84,993
Department of Commerce
General Administration
OMB NO: 0605-0001 EXPIRATION DATE: 04/30/2003
RESPS:2,710 HOURS:678 COSTS(000):$0
Applicant for Funding Assistance
FORMS: CD-346-LF
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2,710 678 $0
Bureau of the Census
OMB NO: 0607-0008 EXPIRATION DATE: 07/31/2003
RESPS:72,000 HOURS:24,000 COSTS(000):$0
Manufacturers' Shipments, Inventories, and Orders Survey
FORMS: M-3(SD) M3-SD(I) M3-1-L1
OMB NO: 0607-0013 EXPIRATION DATE: 10/31/2005
RESPS:22,977 HOURS:9,299 COSTS(000):$0
Annual Retail Trade Survey
FORMS: SA-44 SA-44A SA-44C SA-44E SA-44N SA-44S SA-45 SA-45C SA-721
OMB NO: 0607-0049 EXPIRATION DATE: 07/31/2005
RESPS:684,000 HOURS:18,012 COSTS(000):$0
Current Population Survey (CPS) Basic Demographics
FORMS: CPS263 CPS263(SP) CPS263A CPS264 CPS264(SP) CPS264A CPS266
BC1428 BC-1428(SP) BC1428(SP)
OMB NO: 0607-0094 EXPIRATION DATE: 02/29/2004
RESPS:113,600 HOURS:20,693 COSTS(000):$0
Report of Privately-owned Residential Building or Zoning Permits
FORMS: C-404
OMB NO: 0607-0104 EXPIRATION DATE: 12/31/2003
RESPS:54,000 HOURS:4,500 COSTS(000):$0
Advance Monthly Retail Sales Survey
FORMS: SM-44(00)A SM-44(00)AS SM-44(00)AE SM-72(00)A
OMB NO: 0607-0110 EXPIRATION DATE: 07/31/2003
RESPS:112,736 HOURS:9,395 COSTS(000):$0
Survey of Housing Starts, Sales, and Completion
FORMS: SOC-QI/SF.1 SOC-QI/MF.1
OMB NO: 0607-0112 EXPIRATION DATE: 09/30/2003
RESPS:23,616 HOURS:5,957 COSTS(000):$0
Quarterly Survey of State and Local Tax Revenues
FORMS: F-71 F-72 F-73
OMB NO: 0607-0117 EXPIRATION DATE: 06/30/2004
RESPS:11,106 HOURS:1,775 COSTS(000):$266
U.S. Census - Age Search
FORMS: BC-600 BC-649(L) BC-658(L)
OMB NO: 0607-0125 EXPIRATION DATE: 05/31/2003
RESPS:900 HOURS:225 COSTS(000):$0
Questionnaire for Building Permit Officials
FORMS: SOC-QBPO
OMB NO: 0607-0130 EXPIRATION DATE: 12/31/2005
RESPS:9,600 HOURS:2,400 COSTS(000):$0
Quarterly Survey of Residential Alterations and Repairs
FORMS: SORAR-705
OMB NO: 0607-0139 EXPIRATION DATE: 08/31/2005
RESPS:16,600 HOURS:4,150 COSTS(000):$0
Census Employment Inquiry
FORMS: BC-170
OMB NO: 0607-0143 EXPIRATION DATE: 01/31/2006
RESPS:400 HOURS:300 COSTS(000):$0
Quarterly Survey of Public Employee-Retirement Systems
FORMS: F10
OMB NO: 0607-0151 EXPIRATION DATE: 11/30/2004
RESPS:13,662 HOURS:40,986 COSTS(000):$0
Boundary and Annexation Survey (BAS)
FORMS: BAS-1 BAS-1A BAS-2 BAS-2A BAS-2CUO BAS-3 BAS-3A BAS-4 BAS-5
BAS-5A
OMB NO: 0607-0152 EXPIRATION DATE: 04/30/2005
RESPS:15,043,756 HOURS:944,188 COSTS(000):$1,000
Shipper's Export Declaration (SED)/Automated Export System (AES)
Program
FORMS: 7525-V AES
OMB NO: 0607-0153 EXPIRATION DATE: 04/30/2004
RESPS:161,280 HOURS:40,320 COSTS(000):$0
Construction Project Reporting Surveys (Private Construction
Projects (C-700), State and Local Governments Projects (C-700
(SL)), and Multifamily Residential Projects (C-700(R))
FORMS: C-700 C-700(SL) C-700(R)
OMB NO: 0607-0175 EXPIRATION DATE: 09/30/2004
RESPS:17,250 HOURS:38,813 COSTS(000):$0
Survey of Plant Capacity Utilization
FORMS: MQC1
OMB NO: 0607-0179 EXPIRATION DATE: 10/31/2005
RESPS:69,120 HOURS:3,456 COSTS(000):$0
Housing Vacancy Survey (HVS)
FORMS: NONE
OMB NO: 0607-0189 EXPIRATION DATE: 08/31/2005
RESPS:43,600 HOURS:9,448 COSTS(000):$0
Business and Professional Classification Report
FORMS: SQ-CLASS
OMB NO: 0607-0190 EXPIRATION DATE: 07/31/2005
RESPS:45,600 HOURS:5,320 COSTS(000):$0
Monthly Wholesale Trade Survey
FORMS: SM-42(00)
OMB NO: 0607-0195 EXPIRATION DATE: 10/31/2004
RESPS:6,000 HOURS:2,364 COSTS(000):$0
Annual Trade Survey
FORMS: SA-42 SA-42A
OMB NO: 0607-0206 EXPIRATION DATE: 08/31/2004
RESPS:5,835 HOURS:2,059 COSTS(000):$0
Current Industrial Reports (CIR) Program (WAVE II-Voluntary)
FORMS: M327G M331J MQ311A MQ325A MQ325C MQ335F MQ335C MA311D MA333N
MA335L
OMB NO: 0607-0350 EXPIRATION DATE: 03/31/2005
RESPS:2,000 HOURS:500 COSTS(000):$0
Survey of Building and Zoning Permit Systems
FORMS: C-411
OMB NO: 0607-0354 EXPIRATION DATE: 10/31/2003
RESPS:80,550 HOURS:33,563 COSTS(000):$0
Annual Demographic Survey -- 2001
FORMS: CPS-580 CPS-580(SP) CPS-676 CPS-676(SP)
OMB NO: 0607-0368 EXPIRATION DATE: 05/31/2005
RESPS:851,525 HOURS:114,421 COSTS(000):$0
Special Census Program
FORMS: SC-1 SC-1SUPP SC-2 SC-920 SC-116 SC-351 SC-921(HU) SC-921(SP)
OMB NO: 0607-0392 EXPIRATION DATE: 08/31/2003
RESPS:13,661 HOURS:8,522 COSTS(000):$0
Current Industrial Reports Program (WAVE-I Mandatory)
FORMS: M311H M311M M311N MA325F MA327C MA331A MA331B MA331E MA333A
MA333M
OMB NO: 0607-0393 EXPIRATION DATE: 08/31/2003
RESPS:3,322 HOURS:2,092 COSTS(000):$0
Current Industrial Reports (CIR) Program (WAVE I - Voluntary)
FORMS: M336L MQ325B MQ327D MQ332E
OMB NO: 0607-0395 EXPIRATION DATE: 08/31/2004
RESPS:24,012 HOURS:15,115 COSTS(000):$0
Current Industrial Reports Program (WAVE-II - Mandatory)
FORMS: MA316A MA321T MA325G M311J M311L M313N M313P MQ314X MQ315A
MQ333W
OMB NO: 0607-0404 EXPIRATION DATE: 05/31/2005
RESPS:500 HOURS:59 COSTS(000):$0
Field Representative Exit Questionnaire, Enumerator Exit
Questionnaire
FORMS: BC-1294 BC-1294(D)
OMB NO: 0607-0422 EXPIRATION DATE: 10/31/2005
RESPS:48,686 HOURS:39,822 COSTS(000):$0
Service Annual Survey
FORMS: SA-484 SA-492 SA-493 SA-511 SA-512 SA-513 SA-514 SA-523 SA-532
SA-541
OMB NO: 0607-0432 EXPIRATION DATE: 07/31/2004
RESPS:37,800 HOURS:77,708 COSTS(000):$0
Quarterly Financial Report (QFR)
FORMS: QFR-101(MG) 101A(MG) 102(TR) 103(NB)
OMB NO: 0607-0444 EXPIRATION DATE: 11/30/2003
RESPS:182,000 HOURS:91,255 COSTS(000):$0
2002 Company Organization Survey
FORMS: NC-99001
OMB NO: 0607-0452 EXPIRATION DATE: 01/31/2005
RESPS:96,591 HOURS:14,542 COSTS(000):$0
Government Employment Forms
FORMS: E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-9
OMB NO: 0607-0459 EXPIRATION DATE: 09/30/2004
RESPS:30 HOURS:15 COSTS(000):$0
School Enrollment Report
FORMS: P-4
OMB NO: 0607-0464 EXPIRATION DATE: 08/31/2005
RESPS:57,000 HOURS:4,275 COSTS(000):$0
The 2002 October School Enrollment Supplement to the Current
Population Survey
FORMS: NONE
OMB NO: 0607-0466 EXPIRATION DATE: 09/30/2003
RESPS:48,000 HOURS:1,200 COSTS(000):$0
Current Population Survey (CPS) - November Voting and
Registration Supplement
FORMS: NONE
OMB NO: 0607-0476 EXPIRATION DATE: 09/30/2005
RESPS:11,641 HOURS:10,274 COSTS(000):$0
Current Industrial Reports (CIR) Program (Wave III-Mandatory and
Voluntary)
FORMS: M311H-M311L M311M-M311N M336G-MQ313D MQ313T-MA311D MA315D-MA327E
MA333D-MA333F MA333N MA334P MA334R MA335L
OMB NO: 0607-0585 EXPIRATION DATE: 03/31/2005
RESPS:47,981 HOURS:115,076 COSTS(000):$0
Governments - Finance Forms
FORMS: F-5 F-11 F-12 F-13 F-21 F-22 F-25 F-28 F-29 F-32
OMB NO: 0607-0700 EXPIRATION DATE: 08/31/2003
RESPS:3,500 HOURS:3,737 COSTS(000):$0
Annual Survey of Local Government Finances, School Systems
FORMS: F-33 F-33-1 F-33-L1 F-33-L2 F-33-L3
OMB NO: 0607-0717 EXPIRATION DATE: 06/30/2005
RESPS:113,004 HOURS:14,761 COSTS(000):$0
Current Retail Sales and Inventory Survey
FORMS: SM-44(00)S SM-44(00)SE SM-44(00)SS SM-44(00)B SM-44(00)BE
SM-44(00)BS SM-44(00)L SM-20(00)LE SM-44(00)LS SM-45(00)S
OMB NO: 0607-0725 EXPIRATION DATE: 08/31/2004
RESPS:5,500 HOURS:5,500 COSTS(000):$0
Questionnaire Pretesting Research
FORMS: NONE
OMB NO: 0607-0760 EXPIRATION DATE: 09/30/2004
RESPS:8,000 HOURS:4,000 COSTS(000):$0
Data User Evaluation Surveys
FORMS: VARIOUS
OMB NO: 0607-0782 EXPIRATION DATE: 02/29/2004
RESPS:61,000 HOURS:145,000 COSTS(000):$0
Annual Capital Expenditures Survey
FORMS: ACE-1(S) ACE-1(M) ACE-1(LONG) ACE-1(I) ACE-2 ACE-2(I)
OMB NO: 0607-0809 EXPIRATION DATE: 04/30/2004
RESPS:114,500 HOURS:3,725 COSTS(000):$0
MAF and TIGER Update Activities
FORMS: NONE
OMB NO: 0607-0810 EXPIRATION DATE: 06/30/2005
RESPS:3,063,000 HOURS:1,927,300 COSTS(000):$0
The American Community Survey
FORMS: ACS-1(2003) ACS-1(2003)PR ACS-1(GQ) ACS-3(GQ) ACS-4(GQ) ACS-290
OMB NO: 0607-0875 EXPIRATION DATE: 02/29/2004
RESPS:243,750 HOURS:119,378 COSTS(000):$0
2001 Panel of the Survey of Income and Program Participation,
Wave 8 Topical Modules
FORMS: 21805(L) SIPP/CAPI 21003
OMB NO: 0607-0879 EXPIRATION DATE: 09/30/2003
RESPS:3,000 HOURS:15,600 COSTS(000):$0
Census 2000 Count Question Resolution Program
FORMS: NONE
OMB NO: 0607-0880 EXPIRATION DATE: 06/30/2004
RESPS:480,000 HOURS:720,000 COSTS(000):$0
2002 Economic Census Covering the Wholesale Trade Sector
FORMS: SEE-ATTACHED
OMB NO: 0607-0881 EXPIRATION DATE: 06/30/2004
RESPS:1,615,029 HOURS:1,282,100 COSTS(000):$0
2002 Economic Census Covering the Retail Trade and Accommodation
and Food Services Sectors
FORMS: SEE-ATTACHED
OMB NO: 0607-0882 EXPIRATION DATE: 07/31/2004
RESPS:633,007 HOURS:829,579 COSTS(000):$0
2002 Economic Census Covering Utilities; Transportation and
Warehousing; Finance and Insurance, and Real Estate and Rental
and Leasing Sectors
FORMS: SEE-ATTACHED
OMB NO: 0607-0883 EXPIRATION DATE: 07/31/2004
RESPS:160,000 HOURS:45,833 COSTS(000):$0
2002 Economic Census Classification Report
FORMS: NC-99026
OMB NO: 0607-0884 EXPIRATION DATE: 07/31/2004
RESPS:400,000 HOURS:66,666 COSTS(000):$0
2002 Economic Census General Classification Report
FORMS: NC-99023 NC-99023-L-1 NC-99023-L-11 NC-99500
OMB NO: 0607-0886 EXPIRATION DATE: 08/31/2004
RESPS:2,442,300 HOURS:48,846 COSTS(000):$0
2002 Economic Census Ownership or Control Flier
FORMS: SEE-ATTACHED
OMB NO: 0607-0887 EXPIRATION DATE: 09/30/2004
RESPS:1,556,857 HOURS:1,403,061 COSTS(000):$0
2002 Economic Census Covering Information; Professional,
Scientific, and Technical Services; Management of Companies and
Enterprise; Administrative and Support and Waste Management ...
FORMS: SEE-ATTACHED
OMB NO: 0607-0888 EXPIRATION DATE: 09/30/2004
RESPS:90,000 HOURS:22,500 COSTS(000):$0
2002 Census of Governments Local Government Directory Survey
FORMS: G-26 G-28 G-29 G-30 G-32 G-33
OMB NO: 0607-0889 EXPIRATION DATE: 10/31/2004
RESPS:200,000 HOURS:400,000 COSTS(000):$0
2002 Economic Census - Commodity Flow Survey (CFS)
FORMS: CFS-1000
OMB NO: 0607-0892 EXPIRATION DATE: 08/31/2004
RESPS:135,300 HOURS:85,170 COSTS(000):$0
2002 Vehicle Inventory and Use Survey
FORMS: TC-9501 TC-9502
OMB NO: 0607-0893 EXPIRATION DATE: 08/31/2004
RESPS:130,000 HOURS:325,000 COSTS(000):$0
2002 Economic Census Covering the Construction Sector
FORMS: CC-23601 CC-23701 CC-23702 CC-23703 CC-23801 CC-23802 CC-23803
CC-23804 CC-23806 CC-23807
OMB NO: 0607-0894 EXPIRATION DATE: 06/30/2004
RESPS:61,500 HOURS:55,750 COSTS(000):$0
2002 Economic Census of Puerto Rico and Island Areas, covering
Puerto Rico, U.S. Virgin Islands, Guam, the Commonwealth of the
Northern Mariana Islands, and American Samoa
FORMS: OA-97120 OA-97220 OA-97123 OA-97223 OA-97130 OA-97230 OA-97142
OA-97242 OA-97144 OA-97244
OMB NO: 0607-0897 EXPIRATION DATE: 08/31/2004
RESPS:14,500 HOURS:55,080 COSTS(000):$0
2002 Economic Census Covering the Mining Sector
FORMS: MI-21101 MI-21102 MI-21201 MI-21202 MI-21203 MI-21204 MI-21205
MI-21206 MI-21207 MI-21208
OMB NO: 0607-0899 EXPIRATION DATE: 08/31/2004
RESPS:260,000 HOURS:940,200 COSTS(000):$0
2002 Economic Census Covering the Manufacturing Sector
FORMS: MA10000 MC31000 MC33000
OMB NO: 0607-0900 EXPIRATION DATE: 12/31/2003
RESPS:240,000 HOURS:40,000 COSTS(000):$0
2003 National Census Test
FORMS: DA-11A DA-1B DA-1C DA-1D DA-1DD DA-1(RH-1) DA-1(RH-2) DA-1(RH-3)
DA-1(RH-4) DA-1(RH-6)
OMB NO: 0607-0901 EXPIRATION DATE: 12/31/2003
RESPS:95,375 HOURS:158,710 COSTS(000):$0
2002 Business Expenses Survey
FORMS: SA-5678(B)
OMB NO: 0607-0902 EXPIRATION DATE: 12/31/2005
RESPS:2,500,000 HOURS:416,666 COSTS(000):$0
2002 Survey of Business Owners and Self-Employed Persons
FORMS: SBO-1 SBO-2
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
63 32,662,059 10,850,261 $1,266
Economic and Statistical Analysis
OMB NO: 0608-0002 EXPIRATION DATE: 07/31/2005
RESPS:1,336 HOURS:3,273 COSTS(000):$0
Institutional Remittances to Foreign Countries (Form BE-40)
FORMS: BE-40
OMB NO: 0608-0004 EXPIRATION DATE: 11/30/2003
RESPS:50,000 HOURS:62,500 COSTS(000):$0
Direct Transactions of U.S. Reporter with Foreign Affiliate
FORMS: BE-577
OMB NO: 0608-0009 EXPIRATION DATE: 12/31/2005
RESPS:15,800 HOURS:19,750 COSTS(000):$0
Transactions of U.S. Affiliate, Except a U.S. Banking Affiliate,
with Foreign Parent (BE-605); and Transactions of U.S. Banking
Affiliate with Foreign Parent (BE-605 Bank)
FORMS: BE-605 BE-605-BANK
OMB NO: 0608-0011 EXPIRATION DATE: 10/31/2004
RESPS:248 HOURS:1,148 COSTS(000):$0
Ocean Freight Revenues and Expenses of United States Carriers
(BE-30) U.S. Airline Operators' Foreign Revenues and Expenses
(BE-37)
FORMS: BE-30 BE-37
OMB NO: 0608-0012 EXPIRATION DATE: 05/31/2004
RESPS:160 HOURS:640 COSTS(000):$0
Foreign Ocean Carriers' Expenses in the United States
FORMS: BE-29
OMB NO: 0608-0013 EXPIRATION DATE: 05/31/2004
RESPS:72 HOURS:360 COSTS(000):$0
Foreign Airline Operators' Revenues and Expenses in the United
States
FORMS: BE-36
OMB NO: 0608-0015 EXPIRATION DATE: 12/31/2004
RESPS:155 HOURS:700 COSTS(000):$0
Annual Survey of Construction, Engineering, Architectural, and
Mining Services Provided by U.S. Firms to Unaffiliated Foreign
Persons
FORMS: BE-47
OMB NO: 0608-0016 EXPIRATION DATE: 10/31/2004
RESPS:325 HOURS:1,300 COSTS(000):$0
Annual Survey of Reinsurance and Other Insurance Transactions by
US Insurance Companies with Foreign Persons
FORMS: 48
OMB NO: 0608-0017 EXPIRATION DATE: 11/30/2003
RESPS:350 HOURS:1,400 COSTS(000):$0
Annual Survey of Royalties, License Fees, and Other Receipts and
Payments for Intangible Rights Between U.S.
FORMS: BE-98
OMB NO: 0608-0034 EXPIRATION DATE: 10/31/2004
RESPS:4,975 HOURS:128,000 COSTS(000):$0
Annual Survey of Foreign Direct Investment in the United States
FORMS: BE-15(LF) BE-15(SF) BE-15(SUPP-C)
OMB NO: 0608-0035 EXPIRATION DATE: 12/31/2003
RESPS:1,200 HOURS:1,800 COSTS(000):$0
Initial Report on a Foreign Person's Direct or Indirect
Acquisition, Establishment, or Purchase of the Operating Assets,
of a U.S. Business Enterprise, Including Real Estate (BE-13); and
FORMS: BE-13 BE-14
OMB NO: 0608-0042 EXPIRATION DATE: 12/31/2005
RESPS:17,700 HOURS:199,500 COSTS(000):$0
Benchmark Survey of Foreign Direct Investment in the United
States - 2002
FORMS: BE-12(LF) BE-12(SF) BE-12-BANK BE-12(X)
OMB NO: 0608-0053 EXPIRATION DATE: 11/30/2003
RESPS:1,500 HOURS:102,600 COSTS(000):$0
Annual Survey of U.S. Direct Investment Abroad (BE-11)
FORMS: BE-11A BE-11B(LF) BE-11B(SF) BE-11C
OMB NO: 0608-0058 EXPIRATION DATE: 10/31/2004
RESPS:1,100 HOURS:13,200 COSTS(000):$0
Benchmark Survey of Selected Services Transactions with
Unaffili- ated Foreign Persons
FORMS: 20
OMB NO: 0608-0060 EXPIRATION DATE: 10/31/2005
RESPS:1,600 HOURS:18,400 COSTS(000):$0
Annual Survey of Selected Services Transaction with Unaffiliated
Foreign Persons
FORMS: BE-22
OMB NO: 0608-0063 EXPIRATION DATE: 09/30/2003
RESPS:375 HOURS:2,600 COSTS(000):$0
Annual Survey of Financial Services Transactions Between U.S.
Financial Services Providers and Unaffiliated Foreign Persons
FORMS: BE-82
OMB NO: 0608-0064 EXPIRATION DATE: 12/31/2003
RESPS:1 HOURS:800 COSTS(000):$0
STAT-USA Customer Satisfaction Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
17 96,897 557,971 $0
Economic Development Administration
OMB NO: 0610-0091 EXPIRATION DATE: 03/31/2005
RESPS:193 HOURS:1,544 COSTS(000):$0
Petition by a Firm for Certification of Eligibility to Apply for
Trade Adjustment Assistance
FORMS: ED-840P
OMB NO: 0610-0093 EXPIRATION DATE: 12/31/2005
RESPS:640 HOURS:34,430 COSTS(000):$77
Guidelines for Comprehensive Economic Development Strategy
FORMS: NONE
OMB NO: 0610-0094 EXPIRATION DATE: 02/28/2006
RESPS:1,900 HOURS:48,700 COSTS(000):$104
Proposal for Federal Assistance and Application for Federal
Assistance
FORMS: ED-900P ED-900A ED-900R
OMB NO: 0610-0095 EXPIRATION DATE: 09/30/2005
RESPS:1,254 HOURS:15,448 COSTS(000):$0
Revolving Loan Fund Reporting Requirements
FORMS: ED-209A ED-209S ED-209I
OMB NO: 0610-0096 EXPIRATION DATE: 02/28/2006
RESPS:1,160 HOURS:23,200 COSTS(000):$0
Requirements for Approved Construction Investments-Ninth Edition
(Revised)
FORMS: NONE
OMB NO: 0610-0097 EXPIRATION DATE: 02/29/2004
RESPS:50 HOURS:150 COSTS(000):$1
Award for Excellence in Economic Development
FORMS: NONE
OMB NO: 0610-0098 EXPIRATION DATE: 06/30/2005
RESPS:2,469 HOURS:21,009 COSTS(000):$0
Data Collection for Compliance with Government Performance and
Results Act of 1993 (GPRA)
FORMS: ED-915 ED-916 ED-917 ED-918
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 7,666 144,481 $182
International Trade Administration
OMB NO: 0625-0034 EXPIRATION DATE: 06/30/2005
RESPS:2,000 HOURS:167 COSTS(000):$0
Mission/Exhibition Evaluation
FORMS: ITA-4075P
OMB NO: 0625-0035 EXPIRATION DATE: 05/31/2005
RESPS:2,000 HOURS:1,000 COSTS(000):$0
Product Characteristics-Design Check-Off Lists
FORMS: ITA-426P
OMB NO: 0625-0037 EXPIRATION DATE: 07/31/2004
RESPS:50 HOURS:100 COSTS(000):$0
Request for Duty-Free Entry of Scientific Instrument or Apparatus
FORMS: ITA-338P
OMB NO: 0625-0039 EXPIRATION DATE: 03/31/2005
RESPS:1,000 HOURS:490 COSTS(000):$0
Overseas Business Interest Questionnaire
FORMS: ITA-471P
OMB NO: 0625-0040 EXPIRATION DATE: 11/30/2005
RESPS:14 HOURS:14 COSTS(000):$0
Application of License to Enter Watches and Watch Movements into
the Customs Territory of the U.S. - Public Law 97-446
FORMS: ITA-334P
OMB NO: 0625-0047 EXPIRATION DATE: 05/31/2005
RESPS:4,000 HOURS:3,000 COSTS(000):$0
Marketing Data Form
FORMS: ITA-466P
OMB NO: 0625-0055 EXPIRATION DATE: 08/31/2004
RESPS:40 HOURS:40 COSTS(000):$0
NATO ICB Bidders List Application
FORMS: ITA-4023P
OMB NO: 0625-0061 EXPIRATION DATE: 07/31/2005
RESPS:2,200 HOURS:733 COSTS(000):$0
Commercial News USA
FORMS: ITA-4063P
OMB NO: 0625-0065 EXPIRATION DATE: 07/31/2004
RESPS:60 HOURS:1,644 COSTS(000):$0
Application for the President's "E" and "E Star" Awards for
Export Expansion
FORMS: 725A
OMB NO: 0625-0105 EXPIRATION DATE: 07/31/2005
RESPS:55 HOURS:2,200 COSTS(000):$0
Petition Format for Requesting Relief Under U.S. Antidumping
Duty Law
FORMS: ITA-357P
OMB NO: 0625-0109 EXPIRATION DATE: 12/31/2004
RESPS:150 HOURS:13,352 COSTS(000):$0
Annual Report from Foreign-Trade Zones
FORMS: ITA-359P
OMB NO: 0625-0118 EXPIRATION DATE: 10/31/2004
RESPS:4,560 HOURS:304 COSTS(000):$0
Information on Articles for Physically or Mentally Handicapped
Persons Imported Free of Duty
FORMS: ITA-362P
OMB NO: 0625-0120 EXPIRATION DATE: 07/31/2005
RESPS:12,000 HOURS:3,000 COSTS(000):$0
Export Trading Companies Contact Faciliation Services
FORMS: ITA-4094P
OMB NO: 0625-0125 EXPIRATION DATE: 06/30/2005
RESPS:30 HOURS:960 COSTS(000):$0
Application for an Export Trade Certificate of Review
FORMS: ITA-4093P
OMB NO: 0625-0130 EXPIRATION DATE: 05/31/2005
RESPS:90 HOURS:900 COSTS(000):$0
Trade Fair Certification Program: Application
FORMS: ITA-4100P
OMB NO: 0625-0134 EXPIRATION DATE: 12/31/2005
RESPS:394 HOURS:66 COSTS(000):$0
Wach Duty-Exemption and 7114 Jewelry Duty-Refund Program
FORMS: ITA-340P ITA-360P ITA-361P
OMB NO: 0625-0139 EXPIRATION DATE: 12/31/2004
RESPS:100 HOURS:9,314 COSTS(000):$0
Foreign-Trade Zone Application
FORMS: NONE
OMB NO: 0625-0143 EXPIRATION DATE: 07/31/2005
RESPS:2,675 HOURS:483 COSTS(000):$0
Information Services Order Form
FORMS: ITA-4096P
OMB NO: 0625-0147 EXPIRATION DATE: 04/30/2003
RESPS:7,500 HOURS:2,792 COSTS(000):$0
Participation Agreement and Trade Mission Application
FORMS: ITA-4008P ITA-4008P-1 ITA-4008P-A
OMB NO: 0625-0148 EXPIRATION DATE: 12/31/2003
RESPS:5 HOURS:200 COSTS(000):$0
Format for Petition Requesting Relief Under U.S. Countervailing
Duty Law
FORMS: ITA-366P
OMB NO: 0625-0151 EXPIRATION DATE: 12/31/2003
RESPS:5,510 HOURS:1,060 COSTS(000):$0
International Buyer Program: Application and Exhibitor Data
FORMS: 4014P 4102P
OMB NO: 0625-0200 EXPIRATION DATE: 12/31/2005
RESPS:1 HOURS:15 COSTS(000):$0
Antidumping and Countervailing Duties, Procedures for Initiation
of Downstream Product Monitoring
FORMS: 4119P
OMB NO: 0625-0211 EXPIRATION DATE: 07/31/2005
RESPS:384 HOURS:1,152 COSTS(000):$0
U.S.-Japan Semiconductor Agreement Data Collection Program
FORMS: ITA-4115P
OMB NO: 0625-0215 EXPIRATION DATE: 05/31/2005
RESPS:60 HOURS:60 COSTS(000):$0
Certified Trade Mission: Application for Status
FORMS: ITA-4127P
OMB NO: 0625-0217 EXPIRATION DATE: 07/31/2005
RESPS:21,280 HOURS:3,381 COSTS(000):$0
User Satisfaction Surveys
FORMS: ITA-4107P ITA-4110P
OMB NO: 0625-0220 EXPIRATION DATE: 03/31/2005
RESPS:430 HOURS:205 COSTS(000):$0
Advocacy Questionnaire
FORMS: ITA-4133P
OMB NO: 0625-0224 EXPIRATION DATE: 10/31/2004
RESPS:265 HOURS:465 COSTS(000):$0
American Management and Business Internship Training (AMBIT)
Program: Applications
FORMS: NONE
OMB NO: 0625-0225 EXPIRATION DATE: 10/31/2004
RESPS:3,035 HOURS:6,793 COSTS(000):$0
SABIT: Applications and Questionnaires
FORMS: NONE
OMB NO: 0625-0227 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:24,840 COSTS(000):$0
Survey of International Air Travelers
FORMS: NONE
OMB NO: 0625-0228 EXPIRATION DATE: 12/31/2003
RESPS:200 HOURS:100 COSTS(000):$0
Application for Designation of a Fair
FORMS: 4135P
OMB NO: 0625-0231 EXPIRATION DATE: 09/30/2004
RESPS:200 HOURS:33 COSTS(000):$0
BISNIS FinanceLink
FORMS: NONE
OMB NO: 0625-0232 EXPIRATION DATE: 09/30/2003
RESPS:2,000 HOURS:350 COSTS(000):$0
Internet Export Finance Matchmaker
FORMS: NONE
OMB NO: 0625-0236 EXPIRATION DATE: 11/30/2005
RESPS:2,040 HOURS:170 COSTS(000):$0
BISNIS Publication Subscription Form
FORMS: NONE
OMB NO: 0625-0237 EXPIRATION DATE: 12/31/2005
RESPS:9,250 HOURS:1,250 COSTS(000):$0
Export Assistance Center Internet Website Form
FORMS: NONE
OMB NO: 0625-0238 EXPIRATION DATE: 08/31/2003
RESPS:50 HOURS:100 COSTS(000):$0
U.S. Government Trade Information Request
FORMS: ITA-4136P
OMB NO: 0625-0239 EXPIRATION DATE: 05/31/2004
RESPS:1,500 HOURS:550 COSTS(000):$0
Information for Certification Under FAQ 6 of the Safe Harbor
Privacy Principles
FORMS: NONE
OMB NO: 0625-0240 EXPIRATION DATE: 07/31/2004
RESPS:68 HOURS:352 COSTS(000):$0
Imports of Certain Worsted Wool Fabric: Implementation of Tariff
Rate Quotas Established Under Title VI of the Trade and
Development Act of 2000.
FORMS: ITA-4139P ITA-4140P
OMB NO: 0625-0241 EXPIRATION DATE: 04/30/2004
RESPS:200 HOURS:33 COSTS(000):$0
Non-Tariffs Barriers Survey
FORMS: NONE
OMB NO: 0625-0245 EXPIRATION DATE: 09/30/2005
RESPS:1,000,000 HOURS:166,667 COSTS(000):$0
Steel Import License
FORMS: 4141P
OMB NO: 0625-0246 EXPIRATION DATE: 09/30/2003
RESPS:1,600 HOURS:400 COSTS(000):$0
ITA Customer Satisfaction Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
40 1,086,997 248,735 $0
Minority Business Development Agency
OMB NO: 0640-0002 EXPIRATION DATE: 12/31/2005
RESPS:2,670 HOURS:5,473 COSTS(000):$0
Online Performance Database, the Online Phoenix Database and the
Online Opportunity Database
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2,670 5,473 $0
National Oceanic and Atmospheric Administration
OMB NO: 0648-0007 EXPIRATION DATE: 07/31/2004
RESPS:100 HOURS:50 COSTS(000):$0
Coast Pilot Report
FORMS: FORM-77-6
OMB NO: 0648-0009 EXPIRATION DATE: 03/31/2005
RESPS:760 HOURS:62 COSTS(000):$0
Billfish Tagging Report
FORMS: 88-162
OMB NO: 0648-0012 EXPIRATION DATE: 04/30/2005
RESPS:1,250 HOURS:10,000 COSTS(000):$5
Fisheries Finance Program Requirements
FORMS: 88-1
OMB NO: 0648-0013 EXPIRATION DATE: 08/31/2004
RESPS:19,812 HOURS:3,171 COSTS(000):$0
Southeast Region Dealer and Interview Family of Forms
FORMS: NONE
OMB NO: 0648-0015 EXPIRATION DATE: 10/31/2004
RESPS:1,236 HOURS:165 COSTS(000):$0
Monthly Cold Storage Report
FORMS: 88-16
OMB NO: 0648-0016 EXPIRATION DATE: 12/31/2003
RESPS:63,849 HOURS:14,086 COSTS(000):$0
Southeast Region Logbook Family of Forms
FORMS: NONE
OMB NO: 0648-0018 EXPIRATION DATE: 12/31/2004
RESPS:1,400 HOURS:680 COSTS(000):$0
Processed Products Family of Forms
FORMS: 88-13 88-13C
OMB NO: 0648-0020 EXPIRATION DATE: 05/31/2003
RESPS:750 HOURS:63 COSTS(000):$0
Pacific Billfish Angler Survey
FORMS: 88-10
OMB NO: 0648-0021 EXPIRATION DATE: 06/30/2004
RESPS:1,600 HOURS:213 COSTS(000):$0
Small-Craft Facility Questionnaire
FORMS: NOAA-FORM-77-1
OMB NO: 0648-0022 EXPIRATION DATE: 12/31/2004
RESPS:15,000 HOURS:45,000 COSTS(000):$0
Cooperative Charting Programs
FORMS: 77-4 77-5
OMB NO: 0648-0025 EXPIRATION DATE: 09/30/2004
RESPS:110 HOURS:330 COSTS(000):$0
Weather Modification Activities Reports
FORMS: 17-4 17-4A 17-4B
OMB NO: 0648-0040 EXPIRATION DATE: 01/31/2004
RESPS:1,550 HOURS:390 COSTS(000):$1
Bluefin Tuna Statistical Document
FORMS: NONE
OMB NO: 0648-0041 EXPIRATION DATE: 05/31/2003
RESPS:5,000 HOURS:1,650 COSTS(000):$27
Capital Construction Fund - Deposit/Withdrawal Report
FORMS: 38-42
OMB NO: 0648-0052 EXPIRATION DATE: 11/30/2004
RESPS:770,504 HOURS:34,887 COSTS(000):$0
Marine Recreational Fisheries Statistics Survey
FORMS: NONE
OMB NO: 0648-0075 EXPIRATION DATE: 07/31/2004
RESPS:2,350 HOURS:422 COSTS(000):$0
Foreign Fishing Reporting Requirements
FORMS: NONE
OMB NO: 0648-0082 EXPIRATION DATE: 10/31/2004
RESPS:400 HOURS:2,017 COSTS(000):$1
Fishermen's Contingency Fund
FORMS: 88-164 88-166
OMB NO: 0648-0084 EXPIRATION DATE: 07/31/2003
RESPS:604 HOURS:6,476 COSTS(000):$1
Scientific Research, Public Display, and Enhancement Permits
Under the Marine Mammal Protection Act, the Fur Seal Act, and
the Endangered Species Act
FORMS: NONE
OMB NO: 0648-0089 EXPIRATION DATE: 03/31/2005
RESPS:25 HOURS:25 COSTS(000):$9
Foreign Fishing Vessel Permit Applications
FORMS: NONE
OMB NO: 0648-0090 EXPIRATION DATE: 06/30/2004
RESPS:1,000 HOURS:2,250 COSTS(000):$3
Interim Capital Construction Fund Agreement and Certificate
Family of Forms
FORMS: NOAA-FORM-88-14
OMB NO: 0648-0119 EXPIRATION DATE: 11/30/2004
RESPS:195 HOURS:6,598 COSTS(000):$0
Coastal Zone Management Program Administration
FORMS: NONE
OMB NO: 0648-0121 EXPIRATION DATE: 05/31/2004
RESPS:32 HOURS:14,180 COSTS(000):$31
Management and Oversight of the National Estuarine Research
Reserve System
FORMS: NONE
OMB NO: 0648-0135 EXPIRATION DATE: 10/31/2004
RESPS:310 HOURS:985 COSTS(000):$3
Saltonstall-Kennedy Grant Program (S-K Program) Applications and
Reports
FORMS: 88-204 88-205
OMB NO: 0648-0141 EXPIRATION DATE: 04/30/2005
RESPS:801 HOURS:1,018 COSTS(000):$1
National Marine Sanctuary Permits
FORMS: NONE
OMB NO: 0648-0145 EXPIRATION DATE: 05/31/2005
RESPS:2 HOURS:40 COSTS(000):$0
Deep Seabed Mining Regulations for Exploration Licenses
FORMS: NONE
OMB NO: 0648-0148 EXPIRATION DATE: 08/31/2004
RESPS:1,175 HOURS:117 COSTS(000):$0
Pacific Tuna Fisheries Logbook
FORMS: NONE
OMB NO: 0648-0151 EXPIRATION DATE: 03/31/2004
RESPS:78 HOURS:7,512 COSTS(000):$1,673
Applications and Reporting Requirements for Small Takes of
Marine Mammals by Specified Activities Under the Marine Mammal
Protection Act
FORMS: NONE
OMB NO: 0648-0157 EXPIRATION DATE: 05/31/2004
RESPS:390 HOURS:440 COSTS(000):$0
NOAA Space-Based Data Collection System (DCS) Agreements
FORMS: NONE
OMB NO: 0648-0174 EXPIRATION DATE: 03/31/2004
RESPS:67 HOURS:314 COSTS(000):$1
Licensing of Private Land Remote-Sensing Space Systems
FORMS: NONE
OMB NO: 0648-0175 EXPIRATION DATE: 03/31/2005
RESPS:130 HOURS:145 COSTS(000):$0
Marine Fisheries Initiative (MARFIN) Research and Development
Grant and Cooperative Agreement Applications
FORMS: NONE
OMB NO: 0648-0178 EXPIRATION DATE: 03/31/2004
RESPS:4,800 HOURS:1,600 COSTS(000):$2
Marine Mammal Stranding Report/Marine Mammal Rehabilitation
Disposition Report
FORMS: FORM-89-864
OMB NO: 0648-0179 EXPIRATION DATE: 12/31/2005
RESPS:51 HOURS:102 COSTS(000):$0
Applications and Reports for Registration as a Tanner or Agent
FORMS: NONE
OMB NO: 0648-0192 EXPIRATION DATE: 03/31/2005
RESPS:195 HOURS:110 COSTS(000):$0
Statement of Financial Interests, Regional Fishery Management
Councils
FORMS: 88-195
OMB NO: 0648-0194 EXPIRATION DATE: 02/29/2004
RESPS:7,032 HOURS:567 COSTS(000):$70
Antarctic Living Marine Resources Conservation and Management
Measures
FORMS: NONE
OMB NO: 0648-0202 EXPIRATION DATE: 03/31/2004
RESPS:610,877 HOURS:22,292 COSTS(000):$1,368
Northeast Region Permit Family of Forms
FORMS: NONE
OMB NO: 0648-0203 EXPIRATION DATE: 06/30/2003
RESPS:2,610 HOURS:605 COSTS(000):$26
Northwest Region Federal Fisheries Permits
FORMS: NONE
OMB NO: 0648-0204 EXPIRATION DATE: 09/30/2003
RESPS:427 HOURS:248 COSTS(000):$0
Southwest Region Permit Family of Forms
FORMS: NONE
OMB NO: 0648-0205 EXPIRATION DATE: 12/31/2003
RESPS:50,712 HOURS:15,434 COSTS(000):$1,222
Southeast Region Permit Family of Forms
FORMS: NONE
OMB NO: 0648-0206 EXPIRATION DATE: 09/30/2003
RESPS:941 HOURS:492 COSTS(000):$1
Alaska Region Permit Family of Forms
FORMS: NONE
OMB NO: 0648-0212 EXPIRATION DATE: 07/31/2005
RESPS:64,750 HOURS:5,940 COSTS(000):$25
Northeast Region Logbook Family of Forms
FORMS: 88-30 88-140
OMB NO: 0648-0213 EXPIRATION DATE: 07/31/2005
RESPS:76,846 HOURS:32,329 COSTS(000):$128
Alaska Region Logbook Family of Forms
FORMS: NONE
OMB NO: 0648-0214 EXPIRATION DATE: 09/30/2003
RESPS:1,030,692 HOURS:2,339 COSTS(000):$3
Southwest Region Logbook Family of Forms
FORMS: NONE
OMB NO: 0648-0216 EXPIRATION DATE: 10/31/2004
RESPS:400 HOURS:43 COSTS(000):$0
Billfish Certificate of Eligibility
FORMS: NONE
OMB NO: 0648-0218 EXPIRATION DATE: 07/31/2004
RESPS:672 HOURS:430 COSTS(000):$73
South Pacific Tuna Act
FORMS: NONE
OMB NO: 0648-0223 EXPIRATION DATE: 03/31/2005
RESPS:400 HOURS:400 COSTS(000):$0
Pacific Albacore Logbook
FORMS: 88-197
OMB NO: 0648-0227 EXPIRATION DATE: 10/31/2004
RESPS:300 HOURS:50 COSTS(000):$0
NOAA Satelite Ground Station Customer Questionnaire
FORMS: NONE
OMB NO: 0648-0228 EXPIRATION DATE: 09/30/2005
RESPS:1 HOURS:1 COSTS(000):$0
U.S. Fisher men Fishing in Russian Waters
FORMS: NONE
OMB NO: 0648-0229 EXPIRATION DATE: 07/31/2005
RESPS:63,520 HOURS:3,451 COSTS(000):$15
Northeast Region Dealer Purchase Reports
FORMS: 88-30 88-142
OMB NO: 0648-0230 EXPIRATION DATE: 03/31/2005
RESPS:24 HOURS:1,048 COSTS(000):$1
Permits for Incidental Taking of Endangered or Threatened Species
FORMS: NONE
OMB NO: 0648-0238 EXPIRATION DATE: 09/30/2005
RESPS:618 HOURS:52 COSTS(000):$0
Surf Clam/Ocean Quahog Transfer Log
FORMS: NONE
OMB NO: 0648-0239 EXPIRATION DATE: 02/28/2006
RESPS:14,464 HOURS:526 COSTS(000):$1
Bluefin Tuna Dealer Reporting Package
FORMS: 88-144
OMB NO: 0648-0240 EXPIRATION DATE: 09/30/2005
RESPS:2 HOURS:1 COSTS(000):$0
Application to Shuck Surf Clams/Ocean Quahogs at Sea
FORMS: NONE
OMB NO: 0648-0243 EXPIRATION DATE: 04/30/2005
RESPS:40 HOURS:3 COSTS(000):$0
Survey of Intent and Capacity to Harvest and Process Fish and
Shellfish (Northwest Region)
FORMS: NONE
OMB NO: 0648-0247 EXPIRATION DATE: 04/30/2005
RESPS:12,000 HOURS:360 COSTS(000):$0
Cooperative Game Fish Tagging Report
FORMS: 88-162
OMB NO: 0648-0259 EXPIRATION DATE: 08/31/2004
RESPS:240 HOURS:8 COSTS(000):$0
Tag Recapture Card
FORMS: NONE
OMB NO: 0648-0262 EXPIRATION DATE: 12/31/2003
RESPS:4 HOURS:1 COSTS(000):$0
Informaiton for Share Transfer in Wreckfish Fishery
FORMS: NONE
OMB NO: 0648-0266 EXPIRATION DATE: 06/30/2005
RESPS:7,082 HOURS:13,065 COSTS(000):$3
Seafood Inspection and Certification Requirements
FORMS: 89-800 89-814 89-819
OMB NO: 0648-0269 EXPIRATION DATE: 10/31/2004
RESPS:8,157 HOURS:3,746 COSTS(000):$1
Western Alaska Community Development Quota Program
FORMS: NONE
OMB NO: 0648-0271 EXPIRATION DATE: 08/31/2003
RESPS:6,836 HOURS:1,705 COSTS(000):$10
Northwest Region Logbook Family of Forms
FORMS: NONE
OMB NO: 0648-0272 EXPIRATION DATE: 03/31/2005
RESPS:46,718 HOURS:13,249 COSTS(000):$82
Individual Fishing Quotas for Pacific Halibut and Sablefish in
the Alaska Fisheries
FORMS: NONE
OMB NO: 0648-0276 EXPIRATION DATE: 06/30/2003
RESPS:4,320 HOURS:346 COSTS(000):$0
Groundfish Tagging Program
FORMS: NONE
OMB NO: 0648-0283 EXPIRATION DATE: 03/31/2004
RESPS:420 HOURS:309 COSTS(000):$1
NOAA's Teacher-At-Sea Program
FORMS: NONE
OMB NO: 0648-0292 EXPIRATION DATE: 08/31/2003
RESPS:10,000 HOURS:1,500 COSTS(000):$0
Reporting Requirements for Commercial Fisheries Authorization
under Section 118 of the Marine Mammal Protection Act
FORMS: NONE
OMB NO: 0648-0293 EXPIRATION DATE: 08/31/2003
RESPS:6,750 HOURS:1,307 COSTS(000):$120
Application for Commercial Fisheries Authorization under Section
FORMS: NONE
OMB NO: 0648-0295 EXPIRATION DATE: 11/30/2004
RESPS:10,000 HOURS:2,500 COSTS(000):$3
Emergency Beacon Registrations
FORMS: NONE
OMB NO: 0648-0304 EXPIRATION DATE: 03/31/2005
RESPS:200 HOURS:100 COSTS(000):$10
High Seas Fishing Permit Application Information
FORMS: NONE
OMB NO: 0648-0308 EXPIRATION DATE: 12/31/2003
RESPS:1,575 HOURS:788 COSTS(000):$0
2002 NOAA Coastal Services Center Coastal Resource Management
Customer Survey
FORMS: NONE
OMB NO: 0648-0309 EXPIRATION DATE: 08/31/2005
RESPS:170 HOURS:695 COSTS(000):$0
Scientific Research, Exempted Fishing, and Exempted Activity
Submissions
FORMS: NONE
OMB NO: 0648-0311 EXPIRATION DATE: 12/31/2005
RESPS:93 HOURS:48 COSTS(000):$0
Report of Whaling Operations
FORMS: NONE
OMB NO: 0648-0314 EXPIRATION DATE: 05/31/2003
RESPS:54 HOURS:4,695 COSTS(000):$0
Designation of Fishery Management Council Members and
Application for Reinstatement of State Authority
FORMS: NONE
OMB NO: 0648-0316 EXPIRATION DATE: 03/31/2005
RESPS:6,841 HOURS:733 COSTS(000):$0
Prohibited Species Donation Program
FORMS: NONE
OMB NO: 0648-0318 EXPIRATION DATE: 11/30/2005
RESPS:3,998 HOURS:1,963 COSTS(000):$84
Observer Providers of the North Pacific
FORMS: NONE
OMB NO: 0648-0323 EXPIRATION DATE: 05/31/2003
RESPS:600 HOURS:110 COSTS(000):$0
Highly Migratory Species Tournament Reporting
FORMS: NONE
OMB NO: 0648-0327 EXPIRATION DATE: 06/30/2005
RESPS:23,359 HOURS:4,668 COSTS(000):$631
Atlantic Highly Migratory Species Vessel Permits
FORMS: NONE
OMB NO: 0648-0328 EXPIRATION DATE: 08/31/2003
RESPS:8,697 HOURS:955 COSTS(000):$0
Atlantic Bluefin Tuna Mandatory Catch Reporting
FORMS: NONE
OMB NO: 0648-0329 EXPIRATION DATE: 02/29/2004
RESPS:72 HOURS:36 COSTS(000):$0
Foreign Fishing Vessels Operating in Internal Waters
FORMS: NONE
OMB NO: 0648-0330 EXPIRATION DATE: 02/29/2004
RESPS:8,002 HOURS:3,508 COSTS(000):$6
At-Sea Scale Certification Program
FORMS: NONE
OMB NO: 0648-0334 EXPIRATION DATE: 12/31/2004
RESPS:244 HOURS:544 COSTS(000):$1
Alaska License Limitation Program for Groundfish, Crab, and
Scallops
FORMS: NONE
OMB NO: 0648-0335 EXPIRATION DATE: 03/31/2004
RESPS:4,000 HOURS:1,033 COSTS(000):$0
Fisheries Certificate of Origin
FORMS: NOAA-FORM-370
OMB NO: 0648-0338 EXPIRATION DATE: 10/31/2004
RESPS:25 HOURS:15 COSTS(000):$0
Implantation and Recovery of Archival Tags
FORMS: NONE
OMB NO: 0648-0342 EXPIRATION DATE: 07/31/2004
RESPS:70,000 HOURS:1,800 COSTS(000):$0
NOAA Customer Surveys
FORMS: NONE
OMB NO: 0648-0345 EXPIRATION DATE: 03/31/2005
RESPS:4,926 HOURS:7,500 COSTS(000):$338
Southeast Region Bycatch Reduction Device Certification Family
of Forms
FORMS: NONE
OMB NO: 0648-0346 EXPIRATION DATE: 09/30/2005
RESPS:20 HOURS:30 COSTS(000):$0
List of Gear by Fisheries and Fishery Management Council
FORMS: NONE
OMB NO: 0648-0348 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:37 COSTS(000):$1
High Seas Fishing Vessel Identification Requirements
FORMS: NONE
OMB NO: 0648-0349 EXPIRATION DATE: 03/31/2005
RESPS:15,000 HOURS:850 COSTS(000):$2
High Seas Fishing Vessel Reporting Requirements
FORMS: NONE
OMB NO: 0648-0350 EXPIRATION DATE: 10/31/2004
RESPS:5,821 HOURS:4,363 COSTS(000):$58
Northeast Region Vessel Identification Requirements
FORMS: NONE
OMB NO: 0648-0351 EXPIRATION DATE: 10/31/2004
RESPS:1,950,283 HOURS:32,664 COSTS(000):$32
Northeast Region Gear Identification Requirements
FORMS: NONE
OMB NO: 0648-0352 EXPIRATION DATE: 04/30/2005
RESPS:12,317 HOURS:3,079 COSTS(000):$3
Northwest Region Gear Identification Requirements
FORMS: NONE
OMB NO: 0648-0353 EXPIRATION DATE: 07/31/2004
RESPS:15,000 HOURS:3,750 COSTS(000):$4
Alaska Region Gear Identification Requirements
FORMS: NONE
OMB NO: 0648-0354 EXPIRATION DATE: 03/31/2005
RESPS:1 HOURS:1 COSTS(000):$0
Foreign Fishing Gear Identification Requirements
FORMS: NONE
OMB NO: 0648-0355 EXPIRATION DATE: 03/31/2005
RESPS:1,984 HOURS:1,488 COSTS(000):$69
Northwest Region Vessel Identification Requirements
FORMS: NONE
OMB NO: 0648-0356 EXPIRATION DATE: 03/31/2005
RESPS:10 HOURS:8 COSTS(000):$0
Foreign Fishing Vessel Identification Requirements
FORMS: NONE
OMB NO: 0648-0357 EXPIRATION DATE: 09/30/2004
RESPS:1,225 HOURS:21 COSTS(000):$1
Gear-Marking Requirements for the Harbor Porpoise Take Reduction
Plan
FORMS: NONE
OMB NO: 0648-0358 EXPIRATION DATE: 04/30/2005
RESPS:7,000 HOURS:5,350 COSTS(000):$214
Southeast Region Vessel Identification Requirements
FORMS: NONE
OMB NO: 0648-0359 EXPIRATION DATE: 04/30/2005
RESPS:112,700 HOURS:2,192 COSTS(000):$15
Southeast Region Gear Identification Requirements
FORMS: NONE
OMB NO: 0648-0360 EXPIRATION DATE: 10/31/2004
RESPS:42,750 HOURS:1,425 COSTS(000):$23
Southwest Region Gear Identification Requirements
FORMS: NONE
OMB NO: 0648-0361 EXPIRATION DATE: 12/31/2004
RESPS:436 HOURS:286 COSTS(000):$7
Southwest Region Vessel Identification Requirements
FORMS: NONE
OMB NO: 0648-0362 EXPIRATION DATE: 09/30/2004
RESPS:1,611 HOURS:580 COSTS(000):$1
Sea Grant Program Application Requirements for Grants, for John
A. Knauss Marine Policy Fellowships, and for Designation as a
Sea Grant College or Regional Consortia
FORMS: 90-1 90-2 90-4
OMB NO: 0648-0363 EXPIRATION DATE: 12/31/2004
RESPS:5,700 HOURS:5,700 COSTS(000):$0
Swordfish Import Certificate of Eligibility
FORMS: NONE
OMB NO: 0648-0364 EXPIRATION DATE: 09/30/2005
RESPS:257,218 HOURS:2,572 COSTS(000):$27
Gear-Marking Requirements for Atlantic Large Whale Take
Reduction Plan
FORMS: NONE
OMB NO: 0648-0365 EXPIRATION DATE: 12/31/2005
RESPS:100 HOURS:50 COSTS(000):$0
Documentation of Fish Harvest
FORMS: NONE
OMB NO: 0648-0367 EXPIRATION DATE: 03/31/2005
RESPS:1 HOURS:10 COSTS(000):$0
Gear-Marking Requirements in Antarctic Fisheries
FORMS: NONE
OMB NO: 0648-0368 EXPIRATION DATE: 09/30/2005
RESPS:3 HOURS:2 COSTS(000):$0
Vessel-Marking Requirements in Antarctic Fisheries
FORMS: NONE
OMB NO: 0648-0369 EXPIRATION DATE: 12/31/2005
RESPS:2,278 HOURS:7,074 COSTS(000):$0
Economic Performance Data for West Coast (California-Alaska)
Commercial Fisheries
FORMS: NONE
OMB NO: 0648-0371 EXPIRATION DATE: 06/30/2005
RESPS:118,016 HOURS:24,295 COSTS(000):$59
Highly Migratory Species Vessel Logbooks and Cost-Earnings Data
Reports
FORMS: 88-191
OMB NO: 0648-0373 EXPIRATION DATE: 06/30/2005
RESPS:12,696 HOURS:7,199 COSTS(000):$161
Atlantic Highly Migratory Species Vessel and Gear Marking
FORMS: NONE
OMB NO: 0648-0374 EXPIRATION DATE: 06/30/2005
RESPS:8,936 HOURS:295 COSTS(000):$4
Atlantic Highly Migratory Species Observer Notification
Requirement
FORMS: NONE
OMB NO: 0648-0376 EXPIRATION DATE: 07/31/2005
RESPS:16,495 HOURS:38,563 COSTS(000):$2
Fishing Capacity Reduction Program Buyback Requests
FORMS: NONE
OMB NO: 0648-0384 EXPIRATION DATE: 10/31/2003
RESPS:1,000 HOURS:1,100 COSTS(000):$0
NOAA Coastal Ocean Program Grants Proposal Application Package
FORMS: NONE
OMB NO: 0648-0387 EXPIRATION DATE: 02/28/2006
RESPS:271 HOURS:144 COSTS(000):$1
International Dolphin Conservation Program
FORMS: NONE
OMB NO: 0648-0392 EXPIRATION DATE: 12/31/2005
RESPS:3,010 HOURS:251 COSTS(000):$0
Monitoring of Fish Trap Fishing in the Gulf of Mexico
FORMS: NONE
OMB NO: 0648-0393 EXPIRATION DATE: 09/30/2003
RESPS:141 HOURS:83 COSTS(000):$1
American Fisheries Act: Vessel and Processor Permit Applications
FORMS: NONE
OMB NO: 0648-0397 EXPIRATION DATE: 04/30/2003
RESPS:75 HOURS:75 COSTS(000):$0
Application Form for Membership on a National Marine Sanctuary
Advisory Council
FORMS: NONE
OMB NO: 0648-0398 EXPIRATION DATE: 04/30/2003
RESPS:4,425 HOURS:8,400 COSTS(000):$17
Alaska Individual Fishing Quota Cost Recovery Program
Requirements
FORMS: NONE
OMB NO: 0648-0400 EXPIRATION DATE: 06/30/2003
RESPS:2,847 HOURS:793 COSTS(000):$0
Commercial Harvesters and Recreational Party and Charter Boat
Socio-cultural and Economic Data Collection Pilot Study
FORMS: NONE
OMB NO: 0648-0401 EXPIRATION DATE: 12/31/2003
RESPS:1,365 HOURS:888 COSTS(000):$0
American Fisheries Act: Recordkeeping and Reporting Requirements
FORMS: NONE
OMB NO: 0648-0402 EXPIRATION DATE: 11/30/2005
RESPS:318 HOURS:6,310 COSTS(000):$4
Application and Reports for Scientific Research and Enhancement
Permits Under the Endangered Species Act
FORMS: NONE
OMB NO: 0648-0403 EXPIRATION DATE: 06/30/2003
RESPS:180 HOURS:68 COSTS(000):$1
Northeast Region Herring Permits
FORMS: NONE
OMB NO: 0648-0404 EXPIRATION DATE: 06/30/2003
RESPS:114,060 HOURS:185 COSTS(000):$67
Northeast Region Vessel Monitoring and Communications
FORMS: NONE
OMB NO: 0648-0405 EXPIRATION DATE: 06/30/2003
RESPS:50 HOURS:25 COSTS(000):$1
Atlantic Herring Processed Products Report
FORMS: NONE
OMB NO: 0648-0406 EXPIRATION DATE: 06/30/2003
RESPS:2,600 HOURS:87 COSTS(000):$3
Northeast Region Herring Dealer Landing Reports
FORMS: NONE
OMB NO: 0648-0407 EXPIRATION DATE: 06/30/2003
RESPS:2,653 HOURS:176 COSTS(000):$1
Atlantic Herring Vessel Trip Reports
FORMS: NONE
OMB NO: 0648-0408 EXPIRATION DATE: 06/30/2003
RESPS:665 HOURS:1,330 COSTS(000):$0
National Marine Sanctuaries - Socioeconomic Impacts of Marine
Reserves
FORMS: NONE
OMB NO: 0648-0409 EXPIRATION DATE: 07/31/2003
RESPS:988 HOURS:725 COSTS(000):$0
Socioeconomic Monitoring Program for the Florida Keys National
Marine Sanctuary
FORMS: NONE
OMB NO: 0648-0410 EXPIRATION DATE: 07/31/2003
RESPS:10,600 HOURS:2,733 COSTS(000):$0
South Florida Artificial and Natural Reefs - Economic Valuation
Study
FORMS: NONE
OMB NO: 0648-0411 EXPIRATION DATE: 07/31/2003
RESPS:4,111 HOURS:20,331 COSTS(000):$8,000
Paperwork Submissions Under the Coastal Zone Management Act
Federal Consistency Requirements
FORMS: NONE
OMB NO: 0648-0412 EXPIRATION DATE: 06/30/2003
RESPS:528 HOURS:18 COSTS(000):$0
Multispecies Pary/Charterboat Closed Area Exemption Certificate
FORMS: NONE
OMB NO: 0648-0413 EXPIRATION DATE: 02/29/2004
RESPS:800 HOURS:3,200 COSTS(000):$0
Fisheries Capacity Reduction Program Advanced Referenda and
Other Requirements
FORMS: NONE
OMB NO: 0648-0416 EXPIRATION DATE: 12/31/2003
RESPS:272,100 HOURS:2,950 COSTS(000):$195
Northeast Region Sea Scallop Exemption Requirements
FORMS: NONE
OMB NO: 0648-0417 EXPIRATION DATE: 08/31/2003
RESPS:18,144 HOURS:145 COSTS(000):$13
Atka Mackerel Fishery Vessel Monitoring System (VMS) Report
FORMS: NONE
OMB NO: 0648-0418 EXPIRATION DATE: 08/31/2003
RESPS:302 HOURS:24 COSTS(000):$0
Tortugas Access Permits
FORMS: NONE
OMB NO: 0648-0419 EXPIRATION DATE: 01/31/2004
RESPS:40 HOURS:40 COSTS(000):$0
StormReady Application Form
FORMS: NONE
OMB NO: 0648-0420 EXPIRATION DATE: 07/31/2003
RESPS:14 HOURS:31 COSTS(000):$0
Alaska Scallop License Limitation Program Application and
Transfer Forms
FORMS: NONE
OMB NO: 0648-0422 EXPIRATION DATE: 04/30/2005
RESPS:6,912 HOURS:230 COSTS(000):$2
Northeast Region Raised Footrope Trawal Exempted Fishery
FORMS: NONE
OMB NO: 0648-0423 EXPIRATION DATE: 12/31/2003
RESPS:41,410 HOURS:3,451 COSTS(000):$0
An Observer Program for Catcher Vessels in the Pacific Coast
Groundfish Fishery
FORMS: NONE
OMB NO: 0648-0424 EXPIRATION DATE: 02/29/2004
RESPS:207 HOURS:37 COSTS(000):$0
Northeast Region Lobster-Black Sea Bass Area 5 Waiver
Requirements
FORMS: NONE
OMB NO: 0648-0425 EXPIRATION DATE: 03/31/2004
RESPS:1,944,000 HOURS:3,600 COSTS(000):$225
AFA Pollock Fishery Vessel Monitoring System
FORMS: NONE
OMB NO: 0648-0427 EXPIRATION DATE: 03/31/2004
RESPS:100 HOURS:8 COSTS(000):$1
Hunger Relief Donation in the At-Sea Whiting Fishery
FORMS: NONE
OMB NO: 0648-0428 EXPIRATION DATE: 03/31/2004
RESPS:134 HOURS:1,072 COSTS(000):$0
Commercial Operator's Annual Report (COAR)
FORMS: NONE
OMB NO: 0648-0431 EXPIRATION DATE: 05/31/2004
RESPS:420 HOURS:564 COSTS(000):$2
Eastern Pacific Tuna Vessel Register Information
FORMS: NONE
OMB NO: 0648-0432 EXPIRATION DATE: 08/31/2004
RESPS:2,020 HOURS:3,517 COSTS(000):$3
Dr. Nancy Foster Scholarship Program
FORMS: CD-346
OMB NO: 0648-0433 EXPIRATION DATE: 09/30/2004
RESPS:40 HOURS:10 COSTS(000):$0
Reporting Requirements for the Ocean Salmon Fishery off the
Coasts of Washington, Oregon, and California
FORMS: NONE
OMB NO: 0648-0435 EXPIRATION DATE: 12/31/2005
RESPS:787 HOURS:316 COSTS(000):$0
Survey to Measure Effectiveness of Community-Oriented Policing
for ESA Enforcement
FORMS: NONE
OMB NO: 0648-0439 EXPIRATION DATE: 07/31/2004
RESPS:435 HOURS:154 COSTS(000):$0
North Carolina and Louisiana Commerical King and/or Spanish
Mackerel Fishermen Pilot Economic Survey
FORMS: NONE
OMB NO: 0648-0440 EXPIRATION DATE: 04/30/2005
RESPS:430 HOURS:2,150 COSTS(000):$4
Coastal Impact Assistance Program: Project Review Checklist
FORMS: NONE
OMB NO: 0648-0441 EXPIRATION DATE: 07/31/2004
RESPS:1,445,568 HOURS:743 COSTS(000):$0
Vessel Monitoring System Requirements in the Western Pacific
Pelagic Longline Fishery
FORMS: NONE
OMB NO: 0648-0442 EXPIRATION DATE: 08/31/2004
RESPS:175 HOURS:44 COSTS(000):$0
Observer Workshop/Conference Survey
FORMS: NONE
OMB NO: 0648-0445 EXPIRATION DATE: 07/31/2005
RESPS:6,986,518 HOURS:13,152 COSTS(000):$491
NMFS Alaska Region Vessel Monitoring System (VMS) Program
FORMS: NONE
OMB NO: 0648-0446 EXPIRATION DATE: 03/31/2005
RESPS:1,002 HOURS:85 COSTS(000):$0
Atlantic Billfish and Swordfish Recreational Landings Call-in
Report
FORMS: NONE
OMB NO: 0648-0447 EXPIRATION DATE: 04/30/2005
RESPS:4,160 HOURS:1,048 COSTS(000):$0
Alaska Marine Sport Fishing Economics Survey
FORMS: NONE
OMB NO: 0648-0448 EXPIRATION DATE: 03/31/2005
RESPS:78 HOURS:78 COSTS(000):$2
Coral Reef Conservation Program Administration
FORMS: NONE
OMB NO: 0648-0449 EXPIRATION DATE: 03/31/2005
RESPS:1,000 HOURS:5,000 COSTS(000):$0
Data Collection on Marine Protected and Managed Areas
FORMS: NONE
OMB NO: 0648-0450 EXPIRATION DATE: 03/31/2005
RESPS:2,041 HOURS:1,097 COSTS(000):$8
American Lobster Requirements for Historical Participation in
Areas 3, 4, and 5
FORMS: NONE
OMB NO: 0648-0451 EXPIRATION DATE: 05/31/2005
RESPS:3,100 HOURS:2,200 COSTS(000):$199
Southeast Region Reef Fish/Coastal Migratory Pelagic Charter
Vessel Permit Issuance
FORMS: NONE
OMB NO: 0648-0452 EXPIRATION DATE: 06/30/2005
RESPS:24 HOURS:2 COSTS(000):$0
Atlantic Highly Migratory Species Protected Species Interaction
Report
FORMS: NONE
OMB NO: 0648-0456 EXPIRATION DATE: 07/31/2005
RESPS:6 HOURS:5 COSTS(000):$0
Southwest Region Seabird-Fisheries Interaction Recovery Reporting
FORMS: NONE
OMB NO: 0648-0458 EXPIRATION DATE: 07/31/2005
RESPS:35 HOURS:55 COSTS(000):$7
Southeast Region Stone Crab Vessel Permit Issuance Under the New
Trap Limitation Program
FORMS: NONE
OMB NO: 0648-0459 EXPIRATION DATE: 04/30/2003
RESPS:84 HOURS:1,520 COSTS(000):$1
Coastal and Estuarine Land Conservation, Planning, Protection,
or Restoration
FORMS: NONE
OMB NO: 0648-0460 EXPIRATION DATE: 12/31/2003
RESPS:15,058 HOURS:5,617 COSTS(000):$26
Subsistence Fishery for Pacific Halibut in Waters Off Alaska
FORMS: NONE
OMB NO: 0648-0461 EXPIRATION DATE: 11/30/2005
RESPS:34,151 HOURS:9,029 COSTS(000):$351
South Atlantic Rock Shrimp Vessel Permits and Monitoring
FORMS: NONE
OMB NO: 0648-0462 EXPIRATION DATE: 11/30/2005
RESPS:815 HOURS:382 COSTS(000):$0
Southwest Region Coral Reef Ecosystems Logbook and Reporting
FORMS: NONE
OMB NO: 0648-0463 EXPIRATION DATE: 11/30/2005
RESPS:14 HOURS:30 COSTS(000):$0
Southwest Region Coral Reef Ecosystems Permit Form
FORMS: NONE
OMB NO: 0648-0464 EXPIRATION DATE: 12/31/2005
RESPS:100 HOURS:150 COSTS(000):$0
Economic Data Collection for the Trap Fishery in the U.S.
Caribbean
FORMS: NONE
OMB NO: 0648-0465 EXPIRATION DATE: 04/30/2003
RESPS:954 HOURS:308 COSTS(000):$0
Revisions to American Lobster Requirements for Historical
Participation in Areas 3, 4, and 5.
FORMS: NONE
OMB NO: 0648-0466 EXPIRATION DATE: 12/31/2005
RESPS:5 HOURS:3,300 COSTS(000):$0
Submission of Conservation Efforts to Make Listings Unnecessary
under the Endangered Species Act
FORMS: NONE
OMB NO: 0648-0467 EXPIRATION DATE: 12/31/2003
RESPS:3,940 HOURS:657 COSTS(000):$0
Southeast Region Electronic Reporting Survey
FORMS: NONE
OMB NO: 0648-0468 EXPIRATION DATE: 02/28/2006
RESPS:20 HOURS:40 COSTS(000):$0
Protocol for Access to Tissue Specimen Samples from the National
Marine Mammal Tissue Bank
FORMS: NONE
OMB NO: 0648-0469 EXPIRATION DATE: 02/28/2006
RESPS:144 HOURS:5 COSTS(000):$0
Scup Gear Restricted Area (GRA) Access Program Exemption
Authorization
FORMS: NONE
OMB NO: 0648-0470 EXPIRATION DATE: 02/28/2006
RESPS:441 HOURS:74 COSTS(000):$1
Reporting of Sea Turtle Incidental Take in Virginia Chesapeake
Bay Pound Net Operations
FORMS: NONE
OMB NO: 0648-0471 EXPIRATION DATE: 02/28/2006
RESPS:1,040 HOURS:141 COSTS(000):$6
Highly Migratory Species Scientific Research Permits, Exempted
Fishing Permits, and Letters of Authorization
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
169 16,592,543 560,503 $16,297
Patent and Trademark Office
OMB NO: 0651-0009 EXPIRATION DATE: 06/30/2005
RESPS:677,151 HOURS:144,587 COSTS(000):$147,135
TRADEMARK PROCESSING (Proposed rulemaking, Processing Fee for
Use of Paper Forms for Submission of Applications for
Registration and Other Documents)
FORMS: 4.8/4.9/4.16 1478(A) 1553 1581 1583 1963 2000 PTOTM/4.16/1583
OMB NO: 0651-0012 EXPIRATION DATE: 04/30/2003
RESPS:15,200 HOURS:6,138 COSTS(000):$0
Admittance To Practice and Roster of Registered Patent Attorneys
Office
FORMS: PTO-158 PTO-158A PTO-275 PTO-107A
OMB NO: 0651-0016 EXPIRATION DATE: 04/30/2003
RESPS:279,796 HOURS:22,340 COSTS(000):$0
Rules for Patent Maintenance Fees
FORMS: PTO/SB/45/47/ 65/66
OMB NO: 0651-0017 EXPIRATION DATE: 07/31/2003
RESPS:330 HOURS:2,270 COSTS(000):$0
Practitioner records maintenance and disclosure before the
patent and trademark office
FORMS: NONE
OMB NO: 0651-0020 EXPIRATION DATE: 10/31/2004
RESPS:26,858 HOURS:30,903 COSTS(000):$5,976
Patent Term Extension
FORMS: NONE
OMB NO: 0651-0021 EXPIRATION DATE: 12/31/2003
RESPS:331,407 HOURS:401,202 COSTS(000):$78,889,386
Patent Cooperation Treaty
FORMS: RO/101/134/144 PTO/1382 PCT/IPEA/401 PCT/IB/328
OMB NO: 0651-0022 EXPIRATION DATE: 01/31/2004
RESPS:3,300 HOURS:3,301 COSTS(000):$1
Deposit of Biological Materials
FORMS: NONE
OMB NO: 0651-0024 EXPIRATION DATE: 08/31/2003
RESPS:6,060 HOURS:7,990 COSTS(000):$0
Requirements for Patent Applications Containing Nucelotide
FORMS: NONE
OMB NO: 0651-0027 EXPIRATION DATE: 06/30/2005
RESPS:298,133 HOURS:149,067 COSTS(000):$12,470
Recording Assignments
FORMS: 1594 1595
OMB NO: 0651-0028 EXPIRATION DATE: 04/30/2003
RESPS:80 HOURS:14 COSTS(000):$0
Fastener Quality Act Insignia Recordal Process
FORMS: PTO-1611
OMB NO: 0651-0030 EXPIRATION DATE: 03/31/2005
RESPS:20,250 HOURS:4,050 COSTS(000):$203
Disclosure Document Program
FORMS: PTO/SB/95
OMB NO: 0651-0031 EXPIRATION DATE: 04/30/2003
RESPS:2,247,270 HOURS:1,021,822 COSTS(000):$15,251
Patent Processing (Updating)
FORMS: PTO/SB/08A/08B 21/22/23/24/25 26/27/30/31/35 36/42/43/61
61/PCT/62/63/64 64PCT/67/68/91 92/96/97 PTO/SB/32/37
PTO-2053-A/B PTO-2054-A/B
OMB NO: 0651-0032 EXPIRATION DATE: 04/30/2003
RESPS:319,350 HOURS:2,984,360 COSTS(000):$75,095
Intial Patent Application
FORMS: PTO/SB/01/01A 02A/02B/02C/03 03A/04/05/06/07 13PCT/17/18/19
29/29A/101/102/ 103/104/105/106 107/108/109/110
OMB NO: 0651-0033 EXPIRATION DATE: 01/31/2004
RESPS:205,480 HOURS:63,640 COSTS(000):$1,540
Post Allowance and Refiling
FORMS: PTO/SB/44/50/51 51S/52/53/55/56 57/58 PTOL-85B
OMB NO: 0651-0034 EXPIRATION DATE: 03/31/2004
RESPS:2,194 HOURS:1,523 COSTS(000):$0
Secrecy, License to export
FORMS: NONE
OMB NO: 0651-0035 EXPIRATION DATE: 11/30/2005
RESPS:338,280 HOURS:31,259 COSTS(000):$170
Representative and Address Provisions
FORMS: PTO/SB/81 PTO/SB/82 PTO/SB/83 PTO/SB/121 PTO/SB/122 PTO/SB/123
PTO/SB/124A PTO/SB/124B PTP/SB/125A PTO/SB/125B
OMB NO: 0651-0036 EXPIRATION DATE: 04/30/2003
RESPS:73 HOURS:29 COSTS(000):$0
Statutory Invention Registration
FORMS: PTO-SB-94
OMB NO: 0651-0040 EXPIRATION DATE: 05/31/2004
RESPS:42,400 HOURS:11,500 COSTS(000):$3,471
Trademark Trail and Appeal Board (TTAB) Actions (formerly
PETITION TO CANCEL)
FORMS: NONE
OMB NO: 0651-0041 EXPIRATION DATE: 06/30/2005
RESPS:11,928 HOURS:1,397 COSTS(000):$4
Public User ID Badging (formerly Public Search Room Badging)
FORMS: PTO-2030
OMB NO: 0651-0042 EXPIRATION DATE: 09/30/2005
RESPS:5,000 HOURS:2,500 COSTS(000):$2
Electronic Application for Patent Examiners-Job Application
Rating System (JARS)
FORMS: PTO_2041
OMB NO: 0651-0043 EXPIRATION DATE: 02/28/2006
RESPS:327,308 HOURS:29,497 COSTS(000):$8
Payment of Patent and Trademark Office Fees by Credit Card
FORMS: PTO-2038
OMB NO: 0651-0044 EXPIRATION DATE: 09/30/2003
RESPS:100 HOURS:26 COSTS(000):$0
Invention Promoters/Promotion Firms Complaints
FORMS: PTO/SB/2048
OMB NO: 0651-0045 EXPIRATION DATE: 04/30/2003
RESPS:10,000 HOURS:5,000 COSTS(000):$0
Public Key Infrastructure (PK) Certificate Action Form
FORMS: PTO-2042
OMB NO: 0651-0046 EXPIRATION DATE: 03/31/2004
RESPS:187 HOURS:28 COSTS(000):$650
Legal Processes
FORMS: NONE
OMB NO: 0651-0047 EXPIRATION DATE: 03/31/2004
RESPS:100 HOURS:150 COSTS(000):$0
Required and Optional Search Criteria for Computer Implemented
Business Method Patent Applications in Class 705
FORMS: NONE
OMB NO: 0651-0048 EXPIRATION DATE: 03/31/2005
RESPS:400 HOURS:74 COSTS(000):$0
Native American Tribal Insignai Database
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
26 5,168,635 4,924,667 $79,151,362
National Telecommunications and Information Administration
OMB NO: 0660-0001 EXPIRATION DATE: 05/31/2003
RESPS:1,966 HOURS:7,836 COSTS(000):$0
Public Telecommunications Facilities Program Grant Monitoring
FORMS: NONE
OMB NO: 0660-0003 EXPIRATION DATE: 10/31/2003
RESPS:450 HOURS:40,250 COSTS(000):$0
Public Telecommunications Facilities Program (PTFP) Application
Form
FORMS: NONE
OMB NO: 0660-0010 EXPIRATION DATE: 04/30/2005
RESPS:252 HOURS:42 COSTS(000):$0
Technology Opportunities Program (TOP) Review Information Form
FORMS: NONE
OMB NO: 0660-0013 EXPIRATION DATE: 04/30/2005
RESPS:210 HOURS:210 COSTS(000):$0
Technology Opportunities Program (TOP) Grant Recipient Survey
FORMS: NONE
OMB NO: 0660-0015 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:1,492 COSTS(000):$0
Performance Reorting System (PRS) for the Technology
Opportunities Program (TOP)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 2,928 49,830 $0
Office of the Secretary
OMB NO: 0690-0018 EXPIRATION DATE: 02/29/2004
RESPS:33,750 HOURS:2,812 COSTS(000):$0
Applicant Background Survey
FORMS: NONE
OMB NO: 0690-0019 EXPIRATION DATE: 08/31/2004
RESPS:32,832 HOURS:32,832 COSTS(000):$0
Commerce Opportunity On-Line
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 66,582 35,644 $0
Bureau of Economic Analysis
OMB NO: 0691-0001 EXPIRATION DATE: 07/31/2003
RESPS:7,500 HOURS:1,875 COSTS(000):$0
BEA Customer Satisfaction Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 7,500 1,875 $0
Technology Administration
OMB NO: 0692-0001 EXPIRATION DATE: 12/31/2005
RESPS:105 HOURS:2,625 COSTS(000):$0
National Medal of Technology Nomination Application
FORMS: NONE
OMB NO: 0692-0006 EXPIRATION DATE: 06/30/2003
RESPS:1,900 HOURS:1,200 COSTS(000):$0
Licensing of Government-owned Inventions
FORMS: NONE
OMB NO: 0692-0009 EXPIRATION DATE: 04/30/2003
RESPS:7 HOURS:70 COSTS(000):$0
Commercial Space Launch Range User Requirements
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 2,012 3,895 $0
National Institute of Standards and Technology
OMB NO: 0693-0003 EXPIRATION DATE: 12/31/2003
RESPS:800 HOURS:2,200 COSTS(000):$0
National Voluntary Laboratory Accreditation Program (NVLAP),
NVLAP Information Collection System
FORMS: NONE
OMB NO: 0693-0006 EXPIRATION DATE: 10/31/2003
RESPS:100 HOURS:10,000 COSTS(000):$0
Malcolm Baldrige National Quality Award Application
FORMS: NONE
OMB NO: 0693-0009 EXPIRATION DATE: 12/31/2003
RESPS:1,000 HOURS:14,875 COSTS(000):$60
Advanced Technology Program
FORMS: NIST-1262 NIST-1263
OMB NO: 0693-0019 EXPIRATION DATE: 08/31/2005
RESPS:10 HOURS:30 COSTS(000):$0
National Voluntary Conformity Assessment System Evaluation
(NVCASE) Program
FORMS: NONE
OMB NO: 0693-0021 EXPIRATION DATE: 09/30/2005
RESPS:6,500 HOURS:1,083 COSTS(000):$0
Manufacturing Extension Partnership (MEP) Client Impact Surveys
FORMS: NONE
OMB NO: 0693-0031 EXPIRATION DATE: 12/31/2005
RESPS:6,000 HOURS:3,500 COSTS(000):$0
National Institute of Standards and Technology Three-Year
Generic Request for Customer Service-Related Data Collection
FORMS: NONE
OMB NO: 0693-0034 EXPIRATION DATE: 05/31/2003
RESPS:30 HOURS:120 COSTS(000):$0
Evaluation of the Common Industry Format (CIF) for Reporting the
Results of Usability Tests
FORMS: NONE
OMB NO: 0693-0035 EXPIRATION DATE: 05/31/2003
RESPS:1,440 HOURS:120 COSTS(000):$0
User Evaluation of DARPA Communicator systems
FORMS: NONE
OMB NO: 0693-0036 EXPIRATION DATE: 08/31/2004
RESPS:30 HOURS:1,875 COSTS(000):$6
BEES Please
FORMS: NONE
OMB NO: 0693-0037 EXPIRATION DATE: 10/31/2005
RESPS:240 HOURS:100 COSTS(000):$0
IRI/NIST Joint Study of Investment Decision Tools
FORMS: NONE
OMB NO: 0693-0038 EXPIRATION DATE: 12/31/2005
RESPS:79 HOURS:396 COSTS(000):$0
National Weights and Measures Benchmarking and Needs Assessment
FORMS: NONE
OMB NO: 0693-0040 EXPIRATION DATE: 03/31/2006
RESPS:547 HOURS:228 COSTS(000):$0
Survey of Advanced Technology Program Joint Venture Participants
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 16,776 34,527 $66
Bureau of Industry and Security
OMB NO: 0694-0001 EXPIRATION DATE: 12/31/2003
RESPS:21 HOURS:11 COSTS(000):$0
Exception to Reporting Requirements under the IC/DV Procedures
FORMS: NONE
OMB NO: 0694-0004 EXPIRATION DATE: 10/31/2004
RESPS:2 HOURS:510 COSTS(000):$0
Foreign Availability Procedures and Criteria
FORMS: NONE
OMB NO: 0694-0009 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Approval of Triangular Transactions Involving Commodities
Covered By A U.S. Import Certificate
FORMS: NONE
OMB NO: 0694-0012 EXPIRATION DATE: 07/31/2004
RESPS:1,177 HOURS:1,298 COSTS(000):$0
Report of Requests for Restrictive Trade Practice or Boycott--
Single or Multiple Transactions
FORMS: BXA-621P BXA-6051P
OMB NO: 0694-0013 EXPIRATION DATE: 03/31/2005
RESPS:80 HOURS:43 COSTS(000):$0
Computers and Related Equipment
FORMS: NONE
OMB NO: 0694-0016 EXPIRATION DATE: 08/31/2004
RESPS:100 HOURS:31 COSTS(000):$0
Delivery Vertification Procedure
FORMS: BXA-647P
OMB NO: 0694-0017 EXPIRATION DATE: 05/31/2004
RESPS:585 HOURS:156 COSTS(000):$0
International Import Certificate
FORMS: FORM-BXA-645P
OMB NO: 0694-0021 EXPIRATION DATE: 02/28/2006
RESPS:3,594 HOURS:959 COSTS(000):$0
Statement by Ultimate Consignee and Purchaser
FORMS: 711
OMB NO: 0694-0023 EXPIRATION DATE: 08/31/2004
RESPS:200 HOURS:104 COSTS(000):$0
Written Assurances for Exports of Technical Data Under License
Exception TSR
FORMS: NONE
OMB NO: 0694-0025 EXPIRATION DATE: 04/30/2004
RESPS:35 HOURS:35 COSTS(000):$0
Short Supply Regulations - Unprocessed Western Red Cedar
FORMS: NONE
OMB NO: 0694-0026 EXPIRATION DATE: 04/30/2005
RESPS:1 HOURS:1 COSTS(000):$0
Short Supply Regulations, Petroleum Products
FORMS: NONE
OMB NO: 0694-0027 EXPIRATION DATE: 05/31/2004
RESPS:15 HOURS:104 COSTS(000):$0
Short Supply Regulations, Petroleum (Crude Oil)
FORMS: NONE
OMB NO: 0694-0029 EXPIRATION DATE: 12/31/2003
RESPS:3 HOURS:1 COSTS(000):$0
License Exception TMP: Special Requirements
FORMS: NONE
OMB NO: 0694-0031 EXPIRATION DATE: 12/31/2003
RESPS:100 HOURS:27 COSTS(000):$0
Application for a Duplicate License
FORMS: NONE
OMB NO: 0694-0033 EXPIRATION DATE: 05/31/2004
RESPS:10 HOURS:10 COSTS(000):$0
License Exception, Humanitarian Donations
FORMS: NONE
OMB NO: 0694-0047 EXPIRATION DATE: 03/31/2005
RESPS:2,896 HOURS:3,602 COSTS(000):$0
Technology Letter of Explanation
FORMS: NONE
OMB NO: 0694-0051 EXPIRATION DATE: 07/31/2004
RESPS:10 HOURS:11 COSTS(000):$0
Application for Transfer of License to Another Party
FORMS: NONE
OMB NO: 0694-0053 EXPIRATION DATE: 12/31/2003
RESPS:707,000 HOURS:14,477 COSTS(000):$0
Defense Priorities and Allocations System
FORMS: NONE
OMB NO: 0694-0057 EXPIRATION DATE: 03/31/2004
RESPS:1,200 HOURS:600 COSTS(000):$0
Request for Special Priorities Assistance
FORMS: BXA-999
OMB NO: 0694-0058 EXPIRATION DATE: 08/31/2004
RESPS:80 HOURS:800 COSTS(000):$0
Procedure for Voluntary Self-Disclosure of Violations of the
Export Administration Regulations
FORMS: NONE
OMB NO: 0694-0073 EXPIRATION DATE: 05/31/2005
RESPS:22 HOURS:78 COSTS(000):$0
Export Controls of High Performance Computers
FORMS: NONE
OMB NO: 0694-0083 EXPIRATION DATE: 06/30/2005
RESPS:3,000 HOURS:1,500 COSTS(000):$0
Competitive Enhancement Needs Assessment Survey Program
FORMS: NONE
OMB NO: 0694-0084 EXPIRATION DATE: 12/31/2005
RESPS:100 HOURS:1,000 COSTS(000):$0
Military Exports
FORMS: NONE
OMB NO: 0694-0086 EXPIRATION DATE: 06/30/2003
RESPS:160 HOURS:23 COSTS(000):$0
Report of Sample Shipments of Chemical Weapon Recursors
FORMS: NONE
OMB NO: 0694-0088 EXPIRATION DATE: 04/30/2005
RESPS:14,191 HOURS:12,777 COSTS(000):$105
Multipurpose Application
FORMS: BXA-748P
OMB NO: 0694-0089 EXPIRATION DATE: 07/31/2004
RESPS:867 HOURS:1,017 COSTS(000):$0
Special Comprehensive License
FORMS: BXA-748P BXA-752P
OMB NO: 0694-0091 EXPIRATION DATE: 04/30/2003
RESPS:792 HOURS:27,020 COSTS(000):$43,732
Chemical Weapons Convention Declaration Forms, Inspections and
FORMS: FORM1-1 FORM1-2 FORM1-2A FORM1-2B FORM1-4 FORM-A FORM-B FORM2-1
FORM2-2
OMB NO: 0694-0092 EXPIRATION DATE: 10/31/2004
RESPS:700,000 HOURS:21,963 COSTS(000):$0
Procedures for Acceptance or Rejection of Rated Order
FORMS: NONE
OMB NO: 0694-0093 EXPIRATION DATE: 04/30/2005
RESPS:6,900 HOURS:1,957 COSTS(000):$0
Import Certificates and End-User Certificates
FORMS: NONE
OMB NO: 0694-0096 EXPIRATION DATE: 10/31/2004
RESPS:201,177 HOURS:249 COSTS(000):$0
Five Year Records Retention Period
FORMS: NONE
OMB NO: 0694-0100 EXPIRATION DATE: 09/30/2005
RESPS:1 HOURS:5 COSTS(000):$0
For the Appointment of a Technical Advisory Committee
FORMS: NONE
OMB NO: 0694-0101 EXPIRATION DATE: 05/31/2004
RESPS:35 HOURS:875 COSTS(000):$0
One-time Report For Foreign Software or Technology Eligible For
De Minimis Exclusion
FORMS: NONE
OMB NO: 0694-0102 EXPIRATION DATE: 09/30/2005
RESPS:2 HOURS:10 COSTS(000):$0
Miscellaneous Activities
FORMS: NONE
OMB NO: 0694-0104 EXPIRATION DATE: 04/30/2003
RESPS:234 HOURS:1,372 COSTS(000):$0
Commercial Encryption Items under the Jurisdiction of the
FORMS: BXA-748P
OMB NO: 0694-0106 EXPIRATION DATE: 07/31/2004
RESPS:3,050 HOURS:559 COSTS(000):$0
Reporting and Recordkeeping Requirements under the Wassenaar
Arrangement
FORMS: NONE
OMB NO: 0694-0107 EXPIRATION DATE: 03/31/2005
RESPS:140 HOURS:35 COSTS(000):$0
National Defense Authorization Act
FORMS: BXA-742R BXA-742S
OMB NO: 0694-0114 EXPIRATION DATE: 02/28/2006
RESPS:1,100 HOURS:550 COSTS(000):$0
Firearms Convention
FORMS: BXA-748P
OMB NO: 0694-0117 EXPIRATION DATE: 04/30/2003
RESPS:356 HOURS:176 COSTS(000):$0
Chemical Weapons Convention, Amendment to the Export
Administration Regulation (End-Use Certificates and Advance
Notifications and Annual Reports)
FORMS: NONE
OMB NO: 0694-0119 EXPIRATION DATE: 09/30/2005
RESPS:6,000 HOURS:24,000 COSTS(000):$0
National Security and Critical Technology Assessments of the US
Industrial Base
FORMS: NONE
OMB NO: 0694-0120 EXPIRATION DATE: 12/31/2005
RESPS:1 HOURS:3,000 COSTS(000):$0
Procedure to initiate an Investigation Under the Trade Expansion
Act of 1962
FORMS: NONE
OMB NO: 0694-0122 EXPIRATION DATE: 12/31/2005
RESPS:1,427,450 HOURS:70,104 COSTS(000):$0
Licensing Responsibilities and Equipment
FORMS: NONE
OMB NO: 0694-0123 EXPIRATION DATE: 03/31/2005
RESPS:100 HOURS:93 COSTS(000):$0
Prior Notification of Exports Under License Exception AGR
FORMS: BXA-748P
OMB NO: 0694-0125 EXPIRATION DATE: 09/30/2003
RESPS:3,900 HOURS:650 COSTS(000):$0
BIS Program Evaluation
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
43 3,086,688 191,794 $43,837
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
390 58,802,663 17,610,334 $79,213,010
Department of Defense
Department of the Air Force
OMB NO: 0701-0001 EXPIRATION DATE: 10/31/2003
RESPS:2,900 HOURS:8,700 COSTS(000):$0
Application for Training Leading to a Commission in the United
States Air Force
FORMS: AF-56
OMB NO: 0701-0026 EXPIRATION DATE: 09/30/2004
RESPS:16,200 HOURS:8,100 COSTS(000):$0
Nomination for Appointment to the United States Military
Academy, Naval Academy, and Air Force Academy
FORMS: DD-1870
OMB NO: 0701-0050 EXPIRATION DATE: 02/29/2004
RESPS:3,600 HOURS:1,800 COSTS(000):$0
Civil Aircraft Landing Permit System
FORMS: DD-2400 DD-2401 DD-2402
OMB NO: 0701-0063 EXPIRATION DATE: 01/31/2004
RESPS:7,010 HOURS:5,258 COSTS(000):$0
Air Force Academy Candidate Activities Record
FORMS: USAF-147
OMB NO: 0701-0064 EXPIRATION DATE: 01/31/2004
RESPS:7,233 HOURS:3,617 COSTS(000):$0
Air Force Academy Candidate Personal Data Record
FORMS: USAFA-146
OMB NO: 0701-0066 EXPIRATION DATE: 02/29/2004
RESPS:6,954 HOURS:3,477 COSTS(000):$0
Air Force Academy Request for Secondary School Transcript
FORMS: USAFA-148
OMB NO: 0701-0070 EXPIRATION DATE: 01/31/2004
RESPS:30,000 HOURS:2,666 COSTS(000):$0
Family Support Center Information
FORMS: AIR-FORCE-2800 AIR-FORCE-2801 AIR-FORCE-2805
OMB NO: 0701-0078 EXPIRATION DATE: 01/31/2004
RESPS:3,600 HOURS:3,600 COSTS(000):$0
Health Professions Accessions Forms
FORMS: AETC-1402 AETC-1437
OMB NO: 0701-0079 EXPIRATION DATE: 12/31/2003
RESPS:110,231 HOURS:69,105 COSTS(000):$0
Non-Prior Service and Prior Service Accessions
FORMS: AETC-1319 AETC-1325 AETC-1419
OMB NO: 0701-0080 EXPIRATION DATE: 01/31/2004
RESPS:1,200 HOURS:1,500 COSTS(000):$0
Air Force Officer Training School (OTS) Accession Forms
FORMS: AETC-1413 AETC-1422
OMB NO: 0701-0087 EXPIRATION DATE: 03/31/2005
RESPS:9,850 HOURS:3,940 COSTS(000):$0
United States Air Force Academy Application
FORMS: USAFA-149
OMB NO: 0701-0096 EXPIRATION DATE: 11/30/2004
RESPS:5,899 HOURS:1,966 COSTS(000):$0
Application for Appointment as Reserve of the Air Force or USAF
Without Component
FORMS: AF-24
OMB NO: 0701-0101 EXPIRATION DATE: 05/31/2004
RESPS:8,000 HOURS:4,000 COSTS(000):$0
Air Force ROTC College Scholarship Application
FORMS: AF-113
OMB NO: 0701-0103 EXPIRATION DATE: 04/30/2004
RESPS:500 HOURS:350 COSTS(000):$0
Air Force ROTC Scholarship Nomination
FORMS: AFOATS-36
OMB NO: 0701-0105 EXPIRATION DATE: 04/30/2004
RESPS:12,000 HOURS:4,000 COSTS(000):$0
Application for Air Force ROTC Membership
FORMS: AFOATS-20
OMB NO: 0701-0114 EXPIRATION DATE: 04/30/2004
RESPS:40 HOURS:20 COSTS(000):$0
Application for Establishment of Air Force Junior ROTC Unit
FORMS: AFOATS-59
OMB NO: 0701-0127 EXPIRATION DATE: 08/31/2003
RESPS:255 HOURS:64 COSTS(000):$0
USAF Museum System Volunteer Application/Registration
FORMS: AF-3569
OMB NO: 0701-0134 EXPIRATION DATE: 07/31/2004
RESPS:144 HOURS:144 COSTS(000):$0
Request for Approval of Foreign Government Employment of Air
Force Members
FORMS: NONE
OMB NO: 0701-0136 EXPIRATION DATE: 08/31/2005
RESPS:500 HOURS:167 COSTS(000):$0
Community College of the Air Force Alumni Survey
FORMS: NONE
OMB NO: 0701-0137 EXPIRATION DATE: 04/30/2003
RESPS:15 HOURS:300 COSTS(000):$0
Commercial Airlift Review
FORMS: AMC-207
OMB NO: 0701-0141 EXPIRATION DATE: 06/30/2004
RESPS:4,000 HOURS:1,000 COSTS(000):$0
Intercontinental Ballistic Missile Hardened Intersite Cable
System Right-of-Way Landowner/Tenant Questionnaire
FORMS: AF-3951
OMB NO: 0701-0146 EXPIRATION DATE: 07/31/2004
RESPS:200 HOURS:17 COSTS(000):$0
Customer Comment Card, Air Force Form 3211
FORMS: 3211
OMB NO: 0701-0147 EXPIRATION DATE: 05/31/2003
RESPS:4,100 HOURS:4,100 COSTS(000):$0
USAF Academy Candidate Writing Sample
FORMS: USAFA-0878
OMB NO: 0701-0149 EXPIRATION DATE: 03/31/2005
RESPS:441 HOURS:110 COSTS(000):$0
Air Force Research Laboratory Public Awareness Survey
FORMS: NONE
OMB NO: 0701-0150 EXPIRATION DATE: 10/31/2005
RESPS:1,300,000 HOURS:1,386,413 COSTS(000):$0
Air Force Recruiting Information Support System (AFRISS)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
25 1,534,872 1,514,414 $0
Department of the Army
OMB NO: 0702-0018 EXPIRATION DATE: 10/31/2003
RESPS:6,320 HOURS:3,160 COSTS(000):$0
Uniform Tender of Rates and/or Charges for Domestic
Transportation Services (DoD/USCG Sponsored Household Goods)
FORMS: MT-HQ-FORM-43-R
OMB NO: 0702-0021 EXPIRATION DATE: 07/31/2005
RESPS:70 HOURS:70 COSTS(000):$0
Application and Contract for Establishment of a Junior Reserve
Officers' Training Corps United
FORMS: DA-FORM-3126
OMB NO: 0702-0022 EXPIRATION DATE: 10/31/2003
RESPS:441,677 HOURS:70,548 COSTS(000):$0
Tender of Service and Letter of Intent for Personal Property
Household Goods and Unaccompanied Baggage Shipments
FORMS: DD-FORM-619 DD-FORM-619-1
OMB NO: 0702-0027 EXPIRATION DATE: 01/31/2006
RESPS:75,000 HOURS:3,750 COSTS(000):$0
Signature and Tally Record
FORMS: DD-1907
OMB NO: 0702-0060 EXPIRATION DATE: 02/28/2006
RESPS:66,200 HOURS:8,350 COSTS(000):$0
Pre-Candidate Procedures
FORMS: USMA-375 USMA-723 USMA-450 USMA-21-12 USMA-21-27 USMA-381
OMB NO: 0702-0061 EXPIRATION DATE: 02/28/2006
RESPS:92,525 HOURS:11,720 COSTS(000):$0
Candidate Procedures
FORMS: 21-16 21-23 21-25 21-26 5-520 5-518 FL546 FL481 5-2 5-26
OMB NO: 0702-0062 EXPIRATION DATE: 02/28/2006
RESPS:16,600 HOURS:1,937 COSTS(000):$0
Offered Candidate Procedures
FORMS: 5-490 2-66 847 5-489 5-519 8-2 6-154 5-515 534 5-516
OMB NO: 0702-0073 EXPIRATION DATE: 02/28/2006
RESPS:11,000 HOURS:8,250 COSTS(000):$0
U.S. Army ROTC 4-year College Scholarship Application (for High
School Students)
FORMS: CC-114-R
OMB NO: 0702-0115 EXPIRATION DATE: 12/31/2003
RESPS:2,240 HOURS:784 COSTS(000):$0
Survey of Army Applicants who were Qualified not Enlisted (QNE)
or Those Who Entered the Delayed Entry Program (DEP) But Chose
Not to Enlist
FORMS: NONE
OMB NO: 0702-0116 EXPIRATION DATE: 12/31/2004
RESPS:519 HOURS:218 COSTS(000):$0
West Point Engineering Graduates Surveys
FORMS: NONE
OMB NO: 0702-0117 EXPIRATION DATE: 03/31/2006
RESPS:1,500 HOURS:375 COSTS(000):$0
Evaluation of Army Benefits Center - Civilian (ABC-C) Retirement
System
FORMS: NONE
OMB NO: 0702-0118 EXPIRATION DATE: 03/31/2006
RESPS:2,500 HOURS:292 COSTS(000):$0
Evaluation of Reasons for Non-Acceptance of Department of Army
Civilian Job Offers
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 716,151 109,454 $0
Department of the Navy
OMB NO: 0703-0011 EXPIRATION DATE: 09/30/2004
RESPS:2,500 HOURS:625 COSTS(000):$0
Academic Certification for Marine Corps Officer Candidate Program
FORMS: NAVMC-10469
OMB NO: 0703-0016 EXPIRATION DATE: 09/30/2004
RESPS:440 HOURS:220 COSTS(000):$0
Individual MCJROTC Instructor Evaluation Summary
FORMS: NAVMC-10942
OMB NO: 0703-0020 EXPIRATION DATE: 09/30/2005
RESPS:2,700 HOURS:2,025 COSTS(000):$0
Enlistee Financial Statement
FORMS: NAVCRUIT-1130/ 13
OMB NO: 0703-0028 EXPIRATION DATE: 09/30/2005
RESPS:40,000 HOURS:10,000 COSTS(000):$0
NROTC Applicant Questionaire
FORMS: NAVCRUIT-1131/6
OMB NO: 0703-0052 EXPIRATION DATE: 12/31/2003
RESPS:65,000 HOURS:13,000 COSTS(000):$0
United States Navy Illicit Behavior Screening Certificate
FORMS: NAVCRUIT-1133/ 65
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 110,640 25,870 $0
Departmental and Others
OMB NO: 0704-0003 EXPIRATION DATE: 09/30/2003
RESPS:28,000 HOURS:14,000 COSTS(000):$0
Application for Correction of Military Records Under the
Provisions of Title 10, U.S. Code, Section 1552
FORMS: DD-149
OMB NO: 0704-0004 EXPIRATION DATE: 11/30/2003
RESPS:8,000 HOURS:6,000 COSTS(000):$0
Application for the Review of Discharge or Dismissal from the
Armed Forces of the United States
FORMS: DD-293
OMB NO: 0704-0006 EXPIRATION DATE: 11/30/2004
RESPS:100,000 HOURS:8,300 COSTS(000):$0
Request for Verification of Birth
FORMS: DD-372
OMB NO: 0704-0007 EXPIRATION DATE: 02/29/2004
RESPS:125,000 HOURS:56,250 COSTS(000):$5
Policy Record Check
FORMS: DD-369
OMB NO: 0704-0020 EXPIRATION DATE: 07/31/2005
RESPS:1,690,048 HOURS:281,675 COSTS(000):$0
Application for Uniformed Services Identification Card -- DEERS
Enrollment
FORMS: DD-FORM-1172
OMB NO: 0704-0055 EXPIRATION DATE: 10/31/2004
RESPS:610 HOURS:610 COSTS(000):$0
Department of Defense Application for Priority Rating for
Production or Construction Equipment
FORMS: DD-691
OMB NO: 0704-0100 EXPIRATION DATE: 10/31/2004
RESPS:3,000 HOURS:1,500 COSTS(000):$2
Application for Discharge of Member of Survivor of Member of
Group Certified to Have Performed Active Duty with the Armed
Forces of the United States
FORMS: DD-2168
OMB NO: 0704-0125 EXPIRATION DATE: 09/30/2004
RESPS:2,403 HOURS:401 COSTS(000):$0
Post-election Survey of Overseas Citizens, Post-election Survey
of Local Election Officials
FORMS: NONE
OMB NO: 0704-0152 EXPIRATION DATE: 05/31/2003
RESPS:27,000 HOURS:4,500 COSTS(000):$0
DOD Educational Loan Repayment Program (LRP)
FORMS: DD-2475
OMB NO: 0704-0167 EXPIRATION DATE: 11/30/2004
RESPS:43,000 HOURS:7,167 COSTS(000):$0
Request for Reference
FORMS: DD-370
OMB NO: 0704-0173 EXPIRATION DATE: 09/30/2003
RESPS:510,000 HOURS:170,000 COSTS(000):$0
Record of Military Processing - Armed Forces of the United States
FORMS: 1966
OMB NO: 0704-0187 EXPIRATION DATE: 12/31/2005
RESPS:1,954,238 HOURS:9,870,858 COSTS(000):$0
Information Collection in Support of the DOD Acquisition Process
FORMS: NONE
OMB NO: 0704-0190 EXPIRATION DATE: 02/28/2006
RESPS:797 HOURS:614 COSTS(000):$0
Appointment of Chaplains for the Military Services
FORMS: DD-2741 DD-2088
OMB NO: 0704-0194 EXPIRATION DATE: 06/30/2004
RESPS:6,400 HOURS:9,493 COSTS(000):$0
Department of Defense Security Agreement, Appendage, and
Certificate Pertaining to Foreign Interests
FORMS: DD-441 DD-441-1 SF-328
OMB NO: 0704-0207 EXPIRATION DATE: 10/31/2004
RESPS:6,000 HOURS:2,000 COSTS(000):$0
Militarily Critical Technical Data Agreement
FORMS: DD-2345
OMB NO: 0704-0214 EXPIRATION DATE: 09/30/2005
RESPS:53,160 HOURS:765,498 COSTS(000):$0
Defense Federal Acquisition Reguilation Supplement (DFARS) Part
217, Special Contracting Methods, and related provisions and
clauses in DFARS 252.217
FORMS: NONE
OMB NO: 0704-0216 EXPIRATION DATE: 08/31/2003
RESPS:49 HOURS:859 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
228, Bonds and Insurance, and related clauses at 252.228
FORMS: NONE
OMB NO: 0704-0225 EXPIRATION DATE: 08/31/2004
RESPS:22,602 HOURS:13,758 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement Part 204,
Administrative Matters, and related clauses at 252.204
FORMS: DD-2051 DD-2051-1
OMB NO: 0704-0229 EXPIRATION DATE: 03/31/2004
RESPS:223,942 HOURS:374,268 COSTS(000):$0
Defense Federal Acquisition Supplement Part 225, Foreign
Acquisition, and related clauses at Part 252.225.
FORMS: DD-2139
OMB NO: 0704-0231 EXPIRATION DATE: 06/30/2004
RESPS:800 HOURS:400 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS)
Subpart 237.70, Mortuary Services, DFARS clause 252.237-7011,
Preparation History, and DD Form 2063, Record of Preparation...
FORMS: DD-2063
OMB NO: 0704-0232 EXPIRATION DATE: 08/31/2004
RESPS:141 HOURS:5,350 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS)
Subpart 215.8, Price Negotiation, and related clauses at 252.215.
FORMS: NONE
OMB NO: 0704-0245 EXPIRATION DATE: 07/31/2004
RESPS:464,682 HOURS:149,874 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
247, Transportation, and related clauses at 252.247
FORMS: NONE
OMB NO: 0704-0246 EXPIRATION DATE: 02/28/2006
RESPS:42,497 HOURS:50,170 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
245, Government Property, related clauses in DFARS 252, and
related forms in DFARS 253
FORMS: DD-FORM-1149 1149C 1342 1419 1637 1639 1640 1662
OMB NO: 0704-0248 EXPIRATION DATE: 10/31/2004
RESPS:7,800,000 HOURS:988,000 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement, Appendix F,
Material Inspection and Receiving Report
FORMS: DD-250 DD-250C DD-250-1
OMB NO: 0704-0250 EXPIRATION DATE: 02/28/2006
RESPS:86,215 HOURS:217,645 COSTS(000):$0
Defense Federal Acquisition Regulation Supplment (DFARS) Part
242, Contract Administration, related clauses in DFARS 252, and
related forms in DFARS 253
FORMS: DD-FORM-1659
OMB NO: 0704-0252 EXPIRATION DATE: 10/31/2004
RESPS:10,500 HOURS:5,250 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement, Use of
Government Sources by Contractors, and related clauses in Part
252
FORMS: NONE
OMB NO: 0704-0253 EXPIRATION DATE: 07/31/2004
RESPS:90 HOURS:1,440 COSTS(000):$0
Subcontracting Policies and Procedures - DOD FAR Supplement Part
244
FORMS: NONE
OMB NO: 0704-0255 EXPIRATION DATE: 10/31/2004
RESPS:2,740 HOURS:276,625 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement Part 236,
Construction and Architect-Engineer Contracts, and Related
Clauses at 252.236
FORMS: NONE
OMB NO: 0704-0259 EXPIRATION DATE: 06/30/2005
RESPS:136 HOURS:552 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
216, Types of Contracts, and related clauses at 252.216
FORMS: NONE
OMB NO: 0704-0261 EXPIRATION DATE: 08/31/2005
RESPS:21,563 HOURS:5,391 COSTS(000):$0
Department of Defense Standard Tender of Freight Services
FORMS: MT-364-R
OMB NO: 0704-0264 EXPIRATION DATE: 06/30/2004
RESPS:2,000 HOURS:833 COSTS(000):$0
Registration for Scientific and Technical Information Services
FORMS: DD-1540
OMB NO: 0704-0267 EXPIRATION DATE: 04/30/2004
RESPS:42,058 HOURS:420,580 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
230, Cost Accounting Standards Administration, and DD Form 1861,
Contract Facilities Capital Cost of Money
FORMS: DD-1861
OMB NO: 0704-0272 EXPIRATION DATE: 08/31/2004
RESPS:14,726 HOURS:9,997 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS)
Subpart 223, Environment, Conservation, and Occupational Safety;
and Related Clauses at DFARS Part 252
FORMS: NONE
OMB NO: 0704-0286 EXPIRATION DATE: 08/31/2004
RESPS:6,153 HOURS:6,153 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement Part 205,
Publicizing Contract Actions, and DFARS 252.205-7000, Provision
of Information to Cooperative Acreement Holders
FORMS: NONE
OMB NO: 0704-0290 EXPIRATION DATE: 06/30/2003
RESPS:43,000 HOURS:5,547 COSTS(000):$0
Armed Forces Participation in Public Events
FORMS: DD-2535 DD-2536
OMB NO: 0704-0305 EXPIRATION DATE: 09/30/2003
RESPS:3,940 HOURS:4,815 COSTS(000):$0
Telecommunications Service Priority System
FORMS: SF-314 SF-315 SF-317 SF-318 SF-319
OMB NO: 0704-0320 EXPIRATION DATE: 07/31/2005
RESPS:178 HOURS:1,246 COSTS(000):$0
Procurement Technical Assistance Center Cooperative Agreement
Performance Report
FORMS: DLA-1806
OMB NO: 0704-0321 EXPIRATION DATE: 05/31/2003
RESPS:5,160 HOURS:7,740 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
232, contract Financing, and the clause at DFARS 252.232-7002
Progress Payments for Foreign Military Sales Acquisition
FORMS: NONE
OMB NO: 0704-0323 EXPIRATION DATE: 07/31/2003
RESPS:293,401 HOURS:12,030 COSTS(000):$0
Third Party Collection Program (Record of Other Health Insurance)
FORMS: DD-2569
OMB NO: 0704-0324 EXPIRATION DATE: 05/31/2004
RESPS:1,165 HOURS:276 COSTS(000):$0
Department of Defense Public and Community Service (PACS) Program
FORMS: 2581 2581-1
OMB NO: 0704-0328 EXPIRATION DATE: 05/31/2005
RESPS:102,000 HOURS:10,200 COSTS(000):$0
DOD Building Pass Application
FORMS: DD-2249
OMB NO: 0704-0332 EXPIRATION DATE: 03/31/2004
RESPS:393 HOURS:931 COSTS(000):$0
Defense Federal Acquistion Regualtion Supplement (DFARS)
Appendix I - - DOD Pilot Mentor Protege Program
FORMS: NONE
OMB NO: 0704-0334 EXPIRATION DATE: 09/30/2004
RESPS:5,000 HOURS:1,667 COSTS(000):$0
Automated Repatriation Reporting System
FORMS: DD-FORM_2585
OMB NO: 0704-0336 EXPIRATION DATE: 10/31/2004
RESPS:15,152 HOURS:821,052 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS)
223.570, Drug-Free Work Force, and DFARS clause 252.223-7004,
Drug-Free Work Force
FORMS: NONE
OMB NO: 0704-0341 EXPIRATION DATE: 10/31/2004
RESPS:1,598 HOURS:1,806 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
239, Acquisition of Information Technology, and associated
clauses at DFARS 252.239-7000 and 252.239-7006
FORMS: NONE
OMB NO: 0704-0347 EXPIRATION DATE: 06/30/2003
RESPS:81 HOURS:7 COSTS(000):$0
Request for Approval for Qualification Training and Approval of
Contractor Flight Crewmember
FORMS: DD-2627 DD-2628
OMB NO: 0704-0357 EXPIRATION DATE: 12/31/2005
RESPS:756 HOURS:126 COSTS(000):$0
Validation of Public or Community Service Employment Performed
by Retired Personnel Retired Under the Temporary Early
Retirement Authority (TERA) for Increased Retirement Compensation
FORMS: 2676
OMB NO: 0704-0359 EXPIRATION DATE: 08/31/2004
RESPS:800 HOURS:800 COSTS(000):$0
Defense Federal Acqusition Regulation Supplement (DFARS) Part
232 Contract Financing, and related clause at DFARS
252.232-7007, Limitation of Government's Obligation
FORMS: NONE
OMB NO: 0704-0364 EXPIRATION DATE: 06/30/2005
RESPS:808 HOURS:202 COSTS(000):$0
Continued Health Care Benefit Program (CHCBP) Application
FORMS: DD-2837
OMB NO: 0704-0366 EXPIRATION DATE: 03/31/2004
RESPS:185 HOURS:1,619 COSTS(000):$0
National Security Education Program (NSEP Grants to Institutions
of Higher Education)
FORMS: DD-2729 DD-2730
OMB NO: 0704-0367 EXPIRATION DATE: 05/31/2004
RESPS:9,314 HOURS:4,657 COSTS(000):$17
Indebtedness of Military Personnel -Involuntary Allotments
FORMS: DD-2653
OMB NO: 0704-0368 EXPIRATION DATE: 03/31/2004
RESPS:600 HOURS:100 COSTS(000):$0
National Security Education Program (Service Agreement Report
for Scholarshi8p and Fellowship Awards)
FORMS: DD-2752 DD-2753
OMB NO: 0704-0369 EXPIRATION DATE: 11/30/2003
RESPS:1,185,005 HOURS:4,320,447 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement Subparts
227.72, Rights in Computer Software and Computer Software
Documentation; and related clauses and provisions at 252.227
FORMS: NONE
OMB NO: 0704-0370 EXPIRATION DATE: 03/31/2005
RESPS:25,120 HOURS:4,127 COSTS(000):$15
Department of Defense Dependents Schools (DoDDS) Overseas
Employment Opportunities for Education
FORMS: DS-5010 DS-5011 DS-5013 DS-5012
OMB NO: 0704-0380 EXPIRATION DATE: 08/31/2004
RESPS:7,500 HOURS:500 COSTS(000):$0
Commissary Customer Service Survey
FORMS: DECA-60-28
OMB NO: 0704-0382 EXPIRATION DATE: 12/31/2004
RESPS:40,000 HOURS:13,200 COSTS(000):$0
End-Use Certificate
FORMS: DLA-1822
OMB NO: 0704-0384 EXPIRATION DATE: 03/31/2006
RESPS:32,164 HOURS:8,041 COSTS(000):$0
DOD Request for Personnel Security Investigations
FORMS: DD-1879
OMB NO: 0704-0386 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:41 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
219, Small Business Programs and Associated Clauses in Part
252.219
FORMS: NONE
OMB NO: 0704-0390 EXPIRATION DATE: 03/31/2005
RESPS:22 HOURS:88 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
229, Taxes, and related clauses at 252.229
FORMS: NONE
OMB NO: 0704-0391 EXPIRATION DATE: 08/31/2003
RESPS:20 HOURS:20 COSTS(000):$0
Defense Export Loan Guarantee (DELG) Application
FORMS: DD-2747
OMB NO: 0704-0394 EXPIRATION DATE: 06/30/2003
RESPS:800 HOURS:200 COSTS(000):$0
Defense Reutilization and Marketing Service Customer Comment Card
FORMS: NONE
OMB NO: 0704-0395 EXPIRATION DATE: 07/31/2003
RESPS:10,000 HOURS:833 COSTS(000):$0
Pentagon Reservation Parking Permit Application
FORMS: DD-1199
OMB NO: 0704-0396 EXPIRATION DATE: 08/31/2003
RESPS:19,000 HOURS:19,000 COSTS(000):$0
Department of Defense Medical Examiniation Review Board Medical
Information Collection Forms
FORMS: DD-2351/-2369 DD-2370/-2372 DD-2374/-2375 DD-2378/-2379
DD-2380/-2381 DD-2382/-2383 DD-2480/-2489 DD-2492/-2632
OMB NO: 0704-0397 EXPIRATION DATE: 02/28/2006
RESPS:440 HOURS:2,120 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS) Part
243, Contract Modification and related clause at DFARS
252.243-7002
FORMS: NONE
OMB NO: 0704-0398 EXPIRATION DATE: 08/31/2004
RESPS:771 HOURS:771 COSTS(000):$0
Substitutions for Military or Federal Specifications and
Standards, Defense Federal Acquisition Regulation Supplement
(DFARS) Section 211.273, and related clause in DFARS 272.211-7005
FORMS: NONE
OMB NO: 0704-0400 EXPIRATION DATE: 12/31/2003
RESPS:300,000 HOURS:150,000 COSTS(000):$0
Central Contractor Registration (CCR)
FORMS: NONE
OMB NO: 0704-0402 EXPIRATION DATE: 11/30/2004
RESPS:200 HOURS:200 COSTS(000):$2
Application for Annuity - Certain Military Surviving Spouses
FORMS: DD-2769
OMB NO: 0704-0403 EXPIRATION DATE: 08/31/2004
RESPS:2,492 HOURS:415 COSTS(000):$0
Customer Satisfaction Survey - Generic Clearance
FORMS: NONE
OMB NO: 0704-0407 EXPIRATION DATE: 05/31/2005
RESPS:50,000 HOURS:5,000 COSTS(000):$0
Commissary Evaluation and Utility Surveys - Generic
FORMS: NONE
OMB NO: 0704-0411 EXPIRATION DATE: 05/31/2003
RESPS:16,470 HOURS:7,400 COSTS(000):$2
Exceptional Family Member Program
FORMS: DD-2792
OMB NO: 0704-0412 EXPIRATION DATE: 07/31/2003
RESPS:145 HOURS:435 COSTS(000):$0
Defense Federal Acquisition Regulation Supplement (DFARS)
Appendix I, DOD Pilot Mentor Protege Program Improvements
FORMS: NONE
OMB NO: 0704-0413 EXPIRATION DATE: 08/31/2003
RESPS:850,000 HOURS:135,833 COSTS(000):$0
Medical Screening of Military Personnel
FORMS: DD-2807-1 DD-2807-2
OMB NO: 0704-0415 EXPIRATION DATE: 03/31/2004
RESPS:300,000 HOURS:100,000 COSTS(000):$0
Application for Department of Defense Common Access Card - Deers
Enrollment
FORMS: DD-1172-2
OMB NO: 0704-0416 EXPIRATION DATE: 12/31/2003
RESPS:1,000 HOURS:2,500 COSTS(000):$0
Defense Systems Management College (DSMC) Information Technology
Study
FORMS: NONE
OMB NO: 0704-0417 EXPIRATION DATE: 09/30/2004
RESPS:11,000 HOURS:13,750 COSTS(000):$0
Personnel Security Investigation Projection for Industry Survey
FORMS: DSS-232
OMB NO: 0704-0418 EXPIRATION DATE: 02/29/2004
RESPS:225.800 HOURS:45,160 COSTS(000):$0
Personnel Security Clearance Change Notification
FORMS: DISCOFORM562
OMB NO: 0704-0420 EXPIRATION DATE: 04/30/2004
RESPS:2,880 HOURS:144 COSTS(000):$0
Interactive Customer Evaluation System (ICE)
FORMS: NONE
OMB NO: 0704-0421 EXPIRATION DATE: 03/31/2005
RESPS:7,275 HOURS:2,001 COSTS(000):$0
Department of Defense Education Activity Customer Satisfaction
Survey for Parents and Students
FORMS: NONE
OMB NO: 0704-0422 EXPIRATION DATE: 04/30/2005
RESPS:1,335 HOURS:334 COSTS(000):$0
2001 Biennial Review of Defense Agencies and DOD Field Activities
FORMS: NONE
OMB NO: 0704-0424 EXPIRATION DATE: 04/30/2005
RESPS:6,000 HOURS:2,500 COSTS(000):$0
Defense Security Service Customer Satisfaction Survey
FORMS: NONE
OMB NO: 0704-0425 EXPIRATION DATE: 08/31/2003
RESPS:50 HOURS:400 COSTS(000):$0
Application for Department of Defense Impact Aid for Children
with Severe Disabilities
FORMS: SD-816 SD-816C
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
81 16,651,996 19,436,292 $43
U.S. Army Corps of Engineers
OMB NO: 0710-0001 EXPIRATION DATE: 11/30/2005
RESPS:214,150 HOURS:17,750 COSTS(000):$0
Corps of Engineers Civil Works Questionnairs - Generic Clearance
FORMS: NONE
OMB NO: 0710-0003 EXPIRATION DATE: 12/31/2004
RESPS:85,500 HOURS:340,000 COSTS(000):$0
Application for a Department of the Army Permit
FORMS: 4345
OMB NO: 0710-0005 EXPIRATION DATE: 09/30/2003
RESPS:5,400 HOURS:2,500 COSTS(000):$0
Record of Arrivals and Departures of Vessels at Marine Terminals.
FORMS: 3926
OMB NO: 0710-0006 EXPIRATION DATE: 09/30/2003
RESPS:228,752 HOURS:44,479 COSTS(000):$0
Vessel Operation Report
FORMS: 3925 3925B 3925P 3925C
OMB NO: 0710-0007 EXPIRATION DATE: 08/31/2005
RESPS:1,489 HOURS:372 COSTS(000):$0
Terminal and Transfer Facilities Description
FORMS: IWR-1 IWR-2 IWR-3 IWR-4 IWR-5 IWR-6 IWR-7 IWR-8 IWR-9
OMB NO: 0710-0008 EXPIRATION DATE: 08/31/2005
RESPS:695,304 HOURS:28,507 COSTS(000):$0
Lock Performance Monitoring System (LPMS) Waterway Traffic Report
FORMS: 3102C 3102D
OMB NO: 0710-0009 EXPIRATION DATE: 10/31/2004
RESPS:2,500 HOURS:2,000 COSTS(000):$0
Description of Vessels, Description of Operations
FORMS: 3931 3932
OMB NO: 0710-0012 EXPIRATION DATE: 08/31/2005
RESPS:60,000 HOURS:15,000 COSTS(000):$0
Customer Service Survey - Regulatory Program US Army Corps of
Engineers
FORMS: ENG-5065
OMB NO: 0710-0013 EXPIRATION DATE: 02/29/2004
RESPS:164,367 HOURS:29,737 COSTS(000):$0
Shipper's Export Declaration (SED) Program
FORMS: 7513
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 1,457,462 480,345 $0
Office of Assistant Secretary for Health Affairs
OMB NO: 0720-0001 EXPIRATION DATE: 08/31/2003
RESPS:14,500,000 HOURS:3,625,000 COSTS(000):$0
Health Insurance Claim Form
FORMS: HCFA-1500
OMB NO: 0720-0005 EXPIRATION DATE: 08/31/2003
RESPS:60 HOURS:30 COSTS(000):$0
Professional Qualifications, Medical and Peer Reviewers
FORMS: CHAMPUS-780
OMB NO: 0720-0006 EXPIRATION DATE: 03/31/2006
RESPS:1,035,000 HOURS:258,750 COSTS(000):$0
CHAMPUS Claims Patient's Request for Medical Payment
FORMS: DD-2642
OMB NO: 0720-0013 EXPIRATION DATE: 03/31/2005
RESPS:2,100,000 HOURS:525,000 COSTS(000):$859
Health Insurance Claim Form, HCFA 1450
FORMS: HCF-1450-UB92
OMB NO: 0720-0015 EXPIRATION DATE: 12/31/2003
RESPS:50,000 HOURS:12,500 COSTS(000):$0
TRICARE Retiree Dental Program Enrollment Application
FORMS: NONE
OMB NO: 0720-0022 EXPIRATION DATE: 02/28/2006
RESPS:885,000 HOURS:44,250 COSTS(000):$0
DoD Active Duty/Reserve Forces Dental Examination
FORMS: DD-2813
OMB NO: 0720-0023 EXPIRATION DATE: 07/31/2003
RESPS:2,000 HOURS:333 COSTS(000):$0
Pharmacy Redesign Pilot Program
FORMS: DD-2814
OMB NO: 0720-0024 EXPIRATION DATE: 06/30/2003
RESPS:900 HOURS:300 COSTS(000):$0
Survey of Prescribers in Military Treatment Facilities and
TRICARE Contracts
FORMS: NONE
OMB NO: 0720-0027 EXPIRATION DATE: 10/31/2004
RESPS:2,106,071 HOURS:703,248 COSTS(000):$0
Health Evaluation Assessment Review (HEAR 2.X)
FORMS: NONE
OMB NO: 0720-0028 EXPIRATION DATE: 03/31/2005
RESPS:20,689 HOURS:2,150 COSTS(000):$0
TRICARE Plus Enrollment and Disenrollment Applications
FORMS: DD-X437 DD-X438
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
10 20,699,720 5,171,561 $859
Defense Finance and Accounting Service
OMB NO: 0730-0001 EXPIRATION DATE: 09/30/2005
RESPS:3,600 HOURS:720 COSTS(000):$0
Child Annuitant's School Certification
FORMS: DD-2788
OMB NO: 0730-0002 EXPIRATION DATE: 04/30/2004
RESPS:108,500 HOURS:9,042 COSTS(000):$0
Statement of Claimant Requesting Recertified Check
FORMS: DD-2660
OMB NO: 0730-0003 EXPIRATION DATE: 06/30/2004
RESPS:15,000 HOURS:2,000 COSTS(000):$0
Customer Satisfaction Surveys - Generic
FORMS: NONE
OMB NO: 0730-0005 EXPIRATION DATE: 12/31/2003
RESPS:386,000 HOURS:193,000 COSTS(000):$0
Personal Check Cashing Agreement
FORMS: DD-2761
OMB NO: 0730-0008 EXPIRATION DATE: 11/30/2004
RESPS:20,520 HOURS:5,064 COSTS(000):$0
Application for Former Spouse Payments from Retired Pay
FORMS: DD-2293
OMB NO: 0730-0009 EXPIRATION DATE: 09/30/2005
RESPS:6,000 HOURS:12,000 COSTS(000):$0
Waiver/Remission of Indebtedness Application
FORMS: DD-2789
OMB NO: 0730-0010 EXPIRATION DATE: 09/30/2005
RESPS:300 HOURS:120 COSTS(000):$0
Custodianship Certificate to Support Claim on Behalf of Minor
Children of Deceased Members of the Armed Forces
FORMS: DD-2790
OMB NO: 0730-0011 EXPIRATION DATE: 08/31/2003
RESPS:120 HOURS:24 COSTS(000):$0
Physician Certificate for Child Annuitant
FORMS: DD-X405
OMB NO: 0730-0012 EXPIRATION DATE: 09/30/2003
RESPS:300 HOURS:150 COSTS(000):$0
Trustee Report
FORMS: DD-2826
OMB NO: 0730-0013 EXPIRATION DATE: 09/30/2003
RESPS:50 HOURS:13 COSTS(000):$0
Application for Trusteeship
FORMS: DD-2827
OMB NO: 0730-0014 EXPIRATION DATE: 05/31/2004
RESPS:19,440 HOURS:24,300 COSTS(000):$0
Dependency Statements: Parent, Child Born Out of Wedlock,
Incapacitated Child Over Age 21, Full ?Time Student 21-22 Years
of Age, and Ward of a Court
FORMS: DD-137-3 DD-137-4 DD-137-5 DD-137-6 DD-137-7
OMB NO: 0730-0015 EXPIRATION DATE: 04/30/2004
RESPS:10,000 HOURS:833 COSTS(000):$0
Request for Information Regarding Deceased Debtor
FORMS: DD-2840
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 569,830 247,266 $0
Office of the Secretary
OMB NO: 0790-0003 EXPIRATION DATE: 09/30/2004
RESPS:150 HOURS:150 COSTS(000):$0
Base Realignment and Closure (BRAC) Military Base Reuse Status
FORMS: DD-2740
OMB NO: 0790-0004 EXPIRATION DATE: 02/29/2004
RESPS:71 HOURS:2,840 COSTS(000):$0
Revitalizing Base Closure Communities, Economic Development
Conveyance Annual Financial Statement
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 221 2,990 $0
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
156 41,740,892 26,988,192 $902
Department of Education
Department of Education
OMB NO: 1800-0011 EXPIRATION DATE: 11/30/2003
RESPS:10,000 HOURS:25,120 COSTS(000):$0
Master Plan for Customer Satisfaction Surveys and Focus Groups
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 10,000 25,120 $0
Office of Elementary and Secondary Education
OMB NO: 1810-0036 EXPIRATION DATE: 02/28/2005
RESPS:1,061,320 HOURS:531,211 COSTS(000):$0
Applications for Assistance (sections 8002 and 8003) Impact Aid
Program
FORMS: ED-4019
OMB NO: 1810-0054 EXPIRATION DATE: 01/31/2004
RESPS:90 HOURS:2,180 COSTS(000):$0
Application for the High School Equivalency Program (HEP) and
College Assistance Migrant Program (CAMP) (1890-0001)(KA)
FORMS: NONE
OMB NO: 1810-0060 EXPIRATION DATE: 04/30/2005
RESPS:3,052 HOURS:4,224 COSTS(000):$0
Annual Report of Children in State Agency and Locally Operated
Institutions for Neglected and Delinquent Children
FORMS: ED-4376
OMB NO: 1810-0540 EXPIRATION DATE: 05/31/2003
RESPS:30 HOURS:450 COSTS(000):$0
Application for the Even Start Family Literacy Program - Indian
Tribes and Tribal Organizations
FORMS: CFDA#84.258
OMB NO: 1810-0541 EXPIRATION DATE: 04/30/2003
RESPS:60 HOURS:2,700 COSTS(000):$0
Migrant Education Even Start Family Literacy
FORMS: NONE
OMB NO: 1810-0576 EXPIRATION DATE: 10/31/2005
RESPS:52 HOURS:18,160 COSTS(000):$0
Consolidated State Application
FORMS: NONE
OMB NO: 1810-0581 EXPIRATION DATE: 05/31/2003
RESPS:33,759 HOURS:2,586,428 COSTS(000):$0
State educational agency local educational agency, and school
data collection and reporting under ESEA, Title I, Part A
FORMS: NONE
OMB NO: 1810-0614 EXPIRATION DATE: 06/30/2003
RESPS:14,452 HOURS:134,768 COSTS(000):$0
consolidated State Performance Report and State Self-Review
FORMS: NONE
OMB NO: 1810-0620 EXPIRATION DATE: 09/30/2005
RESPS:25 HOURS:200 COSTS(000):$0
State Agency Use of Alternative Method to Distribute Title I
Funds to LEAs with Fewer Than 20,000 Total Residents
FORMS: NONE
OMB NO: 1810-0622 EXPIRATION DATE: 09/30/2005
RESPS:52 HOURS:2,080 COSTS(000):$0
SEA Procedures for Adjusting ED-Determined Title I Allocations
to Local Education Agencies (LEAs)
FORMS: NONE
OMB NO: 1810-0625 EXPIRATION DATE: 04/30/2003
RESPS:45 HOURS:1,800 COSTS(000):$0
Ed-Flex State Application Guidance
FORMS: NONE
OMB NO: 1810-0634 EXPIRATION DATE: 04/30/2003
RESPS:23 HOURS:552 COSTS(000):$0
Reading Excellence Act Performance Report (KA)
FORMS: CFDA#84.338
OMB NO: 1810-0646 EXPIRATION DATE: 10/31/2005
RESPS:4,552 HOURS:4,830 COSTS(000):$0
Application Package for the REAP Small, Rural School Achievement
Program (KA)
FORMS: 84.358A
OMB NO: 1810-0648 EXPIRATION DATE: 07/31/2005
RESPS:57 HOURS:3,306 COSTS(000):$0
Application for State Grants for Reading First (KA)
FORMS: CFDA#84.357
OMB NO: 1810-0649 EXPIRATION DATE: 04/30/2003
RESPS:100 HOURS:500 COSTS(000):$0
FY 2002 Migrant Education Program (MEP) Consortium Incentive
Grants (1890-0001) (KA)
FORMS: CFDA384.144
OMB NO: 1810-0652 EXPIRATION DATE: 05/31/2005
RESPS:1,500 HOURS:45,000 COSTS(000):$0
Application for Improving Literacy Through School Libraries
Grant Program
FORMS: 84.364
OMB NO: 1810-0653 EXPIRATION DATE: 06/30/2005
RESPS:56 HOURS:112 COSTS(000):$0
State Progress Report - School Renovation, IDEA, and Technology
Grants Program (KA)
FORMS: 84.352A
OMB NO: 1810-0654 EXPIRATION DATE: 10/31/2004
RESPS:932 HOURS:14,332 COSTS(000):$0
Early Reading First Program Federal Register Notice Inviting
Applications, and Application Packet (KA)
FORMS: 84.359
OMB NO: 1810-0655 EXPIRATION DATE: 01/31/2006
RESPS:240 HOURS:19,200 COSTS(000):$0
Local-Flex Application (KA)
FORMS: NONE
OMB NO: 1810-0656 EXPIRATION DATE: 12/31/2005
RESPS:100 HOURS:200 COSTS(000):$0
FY 2002 Native Hawaiian Education Council
FORMS: 84.362B
OMB NO: 1810-0657 EXPIRATION DATE: 08/31/2003
RESPS:438 HOURS:1,454 COSTS(000):$0
Impact Aid Discretionary Construction Grant Program
FORMS: 84.041
OMB NO: 1810-0660 EXPIRATION DATE: 02/28/2006
RESPS:21 HOURS:13,440 COSTS(000):$0
State-Flex Application (KA)
FORMS: NONE
OMB NO: 1810-0662 EXPIRATION DATE: 05/31/2003
RESPS:43 HOURS:19,925 COSTS(000):$0
Migrant Education Program (MEP) Final Regulations Sections
200.83 200.84 and 200.88
FORMS: CFDA-84.011
OMB NO: 1810-0663 EXPIRATION DATE: 01/31/2006
RESPS:51 HOURS:612 COSTS(000):$0
Information on Students Served by McKinney-Vento Homeless
Assistance Act Subgrants
FORMS: CDF#84.196
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
24 1,121,050 3,407,664 $0
Office of Special Education and Rehabilitative Services
OMB NO: 1820-0009 EXPIRATION DATE: 07/31/2005
RESPS:52 HOURS:702 COSTS(000):$0
Report of Randolph-Sheppard Vending Facility Program (SC)
FORMS: RSA-15
OMB NO: 1820-0013 EXPIRATION DATE: 02/28/2006
RESPS:320 HOURS:320 COSTS(000):$0
Quarterly Cumulative Caseload Report (SC)
FORMS: RSA-113
OMB NO: 1820-0017 EXPIRATION DATE: 02/28/2006
RESPS:82 HOURS:385 COSTS(000):$0
Annual Program Cost Report (SC)
FORMS: RSA-2
OMB NO: 1820-0018 EXPIRATION DATE: 08/31/2004
RESPS:1,000 HOURS:40,000 COSTS(000):$0
Application Kit for New Grants Under the Rehabilitation Services
Administration
FORMS: NONE
OMB NO: 1820-0027 EXPIRATION DATE: 11/30/2003
RESPS:1,000 HOURS:20,000 COSTS(000):$0
Applications for Grants under Disability and Rehabilitation
Research (1890-0001)(SC)
FORMS: NONE
OMB NO: 1820-0028 EXPIRATION DATE: 05/31/2003
RESPS:1,200 HOURS:30,000 COSTS(000):$0
Discretionary Grant Application -- Individuals with Disabilities
Education Act
FORMS: NONE
OMB NO: 1820-0030 EXPIRATION DATE: 01/31/2006
RESPS:57 HOURS:570 COSTS(000):$0
State Eligibility Plan Under Part B of the Individuals with
Disabilities Education Act (SC)
FORMS: ED-9055
OMB NO: 1820-0043 EXPIRATION DATE: 07/31/2004
RESPS:58 HOURS:30,682 COSTS(000):$0
Report of Children with Disabilities Receiving Special Education
under Part B of the Individuals with Disabilites Education Act
(SC)
FORMS: 869-5
OMB NO: 1820-0500 EXPIRATION DATE: 01/31/2004
RESPS:82 HOURS:1,002,050 COSTS(000):$0
State Vocational Rehabilitation Services Program Final Rules
FORMS: ED(RSA)-SPVR
OMB NO: 1820-0508 EXPIRATION DATE: 05/31/2003
RESPS:80 HOURS:4,240 COSTS(000):$0
Final Regulations to Amend CFR, Title 34, Chapter III, Part 361,
by adding a new subpart E, entitled "Evaluation Standards and
Performance Indicators"
FORMS: RSA-911
OMB NO: 1820-0509 EXPIRATION DATE: 02/28/2005
RESPS:75,560 HOURS:15,292 COSTS(000):$0
Lists of Hearing Officers and Mediators
FORMS: NONE
OMB NO: 1820-0514 EXPIRATION DATE: 12/31/2003
RESPS:1,170,000 HOURS:40,667 COSTS(000):$105,000
Application for Free Loan Service of Captioned Media Program
(English and Spanish Version) and Media Response Card (English
and Spanish Version)
FORMS: NONE
OMB NO: 1820-0517 EXPIRATION DATE: 07/31/2004
RESPS:58 HOURS:272,890 COSTS(000):$0
Part B, Individuals with Disabilities Education Act
Implementation of FAPE Requirements (SC)
FORMS: NONE
OMB NO: 1820-0518 EXPIRATION DATE: 07/31/2004
RESPS:58 HOURS:7,685 COSTS(000):$0
Personnel Employed to Provide Special Education and Related
Services for Children with Disabilities (SC)
FORMS: NONE
OMB NO: 1820-0520 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:9 COSTS(000):$0
Written Application for the Client Assistance Program
FORMS: NONE
OMB NO: 1820-0521 EXPIRATION DATE: 07/31/2004
RESPS:58 HOURS:53,244 COSTS(000):$0
Report of Children with Disabilities Exiting Special Education
During the School Year (SC)
FORMS: 869-3
OMB NO: 1820-0527 EXPIRATION DATE: 04/30/2004
RESPS:55 HOURS:3,300 COSTS(000):$0
State Plan for Independent Living and Center for Independent
Living Programs (SC)
FORMS: NONE
OMB NO: 1820-0528 EXPIRATION DATE: 02/29/2004
RESPS:56 HOURS:350 COSTS(000):$7
Annual Client Assistance Program (CAP) Report
FORMS: RSA-227
OMB NO: 1820-0530 EXPIRATION DATE: 02/29/2004
RESPS:450 HOURS:1,800 COSTS(000):$0
Performance Report - Training Personnel for the Education of
Individuals with Disabilities Education Act (IDEA) (SC)
FORMS: NONE
OMB NO: 1820-0550 EXPIRATION DATE: 04/30/2005
RESPS:56 HOURS:168 COSTS(000):$0
Infants and Toddlers with Disabilities Program (Part C) of the
Individuals with Disabilities Education Act (IDEA)
FORMS: 1-B20-26P
OMB NO: 1820-0556 EXPIRATION DATE: 07/31/2004
RESPS:57 HOURS:5,187 COSTS(000):$0
Report of Early Intervention Services on IFSPs Provided to
Infants, Toddlers and Their Families in Accordance with Part C
and Report of Number and Type of Personnel Employed and........
FORMS: NONE
OMB NO: 1820-0557 EXPIRATION DATE: 07/31/2004
RESPS:57 HOURS:5,472 COSTS(000):$0
Report of Infants and Toddlers Receiving Early Intervention
Services and of Program Settings Where Services are Provided in
Accordance with Part C, and Report on Infants and Toddlers.....
FORMS: NONE
OMB NO: 1820-0563 EXPIRATION DATE: 11/30/2005
RESPS:80 HOURS:160 COSTS(000):$3
Annual Report on Appeals Process (SC)
FORMS: RSA-722
OMB NO: 1820-0572 EXPIRATION DATE: 02/28/2005
RESPS:56 HOURS:2,240 COSTS(000):$0
Annual Progress Reporting form for Assistive Technology Grantees
(SC)
FORMS: NONE
OMB NO: 1820-0578 EXPIRATION DATE: 08/31/2003
RESPS:57 HOURS:1,710 COSTS(000):$0
Annual Performance Report and Report to the Secretary Under the
Infants and Toddlers with Disabilities Proram (Part C, IDEA)
FORMS: NONE
OMB NO: 1820-0599 EXPIRATION DATE: 02/28/2005
RESPS:1,079 HOURS:10,790 COSTS(000):$0
Part B Complaint Procedures (SC)
FORMS: NONE
OMB NO: 1820-0600 EXPIRATION DATE: 02/28/2005
RESPS:28,844 HOURS:28,844 COSTS(000):$0
Local Educational Agency Application Under Part B of the
FORMS: NONE
OMB NO: 1820-0606 EXPIRATION DATE: 11/30/2003
RESPS:336 HOURS:11,760 COSTS(000):$0
Section 704 Annual Performance Report (Parts I and II)
FORMS: ED(RSA)-704-I ED(RSA)-704-II
OMB NO: 1820-0608 EXPIRATION DATE: 03/31/2004
RESPS:55 HOURS:440 COSTS(000):$0
Independent Living Services For Older Individuals Who Are Blind
FORMS: ED(RSA)-7-OB
OMB NO: 1820-0616 EXPIRATION DATE: 12/31/2003
RESPS:6,689 HOURS:5,072 COSTS(000):$0
National Early Intervention Longitudinal Study
FORMS: NONE
OMB NO: 1820-0617 EXPIRATION DATE: 02/29/2004
RESPS:1 HOURS:165 COSTS(000):$0
Grantee Reporting form (SC)
FORMS: NONE
OMB NO: 1820-0620 EXPIRATION DATE: 09/30/2005
RESPS:30 HOURS:2,700 COSTS(000):$0
Application for New Grants -- State Program Improvement Grants
for Children with Disabilities
FORMS: NONE
OMB NO: 1820-0621 EXPIRATION DATE: 07/31/2004
RESPS:58 HOURS:149,350 COSTS(000):$0
Report of Children with Disabilities Unilaterally Removed or
Suspended/Expelled for More Than 10 Days (SC)
FORMS: NONE
OMB NO: 1820-0622 EXPIRATION DATE: 05/31/2005
RESPS:8,000 HOURS:152,500 COSTS(000):$0
Special Education - Personnel Preparation to Improve Services
and Results for Children with Disabilities
FORMS: NONE
OMB NO: 1820-0625 EXPIRATION DATE: 08/31/2005
RESPS:57 HOURS:9 COSTS(000):$0
Protection and Advocacy of Individual Rights (PAIR) Program
Assurances (SC)
FORMS: NONE
OMB NO: 1820-0627 EXPIRATION DATE: 03/31/2006
RESPS:57 HOURS:342 COSTS(000):$0
Annual Protection and Advocacy of Individual Rights (PAIR)
Program Performance Report (SC)
FORMS: RSA-509
OMB NO: 1820-0632 EXPIRATION DATE: 06/30/2003
RESPS:32,138 HOURS:17,049 COSTS(000):$0
Special Education Elementary Longitudinal Study (Seels)
FORMS: NONE
OMB NO: 1820-0633 EXPIRATION DATE: 04/30/2003
RESPS:5,595 HOURS:11,262 COSTS(000):$0
State and Local Implementation of IDEA '97
FORMS: NONE
OMB NO: 1820-0634 EXPIRATION DATE: 10/31/2003
RESPS:57 HOURS:1,680 COSTS(000):$39
Alternative Financing Program and the Alternate Financing
FORMS: NONE
OMB NO: 1820-0635 EXPIRATION DATE: 10/31/2005
RESPS:17,347 HOURS:8,965 COSTS(000):$0
National Longitudinal Transition Study-2 (NLTS2)
FORMS: NONE
OMB NO: 1820-0636 EXPIRATION DATE: 12/31/2003
RESPS:464 HOURS:684 COSTS(000):$0
Evaluation of the American Indian Vocational Rehabilitation
Services (AIVRS) Program (SC)
FORMS: NONE
OMB NO: 1820-0637 EXPIRATION DATE: 12/31/2003
RESPS:300 HOURS:100 COSTS(000):$0
NIDRR Quality of Research Rating Scale
FORMS: NONE
OMB NO: 1820-0640 EXPIRATION DATE: 03/31/2004
RESPS:1,003 HOURS:1,575 COSTS(000):$0
Evaluation of Independent Living Programs (SC)
FORMS: NONE
OMB NO: 1820-0642 EXPIRATION DATE: 02/29/2004
RESPS:193 HOURS:3,088 COSTS(000):$0
Annual Performance Reporting Forms for NIDRR Grantees (RERCs,
RRTCs, DBTACs, DRRPs, Model Systems, Dissemination &
Utillization Projects) (SC)
FORMS: NONE
OMB NO: 1820-0644 EXPIRATION DATE: 07/31/2004
RESPS:58 HOURS:18,312 COSTS(000):$0
Consolidated Data Collection on Students with Disabilities (SC)
FORMS: NONE
OMB NO: 1820-0646 EXPIRATION DATE: 09/30/2004
RESPS:73 HOURS:2,044 COSTS(000):$0
Annual Progress Reporting Form for Special Demonstration
Programs (SC)
FORMS: NONE
OMB NO: 1820-0649 EXPIRATION DATE: 01/31/2004
RESPS:135 HOURS:333 COSTS(000):$0
An Evaluation of the State Program Improvement Grant (SIG)
Program
FORMS: NONE
OMB NO: 1820-0650 EXPIRATION DATE: 04/30/2005
RESPS:462 HOURS:498 COSTS(000):$0
Evaluation of the Projects With Industry (PWI) Program
FORMS: NONE
OMB NO: 1820-0655 EXPIRATION DATE: 01/31/2005
RESPS:66 HOURS:1,056 COSTS(000):$0
Annual Progress Reporting Form for the American Indian
Vocational Rehabilitation Services (AIVRS) Program
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
49 1,353,687 1,967,741 $105,049
Office of Vocational and Adult Education
OMB NO: 1830-0029 EXPIRATION DATE: 04/30/2003
RESPS:56 HOURS:12,208 COSTS(000):$0
Carl D. Perkins Vocational and Technical Education
FORMS: NONE
OMB NO: 1830-0503 EXPIRATION DATE: 04/30/2004
RESPS:54 HOURS:6,845 COSTS(000):$526
Vocational Technical Education Annual Performance and Financial
Reports (SC)
FORMS: NONE
OMB NO: 1830-0537 EXPIRATION DATE: 04/30/2003
RESPS:689 HOURS:669 COSTS(000):$0
National Survey to Determine the Need for Special Education
Services (JM)
FORMS: NONE
OMB NO: 1830-0541 EXPIRATION DATE: 05/31/2003
RESPS:59 HOURS:2,124 COSTS(000):$0
Carl D. Perkins Vocational and Technical Education
Act--Occupational and Employment Information State Grants
(Section 118, PL 105-332) (1890-0001) (SC)
FORMS: CFDA#84.346
OMB NO: 1830-0542 EXPIRATION DATE: 09/30/2003
RESPS:639 HOURS:75,632 COSTS(000):$0
Application for Vocational and Technical Education Direct Grants
(1890-0001) (SC)
FORMS: NONE
OMB NO: 1830-0544 EXPIRATION DATE: 11/30/2003
RESPS:38 HOURS:95 COSTS(000):$0
Indian Vocational Education Program Technology Survey
FORMS: NONE
OMB NO: 1830-0546 EXPIRATION DATE: 11/30/2003
RESPS:11 HOURS:440 COSTS(000):$0
Career Cluster Cooperative Agreements with States
FORMS: NONE
OMB NO: 1830-0548 EXPIRATION DATE: 01/31/2004
RESPS:59 HOURS:4,720 COSTS(000):$0
America's Career Resource Network State Grants Annual
Performance Reports
FORMS: NONE
OMB NO: 1830-0549 EXPIRATION DATE: 02/29/2004
RESPS:1,049 HOURS:831 COSTS(000):$0
New American High Schools Implementation Study
FORMS: NONE
OMB NO: 1830-0550 EXPIRATION DATE: 02/29/2004
RESPS:50 HOURS:2,400 COSTS(000):$0
Tech-Prep Demonstration Grants (1890-0001)(SC)
FORMS: NONE
OMB NO: 1830-0551 EXPIRATION DATE: 06/30/2004
RESPS:20 HOURS:1,000 COSTS(000):$0
High School Reform State Grants (1890-0001) (SC)
FORMS: NONE
OMB NO: 1830-0552 EXPIRATION DATE: 02/29/2004
RESPS:700 HOURS:47,000 COSTS(000):$0
The Smaller Learning Communities Program (SLC) (1890-0001) (SC)
FORMS: NONE
OMB NO: 1830-0553 EXPIRATION DATE: 10/31/2003
RESPS:161 HOURS:1,288 COSTS(000):$0
Annual Performance Report for the Smaller Learning Communities
Grant Program
FORMS: CFDA#:84.215L
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
13 3,585 155,252 $526
Office of Postsecondary Education
OMB NO: 1840-0005 EXPIRATION DATE: 06/30/2004
RESPS:670 HOURS:12,560 COSTS(000):$0
Fulbright-Hays Training Grants Faculty Research Abroad Program -
CFDA 84.019 Doctoral Dissertation Research Abroad Program - CFDA
84.022
FORMS: NONE
OMB NO: 1840-0007 EXPIRATION DATE: 06/30/2003
RESPS:370 HOURS:30,200 COSTS(000):$0
Grant Application under the Teacher Quality Enhancement Grants,
for the preparation of applications for: Partnership Grants.....
FORMS: NONE
OMB NO: 1840-0017 EXPIRATION DATE: 06/30/2003
RESPS:1,200 HOURS:40,800 COSTS(000):$0
Application for Grants under Student Support Services Program
FORMS: NONE
OMB NO: 1840-0065 EXPIRATION DATE: 06/30/2004
RESPS:1,300 HOURS:44,200 COSTS(000):$0
Application for Grants Under Talent Search and Educational
Opportunity Centers Programs
FORMS: NONE
OMB NO: 1840-0068 EXPIRATION DATE: 06/30/2004
RESPS:528 HOURS:38,550 COSTS(000):$0
Applications for Title VI International Education Programs
FORMS: CFDA-84.153 84.021 84.017 84.016 84.15A 84.15B 84.274 84.229
OMB NO: 1840-0103 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:8,400 COSTS(000):$0
Application for Designation as an Eligible Institution
(1890-0001) for Title III and V
FORMS: 1049
OMB NO: 1840-0109 EXPIRATION DATE: 02/28/2005
RESPS:200 HOURS:8,000 COSTS(000):$0
Application for Grants Under the Minority Science and
Engineering Improvement Program (1890-0001) (JS)
FORMS: NONE
OMB NO: 1840-0113 EXPIRATION DATE: 11/30/2003
RESPS:117 HOURS:889 COSTS(000):$0
Application for Strengthening Historically Black Colleges and
Universities Program and Historically Black Graduate
Institutions Program (JS)
FORMS: ED-852
OMB NO: 1840-0130 EXPIRATION DATE: 03/31/2006
RESPS:1 HOURS:6,983 COSTS(000):$0
Teacher Cancellation Low Income Directory (JS)
FORMS: CFDA-34.674
OMB NO: 1840-0501 EXPIRATION DATE: 07/31/2003
RESPS:500 HOURS:2,000 COSTS(000):$0
Fulbright-Hays Seminars Abroad Program
FORMS: CFDA#84.018
OMB NO: 1840-0507 EXPIRATION DATE: 08/31/2004
RESPS:25 HOURS:113 COSTS(000):$0
Performance Report for the Training Programs for Federal TRIO
Programs
FORMS: CFDA#84.103
OMB NO: 1840-0514 EXPIRATION DATE: 12/31/2003
RESPS:1,650 HOURS:19,500 COSTS(000):$0
FIPSE Comprehensive Program Grant Application
FORMS: 84.116A=CFDA 84.116B=CFDA
OMB NO: 1840-0525 EXPIRATION DATE: 10/31/2003
RESPS:1 HOURS:3,060 COSTS(000):$0
Annual Performance Report for the Student Support Services
Program (JS)
FORMS: 84.042A
OMB NO: 1840-0550 EXPIRATION DATE: 08/31/2005
RESPS:483 HOURS:16,422 COSTS(000):$0
Application for Grants under Upward Bound (UB) & Upward Bound
Math/Sciencer (UBMS) Programs (1890-00001) (JS)
FORMS: NONE
OMB NO: 1840-0562 EXPIRATION DATE: 04/30/2003
RESPS:2,000 HOURS:10,000 COSTS(000):$0
Application Package for the Jacob K. Javits Fellowship Program
FORMS: NONE
OMB NO: 1840-0564 EXPIRATION DATE: 07/31/2003
RESPS:330 HOURS:990 COSTS(000):$0
Financial Report for the Endowment Challenge Grant Program
FORMS: NONE
OMB NO: 1840-0595 EXPIRATION DATE: 08/31/2003
RESPS:57 HOURS:456 COSTS(000):$0
Paul Douglas Teacher Scholarship Program Performance Report
FORMS: 40-31P CFDA#84.176
OMB NO: 1840-0604 EXPIRATION DATE: 08/31/2003
RESPS:325 HOURS:13,432 COSTS(000):$0
Application Package for the Graduate Assistance in Areas of
National Need (GAANN) Fellowship Program
FORMS: CFDA=84.200
OMB NO: 1840-0616 EXPIRATION DATE: 06/30/2004
RESPS:50 HOURS:750 COSTS(000):$0
Application for Centers for International Business Education
Program
FORMS: CFDA-84.220
OMB NO: 1840-0617 EXPIRATION DATE: 09/30/2003
RESPS:57 HOURS:4,580 COSTS(000):$0
Targeted Teacher Deferment (Teacher Shortage Area)
FORMS: NONE
OMB NO: 1840-0619 EXPIRATION DATE: 07/31/2005
RESPS:300 HOURS:1,500 COSTS(000):$0
Application for Grants Under Ronald E. McMair Postbaccalaureate
Achievement Program
FORMS: NONE
OMB NO: 1840-0630 EXPIRATION DATE: 08/31/2004
RESPS:100 HOURS:400 COSTS(000):$8,000
Report of Financial Need and Certification for the Jacob K.
Javits Fellowship Program
FORMS: 40-1304 CFDA#84.170
OMB NO: 1840-0636 EXPIRATION DATE: 02/29/2004
RESPS:80 HOURS:2,400 COSTS(000):$0
European Community/United States of America Cooperation Program
in Higher Education and Vocational Education and Training
FORMS: ED40-514
OMB NO: 1840-0640 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:702 COSTS(000):$17,160
Performance Report for the Ronald E. McNair Postbaccalaureate
Achievement Program
FORMS: CFDA-84.217
OMB NO: 1840-0702 EXPIRATION DATE: 08/31/2005
RESPS:20 HOURS:600 COSTS(000):$0
The Program for North American Mobility in Higher Education (JS)
FORMS: NONE
OMB NO: 1840-0729 EXPIRATION DATE: 08/31/2003
RESPS:30 HOURS:150 COSTS(000):$0
Final Performance Report for the Business in International
Education Program
FORMS: NONE
OMB NO: 1840-0737 EXPIRATION DATE: 12/31/2005
RESPS:1 HOURS:9,000 COSTS(000):$0
Child Care Access Means Parents in School (CCAMPIS) Program - A
Guide for the Preparation of Applications
FORMS: CFDA-84.335A
OMB NO: 1840-0738 EXPIRATION DATE: 05/31/2005
RESPS:75 HOURS:2,250 COSTS(000):$0
Application Demonstration Projects for Faculty Training in
Disability Issues (1890-0001)
FORMS: 84.333
OMB NO: 1840-0740 EXPIRATION DATE: 04/30/2003
RESPS:300 HOURS:18,000 COSTS(000):$0
Application Package for Gaining Early Awareness and Readiness for
FORMS: NONE
OMB NO: 1840-0744 EXPIRATION DATE: 04/30/2003
RESPS:1,250 HOURS:127,624 COSTS(000):$3,757
Reference and Reporting Guide for Preparing State and
Institutional Reports on Teacher Quality and Preparation
FORMS: NONE
OMB NO: 1840-0746 EXPIRATION DATE: 12/31/2003
RESPS:50 HOURS:500 COSTS(000):$0
Application for Grants Under the TRIO Dissemination Partnership
Program (84.344) (1890-0001) (JS)
FORMS: 84.344
OMB NO: 1840-0748 EXPIRATION DATE: 03/31/2006
RESPS:1 HOURS:2,250 COSTS(000):$0
Graduate Assistance in Areas of National Need Performance Report
FORMS: NONE
OMB NO: 1840-0750 EXPIRATION DATE: 08/31/2004
RESPS:30,544 HOURS:6,340 COSTS(000):$0
Distance Education Demonstration Program Annual Reporting Form
FORMS: NONE
OMB NO: 1840-0755 EXPIRATION DATE: 05/31/2003
RESPS:100 HOURS:6,000 COSTS(000):$0
Application for Grants Under the Community Scholarship
Mobilization Program
FORMS: CFDA#84.347
OMB NO: 1840-0756 EXPIRATION DATE: 05/31/2003
RESPS:20 HOURS:400 COSTS(000):$0
First and Second Year Annual Progress Reports for the European
Community/US Joint Consortia Program
FORMS: ED-514
OMB NO: 1840-0757 EXPIRATION DATE: 10/31/2004
RESPS:40 HOURS:1,600 COSTS(000):$0
Learning Anytime Anywhere Partnerships (LAAP) Guidelines for
Annual Performance Reports with Auxiliary Collection Instruments
(JS)
FORMS: NONE
OMB NO: 1840-0758 EXPIRATION DATE: 07/31/2003
RESPS:140 HOURS:2,800 COSTS(000):$0
Comprehensive Program Annual Performance Report
FORMS: ED524-B
OMB NO: 1840-0759 EXPIRATION DATE: 02/28/2005
RESPS:1,411 HOURS:18,242 COSTS(000):$0
The Evaluation of Exchange, Language, International and Area
Studies (EELIAS), NRC, FLAS and IIPP, UISFUL, Business and
International Education Program (BIE), Centers for..............
FORMS: NONE
OMB NO: 1840-0760 EXPIRATION DATE: 07/31/2003
RESPS:60 HOURS:1,200 COSTS(000):$0
Annual Reporting Forms for the Program for North American
Mobility in Higher Education
FORMS: NONE
OMB NO: 1840-0761 EXPIRATION DATE: 10/31/2003
RESPS:80 HOURS:2,400 COSTS(000):$0
The US-Brazil Higher Education Consortia Program Application for
the US-Brazil Higher Education Consortia Program
FORMS: CFDA-84.116
OMB NO: 1840-0762 EXPIRATION DATE: 01/31/2004
RESPS:1 HOURS:13,500 COSTS(000):$104
Annual Performance Report for the Upward Bound, Upward Bound
Math/Science, and Veterans Upward Bound Programs
FORMS: NONE
OMB NO: 1840-0763 EXPIRATION DATE: 02/29/2004
RESPS:1 HOURS:609 COSTS(000):$0
18 and 36 months Performance Reports for the Child Care Access
Parents in Schools Program
FORMS: NONE
OMB NO: 1840-0764 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:2,000 COSTS(000):$0
Final Performance Report for Grants Under Title III -
Institutional Aid Programs
FORMS: CFDA#S-84.031A 84.031B 84.031N 84.031S 84.031T 84.031W 84.120A
OMB NO: 1840-0766 EXPIRATION DATE: 04/30/2005
RESPS:631 HOURS:11,358 COSTS(000):$0
Annual Performance Report for Title III and Title V Grantees
FORMS: 84.031A 84.031T 84.031N 84.031S 84.031W 84.120A
OMB NO: 1840-0767 EXPIRATION DATE: 06/30/2005
RESPS:125 HOURS:20,000 COSTS(000):$0
Teacher Recruitment Application Package
FORMS: NONE
OMB NO: 1840-0769 EXPIRATION DATE: 11/30/2005
RESPS:15 HOURS:525 COSTS(000):$0
Final Performance Report Guidelines for the Learning Anytine
Anywhere Parternships (LAAP) Program (JS)
FORMS: 84.339
OMB NO: 1840-0770 EXPIRATION DATE: 11/30/2005
RESPS:35 HOURS:700 COSTS(000):$0
Final Reporting Forms for FIPSE International Consortia Programs
FORMS: 84.116J 84.116M 84.116N
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
47 45,277 514,935 $29,021
Office of Federal Student Aid
OMB NO: 1845-0001 EXPIRATION DATE: 10/31/2005
RESPS:13,726,803 HOURS:7,680,346 COSTS(000):$0
Free Application for Federal Student Aid (FAFSA)
FORMS: ED-255
OMB NO: 1845-0002 EXPIRATION DATE: 08/31/2003
RESPS:4,660 HOURS:2,151 COSTS(000):$35
Student Aid Internet Gateway (SAIG) Enrollment form
FORMS: NONE
OMB NO: 1845-0003 EXPIRATION DATE: 01/31/2006
RESPS:61 HOURS:1,036 COSTS(000):$0
Application for 34 CFR Part 602 The Secretary's Recognition of
Accrediting Agencies (JS)
FORMS: NONE
OMB NO: 1845-0004 EXPIRATION DATE: 12/31/2003
RESPS:10,300 HOURS:228,150 COSTS(000):$0
Student Right-to-Know Act (SRK)
FORMS: NONE
OMB NO: 1845-0005 EXPIRATION DATE: 09/30/2005
RESPS:1,148,819 HOURS:183,811 COSTS(000):$0
FFEL Deferment Requests (JS)
FORMS: NONE
OMB NO: 1845-0006 EXPIRATION DATE: 09/30/2005
RESPS:2,887,200 HOURS:2,165,400 COSTS(000):$0
Federal Stafford Loan (Subsidized and Unsubsidized) Program
Master Promissory Note (JS)
FORMS: CFDA=84.032
OMB NO: 1845-0007 EXPIRATION DATE: 10/31/2005
RESPS:706,000 HOURS:353,000 COSTS(000):$0
Federal Direct Stafford/Ford Loan and Federal Direct
Unsubsidized Stafford/Ford Loan Master Promissory Note
FORMS: NONE
OMB NO: 1845-0008 EXPIRATION DATE: 12/31/2004
RESPS:20,524,631 HOURS:4,871,526 COSTS(000):$0
Student Aid Report (SAR)
FORMS: ED-255-1
OMB NO: 1845-0009 EXPIRATION DATE: 10/31/2004
RESPS:100,000 HOURS:50,000 COSTS(000):$0
Federal PLUS Loan Program Application Documents (JS)
FORMS: NONE
OMB NO: 1845-0010 EXPIRATION DATE: 02/28/2006
RESPS:1,800 HOURS:9,900 COSTS(000):$0
Regulations for Equity in Athletics Disclosure Act (EADA) (JS)
FORMS: NONE
OMB NO: 1845-0011 EXPIRATION DATE: 06/30/2005
RESPS:1 HOURS:143,030 COSTS(000):$0
William D. Ford Federal Direct Loan Program Deferment Request
Forms
FORMS: NONE
OMB NO: 1845-0012 EXPIRATION DATE: 10/31/2005
RESPS:2,970 HOURS:20,830 COSTS(000):$0
Application for Approval to Participate in Federal Student
Financial Aid Programs
FORMS: E40-34P CFDA:84.007 84.032 84.033 84.063 84.038 84.268
OMB NO: 1845-0013 EXPIRATION DATE: 08/31/2003
RESPS:17,200 HOURS:41,925 COSTS(000):$0
Lender's Request for Payment of Interest and Special Allowance
(JS)
FORMS: ED-799
OMB NO: 1845-0014 EXPIRATION DATE: 11/30/2004
RESPS:1,927,000 HOURS:635,910 COSTS(000):$0
William D. Ford Federal Direct Loan Program Repayment Plan
Selection Form (JS)
FORMS: NONE
OMB NO: 1845-0015 EXPIRATION DATE: 06/30/2005
RESPS:55,200 HOURS:27,600 COSTS(000):$0
Federal Family Education Loan, Direct Loan, and Perkins Loan
Discharge Applications (JS)
FORMS: NONE
OMB NO: 1845-0016 EXPIRATION DATE: 01/31/2006
RESPS:690,685 HOURS:227,927 COSTS(000):$0
Direct Loan Income Contingent Repayment Plan Alternative
Documentation of Income (LO)
FORMS: 84.268
OMB NO: 1845-0017 EXPIRATION DATE: 01/31/2006
RESPS:314,861 HOURS:62,972 COSTS(000):$0
Direct Loan Income Contingent Repayment Plan - Consent to
Disclosure of Tax Information (LO)
FORMS: 84.268
OMB NO: 1845-0018 EXPIRATION DATE: 01/31/2006
RESPS:4,092 HOURS:818 COSTS(000):$0
William D. Ford Federal Direct Loan Program Statutory
Forbearance Forms (LO)
FORMS: NONE
OMB NO: 1845-0019 EXPIRATION DATE: 10/31/2005
RESPS:95,262 HOURS:25,859 COSTS(000):$0
Federal Perkins Loan Program Regulations and General Provision
Regulations
FORMS: CFDA=84.038
OMB NO: 1845-0020 EXPIRATION DATE: 10/31/2005
RESPS:858,981 HOURS:10,128,562 COSTS(000):$1,253
Federal Family Education Loan Program Regulations
FORMS: CFDA-84.032
OMB NO: 1845-0021 EXPIRATION DATE: 10/31/2005
RESPS:846,034 HOURS:211,520 COSTS(000):$0
William D. Ford Federal Direct Loan Program
FORMS: CFDA=84.0268
OMB NO: 1845-0022 EXPIRATION DATE: 10/31/2005
RESPS:93,877 HOURS:1,209,890 COSTS(000):$5,040
Cohort Default Rates for Institutions Participating in the FFEL
or Direct Loan Programs
FORMS: NONE
OMB NO: 1845-0023 EXPIRATION DATE: 10/31/2005
RESPS:2,800,642 HOURS:61,879 COSTS(000):$0
Federal Perkins Loan Program Regulations
FORMS: CFDA=84.037
OMB NO: 1845-0026 EXPIRATION DATE: 03/31/2004
RESPS:612 HOURS:33,660 COSTS(000):$0
Guaranty Agency Financial Report (JS)
FORMS: 2000
OMB NO: 1845-0028 EXPIRATION DATE: 07/31/2004
RESPS:56 HOURS:112 COSTS(000):$0
The joint application for the Leveraging Educational Assistance
Partnership and Special LEAP Programs
FORMS: ED-1288
OMB NO: 1845-0030 EXPIRATION DATE: 04/30/2004
RESPS:1 HOURS:26,280 COSTS(000):$0
Fiscal Operations Report and Application to Participate (FISAP)
Opportunity Grant and Federal Work-Study Programs
FORMS: ED-646-1
OMB NO: 1845-0031 EXPIRATION DATE: 04/30/2003
RESPS:660,000 HOURS:132,000 COSTS(000):$0
William D. Ford Federal Direct Loan Program General Forberance
Request Form
FORMS: NONE
OMB NO: 1845-0032 EXPIRATION DATE: 02/28/2006
RESPS:121 HOURS:20 COSTS(000):$0
Lender's Application Process (LAP) (JS)
FORMS: NONE
OMB NO: 1845-0035 EXPIRATION DATE: 05/31/2003
RESPS:29,952 HOURS:179,712 COSTS(000):$72
National Student Loan Data System (NSLDS)
FORMS: NONE
OMB NO: 1845-0036 EXPIRATION DATE: 06/30/2003
RESPS:263,000 HOURS:263,000 COSTS(000):$0
Federal Family Education Loan Program Federal Consolidation Loan
Application and Promissory Note
FORMS: NONE
OMB NO: 1845-0038 EXPIRATION DATE: 10/31/2005
RESPS:6,576 HOURS:1,218,718 COSTS(000):$101
Student Assistance General Provisions - Subpart K - Cash
Management (JS)
FORMS: NONE
OMB NO: 1845-0039 EXPIRATION DATE: 06/30/2003
RESPS:3,950,083 HOURS:396,200 COSTS(000):$2,959
Federal Pell Grant Program Recipient Financial Management System
(RFMS)
FORMS: CFDA#84.063
OMB NO: 1845-0040 EXPIRATION DATE: 02/28/2005
RESPS:210,000 HOURS:6,993 COSTS(000):$0
William D. Ford Federal Direct Loan (Direct Loan) Program
Electronic Debit Account Application and Brochure (JS)
FORMS: NONE
OMB NO: 1845-0041 EXPIRATION DATE: 06/30/2004
RESPS:1 HOURS:354,453 COSTS(000):$65,000
Student Assistance General Provisions - Subpart E (Verification
of Student Aid Application Information)
FORMS: NONE
OMB NO: 1845-0042 EXPIRATION DATE: 02/28/2005
RESPS:1,804 HOURS:487 COSTS(000):$0
Lender's Application for Payment of Insurance Claim
FORMS: ED-1207
OMB NO: 1845-0044 EXPIRATION DATE: 03/31/2005
RESPS:56 HOURS:560 COSTS(000):$0
The Leveraging Educational Assistance Partnership (LEAP) and
Special Leveraging Educational Assistance Partnership (SLEAP)
Programs
FORMS: ED-FORM-1288-1 CFDA-84.069A-B
OMB NO: 1845-0045 EXPIRATION DATE: 01/31/2004
RESPS:1 HOURS:6,000 COSTS(000):$0
Clearance Package for OSFA customer Satisfaction Survey Master
Plan
FORMS: NONE
OMB NO: 1845-0046 EXPIRATION DATE: 08/31/2004
RESPS:9,804 HOURS:10,621 COSTS(000):$0
Consolidation Loan Rebate Fee Report
FORMS: ED-4-619
OMB NO: 1845-0047 EXPIRATION DATE: 08/31/2004
RESPS:300,000 HOURS:75,000 COSTS(000):$0
Income Contingent Repayment Plan Consent to Disclosure of Tax
Information
FORMS: NONE
OMB NO: 1845-0048 EXPIRATION DATE: 04/30/2003
RESPS:21,262 HOURS:10,631 COSTS(000):$0
Federal Perkins/NDSL Loan Assignment form (JS)
FORMS: ED-553 CFDA#84.038
OMB NO: 1845-0049 EXPIRATION DATE: 10/31/2005
RESPS:150,021 HOURS:75,450 COSTS(000):$0
Application for Ability to Benefit Testing Approval (JS)
FORMS: CFDA#84.032 84.063 84.268
OMB NO: 1845-0051 EXPIRATION DATE: 04/30/2003
RESPS:81,458 HOURS:40,729 COSTS(000):$55
Federal Direct PLUS Loan Application and Promissory Note
FORMS: NONE
OMB NO: 1845-0052 EXPIRATION DATE: 04/30/2005
RESPS:93,837 HOURS:23,209 COSTS(000):$71
Student Assistance General Provisions--Subpart I--Immigration
Status Confirmation
FORMS: NONE
OMB NO: 1845-0053 EXPIRATION DATE: 01/31/2005
RESPS:1,028,500 HOURS:681,875 COSTS(000):$0
Federal Direct Coonsolidation Loan Program Application Documents
(JS)
FORMS: NONE
OMB NO: 1845-0054 EXPIRATION DATE: 10/31/2004
RESPS:500 HOURS:2,500 COSTS(000):$0
Notice Inviting Proposals for Participation in the Experimental
Sites Initiative (JS)
FORMS: 84.07 84.032 84.033 84.063 84.038 84.268
OMB NO: 1845-0055 EXPIRATION DATE: 10/31/2004
RESPS:125 HOURS:125 COSTS(000):$0
Federal Register Notice Inviting Applications for Participation
in the Quality Assurance Program
FORMS: NONE
OMB NO: 1845-0057 EXPIRATION DATE: 06/30/2005
RESPS:2,790 HOURS:618 COSTS(000):$0
Child Care Provider Loan Forgiveness Application and Forgiveness
Forbearance form (JS)
FORMS: NONE
OMB NO: 1845-0058 EXPIRATION DATE: 10/31/2004
RESPS:600 HOURS:300 COSTS(000):$0
Loan Discharge Application: Unpaid Refund
FORMS: NONE
OMB NO: 1845-0059 EXPIRATION DATE: 10/31/2004
RESPS:21,425 HOURS:6,929 COSTS(000):$0
Federal Direct Loan Program and Federal Family Education Loan
Program Teacher Loan Forgiveness Form
FORMS: NONE
OMB NO: 1845-0060 EXPIRATION DATE: 04/30/2003
RESPS:20,365 HOURS:10,183 COSTS(000):$0
Endorser Addendum to Federal Direct PLUS Loan Application and
Promissory Note (JS)
FORMS: NONE
OMB NO: 1845-0061 EXPIRATION DATE: 10/31/2004
RESPS:690,000 HOURS:345,000 COSTS(000):$0
Federal Perkins Loan/NDSL Promissory Notes
FORMS: CFDA#84-038
OMB NO: 1845-0065 EXPIRATION DATE: 12/31/2005
RESPS:15,000 HOURS:7,500 COSTS(000):$0
Federal Family Education Loan, Direct Loan, and Perkins Loan
Discharge Applications (JS)
FORMS: CFDA=84.032 84.268 84.037
OMB NO: 1845-0066 EXPIRATION DATE: 06/30/2005
RESPS:150 HOURS:1,650 COSTS(000):$0
Experimental Sites Initiative - Data Collection Instrument (JS)
FORMS: CFDA84.032(FFEL 84.038(PERKINS) 84.033(FWS) 84.063(PELL)
84.268(DL)
OMB NO: 1845-0068 EXPIRATION DATE: 01/31/2006
RESPS:225,000 HOURS:112,500 COSTS(000):$0
Federal Direct PLUS Loan Application and Master Promissory Note
(PLUS MPN), and Endorser Addendum
FORMS: NONE
OMB NO: 1845-0069 EXPIRATION DATE: 01/31/2006
RESPS:33,333 HOURS:16,667 COSTS(000):$0
Federal PLUS Program Maser Promissory Note (JS)
FORMS: CFDA-84.032
OMB NO: 1845-0072 EXPIRATION DATE: 09/30/2003
RESPS:4,000 HOURS:4,000 COSTS(000):$200
eZ-Audit: Electronic Submission of Financial Statements and
Compliance Audits
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
56 54,637,512 32,387,724 $74,786
Institute of Education Sciences
OMB NO: 1850-0067 EXPIRATION DATE: 11/30/2004
RESPS:284 HOURS:11,004 COSTS(000):$0
Common Core of Data Surveys
FORMS: NONE
OMB NO: 1850-0582 EXPIRATION DATE: 04/30/2003
RESPS:60,282 HOURS:202,636 COSTS(000):$0
Integrated Postsecondary Education Data System (IPEDS),
Introduction of the Web-Based Collection on Institutional Price
& Student Financial Aid and modifications to the 2000-2002
data....
FORMS: NONE
OMB NO: 1850-0598 EXPIRATION DATE: 08/31/2004
RESPS:2,764 HOURS:2,232 COSTS(000):$0
Field test activities and the 2003-2004 full-scale Schools and
Staffing Survey (SASS): LEA, Principal, School, Teacher, Library
FORMS: NONE
OMB NO: 1850-0601 EXPIRATION DATE: 05/31/2003
RESPS:750 HOURS:11,250 COSTS(000):$0
Application for the Field-Initiated Studies Educational Research
Grant Program
FORMS: NONE
OMB NO: 1850-0608 EXPIRATION DATE: 02/29/2004
RESPS:1,200 HOURS:531 COSTS(000):$0
National Survey of Postsecondary Faculty: 2004 (NSOPF:04) --
Faculty Survey (KI)
FORMS: NONE
OMB NO: 1850-0617 EXPIRATION DATE: 05/31/2003
RESPS:18,279 HOURS:4,616 COSTS(000):$0
2000-01 Teacher Follow-up Survey
FORMS: NONE
OMB NO: 1850-0628 EXPIRATION DATE: 02/28/2006
RESPS:658,800 HOURS:169,101 COSTS(000):$0
National Assessment of Educational Progress 2003 Charter Schools
Questions
FORMS: NONE
OMB NO: 1850-0631 EXPIRATION DATE: 04/30/2003
RESPS:569 HOURS:224 COSTS(000):$0
Beginning Postsecondary Students Longitudinal Study 1996-2001
(BPS: 1996/2001)
FORMS: NONE
OMB NO: 1850-0645 EXPIRATION DATE: 03/31/2004
RESPS:6,900 HOURS:3,885 COSTS(000):$0
IEA Progress in International Reading Literacy Study
FORMS: NONE
OMB NO: 1850-0652 EXPIRATION DATE: 12/31/2005
RESPS:1,270 HOURS:941 COSTS(000):$0
Education Longitudinal Study of 2002, First Followup
FORMS: NONE
OMB NO: 1850-0654 EXPIRATION DATE: 06/30/2004
RESPS:13,000 HOURS:5,850 COSTS(000):$0
National Assessment of Adult Literacy
FORMS: NONE
OMB NO: 1850-0665 EXPIRATION DATE: 08/31/2005
RESPS:150 HOURS:446 COSTS(000):$0
2004 National Survey of Postsecondary Faculty (NSOPF:04): List
Collection Procedures and Institution Questionnaire (KA)
FORMS: NONE
OMB NO: 1850-0666 EXPIRATION DATE: 06/30/2004
RESPS:1,204 HOURS:4,125 COSTS(000):$0
National Postsecondary Student Aid Study: 2004
FORMS: NONE
OMB NO: 1850-0689 EXPIRATION DATE: 06/30/2005
RESPS:56 HOURS:2,520 COSTS(000):$0
Public Libraries Survey, 2002-2004
FORMS: NONE
OMB NO: 1850-0695 EXPIRATION DATE: 02/28/2006
RESPS:25,710 HOURS:20,730 COSTS(000):$0
Trends in International Mathematics and Science Study (TIMSS):
2003 (KA)
FORMS: NONE
OMB NO: 1850-0705 EXPIRATION DATE: 06/30/2005
RESPS:51 HOURS:561 COSTS(000):$0
State Library Agencies Survey
FORMS: NONE
OMB NO: 1850-0729 EXPIRATION DATE: 03/31/2005
RESPS:10,063 HOURS:4,081 COSTS(000):$0
Baccalaureate and Beyond Longitudinal Study, Third Followup
(B&B:93/2003)
FORMS: NONE
OMB NO: 1850-0733 EXPIRATION DATE: 10/31/2003
RESPS:10,518 HOURS:7,889 COSTS(000):$0
NCES Quick Response Information System (KA)
FORMS: NONE
OMB NO: 1850-0746 EXPIRATION DATE: 05/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Standards for Evaluation of the Performance of Recipients of
OERI Grants, Cooperative Agreements, and Contracts
FORMS: NONE
OMB NO: 1850-0750 EXPIRATION DATE: 02/28/2005
RESPS:22,253 HOURS:14,990 COSTS(000):$0
Early Childhood Longitudinal Study (ECLS) - Kindergarten cohort,
third grade followup, field test for fourth and fifth grade
survey activities
FORMS: NONE
OMB NO: 1850-0755 EXPIRATION DATE: 06/30/2004
RESPS:10,800 HOURS:29,875 COSTS(000):$0
Program for International Student Assessment (PISA)
FORMS: NONE
OMB NO: 1850-0756 EXPIRATION DATE: 11/30/2005
RESPS:31,364 HOURS:23,114 COSTS(000):$0
Early Childhood Longitudinal Study: Birth Cohort/24 Month
Followup (KI)
FORMS: NONE
OMB NO: 1850-0758 EXPIRATION DATE: 10/31/2004
RESPS:97,750 HOURS:24,500 COSTS(000):$0
National Assessment of Educational Progress, 2002 Field Test and
2003 Full Scale Assessment of Reading, Math, and Foreign Language
FORMS: NONE
OMB NO: 1850-0763 EXPIRATION DATE: 04/30/2003
RESPS:80 HOURS:9,600 COSTS(000):$0
Application for a Comprehensive School Reform Educational
Research Grant
FORMS: NONE
OMB NO: 1850-0768 EXPIRATION DATE: 02/28/2005
RESPS:62,627 HOURS:10,750 COSTS(000):$0
National Househld Education Surveys Program of 2003 (NHES: 2003)
FORMS: NONE
OMB NO: 1850-0769 EXPIRATION DATE: 09/30/2003
RESPS:36,253 HOURS:15,721 COSTS(000):$0
The Impact of ICT on Learning: Quasi-Experimental Study
FORMS: NONE
OMB NO: 1850-0771 EXPIRATION DATE: 12/31/2003
RESPS:5,750 HOURS:1,438 COSTS(000):$0
NAEP Technology Based Assessment Project, Pretest and Field Test
FORMS: NONE
OMB NO: 1850-0776 EXPIRATION DATE: 12/31/2003
RESPS:1,500 HOURS:4,500 COSTS(000):$0
International Adult Literacy and Lifeskills Survey (KI)
FORMS: NONE
OMB NO: 1850-0781 EXPIRATION DATE: 08/31/2005
RESPS:3,400 HOURS:5,950 COSTS(000):$0
Academic Libraries Survey: 2002-2005 (KA)
FORMS: NONE
OMB NO: 1850-0783 EXPIRATION DATE: 11/30/2005
RESPS:8,791 HOURS:5,242 COSTS(000):$0
Preschool Curricula Evaluation Research (PCER) Program
FORMS: NONE
OMB NO: 1850-0784 EXPIRATION DATE: 03/31/2006
RESPS:3,500 HOURS:1,155 COSTS(000):$46,200
Even Start and Title I Preschool Classroom Literacy Environment
and Outcomes Study (JM)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
31 1,095,919 599,458 $46,200
Office of Innovation and Improvement
OMB NO: 1855-0001 EXPIRATION DATE: 05/31/2005
RESPS:30 HOURS:720 COSTS(000):$0
Application for Grants, Public Charter Schools Program
(1890-0001) (KA)
FORMS: NONE
OMB NO: 1855-0002 EXPIRATION DATE: 05/31/2005
RESPS:200 HOURS:8,000 COSTS(000):$0
Parental Assistance Program Application
FORMS: CFDA#84.310A
OMB NO: 1855-0003 EXPIRATION DATE: 08/31/2003
RESPS:58 HOURS:226 COSTS(000):$0
Goals 2000, Parental Information and Resource Center's Annual/
Final Performance Report (JM)
FORMS: NONE
OMB NO: 1855-0004 EXPIRATION DATE: 05/31/2003
RESPS:200 HOURS:3,200 COSTS(000):$0
Arts in Education Competitive Grants Program
FORMS: CFDA-84.926B
OMB NO: 1855-0005 EXPIRATION DATE: 05/31/2004
RESPS:200 HOURS:6,000 COSTS(000):$0
Applications for Grants Under the Dropout Prevention
Demonstration Program
FORMS: NONE
OMB NO: 1855-0006 EXPIRATION DATE: 05/31/2004
RESPS:60 HOURS:3,600 COSTS(000):$0
Applications for Grants Under the Arts in Education
Demonstration and Dissemination Grant Program
FORMS: NONE
OMB NO: 1855-0007 EXPIRATION DATE: 02/28/2006
RESPS:30 HOURS:2,400 COSTS(000):$0
Credit Enhancement for Charter School Facilities Program
FORMS: NONE
OMB NO: 1855-0008 EXPIRATION DATE: 05/31/2003
RESPS:211 HOURS:2,975 COSTS(000):$0
Technology Innovation Challenge Grant Program Online Annual
FORMS: CFDA-84.303A
OMB NO: 1855-0009 EXPIRATION DATE: 05/31/2003
RESPS:23 HOURS:3,260 COSTS(000):$0
Star Schools Program Online Annual Performance Reporting System
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 1,012 30,381 $0
Office of Intergovernmental and Interagency Affairs
OMB NO: 1860-0504 EXPIRATION DATE: 11/30/2004
RESPS:2,600 HOURS:41,600 COSTS(000):$0
Applications for the U.S. Presidential Scholars Program
FORMS: NONE
OMB NO: 1860-0505 EXPIRATION DATE: 10/31/2004
RESPS:720 HOURS:60 COSTS(000):$0
Sign-on form for Partnership for Family Involvement in Education
FORMS: NONE
OMB NO: 1860-0506 EXPIRATION DATE: 11/30/2005
RESPS:420 HOURS:16,800 COSTS(000):$0
No Child Left Behind--Blue Ribbon Schools Program
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 3,740 58,460 $0
Office of Safe and Drug Free Schools
OMB NO: 1865-0001 EXPIRATION DATE: 11/30/2003
RESPS:400 HOURS:9,500 COSTS(000):$0
Safe and Drug-Free Schools and Communities National
Programs--Federal Activities Discretionary Grant Program
FORMS: CFDA#84.184K 84.184M
OMB NO: 1865-0002 EXPIRATION DATE: 08/31/2003
RESPS:12,672 HOURS:27,042 COSTS(000):$0
Gun-Free Schools Act Report (KA)
FORMS: NONE
OMB NO: 1865-0003 EXPIRATION DATE: 07/31/2003
RESPS:75 HOURS:1,650 COSTS(000):$0
Safe and Drug-Free Schools and Communities National Programs--
Federal Activities--Grant Competition to Prevent High-Risk
Drinking and Violent Behavior Among College Students
FORMS: 84.184H
OMB NO: 1865-0004 EXPIRATION DATE: 05/31/2004
RESPS:450 HOURS:13,500 COSTS(000):$0
Safe Schools/Healthy Students Intiative
FORMS: CFDA-84.184L
OMB NO: 1865-0006 EXPIRATION DATE: 01/31/2006
RESPS:50,000 HOURS:30,000 COSTS(000):$0
National College Alcohol, Drug and Violence Survey
FORMS: NONE
OMB NO: 1865-0008 EXPIRATION DATE: 04/30/2003
RESPS:400 HOURS:11,200 COSTS(000):$0
Elementary School Counseling Demonstration Program
FORMS: NONE
OMB NO: 1865-0009 EXPIRATION DATE: 09/30/2003
RESPS:56 HOURS:2,240 COSTS(000):$0
Safe and Drug-Free Schools and Communities Act of the Governor's
Report Forms
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 64,053 95,132 $0
Office for Civil Rights
OMB NO: 1870-0500 EXPIRATION DATE: 12/31/2003
RESPS:33,000 HOURS:337,500 COSTS(000):$0
2002 Elementary and Secondary School Survey (also referred to as
the Elementary and Secondary School Civil Rights Compliance
Report)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 33,000 337,500 $0
Office of the Under Secretary
OMB NO: 1875-0106 EXPIRATION DATE: 11/30/2004
RESPS:17,000 HOURS:4,250 COSTS(000):$0
Application for Federal Education Assistance (AFEA)
FORMS: NONE
OMB NO: 1875-0154 EXPIRATION DATE: 12/31/2004
RESPS:1 HOURS:3,098 COSTS(000):$0
National Evaluation of Upward Bound and Upward Bound Math Science
FORMS: NONE
OMB NO: 1875-0177 EXPIRATION DATE: 05/31/2003
RESPS:350,427 HOURS:56,423 COSTS(000):$16
21st Century Community Learning Centers Annual Performance Report
FORMS: NONE
OMB NO: 1875-0180 EXPIRATION DATE: 07/31/2003
RESPS:185 HOURS:6,474 COSTS(000):$0
Annual Performance Reporting for the Gaining Early Awareness
FORMS: CFDA#:84.334
OMB NO: 1875-0182 EXPIRATION DATE: 08/31/2003
RESPS:800 HOURS:800 COSTS(000):$0
Class-Size Reduction Program
FORMS: NONE
OMB NO: 1875-0183 EXPIRATION DATE: 11/30/2003
RESPS:26,325 HOURS:42,090 COSTS(000):$0
Evaluation of the 21st Century Community Learning Centers Program
FORMS: NONE
OMB NO: 1875-0185 EXPIRATION DATE: 09/30/2003
RESPS:303 HOURS:1,515 COSTS(000):$0
Annual Performance Report for the Preparing Tomorrow's Teachers
FORMS: NONE
OMB NO: 1875-0186 EXPIRATION DATE: 10/31/2003
RESPS:1 HOURS:7,916 COSTS(000):$0
Moving Standards to the Classroom: A Study of Standard-Based
Mathematics Instruction in Six States
FORMS: NONE
OMB NO: 1875-0190 EXPIRATION DATE: 10/31/2003
RESPS:77 HOURS:3,161 COSTS(000):$0
Teacher Quality Enhancement Grants Program Annual Performance
FORMS: NONE
OMB NO: 1875-0191 EXPIRATION DATE: 10/31/2003
RESPS:11,565 HOURS:5,210 COSTS(000):$0
The National Evaluation of GEAR UP
FORMS: NONE
OMB NO: 1875-0193 EXPIRATION DATE: 02/29/2004
RESPS:3,000 HOURS:1,500 COSTS(000):$0
Study to Assess the Quality of Vocational Education in the
United States
FORMS: NONE
OMB NO: 1875-0194 EXPIRATION DATE: 11/30/2003
RESPS:873 HOURS:2,055 COSTS(000):$99
Assessing Literacy Models in the Boston Public Schools (JM)
FORMS: NONE
OMB NO: 1875-0195 EXPIRATION DATE: 01/31/2004
RESPS:1 HOURS:15,408 COSTS(000):$0
Redesignation of Students Served by Title VII Projects
(1890-0001) (JM)
FORMS: NONE
OMB NO: 1875-0196 EXPIRATION DATE: 03/31/2004
RESPS:1,298 HOURS:1,044 COSTS(000):$0
Evaluation of the Federal Class Size Reduction Program (JM)
FORMS: NONE
OMB NO: 1875-0199 EXPIRATION DATE: 05/31/2005
RESPS:1,275 HOURS:2,513 COSTS(000):$0
Evaluation of the Partnership Grants Program, Title II, Higher
Education Act Revision of Collection
FORMS: NONE
OMB NO: 1875-0201 EXPIRATION DATE: 05/31/2004
RESPS:2,200 HOURS:1,000 COSTS(000):$0
Evaluation of the State Grants Program and Teacher Recruitment
FORMS: NONE
OMB NO: 1875-0203 EXPIRATION DATE: 05/31/2004
RESPS:249 HOURS:9,520 COSTS(000):$0
GEPA Section 424 Data Collection on the Distribution of Federal
Education Funds (JM)
FORMS: NONE
OMB NO: 1875-0204 EXPIRATION DATE: 06/30/2004
RESPS:14,326 HOURS:13,753 COSTS(000):$0
Study of the SDFSCA Middle School Coordinator Initiative
FORMS: NONE
OMB NO: 1875-0205 EXPIRATION DATE: 01/31/2005
RESPS:6,384 HOURS:5,829 COSTS(000):$0
Evaluation of Title I Accountability Systems and School
Improvement Efforts (TASSIE)
FORMS: NONE
OMB NO: 1875-0207 EXPIRATION DATE: 08/31/2004
RESPS:2,000 HOURS:8,000 COSTS(000):$0
National Study of Title I Schools - Sampling Package
FORMS: NONE
OMB NO: 1875-0210 EXPIRATION DATE: 08/31/2004
RESPS:168 HOURS:144 COSTS(000):$0
State Vocational Directors Survey on Perkins III Funding and
Accountability Systems
FORMS: NONE
OMB NO: 1875-0212 EXPIRATION DATE: 10/31/2004
RESPS:106 HOURS:264 COSTS(000):$0
Study of State Administration of Even Start and Statewide Family
Literacy Initiative Grants
FORMS: NONE
OMB NO: 1875-0215 EXPIRATION DATE: 02/28/2005
RESPS:1,035 HOURS:735 COSTS(000):$0
The Reading Excellence Act School and Classroom Implementation
and Impact Study, Sampling Clearance Package
FORMS: NONE
OMB NO: 1875-0217 EXPIRATION DATE: 03/31/2005
RESPS:1,377 HOURS:3,123 COSTS(000):$282,745
The National Evaluation of Smaller Learning Communities (SC)
FORMS: NONE
OMB NO: 1875-0218 EXPIRATION DATE: 02/28/2005
RESPS:1,005 HOURS:488 COSTS(000):$0
Information Technology Skill Certification Study
FORMS: NONE
OMB NO: 1875-0219 EXPIRATION DATE: 04/30/2005
RESPS:2,897 HOURS:909 COSTS(000):$0
An Evaluation of the Rehabilitation Services Administration
(RSA) Training Programs' Responsiveness to State VR Agency Needs
for Qualified Personnel
FORMS: NONE
OMB NO: 1875-0221 EXPIRATION DATE: 07/31/2003
RESPS:220 HOURS:272 COSTS(000):$0
Study to Assess Funding, Accountability, and One-Stop Delivery
Systems in Adult Education
FORMS: NONE
OMB NO: 1875-0222 EXPIRATION DATE: 01/31/2006
RESPS:4,380 HOURS:2,567 COSTS(000):$0
Longitudinal Assessment of CSR Implementation and Outcomes
(LACIO)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
28 449,478 200,061 $282,860
Office of English Language Acquisition
OMB NO: 1885-0513 EXPIRATION DATE: 08/31/2004
RESPS:1,313 HOURS:7,828 COSTS(000):$0
Biennial Report Form for the Emergency Immigrant Education
FORMS: ED-T85-IP
OMB NO: 1885-0531 EXPIRATION DATE: 11/30/2003
RESPS:300 HOURS:7,650 COSTS(000):$0
Application for Grants Under School Improvement: Elementary
School Foreign Language Incentive Program (SC)
FORMS: 84.294A
OMB NO: 1885-0540 EXPIRATION DATE: 01/31/2006
RESPS:250 HOURS:20,000 COSTS(000):$0
School Improvement: Foreign Language Assistance Program for
Local Educational Agencies (1890-0001)(SC)
FORMS: 84.293B
OMB NO: 1885-0544 EXPIRATION DATE: 01/31/2006
RESPS:50 HOURS:4,000 COSTS(000):$0
School Improvement Foreign Language Assistance Program for State
Educational Agencies (1890-0001)(SC)
FORMS: 84.293C
OMB NO: 1885-0550 EXPIRATION DATE: 04/30/2004
RESPS:300 HOURS:30,600 COSTS(000):$0
Application for Grants Under English Language Acquisition:
National Professional Development Program (1890-0001) (SC)
FORMS: NONE
OMB NO: 1885-0551 EXPIRATION DATE: 10/31/2005
RESPS:100 HOURS:8,200 COSTS(000):$0
Application for Grants Under English Language Acquisition and
Language Enhancement: Native American and Alaska Native Children
in School (SC)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
6 2,313 78,278 $0
Office of the Chief Financial Officer
OMB NO: 1890-0001 EXPIRATION DATE: 03/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Streamlined Clearance Process for Discretionary Grant
FORMS: NONE
OMB NO: 1890-0004 EXPIRATION DATE: 04/30/2003
RESPS:23,248 HOURS:500,055 COSTS(000):$2
Grant Performance Report (JM)
FORMS: 524 524-B
OMB NO: 1890-0006 EXPIRATION DATE: 09/30/2004
RESPS:1 HOURS:1 COSTS(000):$0
Sreamlined Process for Education Department General
Administrative Regulations (EDGAR) Approved Grant Applications
FORMS: NONE
OMB NO: 1890-0007 EXPIRATION DATE: 09/30/2004
RESPS:21,200 HOURS:31,800 COSTS(000):$0
GEPA Section 427 Guidance for All Grant Applications (JM)
FORMS: NONE
OMB NO: 1890-0009 EXPIRATION DATE: 06/30/2005
RESPS:10,297 HOURS:244,906 COSTS(000):$0
Generic Application Package for Discretionary Grant Programs
FORMS: NONE
OMB NO: 1890-0012 EXPIRATION DATE: 02/28/2006
RESPS:250 HOURS:10,000 COSTS(000):$0
Small Business Innovation Research (SBIR) Program - Phase I -
Grant Application Package
FORMS: CFDA#-84.133S 84.305S 84.191S 84.051S 84.017S
OMB NO: 1890-0014 EXPIRATION DATE: 01/31/2006
RESPS:17,000 HOURS:1,360 COSTS(000):$0
Survey on Ensuring Equal Opportunity for Applicants
FORMS: NONE
OMB NO: 1890-0015 EXPIRATION DATE: 03/31/2006
RESPS:50 HOURS:3,750 COSTS(000):$0
Small Business Innovation Research (SBIR) Program - Phase II -
Grant Application Package
FORMS: 84.133S 84.305S 84.191S 84.051S 84.017S
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
8 72,047 791,873 $2
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
283 58,892,673 40,649,579 $538,444
Department of Energy
Departmental and Others
OMB NO: 1901-0260 EXPIRATION DATE: 07/31/2003
RESPS:468 HOURS:2,664 COSTS(000):$0
Standard Contract for Disposal of Spent Nuclear Fuel and/or
High- Level Radioactive Waste
FORMS: 830-G
OMB NO: 1901-0287 EXPIRATION DATE: 02/28/2005
RESPS:127 HOURS:1,237 COSTS(000):$0
Nuclear Fuel Data Form
FORMS: RW-859
OMB NO: 1901-0288 EXPIRATION DATE: 08/31/2005
RESPS:300 HOURS:7,310 COSTS(000):$0
Electric Emergency Incident and Disturbance Report
FORMS: 417
OMB NO: 1901-0294 EXPIRATION DATE: 03/31/2005
RESPS:1,370 HOURS:4,240 COSTS(000):$0
Import and Export of Natural Gas
FORMS: FE-746R
OMB NO: 1901-0296 EXPIRATION DATE: 02/29/2004
RESPS:540 HOURS:1,650 COSTS(000):$0
Report of International Electrical Export/Import Data
FORMS: FE-781R
OMB NO: 1901-0302 EXPIRATION DATE: 09/30/2003
RESPS:50,000 HOURS:12,500 COSTS(000):$0
DOE Customer Surveys
FORMS: 887
OMB NO: 1901-0303 EXPIRATION DATE: 07/31/2003
RESPS:40 HOURS:160 COSTS(000):$0
Annual Geothermal Heat Pump Manufacturers Survey
FORMS: 902
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 52,845 29,761 $0
Economic Regulatory Administration
OMB NO: 1903-0073 EXPIRATION DATE: 02/28/2006
RESPS:100 HOURS:400 COSTS(000):$0
Recordkeeping Requirements of DOE's General Allocation and Price
Rules
FORMS: 766R
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 100 400 $0
Energy Information Administration
OMB NO: 1905-0057 EXPIRATION DATE: 12/31/2003
RESPS:4,505 HOURS:74,236 COSTS(000):$0
Oil and Gas Reserves System Surveys
FORMS: 23 23P 64A
OMB NO: 1905-0092 EXPIRATION DATE: 02/29/2004
RESPS:5,127 HOURS:2,842 COSTS(000):$0
Residential Energy Consumption Survey (RECS)
FORMS: 457-A/G
OMB NO: 1905-0129 EXPIRATION DATE: 11/30/2004
RESPS:37,960 HOURS:173,990 COSTS(000):$0
Electric Power Surveys
FORMS: EIA-411 EIA-412 EIA-423 EIA-767 EIA-826 EIA-860 EIA-861 EIA-906
OMB NO: 1905-0149 EXPIRATION DATE: 11/30/2005
RESPS:30 HOURS:13,470 COSTS(000):$0
Financial Reporting System
FORMS: 28
OMB NO: 1905-0160 EXPIRATION DATE: 11/30/2003
RESPS:132 HOURS:2,424 COSTS(000):$0
Uranium Data Program
FORMS: 851 858
OMB NO: 1905-0165 EXPIRATION DATE: 01/31/2006
RESPS:47,117 HOURS:60,006 COSTS(000):$0
Petroleum Supply Reporting System
FORMS: EIA-800-804 807 810-814 816 817 819M 820
OMB NO: 1905-0167 EXPIRATION DATE: 03/31/2005
RESPS:5,201 HOURS:9,246 COSTS(000):$0
Coal Program Package
FORMS: EIA-1 3 4 5 6A 6Q 7A 20
OMB NO: 1905-0169 EXPIRATION DATE: 03/31/2006
RESPS:6,000 HOURS:55,291 COSTS(000):$0
Manufacturing Energy Consumption Survey (MECS)
FORMS: 846(A) 846(B) 846(C)
OMB NO: 1905-0174 EXPIRATION DATE: 11/30/2003
RESPS:134,594 HOURS:125,513 COSTS(000):$0
Petroleum Marketing Program
FORMS: 14 182 782A/B/C 821 856 863 877 878 888
OMB NO: 1905-0175 EXPIRATION DATE: 11/30/2005
RESPS:12,564 HOURS:45,464 COSTS(000):$0
Natural Gas Data Collection Program Package
FORMS: 176 191 857 895 910 912
OMB NO: 1905-0186 EXPIRATION DATE: 08/31/2005
RESPS:4,000 HOURS:1,000 COSTS(000):$0
Generic Clearance of Questionnaire Testing, Evaluation, and
Research
FORMS: 882-T
OMB NO: 1905-0191 EXPIRATION DATE: 05/31/2004
RESPS:2,491 HOURS:10,323 COSTS(000):$0
Annual Survey of Alternative Fueled Vehicle Suppliers and Users
FORMS: EIA-886
OMB NO: 1905-0194 EXPIRATION DATE: 10/31/2003
RESPS:220 HOURS:7,000 COSTS(000):$0
Voluntary Reporting of Greenhouse Gases
FORMS: EIA-1605 EIA-1605EZ
OMB NO: 1905-0196 EXPIRATION DATE: 09/30/2004
RESPS:110 HOURS:330 COSTS(000):$0
Annual Solar Thermal Collector Manufacturers Survey and Annual
Photovoltaic Module/Cell Manufacturers Survey
FORMS: EIA-63A EIA-63B
OMB NO: 1905-0202 EXPIRATION DATE: 05/31/2004
RESPS:2,112 HOURS:6,572 COSTS(000):$0
Monthly Natural Gas Marketers Survey
FORMS: EIA-910
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
15 262,163 587,707 $0
Office of Administration
OMB NO: 1910-0068 EXPIRATION DATE: 10/31/2004
RESPS:75 HOURS:450 COSTS(000):$0
Renewable Energy Production Incentive
FORMS: NONE
OMB NO: 1910-0100 EXPIRATION DATE: 04/30/2005
RESPS:438 HOURS:6,814 COSTS(000):$0
Information Management
FORMS: NONE
OMB NO: 1910-0300 EXPIRATION DATE: 03/31/2006
RESPS:11,344 HOURS:269,475 COSTS(000):$0
Environment Safety and Health
FORMS: NONE
OMB NO: 1910-0400 EXPIRATION DATE: 12/31/2005
RESPS:44,457 HOURS:415,544 COSTS(000):$0
Financial Assistance
FORMS: NONE
OMB NO: 1910-0500 EXPIRATION DATE: 04/30/2003
RESPS:12,715 HOURS:164,528 COSTS(000):$0
Financial Management
FORMS: NONE
OMB NO: 1910-0600 EXPIRATION DATE: 03/31/2005
RESPS:575 HOURS:10,421 COSTS(000):$0
Industrial Relations
FORMS: NONE
OMB NO: 1910-0800 EXPIRATION DATE: 03/31/2005
RESPS:1 HOURS:14,100 COSTS(000):$0
Legal Collections Package
FORMS: NONE
OMB NO: 1910-1000 EXPIRATION DATE: 04/30/2003
RESPS:3,857 HOURS:247,374 COSTS(000):$0
Personal Property
FORMS: NONE
OMB NO: 1910-1400 EXPIRATION DATE: 02/29/2004
RESPS:99 HOURS:1,584 COSTS(000):$0
Compliance Statement: Energy/Water Conservation Standards for
Appliances
FORMS: NONE
OMB NO: 1910-1800 EXPIRATION DATE: 04/30/2003
RESPS:86,596 HOURS:612,985 COSTS(000):$0
Safe Guards and Security
FORMS: NONE
OMB NO: 1910-4100 EXPIRATION DATE: 02/28/2005
RESPS:3,811 HOURS:1,086,529 COSTS(000):$0
Procurement (see attached chart for the collection requirements).
FORMS: NONE
OMB NO: 1910-5101 EXPIRATION DATE: 03/31/2006
RESPS:310 HOURS:1,550 COSTS(000):$0
U.S Dept. of Energy: Annual Alternative Fuel Vehical Acquisition
Report for State Government & Alternative Fuel Provider Fleets
FORMS: DOE\FCVT\101
OMB NO: 1910-5102 EXPIRATION DATE: 03/31/2006
RESPS:36 HOURS:5,350 COSTS(000):$0
Make or Buy Plans
FORMS: NONE
OMB NO: 1910-5104 EXPIRATION DATE: 08/31/2004
RESPS:41 HOURS:12,300 COSTS(000):$452
10 CFR 431 -- Energy Efficiency Program for Certain Commercial
and Industrial Equipment: Test Procedures, Labeling, and
Certification Requirements for Electric Motors
FORMS: NONE
OMB NO: 1910-5105 EXPIRATION DATE: 08/31/2004
RESPS:50 HOURS:50,000 COSTS(000):$0
Occupational Radiation Protection Program
FORMS: NONE
OMB NO: 1910-5111 EXPIRATION DATE: 04/30/2003
RESPS:20 HOURS:100 COSTS(000):$0
Disclosure of Relevant Interests by Firms That Are Members of
Apparent Successful Offeror Joint Venture of Other Formal
Teaming Arrangement
FORMS: NONE
OMB NO: 1910-5112 EXPIRATION DATE: 04/30/2003
RESPS:30,861 HOURS:54,762 COSTS(000):$2,088
Chronic Beryllium Disease Prevention Program
FORMS: NONE
OMB NO: 1910-5115 EXPIRATION DATE: 04/30/2004
RESPS:36 HOURS:515 COSTS(000):$0
Contractor Legal Management Requirements
FORMS: NONE
OMB NO: 1910-5117 EXPIRATION DATE: 03/31/2005
RESPS:124 HOURS:31,000 COSTS(000):$1,364
10 CFR Part 431 - Certification Requirements for Commercial
Heating and Air Conditioning Equipment
FORMS: NONE
OMB NO: 1910-5118 EXPIRATION DATE: 06/30/2005
RESPS:96 HOURS:100 COSTS(000):$0
Technology Partnerships Ombudsmen Reporting Requirements
FORMS: NONE
OMB NO: 1910-5120 EXPIRATION DATE: 08/31/2005
RESPS:8,000 HOURS:8,000 COSTS(000):$0
Physicians Panel Guidelines
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
21 203,542 2,993,481 $3,904
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
44 518,650 3,611,349 $3,904
Department of Health and Human Services
Food and Drug Administration
OMB NO: 0910-0001 EXPIRATION DATE: 03/31/2005
RESPS:20,360 HOURS:1,984,003 COSTS(000):$0
Applications for FDA Approval to Market a New Drug -- Part 314
FORMS: NONE
OMB NO: 0910-0012 EXPIRATION DATE: 04/30/2003
RESPS:6,750 HOURS:54,225 COSTS(000):$0
Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product
Defect Report, and Transmittal of Periodic Reports and
Promotional Material for New Animal Drugs. 21 CFR Part 510
FORMS: FDA-1932 FDA-1932A FDA-2301
OMB NO: 0910-0014 EXPIRATION DATE: 01/31/2006
RESPS:541,986 HOURS:36,040,829 COSTS(000):$0
Investigational New Drug (IND) Regulations
FORMS: FDA-1571 FDA-1572
OMB NO: 0910-0016 EXPIRATION DATE: 10/31/2003
RESPS:13 HOURS:69,320 COSTS(000):$0
Food Additive Petitions
FORMS: NONE
OMB NO: 0910-0021 EXPIRATION DATE: 07/31/2003
RESPS:58 HOURS:204 COSTS(000):$0
Interstate Shellfish Dealer's Certificate
FORMS: FDA-3038
OMB NO: 0910-0025 EXPIRATION DATE: 11/30/2003
RESPS:47,343 HOURS:324,957 COSTS(000):$0
Reporting and Recordkeeping Requirements and Availability of
Sample Electronic Products for Manufacturers and Distributors of
Electronic
FORMS: FDA-2579 FDA-2767 FDA-2877 FDA-3147
OMB NO: 0910-0027 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:20 COSTS(000):$0
Voluntary Registration of Cosmetics Product Establishment
FORMS: FDA-2511
OMB NO: 0910-0030 EXPIRATION DATE: 11/30/2005
RESPS:2,015 HOURS:987 COSTS(000):$0
Cosmetic Product Voluntary Reporting Program - 21 CFR Part 720
FORMS: FDA-2512 2512A 2514
OMB NO: 0910-0032 EXPIRATION DATE: 07/31/2004
RESPS:1,582 HOURS:383,793 COSTS(000):$0
New Animal Drug Application, 21 CFR Part 514
FORMS: FDA-356V
OMB NO: 0910-0037 EXPIRATION DATE: 08/31/2005
RESPS:8,050 HOURS:1,502,828 COSTS(000):$0
Food Canning Establishment Registration Process Filing and
Recordkeeping for Acidified Foods and Thermally Processed
Low-Acid Foods in hermetically Sealed Containers
FORMS: 2541 2541A 2541C
OMB NO: 0910-0045 EXPIRATION DATE: 07/31/2004
RESPS:66,223 HOURS:33,112 COSTS(000):$0
Registration of Producers of Drugs and Lisitng of Drugs in
Commercial Distribution
FORMS: 2656 2656E 2657 2658
OMB NO: 0910-0046 EXPIRATION DATE: 08/31/2003
RESPS:2,533,355 HOURS:354,714 COSTS(000):$0
Electronic Importer's Entry Notice
FORMS: NONE
OMB NO: 0910-0052 EXPIRATION DATE: 02/28/2006
RESPS:3,167 HOURS:1,753 COSTS(000):$0
Blood Establishment Registration and Product Listing Form FDA
2830
FORMS: FDA-2830
OMB NO: 0910-0053 EXPIRATION DATE: 10/31/2004
RESPS:411 HOURS:2,910 COSTS(000):$0
Radioactive Drug Research Committee (RDRC) Report on Research
Use of Radioactive Drug Study Summary
FORMS: FDA-2914 FDA-2915
OMB NO: 0910-0073 EXPIRATION DATE: 07/31/2004
RESPS:1 HOURS:3,167,670 COSTS(000):$1,182
Medical Devices: Current Good Manufacturing Practice (CGMP),
Quality System (Q/S) Regulation; 21 CFR Part 820
FORMS: NONE
OMB NO: 0910-0078 EXPIRATION DATE: 08/31/2003
RESPS:4,527 HOURS:61,021 COSTS(000):$0
Investigational Device Exemptions Reports and Records - 21 CFR
812
FORMS: NONE
OMB NO: 0910-0114 EXPIRATION DATE: 08/31/2003
RESPS:26 HOURS:461 COSTS(000):$0
Administrative Detention and Banned Medical Devices
FORMS: NONE
OMB NO: 0910-0116 EXPIRATION DATE: 11/30/2005
RESPS:42,435 HOURS:335,346 COSTS(000):$0
Current Good Manufacturing Practices and Related Regulations for
Blood and Blood Components; and "Lookback" Requirements
FORMS: NONE
OMB NO: 0910-0117 EXPIRATION DATE: 03/31/2005
RESPS:21,510 HOURS:68,245 COSTS(000):$0
New Animal Drugs for Investigational Use - 21 CFR Part 511
FORMS: 3458
OMB NO: 0910-0119 EXPIRATION DATE: 09/30/2004
RESPS:36,150 HOURS:1,311,157 COSTS(000):$0
Good Laboratory Practice (GLP) Regulations for Nonclinical
Laboratory Studies - 21 CFR Part 58
FORMS: NONE
OMB NO: 0910-0120 EXPIRATION DATE: 09/30/2004
RESPS:4,000 HOURS:331,000 COSTS(000):$0
Premarket Notification 510(K) Submissions
FORMS: FDA-3514
OMB NO: 0910-0129 EXPIRATION DATE: 05/31/2003
RESPS:3 HOURS:330 COSTS(000):$0
Applications for Exemption From Federal Preemption of State and
Local Medical Device Requirements-21 CFR Part 808
FORMS: NONE
OMB NO: 0910-0130 EXPIRATION DATE: 09/30/2004
RESPS:29,200 HOURS:131,400 COSTS(000):$0
Protection of Human Subjects; Recordkeeping and Reporting
Requirements for Institutional Review Boards (IRB's)
FORMS: NONE
OMB NO: 0910-0131 EXPIRATION DATE: 11/30/2003
RESPS:1,800 HOURS:7,200 COSTS(000):$0
Agreement for Shipments of Devices for Sterilization
FORMS: NONE
OMB NO: 0910-0132 EXPIRATION DATE: 11/30/2003
RESPS:1 HOURS:2,614 COSTS(000):$0
Affirmation of Generally Recognized as Safe GRAS Status
FORMS: NONE
OMB NO: 0910-0133 EXPIRATION DATE: 07/31/2005
RESPS:11 HOURS:191 COSTS(000):$0
Temporary Marketing Permit Applications
FORMS: NONE
OMB NO: 0910-0138 EXPIRATION DATE: 01/31/2006
RESPS:6 HOURS:3,000 COSTS(000):$0
Reclassification Petitions for Medical Devices
FORMS: FDA-3427 3428 3429
OMB NO: 0910-0139 EXPIRATION DATE: 08/31/2005
RESPS:4,184 HOURS:848,625 COSTS(000):$0
Current Good Manufacturing Practice; Proposed Amendment of
Certain Requirements for Finished Pharmaceuticals
FORMS: NONE
OMB NO: 0910-0152 EXPIRATION DATE: 09/30/2004
RESPS:36,444,150 HOURS:7,317,151 COSTS(000):$0
Current Good Manufacturing Practice for Medicated Feed, 21 CFR
Part 225
FORMS: NONE
OMB NO: 0910-0154 EXPIRATION DATE: 09/30/2004
RESPS:180,550 HOURS:187,450 COSTS(000):$0
Good Manufacturing Practice for Type A Medicated Articles, 21
CFR Part 226
FORMS: NONE
OMB NO: 0910-0167 EXPIRATION DATE: 07/31/2004
RESPS:1 HOURS:20,964 COSTS(000):$0
Orphan Drug Products
FORMS: NONE
OMB NO: 0910-0182 EXPIRATION DATE: 04/30/2004
RESPS:23,070,000 HOURS:19,225 COSTS(000):$0
Use of Impact Resistant Lenses in Eyeglasses and Sunglasses OMB
No. 0910-0182
FORMS: NONE
OMB NO: 0910-0183 EXPIRATION DATE: 03/31/2006
RESPS:476 HOURS:5,678 COSTS(000):$0
General Administrative Procedures: Citizen Petitions; Petition
for Reconsideration or Stay of Action; Advisory Opinions
FORMS: NONE
OMB NO: 0910-0184 EXPIRATION DATE: 02/28/2006
RESPS:10 HOURS:200 COSTS(000):$0
Filing Objections and Requests for a Hearing on a Regulation or
Order
FORMS: NONE
OMB NO: 0910-0185 EXPIRATION DATE: 07/31/2005
RESPS:3 HOURS:6,000 COSTS(000):$9
Labeling Requirements for Color Additives (other than hair dyes)
and Petitions
FORMS: NONE
OMB NO: 0910-0186 EXPIRATION DATE: 04/30/2003
RESPS:360 HOURS:360 COSTS(000):$0
Irradiation in the Production, Processing and Handling of Food
FORMS: NONE
OMB NO: 0910-0188 EXPIRATION DATE: 07/31/2005
RESPS:3 HOURS:18,956 COSTS(000):$0
Infant Formula Recall Regulations - 21 CFR Part 107
FORMS: NONE
OMB NO: 0910-0191 EXPIRATION DATE: 04/30/2006
RESPS:1 HOURS:1,020 COSTS(000):$0
Notice of Participation
FORMS: NONE
OMB NO: 0910-0192 EXPIRATION DATE: 03/31/2004
RESPS:12 HOURS:120 COSTS(000):$0
Petition for Administrative Reconsideration of Action - 21 CFR
10.33
FORMS: NONE
OMB NO: 0910-0194 EXPIRATION DATE: 03/31/2004
RESPS:13 HOURS:130 COSTS(000):$0
Petition for Administrative Stay of Action - 21 CFR 10.35
FORMS: NONE
OMB NO: 0910-0206 EXPIRATION DATE: 08/31/2003
RESPS:7,221 HOURS:21,878 COSTS(000):$0
Request for Samples and Protocols
FORMS: NONE
OMB NO: 0910-0212 EXPIRATION DATE: 09/30/2005
RESPS:1,632 HOURS:2,424 COSTS(000):$0
Regulations Under the Federal Import Milk Act (21 CFR Part 1210)
(formerly Federal Import Milk Act)
FORMS: FDA-1815 1993 1994 1995 1996 1997
OMB NO: 0910-0216 EXPIRATION DATE: 08/31/2004
RESPS:4,346 HOURS:2,172 COSTS(000):$0
Color Additive Certification Requests and Recordkeeping
FORMS: NONE
OMB NO: 0910-0230 EXPIRATION DATE: 09/30/2005
RESPS:10,959 HOURS:287,574 COSTS(000):$1,416
Postmarketing Adverse Drug Experienced Reporting - 21 CFR
310.305 and 314.80
FORMS: FDA-3500 FDA-3500A
OMB NO: 0910-0231 EXPIRATION DATE: 08/31/2004
RESPS:487 HOURS:107,321 COSTS(000):$0
Premarket Approval of Medical Devices; 21 CFR Part 814
FORMS: NONE
OMB NO: 0910-0233 EXPIRATION DATE: 09/30/2004
RESPS:1 HOURS:100 COSTS(000):$0
Patent Term Restoration, due Diligence Petitions, Filing,
Format, and Content of Petitions
FORMS: NONE
OMB NO: 0910-0249 EXPIRATION DATE: 10/31/2004
RESPS:12,985 HOURS:157,675 COSTS(000):$0
FDA Recall Regulations
FORMS: NONE
OMB NO: 0910-0256 EXPIRATION DATE: 02/29/2004
RESPS:40 HOURS:25,560 COSTS(000):$0
Infant Formula Requirements
FORMS: NONE
OMB NO: 0910-0264 EXPIRATION DATE: 11/30/2003
RESPS:20 HOURS:50 COSTS(000):$0
Export of Medical Devices - Foreign Letters of Approval
FORMS: NONE
OMB NO: 0910-0275 EXPIRATION DATE: 10/31/2005
RESPS:1 HOURS:10 COSTS(000):$0
State Enforcement Notifications (21 CFR 100.2(d))
FORMS: NONE
OMB NO: 0910-0277 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:40 COSTS(000):$0
State Petitions for Exemption from Preemption
FORMS: NONE
OMB NO: 0910-0279 EXPIRATION DATE: 06/30/2004
RESPS:1 HOURS:609 COSTS(000):$0
Year 2001 Updates of a National Survey of Prescription Drug
Informaion Provided to Patients
FORMS: NONE
OMB NO: 0910-0291 EXPIRATION DATE: 04/30/2003
RESPS:332,414 HOURS:332,414 COSTS(000):$0
MedWatch: The FDA Medical Products Reporting Program
FORMS: FDA-3500 3500A
OMB NO: 0910-0297 EXPIRATION DATE: 02/29/2004
RESPS:2,921 HOURS:876 COSTS(000):$0
User Fee Cover Sheet
FORMS: FDA-3397
OMB NO: 0910-0298 EXPIRATION DATE: 02/29/2004
RESPS:6 HOURS:288 COSTS(000):$0
Food additives; Threshold of Regulation for Substances Used in
Food-Contact Articles
FORMS: NONE
OMB NO: 0910-0302 EXPIRATION DATE: 03/31/2004
RESPS:56 HOURS:382,388 COSTS(000):$0
Human Tissue Intended for Transplantation
FORMS: NONE
OMB NO: 0910-0303 EXPIRATION DATE: 05/31/2003
RESPS:4,500 HOURS:270,000 COSTS(000):$0
Electronic Records: Electronic Signatures
FORMS: NONE
OMB NO: 0910-0308 EXPIRATION DATE: 04/30/2003
RESPS:17,406 HOURS:268,803 COSTS(000):$0
Adverse Experience Reporting for Licensed Biological Products;
and General Records
FORMS: N/A
OMB NO: 0910-0309 EXPIRATION DATE: 02/29/2004
RESPS:39,996,722 HOURS:3,516,183 COSTS(000):$21
Mammography Facilities, Standards, and Lay Summaries For Patients
FORMS: FDA-3422
OMB NO: 0910-0320 EXPIRATION DATE: 08/31/2004
RESPS:206 HOURS:555 COSTS(000):$0
Request for Information from U.S. Processors that Export to the
European Community
FORMS: NONE
OMB NO: 0910-0322 EXPIRATION DATE: 08/31/2003
RESPS:10,941 HOURS:230,040 COSTS(000):$0
21 CFR 25 - Environmental Impact Considerations
FORMS: NONE
OMB NO: 0910-0325 EXPIRATION DATE: 09/30/2005
RESPS:2 HOURS:8,320 COSTS(000):$0
Extra Label Drug Use in Animals
FORMS: NONE
OMB NO: 0910-0330 EXPIRATION DATE: 07/31/2005
RESPS:35 HOURS:700 COSTS(000):$0
Premarket Notification for a New Dietary Ingredient
FORMS: NONE
OMB NO: 0910-0331 EXPIRATION DATE: 12/31/2003
RESPS:2,500 HOURS:1,875 COSTS(000):$0
Food Labeling; Notification Procedures for Statement on Dietary
Supplements
FORMS: NONE
OMB NO: 0910-0332 EXPIRATION DATE: 11/30/2005
RESPS:129 HOURS:11,398 COSTS(000):$0
Medical Devices; Humanitarian Use Devices; 21 CFR Part 814 -
Subpart H
FORMS: NONE
OMB NO: 0910-0337 EXPIRATION DATE: 11/30/2003
RESPS:175 HOURS:72 COSTS(000):$0
Medicated Feed Mill License Application
FORMS: FDA-3448
OMB NO: 0910-0338 EXPIRATION DATE: 08/31/2005
RESPS:5,715 HOURS:301,752 COSTS(000):$349
General Licensing Provisions: Biologics License Application,
Changes to an Approved Application, Labeling; and Revocation and
Suspension
FORMS: FDA-2567 FDA-356H
OMB NO: 0910-0339 EXPIRATION DATE: 02/29/2004
RESPS:1 HOURS:14,420 COSTS(000):$0
Substances Prohibited from use in Animal Food or Feed; Animal
Proteins Prohibited in Ruminant Feed, 21 CFR 589.2000
FORMS: NONE
OMB NO: 0910-0340 EXPIRATION DATE: 04/30/2005
RESPS:39,910 HOURS:120,525 COSTS(000):$0
Over-the-Counter Human Drugs; Labeling Requirements
FORMS: NONE
OMB NO: 0910-0341 EXPIRATION DATE: 05/31/2003
RESPS:924 HOURS:157 COSTS(000):$0
FDA Safety Alert/Public Health Advisory Readership Survey
FORMS: NONE
OMB NO: 0910-0342 EXPIRATION DATE: 05/31/2003
RESPS:60 HOURS:9,900 COSTS(000):$0
Notice of a Claim for GRAS exemption based on a GRAS
Determination
FORMS: NONE
OMB NO: 0910-0345 EXPIRATION DATE: 02/29/2004
RESPS:2,000 HOURS:1,000 COSTS(000):$0
Food Safety Survey
FORMS: NONE
OMB NO: 0910-0352 EXPIRATION DATE: 11/30/2003
RESPS:45 HOURS:4,320 COSTS(000):$0
Latex Condoms; User Labeling - Expiration Dating (21 CFR 801.435)
FORMS: NONE
OMB NO: 0910-0353 EXPIRATION DATE: 03/31/2004
RESPS:18 HOURS:1,178 COSTS(000):$0
Sterility Requirement for Aqueous-Based Drug Products for Oral
Inhalation; final rule
FORMS: NONE
OMB NO: 0910-0354 EXPIRATION DATE: 02/29/2004
RESPS:5,850 HOURS:627,075 COSTS(000):$0
Procedures for the Safe Processing and Importing of Fish and
Fishery Products; 21 CFR Part 123
FORMS: NONE
OMB NO: 0910-0356 EXPIRATION DATE: 02/29/2004
RESPS:860 HOURS:544,036 COSTS(000):$0
Substantial Evidence of Effectiveness of New Animal Drugs
FORMS: NONE
OMB NO: 0910-0359 EXPIRATION DATE: 03/31/2005
RESPS:880 HOURS:13,200 COSTS(000):$0
Reports of corrections and Removals; 21 CFR Part 806
FORMS: NONE
OMB NO: 0910-0360 EXPIRATION DATE: 03/31/2005
RESPS:20,000 HOURS:6,000 COSTS(000):$0
Customer/Partner Service Surveys - (Extension)
FORMS: NONE
OMB NO: 0910-0361 EXPIRATION DATE: 03/31/2004
RESPS:300 HOURS:15,000 COSTS(000):$0
Classification/reclassification; Restricted Devices; Analyte
Specific Reagents
FORMS: N/A
OMB NO: 0910-0363 EXPIRATION DATE: 10/31/2005
RESPS:1,880,521 HOURS:120,184 COSTS(000):$0
Veterinary Feed Directive (VFD) 21 CFR Part 558
FORMS: NONE
OMB NO: 0910-0364 EXPIRATION DATE: 04/30/2004
RESPS:30 HOURS:30 COSTS(000):$15
Nutrition Labeline: Declaration of Caloric Amounts and Serving
Sizes for Breath Mints
FORMS: NONE
OMB NO: 0910-0368 EXPIRATION DATE: 03/31/2004
RESPS:20 HOURS:2,000 COSTS(000):$0
OTC Test Sample Collection Systems for Drugs of Abuse Testing -
21 CFR Part 809
FORMS: NONE
OMB NO: 0910-0370 EXPIRATION DATE: 07/31/2004
RESPS:588 HOURS:1,920 COSTS(000):$0
Specific Requirements on Content and Format of Labeling;
Geriatric Use Subsection
FORMS: NONE
OMB NO: 0910-0374 EXPIRATION DATE: 08/31/2005
RESPS:3 HOURS:1,153 COSTS(000):$0
Guidance for Industry: Notification of a Health Claim or
Nutrient Content Claim Based on an Authoritative Statement of a
Scientific Body
FORMS: NONE
OMB NO: 0910-0375 EXPIRATION DATE: 10/31/2004
RESPS:140 HOURS:7,960 COSTS(000):$0
Medical Devices; Third Party Review Under FDAMA
FORMS: NONE
OMB NO: 0910-0376 EXPIRATION DATE: 10/31/2004
RESPS:16,640 HOURS:33,280 COSTS(000):$0
Transmittal of Advertising and Promotional Labeling for Drugs
and Biologics for Human Use
FORMS: FDA-2253
OMB NO: 0910-0378 EXPIRATION DATE: 03/31/2005
RESPS:220 HOURS:5,760 COSTS(000):$0
Medical Devices; Third-Party Premarket Submission Review and
Quality System Inspections Under U.S./E.C. Mutual Recognition
Agreement
FORMS: NONE
OMB NO: 0910-0381 EXPIRATION DATE: 02/29/2004
RESPS:509,579 HOURS:1,594,269 COSTS(000):$16,800
Food Labeling Regulations
FORMS: NONE
OMB NO: 0910-0387 EXPIRATION DATE: 03/31/2005
RESPS:1 HOURS:66,461 COSTS(000):$0
Medical Device Registration and Listing: 21 CFR Parts 807.22 and
807.31
FORMS: 2891 2891A 2782
OMB NO: 0910-0389 EXPIRATION DATE: 06/30/2005
RESPS:86 HOURS:6,480 COSTS(000):$0
Guidance for Industry: Fast Track Drug Development Programs -
Designation, Development & Application Review
FORMS: NONE
OMB NO: 0910-0390 EXPIRATION DATE: 11/30/2005
RESPS:4,492 HOURS:52,208 COSTS(000):$0
Dissemination of Information on Unapproved/New Uses for Marketed
Drugs, Biologics, and Devices
FORMS: NONE
OMB NO: 0910-0392 EXPIRATION DATE: 10/31/2005
RESPS:64 HOURS:18,557 COSTS(000):$80,000
Regulations Requiring Manufacturers to Assess the Safety and
Effectiveness of New Drugs and Biological Products in Pediatric
Patients
FORMS: NONE
OMB NO: 0910-0393 EXPIRATION DATE: 03/31/2005
RESPS:460,012 HOURS:2,651 COSTS(000):$0
Prescription Drug Product Labeling - Medication Guide Requirement
FORMS: NONE
OMB NO: 0910-0395 EXPIRATION DATE: 01/31/2005
RESPS:850 HOURS:213 COSTS(000):$83
Food Labeling: Nutrition Labeling of Dietary Supplements on a
"Per Day" Basis
FORMS: NONE
OMB NO: 0910-0396 EXPIRATION DATE: 02/28/2006
RESPS:1 HOURS:18,750 COSTS(000):$0
Financial Disclosure by Clinical Investigators
FORMS: 3454 3455
OMB NO: 0910-0409 EXPIRATION DATE: 09/30/2005
RESPS:2 HOURS:4,000 COSTS(000):$0
Regulations for In Vivo Radiopharmaceuticals Used for Diagnosis
and Monitoring
FORMS: NONE
OMB NO: 0910-0423 EXPIRATION DATE: 04/30/2003
RESPS:2 HOURS:247 COSTS(000):$0
New Drug and Biological Drug Products; Evidence Needed to
Demonstrate Efficacy of New Drugs for Use Against Lethal or
Permanently Disabling Toxic Substances When Efficacy Studies...
FORMS: NONE
OMB NO: 0910-0428 EXPIRATION DATE: 12/31/2005
RESPS:25 HOURS:25 COSTS(000):$0
Record Retention Requirements for the Soy Protein/CHD Health
Claim
FORMS: NONE
OMB NO: 0910-0429 EXPIRATION DATE: 02/28/2006
RESPS:3,103 HOURS:42,760 COSTS(000):$0
Guidance for Industry on Formal Mettings with Sponsors and
Applicants for PDUFA Products
FORMS: 1571 1572 356H
OMB NO: 0910-0430 EXPIRATION DATE: 02/28/2006
RESPS:3 HOURS:96 COSTS(000):$0
Guidance for Industry on Formal Dispute Resolutions; Appeals
Above the Division Level
FORMS: FDA-1571 FDA-356H
OMB NO: 0910-0431 EXPIRATION DATE: 03/31/2004
RESPS:12,278 HOURS:842,020 COSTS(000):$0
Changes to an Approved NDA or ANDA
FORMS: NONE
OMB NO: 0910-0432 EXPIRATION DATE: 01/31/2006
RESPS:2 HOURS:1,082 COSTS(000):$0
Medical Device Recall Authority
FORMS: NONE
OMB NO: 0910-0433 EXPIRATION DATE: 02/29/2004
RESPS:548 HOURS:4,384 COSTS(000):$0
Postmarketing Studies for Human Drugs and Licensed Biological
Products; Status Reports
FORMS: FDA-2252
OMB NO: 0910-0435 EXPIRATION DATE: 05/31/2003
RESPS:96,935,065 HOURS:3,361,996 COSTS(000):$0
Prescription Drug Marketing Act of 1987; Policies, Requirements,
and Administrative Procedures
FORMS: NONE
OMB NO: 0910-0437 EXPIRATION DATE: 04/30/2003
RESPS:39,764 HOURS:91,306 COSTS(000):$0
Medical Devices; Medical Device Reporting;manufacturer
reportiing importer reporting, user facility reporting,
distributor reporting
FORMS: FDA-3419 FDA-3417
OMB NO: 0910-0439 EXPIRATION DATE: 04/30/2003
RESPS:265 HOURS:3,710 COSTS(000):$0
Aluminum in Large and Small Volume Parenterals Used in Total
Parenteral Nutrition
FORMS: NONE
OMB NO: 0910-0442 EXPIRATION DATE: 04/30/2005
RESPS:10,174,876 HOURS:2,790,329 COSTS(000):$0
Medical Device Tracking Regulations
FORMS: NONE
OMB NO: 0910-0443 EXPIRATION DATE: 06/30/2003
RESPS:1 HOURS:250 COSTS(000):$0
Survey of Incidence of Gastroenterolocial Parasitic Infections
in the United States as a Result of Consumption of Raw Fish
FORMS: NONE
OMB NO: 0910-0445 EXPIRATION DATE: 09/30/2003
RESPS:182 HOURS:51,688 COSTS(000):$0
Submitting and Reviewing Complete Responses to Clinical Holds;
Guidance for Industry
FORMS: NONE
OMB NO: 0910-0448 EXPIRATION DATE: 11/30/2003
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Adoption of FDA Food Code by Local, State, and Tribal Governments
FORMS: NONE
OMB NO: 0910-0449 EXPIRATION DATE: 11/30/2003
RESPS:502 HOURS:23,328 COSTS(000):$0
Postmarket Surveillance
FORMS: NONE
OMB NO: 0910-0450 EXPIRATION DATE: 11/30/2003
RESPS:66 HOURS:27 COSTS(000):$0
Guidance for Industry on How to Use E-Mail to Submit a Notice of
Intent to Slaughter for Human Food Purposes
FORMS: 3487
OMB NO: 0910-0452 EXPIRATION DATE: 11/30/2003
RESPS:168 HOURS:116 COSTS(000):$0
Guidance for Industry on How to Use E-Mail to Submit a Request
for a Meeting or Teleconference to the Office of New Animal Drug
Evaluation
FORMS: FDA-3488
OMB NO: 0910-0453 EXPIRATION DATE: 11/30/2003
RESPS:324 HOURS:262 COSTS(000):$0
Guidance for Industry on How to Use E-Mail to Submit a Notice of
Final Disposition of Animals Not Inded for Immediate Slaughter
FORMS: FDA-3486
OMB NO: 0910-0454 EXPIRATION DATE: 11/30/2003
RESPS:140 HOURS:140 COSTS(000):$0
Guidance: How to Use E-Mail to Submit Information to the Center
for Veterinary Medicine
FORMS: NONE
OMB NO: 0910-0455 EXPIRATION DATE: 11/30/2003
RESPS:83 HOURS:1,529 COSTS(000):$1
Documentation for demonstrating compliance with the Channels
FORMS: NONE
OMB NO: 0910-0456 EXPIRATION DATE: 01/31/2004
RESPS:53 HOURS:343 COSTS(000):$0
PHS (Public Health Service) Guideline on Infectious Disease
Issues in Xenotransplantation
FORMS: NONE
OMB NO: 0910-0457 EXPIRATION DATE: 03/31/2005
RESPS:2,000 HOURS:1,000 COSTS(000):$0
Rapid Response Surveys
FORMS: NONE
OMB NO: 0910-0458 EXPIRATION DATE: 02/29/2004
RESPS:60,751 HOURS:261,648 COSTS(000):$0
Biological Products: Reporting of Biological Product Deviations
FORMS: FDA-3486
OMB NO: 0910-0459 EXPIRATION DATE: 03/31/2004
RESPS:34,660 HOURS:202,496 COSTS(000):$0
Information Program on Clinical Trials for Serious and Life-
Threatening Diseases
FORMS: NONE
OMB NO: 0910-0461 EXPIRATION DATE: 02/29/2004
RESPS:10 HOURS:20 COSTS(000):$0
Substances Approved for Use in the Preparatin of Meat and
Poultry Products
FORMS: NONE
OMB NO: 0910-0466 EXPIRATION DATE: 03/31/2004
RESPS:15,035 HOURS:358,465 COSTS(000):$0
Hazard Analysis and Critical Control Point (HACCP) Procedures
for the Safe and Sanitary Processing of Juice (21 CFR Part 120)
FORMS: NONE
OMB NO: 0910-0467 EXPIRATION DATE: 04/30/2004
RESPS:6 HOURS:120 COSTS(000):$0
Request for Review of Scientific Disputes Concerning the
Regulation of Medical Devices
FORMS: NONE
OMB NO: 0910-0469 EXPIRATION DATE: 07/31/2004
RESPS:1,225 HOURS:1,525 COSTS(000):$0
Human Cells, Tissues, and Cellular and Tissue-Based Products;
Establishments Registration and Listing; Final Rule
FORMS: FDA-3356
OMB NO: 0910-0470 EXPIRATION DATE: 07/31/2004
RESPS:240 HOURS:3,180 COSTS(000):$0
Guidance for Industry on Special Protocol Assessment
FORMS: NONE
OMB NO: 0910-0471 EXPIRATION DATE: 07/31/2004
RESPS:1,245 HOURS:934 COSTS(000):$0
Adverse Event Pilot Program for Medical Devices
FORMS: NONE
OMB NO: 0910-0472 EXPIRATION DATE: 08/31/2004
RESPS:29,356 HOURS:3,125 COSTS(000):$0
Requirements for Testing Human Blood Donors for Evidence of
Infection Due to Communicable Disease Agents
FORMS: NONE
OMB NO: 0910-0474 EXPIRATION DATE: 08/31/2004
RESPS:416,021 HOURS:141,681 COSTS(000):$0
General Requirements for Blood, Blood Components, and Blood
Derivatives; Donor Notification
FORMS: NONE
OMB NO: 0910-0477 EXPIRATION DATE: 10/31/2004
RESPS:5,272 HOURS:659 COSTS(000):$0
Survey of Single-Use Medical Device (SUD) Reuse and Reprocessing
in Hospitals
FORMS: NONE
OMB NO: 0910-0478 EXPIRATION DATE: 05/31/2003
RESPS:5,000 HOURS:6,500 COSTS(000):$0
Consumer and Producer Surveys on Economic Issues
FORMS: NONE
OMB NO: 0910-0479 EXPIRATION DATE: 06/30/2003
RESPS:1 HOURS:637 COSTS(000):$0
Assessment of Physician and Patient Attitudes Toward
Direct-to-Consumer (DTC) Promotion of Prescription Drugs
FORMS: NONE
OMB NO: 0910-0480 EXPIRATION DATE: 11/30/2003
RESPS:3 HOURS:17,403 COSTS(000):$56
Providing Regulatory Submissions in Electronic Format for Food
Additive and Color Additive Petitions
FORMS: FDA-3503 FDA-3504
OMB NO: 0910-0482 EXPIRATION DATE: 01/31/2005
RESPS:2,065 HOURS:31,106 COSTS(000):$0
Exports: Notification and Recordkeeping Requirements
FORMS: NONE
OMB NO: 0910-0483 EXPIRATION DATE: 03/31/2005
RESPS:108,148 HOURS:52,333 COSTS(000):$0
Foreign Establishment Registration and Listing
FORMS: FDA-2656 -2830 -2891
OMB NO: 0910-0484 EXPIRATION DATE: 03/31/2005
RESPS:307 HOURS:1,417 COSTS(000):$0
Suggested Documentation for Demonstrating Compliance with
Channels of Trade Provision for Foods with Vinclozolin Residues
FORMS: NONE
OMB NO: 0910-0485 EXPIRATION DATE: 03/31/2005
RESPS:2,320,385 HOURS:3,191,305 COSTS(000):$0
Medical Device Labeling Regulations
FORMS: NONE
OMB NO: 0910-0486 EXPIRATION DATE: 04/30/2005
RESPS:53 HOURS:813 COSTS(000):$1
Requirements for States as Certification Agencies
FORMS: NONE
OMB NO: 0910-0489 EXPIRATION DATE: 03/31/2005
RESPS:2,000 HOURS:922 COSTS(000):$0
Health and Diet Survey
FORMS: NONE
OMB NO: 0910-0492 EXPIRATION DATE: 01/31/2004
RESPS:7,000 HOURS:4,000 COSTS(000):$0
Consumer Surveys on Food and Dietary Supplement Labeling Issues
FORMS: NONE
OMB NO: 0910-0493 EXPIRATION DATE: 09/30/2005
RESPS:12 HOURS:960 COSTS(000):$0
Salmonella Discovery System Pilot Study
FORMS: NONE
OMB NO: 0910-0494 EXPIRATION DATE: 04/30/2003
RESPS:1,200 HOURS:300 COSTS(000):$0
The Evaluation of Long-Term Antibiotic Drug Therapy for Persons
Involved in Anthrax Remediation Activities
FORMS: NONE
OMB NO: 0910-0495 EXPIRATION DATE: 11/30/2005
RESPS:1,216 HOURS:35,700 COSTS(000):$38,875
Food Additives; Food Contact Substances Notification System
FORMS: 3479 3480
OMB NO: 0910-0497 EXPIRATION DATE: 05/31/2004
RESPS:1,683 HOURS:3,352 COSTS(000):$0
Focus Groups as Used by the Food and Drug Administration
FORMS: NONE
OMB NO: 0910-0498 EXPIRATION DATE: 11/30/2005
RESPS:9,787 HOURS:13,287 COSTS(000):$766
Export Certificates for FDA Regulated Products Under U.S.C.
Sections 801(e) and 802
FORMS: NONE
OMB NO: 0910-0500 EXPIRATION DATE: 06/30/2004
RESPS:30 HOURS:3,000 COSTS(000):$0
FDA Rapid Response Surveys
FORMS: NONE
OMB NO: 0910-0501 EXPIRATION DATE: 06/30/2004
RESPS:1 HOURS:112 COSTS(000):$0
Telephone Questionnaire Administration to Control Subjects
Recruited into FDA Lyme Vaccine Safety Study, "A Case-Control
Study of HLA Type and T-Cell Reactivity to Recombinat Outer.....
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
146 216,619,428 75,377,571 $139,574
Health Services Administration
OMB NO: 0915-0028 EXPIRATION DATE: 03/31/2004
RESPS:80 HOURS:14 COSTS(000):$0
Scholarship Program for Students of Exceptional Financial Need
(EFN) and Program of Financial Assistance for Disadvantages Heal
Professions Students (FADHPS) Application
FORMS: HRSA-525
OMB NO: 0915-0034 EXPIRATION DATE: 07/31/2003
RESPS:227,552 HOURS:13,703 COSTS(000):$0
Health Education Assistance Loan (HEAL) Program: Forms
FORMS: HRSA-504 HRSA-508
OMB NO: 0915-0036 EXPIRATION DATE: 08/31/2005
RESPS:26,700 HOURS:4,958 COSTS(000):$11
Health Education Assistance Loan (HEAL) Program: Lender's
Application for Insurance Claim Form and Request for Collection
Assistance Form
FORMS: 510 513
OMB NO: 0915-0043 EXPIRATION DATE: 10/31/2003
RESPS:12,088 HOURS:6,066 COSTS(000):$0
Health Education Assistance Loan (HEAL) Program Information
Collection Requirements - Forms
FORMS: HRSA-502-1 HRSA-502-2 HRSA-512
OMB NO: 0915-0044 EXPIRATION DATE: 01/31/2006
RESPS:7,048 HOURS:5,192 COSTS(000):$0
Health Professions Student Loan and Nursing Student Loan
Programs-Forms
FORMS: HRSA-501 HRSA-519
OMB NO: 0915-0047 EXPIRATION DATE: 08/31/2005
RESPS:92,571 HOURS:37,428 COSTS(000):$0
Health Professions Student Loan (HPSL) Program and Nursing
Student Loan (NSL) Program: Admin. Requirements (Regs. & Policy)
FORMS: NONE
OMB NO: 0915-0060 EXPIRATION DATE: 06/30/2003
RESPS:12,540 HOURS:70,313 COSTS(000):$27
HRSA Competing Training Grant Application
FORMS: PHS-6025-1
OMB NO: 0915-0061 EXPIRATION DATE: 04/30/2003
RESPS:626 HOURS:6,260 COSTS(000):$0
The Uniform Progress Reports (UPR) for HRSA Continuation
Training Grants
FORMS: NONE
OMB NO: 0915-0077 EXPIRATION DATE: 02/28/2006
RESPS:82,197 HOURS:48,072 COSTS(000):$0
Uncompensated Services Assurance Report
FORMS: HRSR-710
OMB NO: 0915-0081 EXPIRATION DATE: 07/31/2003
RESPS:14 HOURS:1 COSTS(000):$0
Black Lung Clinics Program (42 CFR 55a and Program Guidelines)
FORMS: NONE
OMB NO: 0915-0099 EXPIRATION DATE: 11/30/2003
RESPS:20 HOURS:60 COSTS(000):$0
Grants for Hospital Construction and Modernization - Federal
Rights of Recovery and Waiver of Recovery (42 CFR 124, Subpart H)
FORMS: NONE
OMB NO: 0915-0108 EXPIRATION DATE: 12/31/2003
RESPS:504,661 HOURS:95,290 COSTS(000):$0
Health Education Assistance Loan (HEAL) Program Regulation - 42
CFR Part 60
FORMS: NONE
OMB NO: 0915-0126 EXPIRATION DATE: 01/31/2004
RESPS:2,443,091 HOURS:304,398 COSTS(000):$13,508
National Practitioner Data Bank for Adverse Information on
Physicians and Other Health Care Practitioners: Regulations and
Forms
FORMS: NONE
OMB NO: 0915-0127 EXPIRATION DATE: 04/30/2005
RESPS:845 HOURS:1,211 COSTS(000):$0
The National Health Service Corps (NHSC) Loan Repayment Program
FORMS: NONE
OMB NO: 0915-0140 EXPIRATION DATE: 03/31/2004
RESPS:1,050 HOURS:1,050 COSTS(000):$3
Nursing Education Loan Repayment Agreements
FORMS: NONE
OMB NO: 0915-0142 EXPIRATION DATE: 08/31/2005
RESPS:100 HOURS:4,000 COSTS(000):$1
Application for Certification as a Federall Qualified Health
Center Look-Alike
FORMS: NONE
OMB NO: 0915-0146 EXPIRATION DATE: 07/31/2003
RESPS:3,100 HOURS:3,100 COSTS(000):$8
The Application for Participation in the National Health Service
Corps Scholarship Program
FORMS: HRSA-856
OMB NO: 0915-0149 EXPIRATION DATE: 11/30/2003
RESPS:450 HOURS:12,600 COSTS(000):$0
Scholarships for Disadvantaged Students Applications
FORMS: NONE
OMB NO: 0915-0150 EXPIRATION DATE: 12/31/2003
RESPS:94 HOURS:94 COSTS(000):$0
Faculty Loan Repayment Program Application
FORMS: HRSA-535
OMB NO: 0915-0151 EXPIRATION DATE: 02/28/2005
RESPS:125 HOURS:2,375 COSTS(000):$0
Ryan White CARE Act Dental Reimbursement Program
FORMS: NONE
OMB NO: 0915-0157 EXPIRATION DATE: 06/30/2004
RESPS:517,693 HOURS:80,362 COSTS(000):$0
Organ Procurement and Transplantation Network and Scientific
Registry of Transplan Recipients Data System
FORMS: NONE
OMB NO: 0915-0158 EXPIRATION DATE: 12/31/2003
RESPS:278 HOURS:22,240 COSTS(000):$0
Grantee Reporting Requirements for the Ryan White Comprehensive
AIDS Resources Emergency Act of 1990 - Title III
FORMS: NONE
OMB NO: 0915-0172 EXPIRATION DATE: 04/30/2003
RESPS:59 HOURS:19,858 COSTS(000):$0
Maternal and Child Health Services Block Grant Annual Report,
Needs Assessment and Application Guidance
FORMS: NONE
OMB NO: 0915-0174 EXPIRATION DATE: 06/30/2003
RESPS:150 HOURS:150 COSTS(000):$0
Loan Information System Records for the DHHS and DHUD Hospital
Mortgage Insurance, Guarantee, and Direct Loan Programs
FORMS: HRSA-906
OMB NO: 0915-0176 EXPIRATION DATE: 10/31/2003
RESPS:9 HOURS:94 COSTS(000):$0
Drug Pricing Program Reporting Requirements
FORMS: NONE
OMB NO: 0915-0179 EXPIRATION DATE: 02/29/2004
RESPS:700 HOURS:700 COSTS(000):$0
Deferment Request Form for the National Health Service Corps
Scholarship Program
FORMS: NONE
OMB NO: 0915-0184 EXPIRATION DATE: 06/30/2004
RESPS:36,460 HOURS:4,862 COSTS(000):$0
Organ Procurement and Transplantation Network
FORMS: NONE
OMB NO: 0915-0185 EXPIRATION DATE: 04/30/2004
RESPS:550 HOURS:343 COSTS(000):$0
Pilot Test of the Community Health Center/National Health
Service Corp User/Visit Survey
FORMS: NONE
OMB NO: 0915-0186 EXPIRATION DATE: 01/31/2005
RESPS:2,785 HOURS:9,142 COSTS(000):$0
Main Study of the Community Health Center/National Health
Service Corps Site User/Visit Survey
FORMS: NONE
OMB NO: 0915-0188 EXPIRATION DATE: 10/31/2004
RESPS:265 HOURS:530 COSTS(000):$10
Data Collection and Reporting Requirements for Healty Schools,
Healthy Communities
FORMS: NONE
OMB NO: 0915-0193 EXPIRATION DATE: 11/30/2003
RESPS:757 HOURS:19,992 COSTS(000):$80,917
Uniform Data System
FORMS: NONE
OMB NO: 0915-0204 EXPIRATION DATE: 03/31/2004
RESPS:351 HOURS:88 COSTS(000):$2
Health Education Assistant Loan (HEAL) Program: Physicians's
Certification of Borrower's Total and Permanent Disability Form
FORMS: HRSA-539
OMB NO: 0915-0206 EXPIRATION DATE: 12/31/2003
RESPS:178 HOURS:9,714 COSTS(000):$403
Ryan White Comprehensive AIDS Resources Emergency Act of 1990,
Amended 1996 - Title IV
FORMS: NONE
OMB NO: 0915-0208 EXPIRATION DATE: 09/30/2003
RESPS:311 HOURS:26 COSTS(000):$0
Professional Training and Information Questionnaire
FORMS: HRSA-551 HRSA-552
OMB NO: 0915-0212 EXPIRATION DATE: 03/31/2006
RESPS:52,050 HOURS:5,075 COSTS(000):$0
Voluntary Partner Surveys to Implement Executive Order 12862 in
the Health Resources and Services Administration
FORMS: NONE
OMB NO: 0915-0219 EXPIRATION DATE: 11/30/2003
RESPS:864 HOURS:648 COSTS(000):$0
AIDS Drug Assistance Program Monthly Report for Ryan White
Comprehensive AIDS Resources Emergency Act Amendments of 1996,
Titles I and II
FORMS: NONE
OMB NO: 0915-0226 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:300 COSTS(000):$0
NHSC and Native Hawaiian Health Scholarship Programs Data
Collection Worksheet
FORMS: NONE
OMB NO: 0915-0227 EXPIRATION DATE: 10/31/2004
RESPS:3,704 HOURS:1,297 COSTS(000):$0
Health Education Assistance Loan (HEAL) Program: Refinancing
Application/Promissory Note
FORMS: HRSA-550
OMB NO: 0915-0230 EXPIRATION DATE: 04/30/2005
RESPS:1,200 HOURS:300 COSTS(000):$0
NHSC Recruitment and Retention Assistance Application
FORMS: NONE
OMB NO: 0915-0232 EXPIRATION DATE: 04/30/2005
RESPS:900 HOURS:24,300 COSTS(000):$33
National Health Service Corps - Uniform Data System
FORMS: NONE
OMB NO: 0915-0233 EXPIRATION DATE: 04/30/2005
RESPS:150 HOURS:150 COSTS(000):$0
Disadvantaged Assistance Tracking and Outcome Report (DATOR) for
Health Careers Opportunity Program and Centers of Excellence
Program
FORMS: NONE
OMB NO: 0915-0234 EXPIRATION DATE: 09/30/2005
RESPS:2,400 HOURS:1,200 COSTS(000):$0
NHSC Waiver Request Worksheets
FORMS: HRSA-553 HRSA-554
OMB NO: 0915-0239 EXPIRATION DATE: 03/31/2004
RESPS:1,282,004 HOURS:187,169 COSTS(000):$2,107
Healthcare Integrity and Protection Data Bank for Final Adverse
Information on Health Care Providers, Suppliers and
Practitioners (45 CFR 61)
FORMS: NONE
OMB NO: 0915-0244 EXPIRATION DATE: 12/31/2003
RESPS:2,025 HOURS:4,725 COSTS(000):$0
Ricky Ray Hemophilia Relief Fund Program
FORMS: NONE
OMB NO: 0915-0245 EXPIRATION DATE: 07/31/2003
RESPS:52,298 HOURS:26,149 COSTS(000):$0
They Ryan White CARE Act Client Demonstration Project Reporting
System
FORMS: NONE
OMB NO: 0915-0247 EXPIRATION DATE: 02/29/2004
RESPS:60 HOURS:3,600 COSTS(000):$0
Children's Hospital Graduate Medical Education Program
FORMS: NONE
OMB NO: 0915-0248 EXPIRATION DATE: 08/31/2003
RESPS:420 HOURS:139 COSTS(000):$0
The Impact of the State Child Health Insurance Program on
Selected Community Health Centers and Maternal and Child Health
Programs
FORMS: NONE
OMB NO: 0915-0250 EXPIRATION DATE: 02/29/2004
RESPS:1,350 HOURS:276 COSTS(000):$0
The National Health Service Corps Scholarship Program In-School
Worksheets
FORMS: NONE
OMB NO: 0915-0253 EXPIRATION DATE: 08/31/2004
RESPS:2,586 HOURS:96,600 COSTS(000):$0
Ryan White Comprehensive Aids Resources Emergency Act of 1990,
Cross-Title Data Report (CTDR) System
FORMS: NONE
OMB NO: 0915-0254 EXPIRATION DATE: 10/31/2004
RESPS:18,671 HOURS:13,440 COSTS(000):$0
U.S. Component of the 2001/2002 World Health Organization Study
of Health Behavior in School Children (WHO-HPSC)
FORMS: NONE
OMB NO: 0915-0256 EXPIRATION DATE: 09/30/2004
RESPS:5 HOURS:35 COSTS(000):$0
Charitable Facility Compliance Alternative (amended) - Final Rule
FORMS: NONE
OMB NO: 0915-0260 EXPIRATION DATE: 04/30/2005
RESPS:1,000 HOURS:750 COSTS(000):$0
Healthy Schools, Healthy Communities User/Visit Surveys
FORMS: NONE
OMB NO: 0915-0261 EXPIRATION DATE: 05/31/2005
RESPS:400 HOURS:400 COSTS(000):$0
Hepatitis B and C Among Health Care for the Homeless Program
Clients
FORMS: NONE
OMB NO: 0915-0262 EXPIRATION DATE: 06/30/2005
RESPS:212 HOURS:3,816 COSTS(000):$0
Office of State and National Partnership's Web-based Semi Annual
Report
FORMS: NONE
OMB NO: 0915-0263 EXPIRATION DATE: 07/31/2003
RESPS:52 HOURS:442 COSTS(000):$0
A Needs Assessment of the Black Lung Clinics Program
FORMS: NONE
OMB NO: 0915-0265 EXPIRATION DATE: 10/31/2003
RESPS:11,250 HOURS:1,000 COSTS(000):$0
Survey on Gender, Ethnic and Racial Backgrounds of Clients and
Staff at Bureau of Primary Health Care Supported Community-Based
Health Service Sites
FORMS: HRSA-105 HRSA-106
OMB NO: 0915-0266 EXPIRATION DATE: 11/30/2004
RESPS:743 HOURS:808 COSTS(000):$0
Private Health Insurance Coverage of Immunosuppressive Drugs
Survey
FORMS: NONE
OMB NO: 0915-0268 EXPIRATION DATE: 12/31/2005
RESPS:152 HOURS:1,216 COSTS(000):$0
Implementation of the Primary Care Surveillance System (PSCC)
Core Data Collection Effort for the Sentinal Centers Network
(SCN)
FORMS: NONE
OMB NO: 0915-0269 EXPIRATION DATE: 12/31/2004
RESPS:2,010 HOURS:505 COSTS(000):$0
Evaluation of the Health Care for the Homeless (HCH) Respite
Pilot Initiative
FORMS: NONE
OMB NO: 0915-0270 EXPIRATION DATE: 03/31/2006
RESPS:1,752 HOURS:483 COSTS(000):$0
Evaluation of the Infant Adoption Awareness Training Program
FORMS: NONE
OMB NO: 0915-0271 EXPIRATION DATE: 03/31/2004
RESPS:56 HOURS:168 COSTS(000):$0
Emergency Medical Services for Children (EMSC) Annual Grantee
Survey
FORMS: NONE
OMB NO: 0915-0272 EXPIRATION DATE: 01/31/2006
RESPS:750 HOURS:4,500 COSTS(000):$0
Maternal and Child Health Bureau Common Grant Guidance for
Discretionay Grants
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
62 5,414,563 1,163,777 $97,030
Indian Health Service
OMB NO: 0917-0002 EXPIRATION DATE: 04/30/2003
RESPS:327,114 HOURS:20,778 COSTS(000):$0
IHS Contract Health Service Report
FORMS: IHS-843-1A
OMB NO: 0917-0006 EXPIRATION DATE: 12/31/2004
RESPS:15,830 HOURS:7,356 COSTS(000):$0
IHS Scholarship Program Application
FORMS: IHS-856 856-2--856-8 IHS-815-818 D-02 F-02 F-04 G-02 G-04 H-07
H-08
OMB NO: 0917-0007 EXPIRATION DATE: 12/31/2003
RESPS:261 HOURS:313 COSTS(000):$0
IHS Urban Indian Health Program Common Reporting Requirements
FORMS: NONE
OMB NO: 0917-0009 EXPIRATION DATE: 05/31/2003
RESPS:3,709 HOURS:2,371 COSTS(000):$0
IHS Medical Staff Credentials and Privileges File
FORMS: NONE
OMB NO: 0917-0014 EXPIRATION DATE: 12/31/2005
RESPS:2,125 HOURS:1,381 COSTS(000):$0
Indian Health Service Loan Repayment Program
FORMS: NONE
OMB NO: 0917-0022 EXPIRATION DATE: 07/31/2003
RESPS:475 HOURS:236 COSTS(000):$0
Evaluation of the Indian Health Service/Bureau of Indian Affairs
Training Practitioners Project
FORMS: NONE
OMB NO: 0917-0024 EXPIRATION DATE: 05/31/2005
RESPS:7,500 HOURS:1,875 COSTS(000):$0
IHS Customer Satisfaction Survey
FORMS: NONE
OMB NO: 0917-0025 EXPIRATION DATE: 11/30/2003
RESPS:1 HOURS:384 COSTS(000):$0
Hoz'ho'nii: An Intervention to Increase Breast and Cervical
Cancer Screening Among Navajo Women
FORMS: NONE
OMB NO: 0917-0026 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:3,720 COSTS(000):$0
Final Rule to Implement Title V of the Tribal Self-Governance
Amendments of 2000
FORMS: NONE
OMB NO: 0917-0027 EXPIRATION DATE: 08/31/2005
RESPS:1 HOURS:202 COSTS(000):$0
Stakeholder Satisfaction with IHS Tribal Consultation
FORMS: NONE
OMB NO: 0917-0028 EXPIRATION DATE: 11/30/2005
RESPS:2,000 HOURS:500 COSTS(000):$20,000
IHS Background Investigatins of Individuals in Positins
Involving Regular Contact with or Control Over Indian Children
FORMS: OPM-306
OMB NO: 0917-0030 EXPIRATION DATE: 09/30/2003
RESPS:542,500 HOURS:174,375 COSTS(000):$0
IHS Forms To Implement The Privacy Rules (43 CFR Parts 160 and
164)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 901,517 213,491 $20,000
Centers for Disease Control and Prevention
OMB NO: 0920-0004 EXPIRATION DATE: 04/30/2003
RESPS:326 HOURS:2,650 COSTS(000):$0
National Disease Surveillance Program II; Disease Summaries
FORMS: CDC52.12 52.13 52.19 52.20 52.28 55.41 55.3 55.9/55.20
55.31/55.31A 55.83A-C
OMB NO: 0920-0006 EXPIRATION DATE: 05/31/2005
RESPS:200 HOURS:167 COSTS(000):$0
Statements in Support of Application for Waiver of
Inadmissibility under Section 212(a)(1)(A)(i) or 212 (a)(1)(A)
(iii)(1) or (11)of Immigration and Nationality Act
FORMS: CDC-4.422-1 CDC-4.422-1A CDC-4.422-1B
OMB NO: 0920-0007 EXPIRATION DATE: 12/31/2003
RESPS:9,365 HOURS:4,927 COSTS(000):$0
Weekly and Annual Morbidity and Mortality Reports
FORMS: CDC-43.5A
OMB NO: 0920-0008 EXPIRATION DATE: 06/30/2003
RESPS:12,000 HOURS:3,000 COSTS(000):$0
Emergency Epidemic Investigations
FORMS: NONE
OMB NO: 0920-0009 EXPIRATION DATE: 02/28/2006
RESPS:51,330 HOURS:14,430 COSTS(000):$0
National Disease Surveillance Program - 1. Case Reports
FORMS: CDC-53.1 CDC-52.15 CDC-56.31A CDC-56.31B CDC-55.54 CDC-52-56
CDC-52.18 CDC-52.60 CDC-54.1 CDC-56.37
OMB NO: 0920-0010 EXPIRATION DATE: 02/28/2006
RESPS:400 HOURS:600 COSTS(000):$0
National Birth Defects Prevention Study
FORMS: NONE
OMB NO: 0920-0012 EXPIRATION DATE: 09/30/2003
RESPS:92,542 HOURS:71,259 COSTS(000):$100
National Nosocomial Infections Surveillance (NNIS) System
FORMS: 57.65 57.66 57.58D 57.58B 57.58H 57.58G 57.58C 57.64A 57.68
57.69/57.70
OMB NO: 0920-0017 EXPIRATION DATE: 04/30/2003
RESPS:55,025 HOURS:4,590 COSTS(000):$0
Application for Training
FORMS: 32.1 36.5
OMB NO: 0920-0020 EXPIRATION DATE: 05/31/2004
RESPS:31,150 HOURS:4,791 COSTS(000):$0
X-Ray Examination Program (42 CFR Part 37)
FORMS: CDC/NIOSH(M)2.8 (M)2.10 (M)2.11 (M)2.12
OMB NO: 0920-0021 EXPIRATION DATE: 04/30/2003
RESPS:150 HOURS:62 COSTS(000):$0
Regulation 42 CFR 37.204 -- National Coal Workers' Autopsy Study
FORMS: NONE
OMB NO: 0920-0026 EXPIRATION DATE: 09/30/2005
RESPS:16,675 HOURS:8,338 COSTS(000):$0
Report of Verified Case of Tuberculosis
FORMS: 72.9 72.9A 72.9B 72.9C
OMB NO: 0920-0033 EXPIRATION DATE: 11/30/2005
RESPS:3,800 HOURS:3,800 COSTS(000):$0
National Surveillance of Dialysis-Associated Diseases
FORMS: NONE
OMB NO: 0920-0102 EXPIRATION DATE: 01/31/2005
RESPS:450 HOURS:90 COSTS(000):$0
Contents of a Request for Health Hazard Evaluation -- 42 CFR
85.3-1
FORMS: NONE
OMB NO: 0920-0106 EXPIRATION DATE: 01/31/2005
RESPS:122 HOURS:4,270 COSTS(000):$0
Preventive Health and Health Services Block Grant
FORMS: NONE
OMB NO: 0920-0109 EXPIRATION DATE: 08/31/2004
RESPS:427 HOURS:97,783 COSTS(000):$0
Tests and Requirements for Certification and Approval of
Respoiratory Protective Devices (42 CFR 84)
FORMS: NONE
OMB NO: 0920-0128 EXPIRATION DATE: 07/31/2003
RESPS:1,000 HOURS:260 COSTS(000):$0
Congenital Syphilis (CS) Case Investigation and Report Form
FORMS: CDC-73.126
OMB NO: 0920-0134 EXPIRATION DATE: 09/30/2004
RESPS:1,923 HOURS:119 COSTS(000):$0
Foreign Quarantine Regulations
FORMS: CDC-75.10A CDC-75.37
OMB NO: 0920-0138 EXPIRATION DATE: 12/31/2004
RESPS:70 HOURS:66 COSTS(000):$0
Pulmonary Function Testing Course Approval Program
FORMS: NONE
OMB NO: 0920-0199 EXPIRATION DATE: 06/30/2003
RESPS:5,370 HOURS:1,925 COSTS(000):$0
Importation of etiological agents and packaging and handling of
infectious substances and select agents
FORMS: CDC-0.753 CDC-0.1241 APPLICATION
OMB NO: 0920-0208 EXPIRATION DATE: 07/31/2003
RESPS:260 HOURS:184 COSTS(000):$0
HIV Prevention and Surveillance Project Reports
FORMS: NONE
OMB NO: 0920-0210 EXPIRATION DATE: 10/31/2003
RESPS:48 HOURS:1,788 COSTS(000):$0
List of Ingredients Added to Tobacco in the Manufacture
FORMS: NONE
OMB NO: 0920-0212 EXPIRATION DATE: 08/31/2005
RESPS:51,781 HOURS:2,653 COSTS(000):$0
National Hospital Discharge Survey
FORMS: NONE
OMB NO: 0920-0213 EXPIRATION DATE: 04/30/2003
RESPS:1,880 HOURS:418 COSTS(000):$0
National Vital Statistics Report Forms
FORMS: CDC-64.146 CDC-64.147
OMB NO: 0920-0214 EXPIRATION DATE: 04/30/2004
RESPS:39,000 HOURS:48,600 COSTS(000):$0
National Health Interview Survey: 2003 Basic Module with Topical
Modules
FORMS: NONE
OMB NO: 0920-0215 EXPIRATION DATE: 11/30/2004
RESPS:780 HOURS:227 COSTS(000):$0
Application Form and Related Forms for the Operation of the
National Death Index
FORMS: CDC/NCHS-6205-1 CDC-6425 CDC-6426 PHS-6205-3
OMB NO: 0920-0217 EXPIRATION DATE: 06/30/2004
RESPS:157 HOURS:44 COSTS(000):$0
NCHS Vital Statistics Training Form
FORMS: CDC-64.52
OMB NO: 0920-0222 EXPIRATION DATE: 02/29/2004
RESPS:550 HOURS:600 COSTS(000):$0
Questionnaire Research Design Laboratory
FORMS: NONE
OMB NO: 0920-0234 EXPIRATION DATE: 09/30/2003
RESPS:70,800 HOURS:6,177 COSTS(000):$0
Medical Care Survey 2001-2002
FORMS: CDC-64.148 CDC-64.149
OMB NO: 0920-0237 EXPIRATION DATE: 05/31/2005
RESPS:13,333 HOURS:56,013 COSTS(000):$0
National Health and Nutrition Examination Survey (NHANES)
FORMS: NONE
OMB NO: 0920-0260 EXPIRATION DATE: 06/30/2004
RESPS:11,350 HOURS:4,093 COSTS(000):$0
Health Hazard Evaluations/Technical Assistance and Emerging
Problems
FORMS: NONE
OMB NO: 0920-0261 EXPIRATION DATE: 01/31/2004
RESPS:61 HOURS:6,150 COSTS(000):$0
NIOSH Training Grants, 42 CFR Part 86, Application and
Regulations
FORMS: CDC-2.145A CDC-2.145B
OMB NO: 0920-0262 EXPIRATION DATE: 06/30/2004
RESPS:3,625 HOURS:3,625 COSTS(000):$0
Supplement to HIV/AIDS Surveillance (SHAS) Project
FORMS: NONE
OMB NO: 0920-0263 EXPIRATION DATE: 02/28/2005
RESPS:100 HOURS:20 COSTS(000):$0
Requirements for a Special Permit to Import Cynomolgus, African
Green, and Rhesus Monkeys into the United States
FORMS: NONE
OMB NO: 0920-0274 EXPIRATION DATE: 08/31/2004
RESPS:4,548 HOURS:852 COSTS(000):$0
CDC Model Performance Evaluation Program (MPEP) for Retroviral
and AIDS-Related
FORMS: NONE
OMB NO: 0920-0278 EXPIRATION DATE: 04/30/2005
RESPS:145,688 HOURS:14,721 COSTS(000):$0
National Hospital Ambulatory Medical Care Survey
FORMS: 101(CDC-64.151) 101/U
OMB NO: 0920-0282 EXPIRATION DATE: 12/31/2003
RESPS:240 HOURS:480 COSTS(000):$0
CDC Childhood Lead Poisoning Prevention Program Quarterly Report
FORMS: NONE
OMB NO: 0920-0295 EXPIRATION DATE: 10/31/2005
RESPS:48,100 HOURS:1,342 COSTS(000):$0
National AIDS and STD Hotline Survey of Callers
FORMS: NONE
OMB NO: 0920-0307 EXPIRATION DATE: 11/30/2004
RESPS:1,308 HOURS:6,300 COSTS(000):$0
Gonococcal Isolate Surveillance Project
FORMS: CDC-73.60A 73.60B 73.60C
OMB NO: 0920-0314 EXPIRATION DATE: 09/30/2003
RESPS:52,000 HOURS:18,361 COSTS(000):$0
National Survey of Family Growth, Cycle 6 Main Study
FORMS: NONE
OMB NO: 0920-0322 EXPIRATION DATE: 02/28/2006
RESPS:300 HOURS:100 COSTS(000):$0
Cholera and other Vibrio Illness Surveillance Report
FORMS: 52.79
OMB NO: 0920-0337 EXPIRATION DATE: 06/30/2004
RESPS:188 HOURS:600 COSTS(000):$0
National Childhood blood Lead Surveillance System
FORMS: NONE
OMB NO: 0920-0338 EXPIRATION DATE: 10/31/2003
RESPS:7 HOURS:296 COSTS(000):$0
List of Ingredients Added to Tobacco in the Manufacture
FORMS: NONE
OMB NO: 0920-0353 EXPIRATION DATE: 10/31/2003
RESPS:62,000 HOURS:1,008 COSTS(000):$0
National Nursing Home Survey
FORMS: NONE
OMB NO: 0920-0401 EXPIRATION DATE: 06/30/2003
RESPS:4,500 HOURS:2,066 COSTS(000):$0
Longitudinal Studies of Chronic Fatigue Syndrome: Sedgwick
County Study 36-Month Follow-up
FORMS: NONE
OMB NO: 0920-0406 EXPIRATION DATE: 12/31/2004
RESPS:381,671 HOURS:150,606 COSTS(000):$0
State and Local Area Integrated Telephone Survey (SLAITS)
FORMS: NONE
OMB NO: 0920-0417 EXPIRATION DATE: 11/30/2003
RESPS:180,510 HOURS:37,397 COSTS(000):$10
National Surveillance System for Health Care Workers
FORMS: NONE
OMB NO: 0920-0427 EXPIRATION DATE: 04/30/2003
RESPS:500 HOURS:500 COSTS(000):$0
The Sentinel Surveillance for Chronic Liver Disease
FORMS: NONE
OMB NO: 0920-0428 EXPIRATION DATE: 02/28/2006
RESPS:16,994 HOURS:42,711 COSTS(000):$0
PHS Supplements to Application for Federal Assistance (SF 424)
FORMS: SF-424 PHS-5161-1 CDC.124(E) CDC.0113 OPHS-1
OMB NO: 0920-0442 EXPIRATION DATE: 12/31/2003
RESPS:223 HOURS:6,300 COSTS(000):$0
Surveillance for Bloodstream and Vascular Access Infections in
Outpatient Hemodialysis Centers
FORMS: NONE
OMB NO: 0920-0444 EXPIRATION DATE: 06/30/2005
RESPS:11 HOURS:18,766 COSTS(000):$0
Annual Submission of the Quantity of Nicotine Contained in
Smokeless Tobacco Products Manufactured, Imported, or Packaged
in the U.S.
FORMS: NONE
OMB NO: 0920-0449 EXPIRATION DATE: 09/30/2003
RESPS:13,000 HOURS:2,166 COSTS(000):$0
The Evaluation of Customer Satisfaction of the Internet Homepage
and Links for CDC and ATSDR
FORMS: NONE
OMB NO: 0920-0450 EXPIRATION DATE: 02/28/2006
RESPS:1,000 HOURS:1,625 COSTS(000):$0
Children's Longitudinal Development Study
FORMS: NONE
OMB NO: 0920-0461 EXPIRATION DATE: 04/30/2003
RESPS:3,130 HOURS:534 COSTS(000):$0
An Evaluation of Targeted Health Communication Messages: Folic
Acid and Neural Tube Defects
FORMS: NONE
OMB NO: 0920-0463 EXPIRATION DATE: 12/31/2005
RESPS:525 HOURS:263 COSTS(000):$0
Longitudinal Surveillance for Beryllium Disease Prevention
FORMS: NONE
OMB NO: 0920-0469 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:126 COSTS(000):$0
National Program of Cancer Registries - Cancer Surveillance
System
FORMS: NONE
OMB NO: 0920-0470 EXPIRATION DATE: 07/31/2003
RESPS:880 HOURS:98 COSTS(000):$0
Possible Estuary Associated Syndrome (PEAS) Surveillance
FORMS: NONE
OMB NO: 0920-0472 EXPIRATION DATE: 06/30/2003
RESPS:2,360 HOURS:510 COSTS(000):$0
Assessment of Exposure to Arsenic through Household Water
FORMS: NONE
OMB NO: 0920-0473 EXPIRATION DATE: 06/30/2003
RESPS:880 HOURS:218 COSTS(000):$0
Surveillance and Evaluation of Plasma Donors for the Human
Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV)
FORMS: NONE
OMB NO: 0920-0475 EXPIRATION DATE: 06/30/2003
RESPS:190 HOURS:55 COSTS(000):$0
Evaluation of the Public Health Prevention Service (PHPS) Program
FORMS: NONE
OMB NO: 0920-0476 EXPIRATION DATE: 06/30/2003
RESPS:14,420 HOURS:2,403 COSTS(000):$0
Evaluation of Viral Hepatitis Education Materials
FORMS: NONE
OMB NO: 0920-0478 EXPIRATION DATE: 07/31/2003
RESPS:290 HOURS:83 COSTS(000):$0
Routine Evaluation of Ongoing NIOSH Worker Notifications
FORMS: NONE
OMB NO: 0920-0479 EXPIRATION DATE: 07/31/2003
RESPS:118 HOURS:236 COSTS(000):$1
Implementation of an Automated Management Information System
FORMS: NONE
OMB NO: 0920-0480 EXPIRATION DATE: 07/31/2003
RESPS:138 HOURS:138 COSTS(000):$0
An evaluation study of Tuberculosis Control and Prevention
measures in Large City and County Jails
FORMS: NONE
OMB NO: 0920-0482 EXPIRATION DATE: 08/31/2003
RESPS:600 HOURS:200 COSTS(000):$0
Silicosis No Mas!: Evaluation of Materials Used for Outreach to
Hispanic Construction Workers
FORMS: NONE
OMB NO: 0920-0485 EXPIRATION DATE: 08/31/2003
RESPS:1,824 HOURS:1,425 COSTS(000):$0
Evaluating National Dissemination Strategies for Effective HIV
Prevention Programs for Youth
FORMS: NONE
OMB NO: 0920-0487 EXPIRATION DATE: 04/30/2003
RESPS:203 HOURS:55 COSTS(000):$0
Microbial Contamination of Produce: A Field Study in the Lower
Rio Grande Valley, Texas
FORMS: NONE
OMB NO: 0920-0488 EXPIRATION DATE: 09/30/2003
RESPS:16,500 HOURS:3,600 COSTS(000):$0
Restrictions on Interstate Travel of Persons
FORMS: NONE
OMB NO: 0920-0493 EXPIRATION DATE: 11/30/2003
RESPS:12,345 HOURS:9,173 COSTS(000):$0
2001 and 2003 Youth Risk Behavior Surveys
FORMS: NONE
OMB NO: 0920-0494 EXPIRATION DATE: 03/31/2005
RESPS:1,220 HOURS:206 COSTS(000):$0
Exposure to Aerosolized Brevetoxins During Red Tide Events
FORMS: NONE
OMB NO: 0920-0495 EXPIRATION DATE: 12/31/2003
RESPS:3,300 HOURS:1,084 COSTS(000):$0
Workplace Exacerbation of Asthma
FORMS: NONE
OMB NO: 0920-0496 EXPIRATION DATE: 12/31/2003
RESPS:3,590 HOURS:1,498 COSTS(000):$0
A Message-Based Intervention for Technology Transfer
FORMS: NONE
OMB NO: 0920-0497 EXPIRATION DATE: 04/30/2004
RESPS:1,040 HOURS:1,248 COSTS(000):$0
Evaluating CDC Funded Health Department HIV Prevention Programs
FORMS: NONE
OMB NO: 0920-0499 EXPIRATION DATE: 03/31/2004
RESPS:64 HOURS:3,296 COSTS(000):$0
Jail STD Prevalence Monitoring System
FORMS: NONE
OMB NO: 0920-0501 EXPIRATION DATE: 04/30/2003
RESPS:1,620 HOURS:485 COSTS(000):$0
A Research Program to Develop Optimal NIOSH Alerts for
Occupational Safety and Health in Farming
FORMS: NONE
OMB NO: 0920-0502 EXPIRATION DATE: 02/29/2004
RESPS:25,200 HOURS:7,918 COSTS(000):$0
Racial and Ethnic Approaches to Community Health (REACH)
FORMS: NONE
OMB NO: 0920-0503 EXPIRATION DATE: 02/29/2004
RESPS:11,300 HOURS:10,525 COSTS(000):$0
The Incidence of Breast and Other Cancers Among Female Flight
Attendants
FORMS: NONE
OMB NO: 0920-0504 EXPIRATION DATE: 02/29/2004
RESPS:40,236 HOURS:13,607 COSTS(000):$0
Thyroid Disease in Persons Exposed to Radioactive Fallout from
Atomic Weapons Testing at the Nevada Test Site: Phase III
FORMS: NONE
OMB NO: 0920-0508 EXPIRATION DATE: 03/31/2004
RESPS:4,000 HOURS:1,666 COSTS(000):$0
Evaluation Research for the National Bone Health Campaign
FORMS: NONE
OMB NO: 0920-0510 EXPIRATION DATE: 04/30/2003
RESPS:680 HOURS:230 COSTS(000):$0
Evaluating the Role of Positive and Negative Emotion in
Promoting Hearing Conservation Behaviors Among Coal Miners
FORMS: NONE
OMB NO: 0920-0511 EXPIRATION DATE: 04/30/2003
RESPS:6,435 HOURS:285 COSTS(000):$0
Developing Communication to Reduce Workplace Violence and
FORMS: NONE
OMB NO: 0920-0512 EXPIRATION DATE: 06/30/2003
RESPS:4,960 HOURS:300 COSTS(000):$0
Preventing Latex Allergy Among Non-healthcare Workers
FORMS: NONE
OMB NO: 0920-0521 EXPIRATION DATE: 07/31/2003
RESPS:955 HOURS:455 COSTS(000):$0
National Survey of STD Services Provided to US College Students
FORMS: NONE
OMB NO: 0920-0525 EXPIRATION DATE: 10/31/2004
RESPS:980 HOURS:1,960 COSTS(000):$0
Assessing the Effectiveness of Community-Based Organizations for
Evaluation
FORMS: NONE
OMB NO: 0920-0526 EXPIRATION DATE: 11/30/2004
RESPS:2,456 HOURS:614 COSTS(000):$0
Evaluation of Viral Hepatitis B Educational Slide Materials
FORMS: NONE
OMB NO: 0920-0527 EXPIRATION DATE: 01/31/2005
RESPS:300 HOURS:350 COSTS(000):$0
Human Exposure to Cyanobacterial (Blue-green Algal) Toxins in
Drinking Water: Risk of Exposure to Microcystins from Public
Water Systems
FORMS: NONE
OMB NO: 0920-0530 EXPIRATION DATE: 05/31/2005
RESPS:15,000 HOURS:16,250 COSTS(000):$0
EEOICPA Dose Reconstruction Inerviews and Form
FORMS: OCAS-1
OMB NO: 0920-0533 EXPIRATION DATE: 04/30/2003
RESPS:900 HOURS:300 COSTS(000):$0
A Survey of Pediatricians' attitudes and practices about
promoting commmunication between parents and their children
about sexuality and sexual risk
FORMS: NONE
OMB NO: 0920-0535 EXPIRATION DATE: 09/30/2005
RESPS:1,152 HOURS:233 COSTS(000):$0
Evaluating Toolbox Training Safety Programs for Construction and
Mining
FORMS: NONE
OMB NO: 0920-0537 EXPIRATION DATE: 07/31/2003
RESPS:1,500 HOURS:3,000 COSTS(000):$0
Communicating NIOSH Safety Information to Youth
FORMS: NONE
OMB NO: 0920-0548 EXPIRATION DATE: 05/31/2005
RESPS:143 HOURS:48 COSTS(000):$0
National Telephone Survey of Urban Mosquito Control Programs
FORMS: NONE
OMB NO: 0920-0551 EXPIRATION DATE: 05/31/2005
RESPS:1,883 HOURS:1,993 COSTS(000):$0
NIOSH Research Study for the Prevention of Work-Related
Musculoskeletal Disorders
FORMS: NONE
OMB NO: 0920-0552 EXPIRATION DATE: 06/30/2005
RESPS:700 HOURS:140 COSTS(000):$0
Preventing Hearing Loss Among Construction Workers
FORMS: NONE
OMB NO: 0920-0555 EXPIRATION DATE: 07/31/2005
RESPS:1,167 HOURS:28,008 COSTS(000):$0
National Public Health Performance Standards Program Local
Public Health Performance Assessment
FORMS: NONE
OMB NO: 0920-0556 EXPIRATION DATE: 01/31/2006
RESPS:400 HOURS:63,400 COSTS(000):$1
Assisted Reproductive Technology (ART) Program Reporting System
FORMS: NONE
OMB NO: 0920-0557 EXPIRATION DATE: 07/31/2005
RESPS:20 HOURS:300 COSTS(000):$0
National Public Health Performance Standards Program State
Public Health Performance Assessment
FORMS: NONE
OMB NO: 0920-0558 EXPIRATION DATE: 08/31/2003
RESPS:1,870 HOURS:247 COSTS(000):$0
Development and Testing of a Tool to Assess the Pubic's
Perception About People with Epilepsy
FORMS: NONE
OMB NO: 0920-0559 EXPIRATION DATE: 08/31/2003
RESPS:416 HOURS:416 COSTS(000):$0
Dissemination of Lessons Learned from the Community Coalition
Partnership Programs for the Prevention of Teen Pregnancy
FORMS: NONE
OMB NO: 0920-0562 EXPIRATION DATE: 12/31/2003
RESPS:9,292 HOURS:6,969 COSTS(000):$0
National Suirvey of US Action Plan for Laboratory Containment of
Wild Polioviruses
FORMS: NONE
OMB NO: 0920-0563 EXPIRATION DATE: 11/30/2003
RESPS:11,050 HOURS:2,869 COSTS(000):$0
Survey to Assess Hepatitis B Vaccination Coverage Among U.S.
Health-Care Workers
FORMS: NONE
OMB NO: 0920-0564 EXPIRATION DATE: 09/30/2003
RESPS:5,000 HOURS:2,292 COSTS(000):$0
Joint Canadian US Survey of Health
FORMS: NONE
OMB NO: 0920-0565 EXPIRATION DATE: 10/31/2003
RESPS:1,200 HOURS:200 COSTS(000):$0
Reactions to Canadian Style Cigarette Warning Labels
FORMS: NONE
OMB NO: 0920-0566 EXPIRATION DATE: 10/31/2004
RESPS:8,000 HOURS:1,333 COSTS(000):$0
Evaluation of Worker Notification Program
FORMS: NONE
OMB NO: 0920-0567 EXPIRATION DATE: 10/31/2003
RESPS:268 HOURS:452 COSTS(000):$0
Evaluability Assessment of the Rape Prevention & Education Grant
Program
FORMS: NONE
OMB NO: 0920-0568 EXPIRATION DATE: 02/28/2005
RESPS:100 HOURS:100 COSTS(000):$0
Perceptions of Tuberculosis Among Foreign-Born Persons
FORMS: NONE
OMB NO: 0920-0569 EXPIRATION DATE: 11/30/2003
RESPS:4,000 HOURS:1,083 COSTS(000):$0
Anthropometric Survey of Respirator Users
FORMS: NONE
OMB NO: 0920-0570 EXPIRATION DATE: 12/31/2003
RESPS:2,010 HOURS:503 COSTS(000):$0
Hospital Bioterrorism Needs Assessment
FORMS: NONE
OMB NO: 0920-0571 EXPIRATION DATE: 04/30/2003
RESPS:273 HOURS:2,343 COSTS(000):$0
Minimum Data Elements (MDEs) System for Technical Assistance
Reporting (STAR) for the National Breast and Cervical Cancer
Early Detection Program (NBCCEDP)
FORMS: NONE
OMB NO: 0920-0572 EXPIRATION DATE: 01/31/2005
RESPS:7,018 HOURS:3,185 COSTS(000):$0
CDC and ATSDR Health Message Testing System and Smallpox
Knowledge Survey
FORMS: NONE
OMB NO: 0920-0573 EXPIRATION DATE: 11/30/2005
RESPS:79,981 HOURS:13,191 COSTS(000):$0
Adult and Pediatric Confidential HIV/AIDS Case Report
FORMS: CDC-50.42A CDC-50.42B
OMB NO: 0920-0574 EXPIRATION DATE: 12/31/2003
RESPS:12,000 HOURS:2,748 COSTS(000):$0
Impact of Community Coordinated Responses for the Prevention of
Intimate Partner Violence: A Random Digit Dial Survey
FORMS: NONE
OMB NO: 0920-0575 EXPIRATION DATE: 06/30/2003
RESPS:1,600 HOURS:533 COSTS(000):$0
Survey of Work-Relaed Assaults Treated in Hospital Emergency
Departments
FORMS: NONE
OMB NO: 0920-0576 EXPIRATION DATE: 08/31/2003
RESPS:15,853 HOURS:35,204 COSTS(000):$0
Possession, Use, and Transfer of Select Agents and Toxins (42
CFR Part 73)
FORMS: NONE
OMB NO: 0920-0577 EXPIRATION DATE: 02/29/2004
RESPS:3,698 HOURS:617 COSTS(000):$0
A and B Reader Surveys
FORMS: NONE
OMB NO: 0920-0578 EXPIRATION DATE: 01/31/2004
RESPS:53 HOURS:27 COSTS(000):$0
State Influenza Surveillance Activities Survey
FORMS: NONE
OMB NO: 0920-0580 EXPIRATION DATE: 02/28/2006
RESPS:1,067 HOURS:6,402 COSTS(000):$0
National Public Health Performance Standards Program Local
Public Health Governance Performance Assessment Tool
FORMS: NONE
OMB NO: 0920-0581 EXPIRATION DATE: 09/30/2004
RESPS:655 HOURS:185 COSTS(000):$0
Evaluation of the ACT Against Violence Training Program
FORMS: NONE
OMB NO: 0920-0582 EXPIRATION DATE: 01/31/2004
RESPS:36,246 HOURS:2,285 COSTS(000):$0
YMC Tracking Study
FORMS: NONE
OMB NO: 0920-0583 EXPIRATION DATE: 03/31/2004
RESPS:5,581 HOURS:485 COSTS(000):$0
YMC Tween Event Follow-up Study
FORMS: NONE
OMB NO: 0920-0584 EXPIRATION DATE: 03/31/2006
RESPS:60,750 HOURS:4,367 COSTS(000):$0
Population-based Research in Attention-Deficit/Hyperactivity
Disorder
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
119 1,842,424 926,468 $112
Agency for Toxic Substances and Disease Registry
OMB NO: 0923-0002 EXPIRATION DATE: 08/31/2003
RESPS:36 HOURS:18 COSTS(000):$0
Information Collection Procedures for Requesting Public Health
Assessments
FORMS: NONE
OMB NO: 0923-0006 EXPIRATION DATE: 10/31/2004
RESPS:6,927 HOURS:3,053 COSTS(000):$0
National Exposure Registry
FORMS: NONE
OMB NO: 0923-0007 EXPIRATION DATE: 09/30/2004
RESPS:150 HOURS:25 COSTS(000):$0
Community Assistance Panels Nomination Form
FORMS: NONE
OMB NO: 0923-0008 EXPIRATION DATE: 11/30/2004
RESPS:9,808 HOURS:7,356 COSTS(000):$0
Hazardous Substances Emergency Events Surveillance
FORMS: NONE
OMB NO: 0923-0016 EXPIRATION DATE: 01/31/2006
RESPS:1,140 HOURS:285 COSTS(000):$0
Reader Evaluation of Public Health Assessments and other Products
FORMS: NONE
OMB NO: 0923-0023 EXPIRATION DATE: 04/30/2003
RESPS:4,334 HOURS:1,083 COSTS(000):$0
Exposure to Volatile Organic Compounds and Childhood Leukemia
Incidence at United States Marine Corps Base Camp Lejeune, North
Carolina
FORMS: NONE
OMB NO: 0923-0030 EXPIRATION DATE: 12/31/2003
RESPS:6,667 HOURS:2,222 COSTS(000):$0
ATSDR Market Survey of Priority Populations
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 29,062 14,042 $0
National Institutes of Health
OMB NO: 0925-0001 EXPIRATION DATE: 05/31/2004
RESPS:114,407 HOURS:1,376,468 COSTS(000):$480
Research and Research Training Grant Applications and Related
Forms
FORMS: PHS-398 PHS-2590 PHS-2271 PHS-3734 HHS-568
OMB NO: 0925-0002 EXPIRATION DATE: 06/30/2005
RESPS:32,228 HOURS:85,679 COSTS(000):$148
Individual National Research Service Award Applications and
Related Forms
FORMS: 416-5 416-7 416-9 6031 6031-1 PHS-416-1
OMB NO: 0925-0046 EXPIRATION DATE: 08/31/2003
RESPS:13,780 HOURS:2,010 COSTS(000):$0
Pretesting of Office of Cancer Communications Messages
FORMS: NONE
OMB NO: 0925-0177 EXPIRATION DATE: 07/31/2005
RESPS:1,630 HOURS:163 COSTS(000):$0
Special Volunteer and Guest Researcher Assignment
FORMS: NIH-590
OMB NO: 0925-0208 EXPIRATION DATE: 10/31/2003
RESPS:1 HOURS:2,783 COSTS(000):$0
NCI Cancer Information Service Demographic/Customer Service Data
Collection
FORMS: NONE
OMB NO: 0925-0216 EXPIRATION DATE: 08/31/2004
RESPS:10,717 HOURS:8,639 COSTS(000):$0
The Framingham Study
FORMS: NONE
OMB NO: 0925-0240 EXPIRATION DATE: 04/30/2004
RESPS:9 HOURS:2,516 COSTS(000):$0
Drug Accountability Record
FORMS: NIH-2564 NIH-2564-1
OMB NO: 0925-0281 EXPIRATION DATE: 02/29/2004
RESPS:15,113 HOURS:3,746 COSTS(000):$0
The Atherosclerosis Risk in communities Study (ARIC)
FORMS: NONE
OMB NO: 0925-0299 EXPIRATION DATE: 02/28/2006
RESPS:21,545 HOURS:11,369 COSTS(000):$0
NIH Intramural Research Training Award Program Application
FORMS: NONE
OMB NO: 0925-0334 EXPIRATION DATE: 04/30/2004
RESPS:6,992 HOURS:1,719 COSTS(000):$0
The Cardiovascular Health Study
FORMS: NONE
OMB NO: 0925-0348 EXPIRATION DATE: 02/28/2005
RESPS:2 HOURS:360 COSTS(000):$0
Hazardous Waste Worker Training - 42 CFR Part 65
FORMS: NONE
OMB NO: 0925-0361 EXPIRATION DATE: 12/31/2004
RESPS:8,045 HOURS:12,611 COSTS(000):$0
National Institutes of Health Loan Repayment Programs
FORMS: NIH-2674-1 NIH-2674-2 NIH-2674-3 NIH-2674-4 NIH-2674-5
NIH-2674-6 NIH-2674-7 NIH-2674-8 NIH-2674-9 NIH-2674-10--12
OMB NO: 0925-0368 EXPIRATION DATE: 01/31/2004
RESPS:265,000 HOURS:30,979 COSTS(000):$0
Tobacco Use Supplement to the Current Population Survey: 2003
Tobacco Use Special Cessation Supplement to CPS
FORMS: NONE
OMB NO: 0925-0378 EXPIRATION DATE: 06/30/2004
RESPS:200 HOURS:125 COSTS(000):$0
Application for the Pharmacology Research Associate Program
FORMS: NIH-2721-1 NIH-2721-2
OMB NO: 0925-0406 EXPIRATION DATE: 11/30/2003
RESPS:25,012 HOURS:13,433 COSTS(000):$0
Agricultural health Study (A Prospective Cohort Study of Cancer
and Other Diseases Among Men and Women in Agriculture) -
Validation Sub-Study on Rheumatoid Arthritis
FORMS: NONE
OMB NO: 0925-0407 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:39,597 COSTS(000):$0
Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening
Trial
FORMS: NONE
OMB NO: 0925-0414 EXPIRATION DATE: 05/31/2003
RESPS:85,011 HOURS:36,467 COSTS(000):$0
Women's Health Initiative Observational Study
FORMS: NONE
OMB NO: 0925-0417 EXPIRATION DATE: 08/31/2005
RESPS:42,800 HOURS:232,080 COSTS(000):$4
Responsibility of Applicants for Promoting Objectivity in
Research for Which Public Health Service Funding is Sought and
Responsible Prospective Contractors--42 CFR Part 50,....
FORMS: NONE
OMB NO: 0925-0423 EXPIRATION DATE: 12/31/2003
RESPS:150,166 HOURS:55,977 COSTS(000):$0
A Prospective Study of Diet and Cancer in Members of the
American Association of Retired Persons (AARP)
FORMS: NONE
OMB NO: 0925-0424 EXPIRATION DATE: 03/31/2005
RESPS:16,481 HOURS:16,481 COSTS(000):$0
National Institutes of Health Construction Grants - 42 CFR Part
52b (Final Rule)
FORMS: NONE
OMB NO: 0925-0438 EXPIRATION DATE: 07/31/2004
RESPS:1,330 HOURS:1,727 COSTS(000):$0
National Institutes of Health Undergraduate Scholarship Program
for Individuals from Disadvantaged Backgrounds
FORMS: NIH-2762-1 NIH-2762-2 NIH-2762-3 NIH-2762-4 NIH-2762-5
OMB NO: 0925-0449 EXPIRATION DATE: 10/31/2003
RESPS:600 HOURS:2,250 COSTS(000):$0
Alcoholism Prevalence and Gene/Environment Interactions in
American Indian Tribes, 10 Tribe Study
FORMS: NONE
OMB NO: 0925-0454 EXPIRATION DATE: 07/31/2004
RESPS:590 HOURS:216 COSTS(000):$0
Case-Cohort Study of Cancer and Related Disorders Among
Benzene-Exposed Workers in China
FORMS: NONE
OMB NO: 0925-0458 EXPIRATION DATE: 03/31/2004
RESPS:5,604 HOURS:1,776 COSTS(000):$0
Generic Clearance for Satisfaction Surveys of Customers and
Other Partners
FORMS: NONE
OMB NO: 0925-0466 EXPIRATION DATE: 04/30/2004
RESPS:14,390 HOURS:7,774 COSTS(000):$0
Evaluation of the National Youth Anti-Drug Media Campaign
(NYAMC): Revision
FORMS: NONE
OMB NO: 0925-0467 EXPIRATION DATE: 09/30/2005
RESPS:15,728 HOURS:7,864 COSTS(000):$0
Young Drivers Intervention Study
FORMS: NONE
OMB NO: 0925-0475 EXPIRATION DATE: 03/31/2005
RESPS:87 HOURS:40 COSTS(000):$0
Training Tomorrow's Scientists: Linking Minorities and Mentors
Through the Web
FORMS: NONE
OMB NO: 0925-0476 EXPIRATION DATE: 04/30/2003
RESPS:18,400 HOURS:2,263 COSTS(000):$0
Request for Generic Clearance to Conduct Voluntary
Customer/Partner Surveys
FORMS: NONE
OMB NO: 0925-0478 EXPIRATION DATE: 06/30/2003
RESPS:55,000 HOURS:11,962 COSTS(000):$0
2000 California Health Interview Survey, Cancer Control Tropical
Module (CHIS, CCTM)
FORMS: NONE
OMB NO: 0925-0479 EXPIRATION DATE: 06/30/2003
RESPS:62 HOURS:16 COSTS(000):$0
Request for Clearance to Conduct Voluntary Customer Satisfaction
Surveys
FORMS: NONE
OMB NO: 0925-0480 EXPIRATION DATE: 07/31/2003
RESPS:12,000 HOURS:2,000 COSTS(000):$0
NIDDK Information Clearinghouses Customer Satisfaction Survey
FORMS: NONE
OMB NO: 0925-0482 EXPIRATION DATE: 02/29/2004
RESPS:5,277 HOURS:1,867 COSTS(000):$0
The Family Health Study (Validation of a Family History of
Cancer Questionnaire for Risk Factor Surveillance)
FORMS: NONE
OMB NO: 0925-0483 EXPIRATION DATE: 03/31/2006
RESPS:1,233 HOURS:205 COSTS(000):$0
Environmental Factors in the Development of Polycystic Ovary
Syndrome
FORMS: NONE
OMB NO: 0925-0484 EXPIRATION DATE: 03/31/2004
RESPS:48,000 HOURS:48,000 COSTS(000):$0
National Epidemiologic Survey on Alcohol and Related Conditions
FORMS: N/A
OMB NO: 0925-0486 EXPIRATION DATE: 04/30/2004
RESPS:104,000 HOURS:8,684 COSTS(000):$0
Evaluation of User Satisfaction with NIH Internet Sites
FORMS: NONE
OMB NO: 0925-0488 EXPIRATION DATE: 05/31/2003
RESPS:400 HOURS:233 COSTS(000):$0
Survey of IRB Chairs Concerning the Implementatin of Pediatric
Research Regulation
FORMS: NONE
OMB NO: 0925-0489 EXPIRATION DATE: 06/30/2004
RESPS:200 HOURS:100 COSTS(000):$0
Customer/Partner Satisfaction Survey of the NIDCD Minority and
Disability Supplement Program
FORMS: NONE
OMB NO: 0925-0491 EXPIRATION DATE: 07/31/2004
RESPS:480 HOURS:160 COSTS(000):$0
The Jackson Heart Study: Annual Follow-up with Third Party
Respondents
FORMS: NONE
OMB NO: 0925-0492 EXPIRATION DATE: 10/31/2003
RESPS:1 HOURS:60 COSTS(000):$0
Validation of Questionnaires Used for Occupational Exposure
Assessment in Case-Control Studies: Occupational History
Questionnaire with Foundry Worker & Textile Industry Job Modules
FORMS: NONE
OMB NO: 0925-0493 EXPIRATION DATE: 09/30/2004
RESPS:555 HOURS:42 COSTS(000):$0
Multi-Ethnic Study of Atherosclerosis (MESA) Event Surveillance
FORMS: NONE
OMB NO: 0925-0494 EXPIRATION DATE: 10/31/2003
RESPS:340 HOURS:340 COSTS(000):$0
A Nested Case-Control Study of Lung Cancer and Diesel Exhaust
Among Non-Metal Miners
FORMS: NONE
OMB NO: 0925-0495 EXPIRATION DATE: 10/31/2004
RESPS:700 HOURS:400 COSTS(000):$0
Leukemia and Other Hematological Diseases Among Cleanup Workers
in Ukraine Following the Chornobyl Accident
FORMS: NONE
OMB NO: 0925-0496 EXPIRATION DATE: 10/31/2003
RESPS:6,223 HOURS:1,556 COSTS(000):$0
Extended Lung Cancer Incidence Follow-Up for the Mayo Lung
Project Participants (MLP-EI)
FORMS: NONE
OMB NO: 0925-0498 EXPIRATION DATE: 04/30/2005
RESPS:520 HOURS:520 COSTS(000):$0
Study of Testicular Germ Cell Cancer in U.S. Military
Servicemen: Sub-study of Maternal Risk Factors
FORMS: NONE
OMB NO: 0925-0499 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:500 COSTS(000):$0
The National Survey to Evaluate the NIH SBIR Program
FORMS: NONE
OMB NO: 0925-0500 EXPIRATION DATE: 06/30/2005
RESPS:2,415 HOURS:746 COSTS(000):$0
National Cancer Institute Cancer Information Service Evaluation
Surveys
FORMS: NONE
OMB NO: 0925-0501 EXPIRATION DATE: 06/30/2005
RESPS:3,750 HOURS:1,313 COSTS(000):$0
Graduate Student Training Programs Application
FORMS: NONE
OMB NO: 0925-0502 EXPIRATION DATE: 05/31/2003
RESPS:448 HOURS:112 COSTS(000):$0
A Follow-up Survey of National Cancer Institute Science
Enrichment Program Students
FORMS: NONE
OMB NO: 0925-0503 EXPIRATION DATE: 06/30/2005
RESPS:300 HOURS:300 COSTS(000):$0
Assessment of the Use of Special Funding for Research on Type 1
Diabetes Provided by the Balanced Budget Act of 1997 and the FY
2001 Consolidated Appropriations Act
FORMS: NONE
OMB NO: 0925-0504 EXPIRATION DATE: 07/31/2003
RESPS:620 HOURS:318 COSTS(000):$0
Evaluation of the NCI State-of-the-Science Web Site
FORMS: NONE
OMB NO: 0925-0505 EXPIRATION DATE: 07/31/2003
RESPS:3,900 HOURS:1,287 COSTS(000):$0
Ethical Issues Associated with Nurse Practitioner and Physician
Assistant Practice:
FORMS: NONE
OMB NO: 0925-0506 EXPIRATION DATE: 10/31/2003
RESPS:50,000 HOURS:10,700 COSTS(000):$0
Retrovirus Epidemiology Donor Study (REDS): A Study of
Motivations and Deterrents to Blood Donation in the United States
FORMS: NONE
OMB NO: 0925-0507 EXPIRATION DATE: 08/31/2003
RESPS:11,350 HOURS:4,049 COSTS(000):$0
Health Information National Trends Survey (HINTS)
FORMS: NONE
OMB NO: 0925-0510 EXPIRATION DATE: 04/30/2003
RESPS:600 HOURS:300 COSTS(000):$0
An Evaluation of the National Cancer Institute Science
Enrichment Program
FORMS: NONE
OMB NO: 0925-0512 EXPIRATION DATE: 12/31/2005
RESPS:15,035 HOURS:1,593 COSTS(000):$0
Behavioral and Environmental Risk Factors for Childhood Drowning
FORMS: NONE
OMB NO: 0925-0513 EXPIRATION DATE: 10/31/2004
RESPS:7,000 HOURS:1,750 COSTS(000):$0
HIV Vaccine Awareness Study - Americans' Attitudes
FORMS: NONE
OMB NO: 0925-0514 EXPIRATION DATE: 10/31/2004
RESPS:8,000 HOURS:2,820 COSTS(000):$0
California Health Interview Survey - Complementary and
Alternative Medicine (CHIS-CAM)
FORMS: NONE
OMB NO: 0925-0515 EXPIRATION DATE: 01/31/2005
RESPS:2,600 HOURS:762 COSTS(000):$0
National Kidney Disease Education Program Evaluation Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
58 1,207,878 2,059,807 $632
Substance Abuse and Mental Health Services Administration
OMB NO: 0930-0074 EXPIRATION DATE: 03/31/2004
RESPS:900 HOURS:176 COSTS(000):$0
Obligated Service for Mental Health Traineeships: Regulations
and Forms
FORMS: SMA-111 SMA-111-1 SMA-111-2
OMB NO: 0930-0078 EXPIRATION DATE: 12/31/2005
RESPS:679,716 HOURS:46,738 COSTS(000):$0
Drug Abuse Warning Network (DAWN)
FORMS: SMA-100-1 SMA-100-2 SMA-100-3 SMA-100-4
OMB NO: 0930-0080 EXPIRATION DATE: 07/31/2004
RESPS:60 HOURS:34,640 COSTS(000):$0
Substance Abuse Prevention and Treatment Block Grant Application
Format - FY2002-2004
FORMS: NONE
OMB NO: 0930-0092 EXPIRATION DATE: 07/31/2004
RESPS:1,485,000 HOURS:259,876 COSTS(000):$73
Confidentiality of Alcohol and Drug Abuse Patient Records - 42
CFR Part 2
FORMS: NONE
OMB NO: 0930-0093 EXPIRATION DATE: 10/31/2003
RESPS:52 HOURS:104 COSTS(000):$0
Annual Census of Patient Characteristics in State and County
Mental Hospital Inpatient Services
FORMS: SMA-102
OMB NO: 0930-0104 EXPIRATION DATE: 06/30/2004
RESPS:16 HOURS:7 COSTS(000):$0
Community Mental Health Centers Construction Grantee Checklist -
Form and Regulations
FORMS: SMA-101
OMB NO: 0930-0106 EXPIRATION DATE: 12/31/2005
RESPS:24,305 HOURS:14,158 COSTS(000):$0
Drug and Alcohol Services Information System (DASIS)
FORMS: NONE
OMB NO: 0930-0110 EXPIRATION DATE: 01/31/2004
RESPS:183,690 HOURS:84,188 COSTS(000):$0
2003 National Survey on Drug Use and Health
FORMS: NONE
OMB NO: 0930-0119 EXPIRATION DATE: 07/31/2005
RESPS:4,186 HOURS:4,093 COSTS(000):$0
2002 Survey of Mental Health Organizations, General Hospital
Mental Health Services, and Managed Care Organizations (SMHO)
FORMS: NONE
OMB NO: 0930-0158 EXPIRATION DATE: 06/30/2003
RESPS:7,093,210 HOURS:1,790,664 COSTS(000):$2,016
Mandatory guidelines for Federal Workplace Drug Testing Program
FORMS: NONE
OMB NO: 0930-0163 EXPIRATION DATE: 02/29/2004
RESPS:60 HOURS:961 COSTS(000):$0
Substance Abuse Prevention and Treatment Block Grant
Regulations- 45 CFR Part 96
FORMS: NONE
OMB NO: 0930-0168 EXPIRATION DATE: 07/31/2004
RESPS:59 HOURS:16,360 COSTS(000):$0
FY 2002-2004 Community Mental Health Services Block Grant
Application: Voluntary Format and Content
FORMS: NONE
OMB NO: 0930-0169 EXPIRATION DATE: 03/31/2004
RESPS:114 HOURS:2,166 COSTS(000):$0
Protection and Advocacy of Individuals with Mental Illness
(PAIMI) Annual Program Performance Report
FORMS: NONE
OMB NO: 0930-0172 EXPIRATION DATE: 02/29/2004
RESPS:136 HOURS:168 COSTS(000):$0
Protection and Advocacy Program for Individuals with Mental
Illness Regulations -- 45 CFR Part 51
FORMS: NONE
OMB NO: 0930-0192 EXPIRATION DATE: 12/31/2005
RESPS:11,255 HOURS:14,164 COSTS(000):$0
National Evaluation of the Comprehensive Community Mental Health
Services for Children and Their Families Program: Phase Two
FORMS: NONE
OMB NO: 0930-0195 EXPIRATION DATE: 09/30/2004
RESPS:12,901 HOURS:2,252 COSTS(000):$0
Participant Feedback for the Mental Health Care Provider
Education in HIV/AIDS Program II and III
FORMS: NONE
OMB NO: 0930-0197 EXPIRATION DATE: 12/31/2004
RESPS:30,150 HOURS:10,375 COSTS(000):$0
Voluntary Customer Satisfaction Surveys to Implement Executive
Order 12862 in the Substance Abuse and Mental Health Services
Administration (SAMHSA)
FORMS: NONE
OMB NO: 0930-0202 EXPIRATION DATE: 07/31/2003
RESPS:731 HOURS:1,171 COSTS(000):$0
Persistent Effects of Treatment Studies
FORMS: NONE
OMB NO: 0930-0203 EXPIRATION DATE: 04/30/2005
RESPS:10 HOURS:23 COSTS(000):$0
Assessment of the National Leadership Institute (NLI) Program
and Services and the Minority Community-based Organization
(MCBO) Program
FORMS: NONE
OMB NO: 0930-0205 EXPIRATION DATE: 01/31/2006
RESPS:454 HOURS:13,794 COSTS(000):$0
Annual Reports for Projects for Assistance in Transition from
Homelessness (PATH)
FORMS: NONE
OMB NO: 0930-0206 EXPIRATION DATE: 09/30/2003
RESPS:8,321 HOURS:1,944 COSTS(000):$1,796
Opiod Drugs in Maintenance and Detoxification Treatment of
Opiate Dependence - 42 CFR Part 8
FORMS: SMA-162 SMA-163 SMA-168
OMB NO: 0930-0208 EXPIRATION DATE: 12/31/2005
RESPS:139,793 HOURS:25,543 COSTS(000):$0
SAMHSA Government Performance and Results Act (GPRA) Client
Outcome Measures for Discretionary Programs
FORMS: NONE
OMB NO: 0930-0209 EXPIRATION DATE: 05/31/2003
RESPS:93,826 HOURS:20,046 COSTS(000):$0
National Evaluation of the Comprehensive Community Mental Health
Services for Children and Their Families Program: Phase Three
FORMS: NONE
OMB NO: 0930-0210 EXPIRATION DATE: 05/31/2003
RESPS:260 HOURS:315 COSTS(000):$0
Registration Form for the National Registry of Effective
Prevention Programs
FORMS: NONE
OMB NO: 0930-0213 EXPIRATION DATE: 06/30/2003
RESPS:24,525 HOURS:17,959 COSTS(000):$0
State Prevention Needs Assessment Surveys: Alcohol and
FORMS: NONE
OMB NO: 0930-0216 EXPIRATION DATE: 09/30/2003
RESPS:48,247 HOURS:6,393 COSTS(000):$0
National Cross-Site Assessment of Addiction Technology Transfer
Centers (ATTC) Network
FORMS: NONE
OMB NO: 0930-0217 EXPIRATION DATE: 01/31/2004
RESPS:10 HOURS:100 COSTS(000):$0
Administrative Reporting Form for the "Women, Co-occurring
Disorders and Violence Cooperative Agreement Program (Phase II)"
FORMS: NONE
OMB NO: 0930-0222 EXPIRATION DATE: 07/31/2004
RESPS:59 HOURS:1,947 COSTS(000):$0
Substance Abuse Prevention and Treatment Block Grant Synar
Report Format, FY 2002-2004
FORMS: NONE
OMB NO: 0930-0223 EXPIRATION DATE: 09/30/2004
RESPS:2,280 HOURS:2,503 COSTS(000):$0
Evaluation of the CMHS/CSAT Collaborative Program on Homeless
Families: Women with Psychiatric, Substance Use, or Co-occuring
Disorders and Their Dependent Children
FORMS: NONE
OMB NO: 0930-0226 EXPIRATION DATE: 07/31/2004
RESPS:313 HOURS:1,204 COSTS(000):$0
Protocols for the Cross-Site Process Evaluation of the State
FORMS: NONE
OMB NO: 0930-0229 EXPIRATION DATE: 04/30/2005
RESPS:6 HOURS:18 COSTS(000):$0
Emergency Response Grants - 42 CFR Part 51
FORMS: NONE
OMB NO: 0930-0230 EXPIRATION DATE: 01/31/2005
RESPS:404 HOURS:1,212 COSTS(000):$0
Core Measures for the Center for Substance Abuse Prevention
FORMS: NONE
OMB NO: 0930-0231 EXPIRATION DATE: 02/28/2005
RESPS:721 HOURS:577 COSTS(000):$0
National Survey on Drug Use and Health: Clinical Validation
Study of Substance Abuse and Dependence Measures
FORMS: NONE
OMB NO: 0930-0232 EXPIRATION DATE: 02/28/2005
RESPS:5,160 HOURS:1,210 COSTS(000):$0
Workplace Helpline Call Record Form and Technical Assistance
Follow-up Survey Form
FORMS: NONE
OMB NO: 0930-0233 EXPIRATION DATE: 05/31/2005
RESPS:2,022 HOURS:170 COSTS(000):$0
Mexican Border Youth Survey
FORMS: NONE
OMB NO: 0930-0234 EXPIRATION DATE: 12/31/2005
RESPS:1,233 HOURS:103 COSTS(000):$0
Notification of Intent to Use Schedule III, IV, or V Opioid
Drugs for the Maintenance and Detoxification Treatment of Opiate
Addiction under 21 USC / 823(g)(2)
FORMS: SMA-167
OMB NO: 0930-0235 EXPIRATION DATE: 06/30/2005
RESPS:905 HOURS:2,034 COSTS(000):$0
Methamphetamine Abuse Treatment - Special Studies
FORMS: NONE
OMB NO: 0930-0236 EXPIRATION DATE: 12/31/2003
RESPS:274 HOURS:224 COSTS(000):$0
An Assessment of the Status of PASRR and Mental Health Services
for Persons in Nursing Facilities
FORMS: NONE
OMB NO: 0930-0238 EXPIRATION DATE: 08/31/2004
RESPS:18,488 HOURS:6,878 COSTS(000):$0
State Treatment Needs Assessment Program (STNAP)
FORMS: NONE
OMB NO: 0930-0240 EXPIRATION DATE: 12/31/2005
RESPS:25,345 HOURS:7,141 COSTS(000):$0
Evaluation of the Center for Substance Abuse Prevention's
Underage Drinking Prevention Public Education Program
FORMS: NONE
OMB NO: 0930-0241 EXPIRATION DATE: 10/31/2005
RESPS:3,200 HOURS:2,804 COSTS(000):$0
Survey of the Characteristics and Funding of School Mental
Health Services
FORMS: NONE
OMB NO: 0930-0243 EXPIRATION DATE: 03/31/2006
RESPS:3,240 HOURS:1,080 COSTS(000):$0
Prevention Program Outcomes Monitoring System
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
42 9,905,637 2,397,483 $3,885
Agency for Health Care Policy and Research
OMB NO: 0935-0104 EXPIRATION DATE: 03/31/2004
RESPS:52,306 HOURS:49,105 COSTS(000):$0
Medical Expenditure Panel Survey Household Component (MEPS-HC) -
2001 through 2004
FORMS: NONE
OMB NO: 0935-0106 EXPIRATION DATE: 09/30/2004
RESPS:112,800 HOURS:20,667 COSTS(000):$515,732
Voluntary Customer Satisfaction Survey Generic Clearance for
FORMS: NONE
OMB NO: 0935-0108 EXPIRATION DATE: 02/28/2005
RESPS:53,660 HOURS:23,216 COSTS(000):$0
Medical Expenditure Panel Survey Medical Provider Component
(MEPS-MPC) for 2001 and 2002
FORMS: NONE
OMB NO: 0935-0110 EXPIRATION DATE: 02/28/2005
RESPS:35,131 HOURS:21,191 COSTS(000):$0
2001-2003 Medical Expenditure Panel Survey-Insurance Component
(MEPS-IC)
FORMS: NONE
OMB NO: 0935-0113 EXPIRATION DATE: 08/31/2003
RESPS:1,125 HOURS:281 COSTS(000):$35,000
Enrolle Survey of Relationship Between Out-of-Pocket Costs and
Use of Prescribed Medications
FORMS: NONE
OMB NO: 0935-0114 EXPIRATION DATE: 01/31/2004
RESPS:280 HOURS:124 COSTS(000):$50,000
Pilot Study of Hospital Adverse Event Reporting Survey
FORMS: NONE
OMB NO: 0935-0115 EXPIRATION DATE: 01/31/2004
RESPS:900 HOURS:300 COSTS(000):$50,000
Pilot Data for the Development of Hospital Patient Safety
Culture Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 256,202 114,884 $650,732
Office of Assistant Secretary for Health
OMB NO: 0937-0025 EXPIRATION DATE: 07/31/2003
RESPS:10,000 HOURS:4,000 COSTS(000):$0
Application for Appointment as a Commissioned Officer in U.S.
Public Health Service Commissioned Corps (and) Reference Request
for Applicants to the USPHS Commissioned Corps
FORMS: PHS-50 PHS-1813
OMB NO: 0937-0095 EXPIRATION DATE: 09/30/2005
RESPS:10 HOURS:40 COSTS(000):$0
Application to the Board of Correction of Public Health Service
Commissioned Corps Records
FORMS: PSC-54
OMB NO: 0937-0166 EXPIRATION DATE: 05/31/2003
RESPS:50,000 HOURS:50,000 COSTS(000):$0
42 CFR Part B: Sterilization of Persons in Federally Assisted
Family Planning Projects
FORMS: NONE
OMB NO: 0937-0191 EXPIRATION DATE: 07/31/2004
RESPS:32 HOURS:6,400 COSTS(000):$226
Application Packets for Real Property for Public Health Purposes
FORMS: HHS-696
OMB NO: 0937-0198 EXPIRATION DATE: 01/31/2006
RESPS:3,300 HOURS:3,721 COSTS(000):$0
Responsibilities of Awardees and Applicant Institutions for
Reporting Possible Misconduct in Science (42 CFR Part 50)
FORMS: PHS-6349
OMB NO: 0937-0200 EXPIRATION DATE: 02/29/2004
RESPS:61,300 HOURS:184,200 COSTS(000):$0
HHS Payment Management System Forms
FORMS: SF-270 SF-272
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
6 124,642 248,361 $226
Centers for Medicare and Medicaid Services
OMB NO: 0938-0008 EXPIRATION DATE: 03/31/2006
RESPS:740,215,135 HOURS:44,189,007 COSTS(000):$0
Health Insurance Common Claims Formand Supporting Regulations:
42 CFR 414.40, 424.32, 424.44
FORMS: CMS-1490S CMS-1490U CMS-1500
OMB NO: 0938-0022 EXPIRATION DATE: 05/31/2004
RESPS:7,310 HOURS:1,311,060 COSTS(000):$0
Home Health Agency Cost Report and Supporting Regulations in 42
CFR 413.20, 413.24, 413.106
FORMS: HCFA-1728-94
OMB NO: 0938-0023 EXPIRATION DATE: 07/31/2005
RESPS:2,000 HOURS:500 COSTS(000):$0
Attending Physicians Statement and Documentation of Medicare
Emergency and Supporting Regulations in 42 CFR, Section 424.103
FORMS: CMS-1771
OMB NO: 0938-0025 EXPIRATION DATE: 10/31/2003
RESPS:14,000 HOURS:5,833 COSTS(000):$0
Request for Termination of Premium-Hospital and/or Supplementary
Medical Insurance and Supporting Regulations in 42 CFR 406.28
and 407.27
FORMS: HCFA-1763
OMB NO: 0938-0027 EXPIRATION DATE: 09/30/2005
RESPS:98 HOURS:172 COSTS(000):$0
The Request for Certification as a Supplier of Portable X-Ray
and Portable X-Ray Survey Report form under the
Medicare/Medicaid Program - Portable X-Ray Survey Report &
Supporting Regulations..
FORMS: CMS-1880 CMS-1882
OMB NO: 0938-0034 EXPIRATION DATE: 10/31/2003
RESPS:55,000 HOURS:9,167 COSTS(000):$0
Request for Hearing for Part B Medicare Claim and Supporting
Regulations in 42 CFR, 405.821
FORMS: HCFA-1965
OMB NO: 0938-0035 EXPIRATION DATE: 06/30/2003
RESPS:2,000 HOURS:716 COSTS(000):$0
SSO Report of State Buy-in Problems, 42 CFR 407.40
FORMS: HCFA-1957
OMB NO: 0938-0037 EXPIRATION DATE: 02/28/2005
RESPS:716 HOURS:71,600 COSTS(000):$0
Outpatient Rehabilitation Cost Report and Supporting Regulations
in 42 CFR 413.20 and 413.24
FORMS: CMS-2088-92
OMB NO: 0938-0041 EXPIRATION DATE: 10/31/2003
RESPS:15,000 HOURS:6,250 COSTS(000):$0
Third Party Premium Billing Request and Supporting Regulations
in 42 CFR 408.6
FORMS: HCFA-2384
OMB NO: 0938-0042 EXPIRATION DATE: 03/31/2004
RESPS:9,301,183 HOURS:390,418 COSTS(000):$0
Request for Medicare Payment - Ambulance and Supporting
Regulations in 42 CFR Section 410.40 and 424.124
FORMS: HCFA-1491
OMB NO: 0938-0045 EXPIRATION DATE: 10/31/2003
RESPS:62,000 HOURS:15,500 COSTS(000):$0
Request for Reconsideration of Part A Medicare Claim and
Supporting Regulations in 42 CFR, 405.711
FORMS: HCFA-2649
OMB NO: 0938-0046 EXPIRATION DATE: 08/31/2004
RESPS:60,000 HOURS:25,000 COSTS(000):$0
End Stage Renal Disease Medical Evidence Report Medicare
Entitlement and/or Patient Registration and Supporting
Regulations in 42 CFR, 405.2133
FORMS: HCFA-2728(ESRD)
OMB NO: 0938-0050 EXPIRATION DATE: 11/30/2005
RESPS:6,010 HOURS:3,980,522 COSTS(000):$0
Hospital and Health Care Complexes Cost Report and Supporting
Regulations in 42 CFR 413.20 and 413.24
FORMS: CMS-2552-96
OMB NO: 0938-0062 EXPIRATION DATE: 11/30/2003
RESPS:6,763 HOURS:20,289 COSTS(000):$0
Intermediate Care Facility for the Mentally Retarded or Persons
with Related Conditions ICF/MR Survey Report Form (3070G-1) and
Suppporting Regulations at 42CFR 431.52, 431.151, 435.1009,....
FORMS: HCFA-3070-G-1
OMB NO: 0938-0065 EXPIRATION DATE: 10/31/2005
RESPS:255 HOURS:446 COSTS(000):$0
Request for Certification in the Medicare and/or Medicaid
Program to Provide Outpatient Physical Therapy and/or Speech
Pathology Services, Outpatient Physical Therapy Speech......
FORMS: CMS-1856 CMS-1893
OMB NO: 0938-0067 EXPIRATION DATE: 04/30/2005
RESPS:224 HOURS:18,144 COSTS(000):$0
Quarterly Medicaid Statement of Expenditures for the Medical
Assistance Program
FORMS: HCFA-64
OMB NO: 0938-0074 EXPIRATION DATE: 12/31/2005
RESPS:661 HOURS:1,157 COSTS(000):$0
Request for Certification as Rural Health Clinic and Rural
Health Clinic Survey Report Form and Supporting Regulations in
42 CFR 491.1-491.11
FORMS: CMS-0029/0030
OMB NO: 0938-0080 EXPIRATION DATE: 07/31/2003
RESPS:90,000 HOURS:26,000 COSTS(000):$0
Application for Health Insurance Benefits Under Medicare for
Individual with Chronic Renal Disease and Supporting Regulations
in 42 CFR 406.13
FORMS: HCFA-43
OMB NO: 0938-0086 EXPIRATION DATE: 10/31/2005
RESPS:125,000 HOURS:62,500 COSTS(000):$0
Disclosure of Ownership and Financial Control Interest Statement
and Supporting Regulations Contained in 42 CFR 420.200-.206 and
455.100-.106
FORMS: CMS-1513
OMB NO: 0938-0101 EXPIRATION DATE: 07/31/2005
RESPS:224 HOURS:8,064 COSTS(000):$0
Medicaid Program Budget Report
FORMS: CMS-37 (HCFA-37)
OMB NO: 0938-0102 EXPIRATION DATE: 10/31/2003
RESPS:108 HOURS:4,860 COSTS(000):$0
Organ Procurement Organization/Histcompatibility Laboratory
Statement of Reimbursable Costs, Manual Instructions and
Supporting Regulations Contained in 42 CFR 413.20 and 413.24
FORMS: HCFA-216
OMB NO: 0938-0107 EXPIRATION DATE: 10/31/2005
RESPS:3,000 HOURS:150,000 COSTS(000):$0
Independent Rural Health Center/Freestanding Federally Qualified
Health Center Cost Report and Supporting Regulations in 42 CFR
Sections 413.20 and 413.24
FORMS: CMS-222-92
OMB NO: 0938-0146 EXPIRATION DATE: 12/31/2005
RESPS:110 HOURS:2,640 COSTS(000):$0
State Medicaid Eligibility Quality Control Samplling Plan and
Supporting Regulations in 42 CFR 431.800 - 431.865
FORMS: CMS-317
OMB NO: 0938-0147 EXPIRATION DATE: 12/31/2005
RESPS:12 HOURS:5,280 COSTS(000):$0
State Medicaid Eligibility Control (MEQC) Sample Selection Lists
and Supporting Regulations at 42 CFR 431.800 431.865
FORMS: CMS-319
OMB NO: 0938-0151 EXPIRATION DATE: 04/30/2003
RESPS:13,250 HOURS:6,625 COSTS(000):$0
Laboratory Personnel Report (CLIA) and Supporting Regulations in
42 CFR 493.1-493.2001
FORMS: HCFA-0209
OMB NO: 0938-0155 EXPIRATION DATE: 12/31/2003
RESPS:14 HOURS:476 COSTS(000):$0
Municipal Health Services Cost Report Form and Supporting
Regulations 42 CFR 405.2470
FORMS: HCFA-255
OMB NO: 0938-0165 EXPIRATION DATE: 03/31/2006
RESPS:225 HOURS:7,860 COSTS(000):$0
Prepaid Health Plan Cost Report
FORMS: CMS-276
OMB NO: 0938-0170 EXPIRATION DATE: 09/30/2005
RESPS:1,363 HOURS:682 COSTS(000):$0
Blood Bank Inspection Checklist and Report and Supporting
Regulations in 42 CFR 493.1269-493-1285
FORMS: CMS-282
OMB NO: 0938-0193 EXPIRATION DATE: 05/31/2004
RESPS:56 HOURS:560 COSTS(000):$0
Transmittal and Notice of Approval of State Plan Material and
Supporting Regulations in 42 CFR 430.10-430.20 and 440.167
FORMS: HCFA-179
OMB NO: 0938-0202 EXPIRATION DATE: 06/30/2005
RESPS:1,231 HOURS:573,646 COSTS(000):$0
Home Office Cost Statement and Supporting Regulations in 42 CFR
413.17 and 413.20
FORMS: CMS-287-92
OMB NO: 0938-0214 EXPIRATION DATE: 05/31/2004
RESPS:867,863,540 HOURS:1,339,982 COSTS(000):$0
Medicare Secondary Payer Information Collection and Supporting
Regulations in 42 CFR 411.25, 489.2, and 489.20
FORMS: CMS-250-254
OMB NO: 0938-0236 EXPIRATION DATE: 08/31/2004
RESPS:3,085 HOURS:604,660 COSTS(000):$0
Independent Renal Dialysis Facility Cost Report and Supporting
Regulations 42 CFR 413.20 and 42 CFR 413.24
FORMS: HCFA-265
OMB NO: 0938-0242 EXPIRATION DATE: 07/31/2003
RESPS:27,900 HOURS:25,000 COSTS(000):$0
Fire Safety Survey Report Forms and supporting regulations in 42
CFR 416.44, 418.100, 482.41, 483.270, and 483.470
FORMS: CMS-2786-A-D 2786-F 2786-G 2786-H 2786-J 2786-K 2786-L 2786-M
2786-P 2786-Q
OMB NO: 0938-0245 EXPIRATION DATE: 04/30/2003
RESPS:10,000 HOURS:2,500 COSTS(000):$0
Request for Enrollment in Supplementary Medical Insurance and
Supporting Regulations in 42 CFR 407.10 & 407.11
FORMS: HCFA-4040
OMB NO: 0938-0251 EXPIRATION DATE: 09/30/2004
RESPS:50,000 HOURS:12,500 COSTS(000):$0
Application for Hospital Insurance in 42 CFR 406.7
FORMS: HCFA-18F5
OMB NO: 0938-0266 EXPIRATION DATE: 04/30/2003
RESPS:2,931 HOURS:1,434 COSTS(000):$0
Ambulatory Surgical Center Request for Certification and Survey
Report and Supporting Regulations in 42 CFR 416.1-416.150
FORMS: HCFA-377 HCFA-378 HCFA-R-54
OMB NO: 0938-0267 EXPIRATION DATE: 04/30/2003
RESPS:540 HOURS:260,848 COSTS(000):$0
Comprehensive Outpatient Rehabilitation Facility (CORF)
Eligibility and Survey Forms and Information Collection
Requirements at 42 CFR 485.56, 485.58, 485.60, 485.64....
FORMS: HCFA-359 360 R-55
OMB NO: 0938-0269 EXPIRATION DATE: 12/31/2005
RESPS:750 HOURS:375 COSTS(000):$0
Request for Accelerated Payments and Supporting Regulations in
42 CFR, section 412.116, 412.632, 413.64, 413.350, and 484.245
FORMS: CMS-9042
OMB NO: 0938-0270 EXPIRATION DATE: 09/30/2004
RESPS:500 HOURS:1,000 COSTS(000):$0
The Financial Statement of Debtor and Supporting Regulations in
42 CFR, Section 405.376
FORMS: HCFA-379
OMB NO: 0938-0272 EXPIRATION DATE: 10/31/2003
RESPS:243 HOURS:18,225 COSTS(000):$0
Annual Report on Home and Community-Based Services Waivers and
Supporting Regulations in 42 CFR 440.181 and 441.300-305, Forms
HCFA-372 and HCFA-372(S)
FORMS: HCFA-372 HCFA-372(S)
OMB NO: 0938-0273 EXPIRATION DATE: 10/31/2005
RESPS:2,833 HOURS:708 COSTS(000):$0
Identification of Extension Units of Outpatient Physical
Therapy/Outpatient Speech Pathology (OPT/OSP) Providers and
Supporting Regulations in 42 CFR Sections 485.701 - 485.729
FORMS: CMS-381
OMB NO: 0938-0279 EXPIRATION DATE: 04/30/2003
RESPS:158,603,290 HOURS:1,960,991 COSTS(000):$0
Medicare Uniform Institutional Provider Bill and Supporting
Regulatins in 42 CFR 424.5
FORMS: HCFA-1450
OMB NO: 0938-0287 EXPIRATION DATE: 12/31/2005
RESPS:27 HOURS:81 COSTS(000):$0
Withholding Medicare Payments to Recover Medicaid Overpayments
and Supporting Regulations in 42 CFR 447.31
FORMS: HCFA-R-0021
OMB NO: 0938-0296 EXPIRATION DATE: 04/30/2004
RESPS:291 HOURS:14,000 COSTS(000):$0
Provider Reimbursement Manual, Part 1-Chapter 27, Sections 2721,
2722 & 2725, Request for Exception to End Stage Renal Disease
Composite Rates & Supporting Regulations in 42 CFR 413.170......
FORMS: HCFA-9044
OMB NO: 0938-0300 EXPIRATION DATE: 10/31/2004
RESPS:51 HOURS:6,891 COSTS(000):$0
Quality Control of Negative Case Actions (NCA)
FORMS: CMS-6401
OMB NO: 0938-0301 EXPIRATION DATE: 11/30/2005
RESPS:30,526 HOURS:900,517 COSTS(000):$0
Medicare Provider Cost Report Reimbursement Questionnaire and
Supporting Regulations 42 CFRE 413.20, 413.24
FORMS: CMS-339
OMB NO: 0938-0313 EXPIRATION DATE: 08/31/2004
RESPS:2,286 HOURS:572 COSTS(000):$0
Hospice Request for Certification in the Medicare Program and
Supporting Regulations Contained in 42 CFR Part 418.1-418.405
FORMS: HCFA-417
OMB NO: 0938-0328 EXPIRATION DATE: 04/30/2003
RESPS:1,500 HOURS:53,163 COSTS(000):$0
Hospital COP-42 CFR 482, 482.12, 482.22, 482.27, 482.30, 482.62,
482.66
FORMS: HCFA-R-48
OMB NO: 0938-0334 EXPIRATION DATE: 04/30/2003
RESPS:3,528 HOURS:9,744 COSTS(000):$0
Conditions of Participation for Rural Health Clinics and
Supporting Regulations in 42 CFR, Section 491.9, Subpart A
FORMS: HCFA-R-38
OMB NO: 0938-0338 EXPIRATION DATE: 09/30/2005
RESPS:645 HOURS:1,612 COSTS(000):$0
Conditions of Participation for Portable X-ray Supliers and
Supporting Regulations in 42 CFR Sections 486.104, 486.106, and
406.110
FORMS: CMS-R-43
OMB NO: 0938-0345 EXPIRATION DATE: 09/30/2005
RESPS:212 HOURS:2,120 COSTS(000):$45
Medicaid Statistical Information System
FORMS: CMS-R-0284
OMB NO: 0938-0354 EXPIRATION DATE: 11/30/2005
RESPS:56 HOURS:1,568 COSTS(000):$15
Annual Early and Periodic Screening, Diagnostic and Treatment
Services (EPSDT) Participation Report
FORMS: CMS-416
OMB NO: 0938-0355 EXPIRATION DATE: 09/30/2003
RESPS:13,994 HOURS:19,884 COSTS(000):$0
Home Health Agency survey and Deficiencies Report, Home Health
Functional Assessment Instrument and Supporting Regulations in
42 CFR Part 484.10 - 42 CFR Part 484.52
FORMS: HCFA-1572 HCFA-1515
OMB NO: 0938-0357 EXPIRATION DATE: 11/30/2005
RESPS:4,750,000 HOURS:1,583,333 COSTS(000):$0
Home Health Services Under Hospital Insurance, Manual
Instructions and Supporting Regulations in 42 CFR 409.40 - 50,
410.36, 410.170, 411.4-.15, 421.100, 424.22, 484.18 and 489.21
FORMS: CMS-485
OMB NO: 0938-0358 EXPIRATION DATE: 12/31/2003
RESPS:2,580 HOURS:645 COSTS(000):$0
Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit
Criteria Work Sheet and Rehabilitation Hospital Criteria Work
Sheet, and Supporting Regulations at 42 CFR 412.20 - 412.30
FORMS: HCFA-437 437A 437B
OMB NO: 0938-0359 EXPIRATION DATE: 03/31/2005
RESPS:899,340 HOURS:26,982 COSTS(000):$0
Medical Records Review Under PPS and Supporting Regulations at
42 CFR 412.40-412.52
FORMS: CMS-R-50
OMB NO: 0938-0360 EXPIRATION DATE: 11/30/2003
RESPS:675 HOURS:1,626 COSTS(000):$0
End Stage Renal Disease Application and Survey and Certification
Report Form and Supporting Regulations 42 CFR 405.2100 - 405.2184
FORMS: HCFA-3427
OMB NO: 0938-0365 EXPIRATION DATE: 05/31/2004
RESPS:7,500 HOURS:862,585 COSTS(000):$0
Home Health Medicare Conditions of Participation (CoP)
Information Collection Requirements as Outlined in Regulation --
42 CFR 484
FORMS: HCFA-R-39
OMB NO: 0938-0372 EXPIRATION DATE: 03/31/2004
RESPS:8,600 HOURS:717 COSTS(000):$0
ESRD Beneficiary Selection and Supporting Regulations Contained
in 42 CFR 414.330
FORMS: HCFA-382
OMB NO: 0938-0373 EXPIRATION DATE: 10/31/2005
RESPS:6,250 HOURS:1,563 COSTS(000):$0
Medicare Participating Physician or Supplier Agreement; CMS-460
FORMS: CMS-460
OMB NO: 0938-0378 EXPIRATION DATE: 08/31/2004
RESPS:250 HOURS:125 COSTS(000):$0
The Medicare/Medicaid Psychiatric Hospital Survey Data Contained
in 42 CFR and Supporting Regultions in 42 CFR 482.60, 482.61,
and 482.62
FORMS: HCFA-724
OMB NO: 0938-0379 EXPIRATION DATE: 08/31/2003
RESPS:2,293 HOURS:5,733 COSTS(000):$0
Hospice Survey and Deficiencies Report Form and Supporting
Regulations at 42 CFr Part 418.1 - 418.405
FORMS: 643
OMB NO: 0938-0380 EXPIRATION DATE: 08/31/2003
RESPS:2,000 HOURS:500 COSTS(000):$0
Hospital Request for Certification in the Medicare/Medicaid
Program
FORMS: HCFA-1514
OMB NO: 0938-0386 EXPIRATION DATE: 04/30/2003
RESPS:3,940 HOURS:143,721 COSTS(000):$0
Conditions for Coverage of Suppliers of End Stage Renal Disease
(ESRD) Services and Supporting Regulations Contained in 42 CFR
405.2100-.2171
FORMS: HCFA-R-52
OMB NO: 0938-0391 EXPIRATION DATE: 02/28/2006
RESPS:60,000 HOURS:120,000 COSTS(000):$0
Statement of Deficiencies and Plan of Correction and Supporting
Regulations Contained in 42 CFR 488.18, 488.26, and 488.28
FORMS: CMS-2567
OMB NO: 0938-0408 EXPIRATION DATE: 07/31/2003
RESPS:25 HOURS:2,000 COSTS(000):$0
Methodology for Estimating Waiver Costs of HCFA Demonstration
Projects
FORMS: HCFA-482
OMB NO: 0938-0426 EXPIRATION DATE: 02/28/2006
RESPS:3,729 HOURS:60,919 COSTS(000):$0
Information Collection Requirements in HSQ-110, Acquisition,
Protection and Disclosure of Peer Review Organization
Information and Supporting Regulations in 42 CFR, Section
480.104, 480.105,..
FORMS: CMS-R-70
OMB NO: 0938-0429 EXPIRATION DATE: 05/31/2004
RESPS:2 HOURS:20 COSTS(000):$0
Imposition of Cost Sharing Charges Under Medicaid and Supporting
Regulations contained in 42 CFR Section 447.53
FORMS: HCFA-R-0053
OMB NO: 0938-0443 EXPIRATION DATE: 04/30/2003
RESPS:15,670 HOURS:3,578 COSTS(000):$0
Information Collection Requirements in 42 CFR 473.18, 473.34,
473.36, and 473.42, PRO Reconsideration and Appeals
FORMS: HCFA-R-72
OMB NO: 0938-0444 EXPIRATION DATE: 10/31/2005
RESPS:1,060 HOURS:22,684 COSTS(000):$0
Information Collection Requirements in Final Peer Review
Organizations Sanction Regulations -- 42 CFR Sections 1004.40,
1004.50, 1004.60, and 1004.70
FORMS: HCFA-R-65
OMB NO: 0938-0445 EXPIRATION DATE: 08/31/2005
RESPS:6,036 HOURS:81,818 COSTS(000):$0
Information Collection Requirements in HSQ-108F Assumption of
Responsibilities and Supporting Regulations in 42 CFR Sections
412.44, 412.46, 431.630, 456.654, 476.71, 476.73, 476.74, 476.78
FORMS: HCFA-R-71
OMB NO: 0938-0447 EXPIRATION DATE: 04/30/2003
RESPS:3,761 HOURS:30,088 COSTS(000):$0
End Stage Renal Disease Medical Information System ESRD Facility
Survey
FORMS: HCFA-2744
OMB NO: 0938-0448 EXPIRATION DATE: 03/31/2006
RESPS:63,000 HOURS:10,710 COSTS(000):$0
End Stage Renal Disease Death Notification P. L. 95-292;
42CFR405.2133; CFR401,422E
FORMS: CMS-2746
OMB NO: 0938-0449 EXPIRATION DATE: 07/31/2005
RESPS:132 HOURS:7,930 COSTS(000):$0
Home and Community-Based Waiver Requests and Supporting
Regulations; 42 CFR 440.180, 441.300-.310
FORMS: CMS-8003
OMB NO: 0938-0454 EXPIRATION DATE: 04/30/2003
RESPS:947,816 HOURS:417,239 COSTS(000):$0
Physician Certifications/Recertifications in Skilled Nursing
Facilities (SNFs) Manual Instructions and Supporting Regulations
42 CFR 424.20
FORMS: HCFA-R-5
OMB NO: 0938-0456 EXPIRATION DATE: 10/31/2003
RESPS:1,350 HOURS:2,700 COSTS(000):$0
Indirect Medical Education (IME) And Supporting Regulations 42
CFR 412.105
FORMS: HCFA-R-64
OMB NO: 0938-0463 EXPIRATION DATE: 05/31/2004
RESPS:15,700 HOURS:2,943,354 COSTS(000):$0
Skilled Nursing Facility and Skilled Nursing Facility Cost
Report and Supporting Regulations in 42 CFR 413.20, 413.24, and
413.106
FORMS: HCFA-2540-96
OMB NO: 0938-0465 EXPIRATION DATE: 11/30/2003
RESPS:3,563,304 HOURS:296,942 COSTS(000):$0
Limitation on Liability and Information Collection Requirements
Referenced in 42 CFR 411.404, 411.406, and 411.408
FORMS: HCFA-R-77
OMB NO: 0938-0467 EXPIRATION DATE: 10/31/2005
RESPS:54 HOURS:99,254 COSTS(000):$0
Income and Eligibility Verification System Reporting and
Supporting Regulations
FORMS: R-0074
OMB NO: 0938-0469 EXPIRATION DATE: 12/31/2004
RESPS:300 HOURS:3,130 COSTS(000):$6,000
The Fiscal Soundness Reporting Requirements (FSRR)
FORMS: 906
OMB NO: 0938-0470 EXPIRATION DATE: 11/30/2003
RESPS:35 HOURS:3,500 COSTS(000):$471
Qualification Application and Supporting Regulations in 42 CFR,
Section 417.408 and 417.143
FORMS: HCFA-901-1
OMB NO: 0938-0477 EXPIRATION DATE: 07/31/2005
RESPS:40 HOURS:160 COSTS(000):$0
Payment Adjustment for Sole Community Hospitals and Supporting
Regulations in 42 CFR Section 412.92
FORMS: CMS-R-79
OMB NO: 0938-0484 EXPIRATION DATE: 04/30/2003
RESPS:1,100 HOURS:275 COSTS(000):$0
Emergency and Foreign Hospital Services -- Beneficiary Statement
in Canadian Travel Claims and Supporting Regulations in 42 CFR,
Section 424.123
FORMS: HCFA-R-96
OMB NO: 0938-0486 EXPIRATION DATE: 10/31/2003
RESPS:10,000 HOURS:2,500 COSTS(000):$0
Regulations for Hearing for Part A Medicare by an Administrative
Law Judge and Supporting Regulations in 42 CFR, 498 Subpart D
and E
FORMS: HCFA-5011A-U6
OMB NO: 0938-0490 EXPIRATION DATE: 10/31/2005
RESPS:4 HOURS:400 COSTS(000):$0
Criteria for Medicare Coverage of Heart Transplants
FORMS: CMS-R-106
OMB NO: 0938-0501 EXPIRATION DATE: 04/30/2004
RESPS:4,300 HOURS:731 COSTS(000):$0
Medicare Qualification Statement for Federal Employees and
Supporting Regulations in 42 CFR 406.15
FORMS: HCFA-565
OMB NO: 0938-0502 EXPIRATION DATE: 01/31/2006
RESPS:1,900,000 HOURS:329,965 COSTS(000):$0
Medicaid - Determining Third Party Liability (TPL) State Plan
Preprint and Supporting Regulations in 42 CFR 433.138
FORMS: CMS-R-107
OMB NO: 0938-0507 EXPIRATION DATE: 06/30/2003
RESPS:85,000 HOURS:2,805 COSTS(000):$0
Medicare Managed Care Disenrollment Form
FORMS: HCFA-566
OMB NO: 0938-0512 EXPIRATION DATE: 11/30/2003
RESPS:69 HOURS:138 COSTS(000):$0
Organ Procurement Organization's Request for Designation and
Supporting Regulations in 42 CFR 486.301 - 486.325
FORMS: CMS-576
OMB NO: 0938-0526 EXPIRATION DATE: 08/31/2004
RESPS:53 HOURS:1 COSTS(000):$0
Peer Review Organization Contracts: Solicitation of Statements
of Interest from In-State Organizations, General Notice--CFR 475
FORMS: HCFA-R-118
OMB NO: 0938-0534 EXPIRATION DATE: 05/31/2003
RESPS:500,000 HOURS:50,000 COSTS(000):$0
Attending Physician's Certification of Medical Necessity for
Home Oxygen Therapy and Supporting Regulations 42 CFR 410.38 and
42 CFR 424.5
FORMS: CMS-484
OMB NO: 0938-0544 EXPIRATION DATE: 02/28/2006
RESPS:13,250 HOURS:6,625 COSTS(000):$0
Survey Report Form Clinical Laboratory Improvement Amendments
(CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001
FORMS: HCFA-1557
OMB NO: 0938-0565 EXPIRATION DATE: 11/30/2005
RESPS:327,947 HOURS:1,096,466 COSTS(000):$0
Internal Revenue Service/Social Security Administration/Centers
for Medicare & Medicaid Services Data Match and Supporting
Regulations in 42 CFR Sections 411.20-411.206
FORMS: CMS-R-137
OMB NO: 0938-0566 EXPIRATION DATE: 06/30/2003
RESPS:19,660,110 HOURS:1,638,345 COSTS(000):$122,700
Advance Beneficiary Notice and Supporting Regulations in 42 CFR
411.404, 411.406, and 411.408
FORMS: CMS-R-131
OMB NO: 0938-0567 EXPIRATION DATE: 10/31/2003
RESPS:1,000 HOURS:2,500 COSTS(000):$0
Request for Hearing for Part B Medicare by an Administrative Law
Judge and Supporting Regulations in 42 CFR, 498 Subpart D and E
FORMS: HCFA-5011B-U6
OMB NO: 0938-0568 EXPIRATION DATE: 04/30/2004
RESPS:49,500 HOURS:50,325 COSTS(000):$0
Medicare Current Beneficiary Survey (MCBS): Rounds 29-37
FORMS: HCFA-P-15A
OMB NO: 0938-0573 EXPIRATION DATE: 10/31/2005
RESPS:650 HOURS:650 COSTS(000):$0
Medicare Geographic Classification Review Board (MGCRB)
Procedures and Criteria and Supporting Regulations in 42 CFR,
Section 412.256 and 412.230
FORMS: CMS-R-0138
OMB NO: 0938-0575 EXPIRATION DATE: 07/31/2003
RESPS:50 HOURS:150 COSTS(000):$0
Analysis of Malpractice Premium Data
FORMS: HCFA-R-143
OMB NO: 0938-0578 EXPIRATION DATE: 07/31/2003
RESPS:2,204 HOURS:54,660 COSTS(000):$948
Medicaid Drug Rebate Program - Manufacturers
FORMS: HCFA-367 HCFA-367A HCFA-367B HCFA-367C
OMB NO: 0938-0579 EXPIRATION DATE: 04/30/2003
RESPS:20 HOURS:535 COSTS(000):$0
Business Proposal Formats for Utilization and Quality Control
Peer Review Organizations (PROs)
FORMS: 718-BP 719-BP 720-BP 721-BP SUM-PS IS CA SS SC-1 SC-2
OMB NO: 0938-0580 EXPIRATION DATE: 04/30/2004
RESPS:12 HOURS:2,110 COSTS(000):$0
Criteria for Medicare Coverage of Liver Transplants
FORMS: HCFA-R-108
OMB NO: 0938-0581 EXPIRATION DATE: 09/30/2004
RESPS:16,000 HOURS:20,000 COSTS(000):$0
Clinical Laboratory Improvement Amendments Application Form 42
CFR 493.1-.2001
FORMS: HCFA-116
OMB NO: 0938-0582 EXPIRATION DATE: 09/30/2003
RESPS:204 HOURS:6,125 COSTS(000):$139
State Drug Rebate (Medicaid)
FORMS: HCFA-368 R-144
OMB NO: 0938-0599 EXPIRATION DATE: 11/30/2004
RESPS:50 HOURS:4,500 COSTS(000):$0
CLIA Budget Workload Reports and Supporting Regulations
Contained in 42 CFR 493.1-.2001
FORMS: CMS-102 CMS-105
OMB NO: 0938-0600 EXPIRATION DATE: 10/31/2005
RESPS:186,800 HOURS:1,120,800 COSTS(000):$0
Medicare Credit Balance Reporting Requirements and Supporting
Regulations in 42 CFR 405.371, 405.378, and 413.20
FORMS: CMS-838
OMB NO: 0938-0610 EXPIRATION DATE: 07/31/2005
RESPS:34,365 HOURS:960,500 COSTS(000):$0
Information Collection Requirements Contained in BDP-718:
Advanced Directives (Medicare and Medicaid) and Supporting
Regulations in 42 CFR Sections 417.436, 417.801, 422.128,....
FORMS: HCFA-R-10
OMB NO: 0938-0612 EXPIRATION DATE: 06/30/2004
RESPS:700,650 HOURS:10,230,714 COSTS(000):$0
Clinical Laboratory Improvement Amendments (CLIA) and the ICRs
contained in the supporting regulations in 42 CFR 493.1-.2001
FORMS: HCFA-R-26
OMB NO: 0938-0618 EXPIRATION DATE: 01/31/2005
RESPS:40 HOURS:2,880 COSTS(000):$0
Limitations on Provider Related Donations and Health Care
Related Taxes; Limitation on payments to Disproportionate Share
Hospitals; Medicaid and Supporting Regulations in 42 CFR 433.68,.
FORMS: HCFA-R-148
OMB NO: 0938-0624 EXPIRATION DATE: 04/30/2003
RESPS:50 HOURS:12 COSTS(000):$0
Hospital Provider of Extended Care Services (Swing-Beds) in the
Medicare and Medicaid Programs, 42 CFR 447.280 and 482.66
FORMS: HCFA-605
OMB NO: 0938-0626 EXPIRATION DATE: 04/30/2003
RESPS:10,000 HOURS:1,250 COSTS(000):$0
Authorization Agreement for Electronic Funds Transfer
FORMS: HCFAA-588
OMB NO: 0938-0650 EXPIRATION DATE: 05/31/2004
RESPS:4,000 HOURS:10,000 COSTS(000):$0
Alternate Quality Assessment Survey
FORMS: HCFA-667
OMB NO: 0938-0653 EXPIRATION DATE: 08/31/2003
RESPS:12,500 HOURS:3,125 COSTS(000):$0
Post Laboratory Survey Questionnaire--Laboratory, and Supporting
Regulations in 42 CFR 493
FORMS: 668B
OMB NO: 0938-0655 EXPIRATION DATE: 10/31/2003
RESPS:1,573 HOURS:786 COSTS(000):$0
Clinical Laboratory Improvement Amendments (CLIA) Adverse Action
Extract and Supporting Regulations at 42 CFr 493.1840
FORMS: HCFA-462A/B
OMB NO: 0938-0657 EXPIRATION DATE: 12/31/2003
RESPS:36 HOURS:108 COSTS(000):$0
End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report
Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR
405.2112
FORMS: HCFA-685
OMB NO: 0938-0658 EXPIRATION DATE: 12/31/2003
RESPS:36 HOURS:1,080 COSTS(000):$0
End-Stage Renal Disease (ESRD) Network Business Proposal Forms
and Supporting Regulations in 432 CFR 405.2110 and 42 CFR
405.2112
FORMS: HCFA-684A-684I
OMB NO: 0938-0667 EXPIRATION DATE: 11/30/2005
RESPS:5,600 HOURS:1 COSTS(000):$0
ICRs Contained in BPD-393, Examination and Treatment for
Emergency Medical Conditions and Women in Labor, 42 CFR 482.12,
488.18, 489.20, and 489.24, and HCFA-1005-IFC,....
FORMS: CMS-R-142
OMB NO: 0938-0670 EXPIRATION DATE: 05/31/2004
RESPS:6 HOURS:1,010 COSTS(000):$0
Criteria for Medicare Coverage of Lung Transplants
FORMS: HCFA-R-170
OMB NO: 0938-0673 EXPIRATION DATE: 07/31/2004
RESPS:5 HOURS:15 COSTS(000):$0
Medicaid Post-Eligibility Preprint--And Supporting Regulations
at 42 CFR 430.10
FORMS: SP0001
OMB NO: 0938-0676 EXPIRATION DATE: 05/31/2004
RESPS:3,744 HOURS:139,560 COSTS(000):$350
Reconciliation of State Invoice and Prior Quarter Adjustment
Statement (Medicaid Drug Rebate Program - Labelers)
FORMS: HCFA-304 HCFA-304A
OMB NO: 0938-0679 EXPIRATION DATE: 04/30/2003
RESPS:6,700,000 HOURS:1,130,000 COSTS(000):$0
Durable Medical Equipment Regional Carrier, Certificate of
Medical Necessity
FORMS: CMS-841 CMS-842 CMS-844 CMS-853
OMB NO: 0938-0685 EXPIRATION DATE: 04/30/2003
RESPS:274,000 HOURS:642,000 COSTS(000):$0
Medicare Federal Health Care Provider/Supplier Enrollment
Application
FORMS: HCFA-855A HCFA-855B HCFA-855I HCFA-855R HCFA-855S
OMB NO: 0938-0686 EXPIRATION DATE: 03/31/2005
RESPS:76 HOURS:768 COSTS(000):$0
Granting and Withdrawal of Deeming Authority to Private
Nonprofit Accrediation Organizations and of State Exemption
Under State Laboratory Programs & Supporting Regulation in 42
CFR 493.551-...
FORMS: HCFA-R-185
OMB NO: 0938-0690 EXPIRATION DATE: 10/31/2005
RESPS:28 HOURS:451 COSTS(000):$0
Granting and Withdrawal of Deeming Authority to National
Accreditation Organizations and Supporting Regulations at 42 CFR
488.4-488.9, and 488.201
FORMS: CMS-R-191
OMB NO: 0938-0691 EXPIRATION DATE: 10/31/2005
RESPS:100 HOURS:100 COSTS(000):$0
Medicare Disproportionate Share Adjustment Procedures and
Criteria and Supporting Regulations in 42 CFR 412.106
FORMS: CMS-R-194
OMB NO: 0938-0692 EXPIRATION DATE: 01/31/2006
RESPS:11,800,000 HOURS:196,666 COSTS(000):$0
"Important Message from Medicare" Title XVII Section 1866(a)(1)
(M), 42 CFR Section 466.78, 489.20, and 489.27
FORMS: CMS-R-193
OMB NO: 0938-0697 EXPIRATION DATE: 12/31/2003
RESPS:57 HOURS:342 COSTS(000):$0
Medicaid Report on Payables and Receivables
FORMS: HCFA-R-199
OMB NO: 0938-0700 EXPIRATION DATE: 04/30/2004
RESPS:450 HOURS:45,000 COSTS(000):$0
Incentive Arrangement Disclosure Form and Supporting Regulations
42 CFR 417.479, 417.500, 422.208, 422.210, 434.44, 434.67,
434.70, 1003.100, 1003.101, 1003.103, 1003.106
FORMS: HCFA-R-201
OMB NO: 0938-0701 EXPIRATION DATE: 09/30/2003
RESPS:313,825 HOURS:186,320 COSTS(000):$0
Health Plan Employer Data and Information Set (HEDIS ) and
Health Outcome Survey (HOS) and Supporting Regulations at CFR
422.152
FORMS: CMS-R-200
OMB NO: 0938-0702 EXPIRATION DATE: 04/30/2003
RESPS:43,000,000 HOURS:2,700,000 COSTS(000):$0
Information Collection Requirements Referenced in HIPAA for the
Group Market -- Supporting Regulations 45 CFR 146 and
Forms/Instructions
FORMS: HCFA-R-206
OMB NO: 0938-0703 EXPIRATION DATE: 04/30/2003
RESPS:3,230,000 HOURS:923,000 COSTS(000):$0
Information Collection Requirements Referenced in HIPAA for the
Form/Instructions
FORMS: HCFA-R-205
OMB NO: 0938-0705 EXPIRATION DATE: 10/31/2003
RESPS:92,803 HOURS:415 COSTS(000):$0
"Maximizing the Effective Use of Telemedicine: A Study of the
Effects, Cost Effectiveness and Utilization Patterns of
Consultations via Telemedicine"
FORMS: HCFA-R-197
OMB NO: 0938-0707 EXPIRATION DATE: 05/31/2005
RESPS:42 HOURS:6,720 COSTS(000):$0
Model Application Template for State Child Health Plan Under
Title XXI of the Social Security Act, State Children's Health
Insurance Program, & Model Application Template and Instructions
FORMS: HCFA-R-211
OMB NO: 0938-0708 EXPIRATION DATE: 04/30/2004
RESPS:1,200 HOURS:744 COSTS(000):$0
Evaluation of the State Medicaid Reform Demonstrations and
Evaluation of the Medicaid Health Reform Demonstrations
FORMS: HCFA-R-207
OMB NO: 0938-0709 EXPIRATION DATE: 03/31/2004
RESPS:69,717 HOURS:32,917 COSTS(000):$0
Data Collection for the Second Generation Social Health
Maintenance Organization Demonstration
FORMS: HCFA-R-204
OMB NO: 0938-0714 EXPIRATION DATE: 10/31/2004
RESPS:200 HOURS:2,000 COSTS(000):$0
Procedures for Advisory Opinions Concerning Physician Referrals
and Supporting Regulations in 42 CFR Sections 411.370 through
411.389
FORMS: HCFA-R-216
OMB NO: 0938-0717 EXPIRATION DATE: 11/30/2004
RESPS:35,000 HOURS:280,000 COSTS(000):$0
Information Collection Requirements Referenced in 42 CFR Section
424.57: Additional DMEPOS Supplier Standards
FORMS: HCFA-R-215
OMB NO: 0938-0721 EXPIRATION DATE: 08/31/2004
RESPS:500 HOURS:42 COSTS(000):$0
Independent Diagnostic Testing Facility and Supporting
Regulations Contained in 42 CFR 410.33
FORMS: HCFA-R-214
OMB NO: 0938-0722 EXPIRATION DATE: 09/30/2004
RESPS:10 HOURS:100 COSTS(000):$0
Medicare+Choice Provider Sponsored Organization Waiver Request
Form and Supporting Regulations at 42 CFR 422.370 through 422.378
FORMS: HCFA-R-231
OMB NO: 0938-0723 EXPIRATION DATE: 10/31/2005
RESPS:5 HOURS:1,000 COSTS(000):$0
Medicare Integrity Program Organizational Conflict of Interest
Disclosure Certificate and Supporting Regultions at 42 CFR
421.300 - 421.318
FORMS: HCFA-R-232
OMB NO: 0938-0730 EXPIRATION DATE: 08/31/2004
RESPS:26,280 HOURS:7,197 COSTS(000):$0
Subpart D-Private Contracts and Supporting Regulations in 42 CFR
405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61,
415.110, and 424.24
FORMS: R-234
OMB NO: 0938-0731 EXPIRATION DATE: 04/30/2005
RESPS:448 HOURS:7,840 COSTS(000):$0
Quarterly Children's Health Insurance Program Statement of
Expenditures for Title XXI
FORMS: HCFA-21 HCFA-21B
OMB NO: 0938-0732 EXPIRATION DATE: 05/31/2004
RESPS:168,000 HOURS:55,450 COSTS(000):$0
The Medicare Managed Care CAHPS Survey and Supporting
Regulations in 42 CFR 417.126 and 417.470
FORMS: HCFA-R-246
OMB NO: 0938-0734 EXPIRATION DATE: 09/30/2004
RESPS:1,500 HOURS:750 COSTS(000):$0
Data Use Agreement Information Collection Requirements, model
language, and supporting regulations in 42 CFR Section 5b
FORMS: HCFA-R-235
OMB NO: 0938-0738 EXPIRATION DATE: 11/30/2005
RESPS:2,400 HOURS:600 COSTS(000):$0
National Medicare Education Program (NMEP) Community Survey of
Medicare Beneficiaries
FORMS: CMS-R-254
OMB NO: 0938-0739 EXPIRATION DATE: 03/31/2006
RESPS:2,657,859 HOURS:2,640,371 COSTS(000):$0
SNF Resident Assessment MDS Data and Supporting Regulations in
42 CFR 413,337, 413.343, 424.32, and 483.20
FORMS: CMS-R-250
OMB NO: 0938-0741 EXPIRATION DATE: 12/31/2005
RESPS:50,000 HOURS:3,300 COSTS(000):$0
Medicare+Choice Disenrollment Form to Original Medicare and
Supporting Regulations 422.66
FORMS: CMS-R-257
OMB NO: 0938-0742 EXPIRATION DATE: 04/30/2003
RESPS:700 HOURS:66,500 COSTS(000):$0
Adjusted Community Rate (ACR) Proposal medicare + Choice
FORMS: CMS-R-228
OMB NO: 0938-0746 EXPIRATION DATE: 10/31/2005
RESPS:54 HOURS:2,160 COSTS(000):$0
Medicaid Disproportionate Share Hospital/Institutions for Mental
Disease
FORMS: CMS-R-266
OMB NO: 0938-0748 EXPIRATION DATE: 12/31/2003
RESPS:1,700 HOURS:12,420 COSTS(000):$0
Medicare DMEPOS Competitive Bidding Demonstration
FORMS: HCFA-R-0264A-H
OMB NO: 0938-0749 EXPIRATION DATE: 10/31/2004
RESPS:20,000 HOURS:10,000 COSTS(000):$0
On-Site Inspection for Durable Medical Equipment (DME) Supplier
Location and Supporting Regulations in 42 CFR, Section 424.57
FORMS: HCFA-R-263
OMB NO: 0938-0753 EXPIRATION DATE: 10/31/2005
RESPS:7,657,534 HOURS:2,120,006 COSTS(000):$0
Medicare Plus Choice Program Requirements Referenced in 42 CFR
422.000-422.700
FORMS: CMS-R-0267
OMB NO: 0938-0754 EXPIRATION DATE: 03/31/2005
RESPS:80,000 HOURS:1 COSTS(000):$0
Inpatient Psychiatric Services for Individuals Under Age 21 and
Supporting regulations in 42 CFR 441.152
FORMS: CMS-R-238
OMB NO: 0938-0756 EXPIRATION DATE: 03/31/2005
RESPS:7,000 HOURS:583 COSTS(000):$0
MSInteractive Survey Tool for www.medicare.gov
FORMS: CMS-R-268
OMB NO: 0938-0758 EXPIRATION DATE: 03/31/2005
RESPS:1,720 HOURS:302,720 COSTS(000):$0
Hospice Cost Report and Supporting Regulations in 42 CFR 413.20
and 413.24
FORMS: CMS-R-249
OMB NO: 0938-0760 EXPIRATION DATE: 07/31/2003
RESPS:9,510,900 HOURS:8,013,013 COSTS(000):$0
Medicare and Medicaid Programs Use of the OASIS as Part of the
CoPs for HHAs and Supporting Regulations in Part 484 of 42 CFR
FORMS: CMS-R-245
OMB NO: 0938-0761 EXPIRATION DATE: 07/31/2003
RESPS:85,200 HOURS:838,408 COSTS(000):$17,800
Medicare and Medicaid Programs: Use and Reporting OASIS Data as
Part of the CoPs for HHAs and Supporting Regulations in 42 CFR
484.11 and 484.20
FORMS: CMS-R-209
OMB NO: 0938-0763 EXPIRATION DATE: 04/30/2003
RESPS:300 HOURS:900 COSTS(000):$0
The Adjusted Community Rate Proposal (ACRP) M+C Plan Benefit
Package & Supporting Regulations in 42 CFR 417.401,
422.1-422.10,
422.50-422.80,422.100-422.132,422.300-422.312,422.400-422.404....
FORMS: HCFA-R-262
OMB NO: 0938-0767 EXPIRATION DATE: 08/31/2004
RESPS:450 HOURS:75 COSTS(000):$0
Medigap Compare
FORMS: HCFA-R-0280
OMB NO: 0938-0768 EXPIRATION DATE: 05/31/2004
RESPS:10 HOURS:750 COSTS(000):$0
Medicare Agreement Application, Health Care Prepayment Plan and
Supporting Regulations in 42 CFR, Section 417.800-.840
FORMS: CMS-R-243
OMB NO: 0938-0769 EXPIRATION DATE: 03/31/2006
RESPS:1,500 HOURS:375 COSTS(000):$0
Request for Retirement Benefit Informatin (BBA '97)
FORMS: CMS-R285
OMB NO: 0938-0770 EXPIRATION DATE: 12/31/2005
RESPS:4,550 HOURS:17,400 COSTS(000):$0
Site Visit Assessment Tool (previously known as Community Mental
Health Center Site Visit Assessment Tool) and Supporting
Regulations in 432 CFR 410.2
FORMS: CMS-R-273
OMB NO: 0938-0776 EXPIRATION DATE: 09/30/2004
RESPS:200 HOURS:8,000 COSTS(000):$0
Medicare Program: Procedures for Making National Coverage
Decisions
FORMS: CMS-R-0290
OMB NO: 0938-0777 EXPIRATION DATE: 04/30/2003
RESPS:9,000 HOURS:1,500 COSTS(000):$0
Medicare Lifestyle Modification Program Demonstration
FORMS: HCFA-R-289
OMB NO: 0938-0778 EXPIRATION DATE: 12/31/2003
RESPS:536 HOURS:1,608 COSTS(000):$0
Medicare + Choice (M + C) Organization Appeals and Grievance
Data Disclosure Requirements and Supporting Regulations in 42
CFR 42 CFR 422.64, 422.11, and 422.560 - 422.622
FORMS: HCFA-R-0282
OMB NO: 0938-0779 EXPIRATION DATE: 07/31/2005
RESPS:90,240 HOURS:42,112 COSTS(000):$0
Medicare CAHPS Disenrollment Surveys
FORMS: CMS-R-295
OMB NO: 0938-0780 EXPIRATION DATE: 03/31/2005
RESPS:10,000 HOURS:833 COSTS(000):$0
Medicare Telephone Customer Satisfaction Survey
FORMS: CMS-R-293
OMB NO: 0938-0781 EXPIRATION DATE: 06/30/2005
RESPS:145,966 HOURS:14,597 COSTS(000):$0
Information Collection Requirements and Supporting Regulations
in 42 CFR, Section 484.10(a)
FORMS: CMS-R-296
OMB NO: 0938-0786 EXPIRATION DATE: 04/30/2003
RESPS:11,609 HOURS:135,110 COSTS(000):$0
External Quality Review of Medicaid MCOs and Supporting
Regulations in 42 CFR 438.360, 438.362, and 438.364
FORMS: HCFA-R-0305
OMB NO: 0938-0787 EXPIRATION DATE: 08/31/2004
RESPS:5,000 HOURS:750 COSTS(000):$0
Request for Employment Information
FORMS: HCFA-R-297
OMB NO: 0938-0790 EXPIRATION DATE: 01/31/2006
RESPS:54 HOURS:44,078 COSTS(000):$0
Medicare and Medicaid: Programs of All-inclusive Care for the
Elderly (PACE) Contained in 42 CFR 460.12-460.210/Medicare and
Medicaid: Program of All-inclusive Care for the Elderly (PACE);..
FORMS: CMS-R-244
OMB NO: 0938-0791 EXPIRATION DATE: 03/31/2004
RESPS:90,070 HOURS:22,503 COSTS(000):$0
A Project to Develop an Outcome-Based Continuous Quality
Improvement System and Core Outcome and Comprehensive Assessment
Data Set for PACE
FORMS: CMS-R-299
OMB NO: 0938-0792 EXPIRATION DATE: 04/30/2003
RESPS:3,573 HOURS:3,663 COSTS(000):$0
Rural Health Clinics: Amendments to Participation Requirements &
Payment Provisions; & Establishments of a Quality Assessment &
Performance Improvement Program & Supporting Regulations.....
FORMS: HCFA-R-0242
OMB NO: 0938-0795 EXPIRATION DATE: 08/31/2004
RESPS:37 HOURS:11,100 COSTS(000):$0
Conflict of Interest and Ownership and Control Information
FORMS: HCFA-R-312
OMB NO: 0938-0796 EXPIRATION DATE: 05/31/2004
RESPS:134,400 HOURS:44,800 COSTS(000):$0
Medicare Consumer Assessment of Health Plan Survey - Fee for
Service (CAHPS-FFS)
FORMS: HCFA-10000
OMB NO: 0938-0797 EXPIRATION DATE: 07/31/2003
RESPS:150 HOURS:566 COSTS(000):$0
Individual Market-Guarantee Issue Election Packet, Supporting
Regulations 45 CFR 148, and forms/instruction
FORMS: HCFA-R-205
OMB NO: 0938-0798 EXPIRATION DATE: 08/31/2003
RESPS:2,752 HOURS:41,063 COSTS(000):$0
Prospective Payments for Hospital Outpatient Services and
Supporting Regulations in 42 CFR 143.65, and 419.42
FORMS: HCFA-R-240
OMB NO: 0938-0799 EXPIRATION DATE: 09/30/2003
RESPS:56 HOURS:5,600 COSTS(000):$0
TWWIA Demonstration to Maintain Independence and Employment
FORMS: HCFA-10006
OMB NO: 0938-0801 EXPIRATION DATE: 08/31/2003
RESPS:51 HOURS:102 COSTS(000):$0
Evaluation of QMB and SLMB Outreach Activities
FORMS: HCFA-R-317
OMB NO: 0938-0802 EXPIRATION DATE: 05/31/2005
RESPS:55 HOURS:193 COSTS(000):$0
Recognition of pass-through payment for drugs and biologicals
under the Outpatient Prospective Payment System and Supporting
Regulations in 42 CFR, Section 419.43, formerly known as......
FORMS: CMS-10008
OMB NO: 0938-0806 EXPIRATION DATE: 08/31/2005
RESPS:10,043 HOURS:19,999 COSTS(000):$0
Informatics, Telemedicine, and Education Demonstration Project
FORMS: HCFA-10014
OMB NO: 0938-0808 EXPIRATION DATE: 10/31/2003
RESPS:2,174 HOURS:4,735 COSTS(000):$0
Study to Support Development and Refinement of a Classification
System and Prospective Payment System for Patients in Inpatient
Rehabilitation Hospitals and Exempt Rehabilitation Units
FORMS: HCFA-R-311
OMB NO: 0938-0810 EXPIRATION DATE: 11/30/2003
RESPS:1,491,700 HOURS:146,070 COSTS(000):$0
Hospital Condition of Participation; Identification of Potential
Organ, Tissue, & Eye Donors & Transplant Hospitals' Provision of
Transplant-Related Data & Supporting Regulation at 42 CFR 482.45
FORMS: HCFA-R-0294
OMB NO: 0938-0811 EXPIRATION DATE: 11/30/2003
RESPS:56 HOURS:5,600 COSTS(000):$0
Ticket to Work and Work Incentives: Medicaid Infrastructure
Grants
FORMS: HCFA-10005
OMB NO: 0938-0812 EXPIRATION DATE: 11/30/2003
RESPS:150 HOURS:37 COSTS(000):$0
Employee Building Pass Application and File
FORMS: HCFA-730 HCFA-182
OMB NO: 0938-0813 EXPIRATION DATE: 12/31/2003
RESPS:1,500 HOURS:500 COSTS(000):$0
Evaluation of the OMB and SLMB Programs -- Beneficiary Survey
FORMS: HCFA-10015
OMB NO: 0938-0817 EXPIRATION DATE: 11/30/2003
RESPS:3,600 HOURS:684 COSTS(000):$0
Survey of Medicare Beneficiaries Who Involuntarily Disenroll
From Their Health Plan
FORMS: CMS-10026
OMB NO: 0938-0818 EXPIRATION DATE: 05/31/2003
RESPS:3,291 HOURS:23,218 COSTS(000):$0
Expanded Coverage for Diabetes Outpatient Self-Management 42 CFR
410.141-410-145 and 414.63
FORMS: R-247
OMB NO: 0938-0819 EXPIRATION DATE: 05/31/2004
RESPS:2,600 HOURS:100 COSTS(000):$0
HIPAAA Nondiscrimination Provisions (Regulation HCFA-2078-P)
FORMS: HCFA-10009
OMB NO: 0938-0820 EXPIRATION DATE: 05/31/2003
RESPS:500 HOURS:542 COSTS(000):$0
Follow-Up of Medicare+Choice Disenrollees Receiving
Fee-for-Service Inpatient Hospital Care
FORMS: HCFA-10017
OMB NO: 0938-0823 EXPIRATION DATE: 04/30/2004
RESPS:150 HOURS:50 COSTS(000):$0
Suggestion Program on Methods to Improve Medicare Efficiency and
Supporting Regulations in 42 CFR 420.410
FORMS: HCFA-R-0255
OMB NO: 0938-0824 EXPIRATION DATE: 05/31/2004
RESPS:75 HOURS:3 COSTS(000):$0
Restraints/Seclusion Death Reporting for Hospitals and
Supporting Regulations at 42 CFR 482.13
FORMS: HCFA-10004
OMB NO: 0938-0826 EXPIRATION DATE: 06/30/2004
RESPS:4,800 HOURS:3,200 COSTS(000):$0
Survey of Medicaid Home and Community-Based Services Waiver and
Personal Care Option Recipients for the Multi-Site Study of
Medicaid HOme and Community-Based Services
FORMS: HCFA-10018
OMB NO: 0938-0827 EXPIRATION DATE: 05/31/2005
RESPS:18 HOURS:194 COSTS(000):$0
HIPA Nondiscrimination Provisions (Regulation HCFA-2022-IFC)
FORMS: HCFA-10001
OMB NO: 0938-0828 EXPIRATION DATE: 06/30/2004
RESPS:1,500 HOURS:500 COSTS(000):$0
Medicare Beneficiary Customer Service Survey
FORMS: HCFA-10022
OMB NO: 0938-0829 EXPIRATION DATE: 05/31/2004
RESPS:29,892 HOURS:2,994 COSTS(000):$0
Medicare+Choice Beneficiary Appeal Notices, "Notice of Denial of
Medical Services", "Notice of Denial of Request for Payment" and
Supporting Regulations in 42 CFR 422.568
FORMS: HCFA-10003
OMB NO: 0938-0832 EXPIRATION DATE: 07/31/2004
RESPS:3,000 HOURS:150 COSTS(000):$0
Health Insurance Benefit Agreement and Supporting Regulations at
42 CFR Part 489
FORMS: HCFA-1561
OMB NO: 0938-0833 EXPIRATION DATE: 03/31/2005
RESPS:2,600,000 HOURS:877,750 COSTS(000):$0
Restraint and Seclusion Standards for Psychiatric Residential
Treatment Facilities
FORMS: CMM-R-306
OMB NO: 0938-0836 EXPIRATION DATE: 02/28/2005
RESPS:108 HOURS:540 COSTS(000):$0
Real Choice Systems Change Grants; Nursing Facility Transition/
Access Housing Grants; Community Personal Assistance Service and
Supports Grants, National Technical Assistance and Learning.....
FORMS: CMS-10037
OMB NO: 0938-0837 EXPIRATION DATE: 03/31/2004
RESPS:5,250 HOURS:782 COSTS(000):$0
Medicare Program Integrity Customer Satisfaction Project
FORMS: CMS-10029
OMB NO: 0938-0840 EXPIRATION DATE: 09/30/2003
RESPS:125 HOURS:11 COSTS(000):$0
Collection of Data on Quality Indicators for Congestive Heart
Failure Submitted by Medicare+Choice Organizations Requesting
Extra Payments in CY2002 and CY2003 and Supporting Regulations...
FORMS: HCFA-10035
OMB NO: 0938-0841 EXPIRATION DATE: 06/30/2004
RESPS:3,748,463 HOURS:720,999 COSTS(000):$0
State Children's Health Insurance Program and Supporting
Regulations in 42 CFR.
FORMS: HCFA-0308
OMB NO: 0938-0842 EXPIRATION DATE: 07/31/2005
RESPS:359,000 HOURS:269,250 COSTS(000):$0
Inpatient Rehabilitation Assessment Instrument and Data Set for
PPS for Inpatient Rehabilitation Facilities and Supporting
Regulations in 42 CFR, Parts 412 and 413
FORMS: CMS-10036
OMB NO: 0938-0843 EXPIRATION DATE: 10/31/2004
RESPS:130,500 HOURS:58,000 COSTS(000):$0
Healthy Aging Smoking Cessation Demonstration
FORMS: HCFA-10012
OMB NO: 0938-0844 EXPIRATION DATE: 03/31/2005
RESPS:5,814 HOURS:1,082 COSTS(000):$0
Medicare Health Survey (MHS)
FORMS: CMS-10024
OMB NO: 0938-0846 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Physicians' Referral to Health Care Entities With Which They
Have Financial Relationships and Supporting Regulations in 42
CFR, Sections 411.1, 411.350 through 411.357 and 424.22
FORMS: CMS-10047
OMB NO: 0938-0847 EXPIRATION DATE: 04/30/2003
RESPS:3,900 HOURS:800 COSTS(000):$0
Long Term Care Awareness Project
FORMS: CMS-10041
OMB NO: 0938-0848 EXPIRATION DATE: 05/31/2005
RESPS:10 HOURS:80 COSTS(000):$0
Health Insurance Flexibility and Accountability Section 1115
Model Waiver
FORMS: 10048
OMB NO: 0938-0850 EXPIRATION DATE: 12/31/2003
RESPS:265 HOURS:159 COSTS(000):$0
State Health Insurance Assistance Program (SHIP) Client Report
FORMS: HCFA-10028A-C
OMB NO: 0938-0851 EXPIRATION DATE: 10/31/2005
RESPS:10,800 HOURS:2,700 COSTS(000):$0
Assessing the CMS Fall Campaigns
FORMS: CMS-10049
OMB NO: 0938-0852 EXPIRATION DATE: 11/30/2004
RESPS:384 HOURS:768 COSTS(000):$0
Durable Medicare Equipment and Prosthetics, Orthotics, and
Supplies (DMEPOS) Supplier Survey: Texas
FORMS: HCFA-10045
OMB NO: 0938-0857 EXPIRATION DATE: 01/31/2005
RESPS:100 HOURS:1,600 COSTS(000):$0
Recognition of pass-through payment for additional (new)
categories of devices under the Outpatient Prospective Payment
System and Supporting Regulations in 42 CFR, Part 419
FORMS: CMS-10052
OMB NO: 0938-0859 EXPIRATION DATE: 02/28/2005
RESPS:20,000 HOURS:5,000 COSTS(000):$0
NMEP Regional Survey of Medicare Beneficiaries
FORMS: CMS-10040
OMB NO: 0938-0860 EXPIRATION DATE: 03/31/2005
RESPS:25 HOURS:250 COSTS(000):$0
Recognition of payment for new technology services for
Ambulatory Payment Classification (APCs) under the Outpatient
Prospective Payment System and Supporting Regulation in.......
FORMS: CMS-10054
OMB NO: 0938-0863 EXPIRATION DATE: 02/28/2005
RESPS:5,680 HOURS:1,914 COSTS(000):$0
Evaluation of the BadgerCare Medicaid Demonstration
FORMS: HCFA-10043
OMB NO: 0938-0866 EXPIRATION DATE: 05/31/2005
RESPS:3,400,000 HOURS:34,000,000 COSTS(000):$0
ICRs Contained in 45 CFR Part 162; HIPAA Standards for
Electronic Transactions
FORMS: CMS-R-0218
OMB NO: 0938-0867 EXPIRATION DATE: 07/31/2003
RESPS:6,322 HOURS:1,581 COSTS(000):$0
Survey of Medicare Private Fee-for-service (PFFS) Enrollees and
Nonenrollees
FORMS: CMS-10059
OMB NO: 0938-0869 EXPIRATION DATE: 04/30/2003
RESPS:3,600 HOURS:1,080 COSTS(000):$0
Survey of Newly Eligible Medicare Beneficiaries
FORMS: CMS-10050
OMB NO: 0938-0871 EXPIRATION DATE: 07/31/2005
RESPS:1,680 HOURS:1,106 COSTS(000):$0
Medicare Lifestyle Modification Program Demonstration
FORMS: CMS-10044
OMB NO: 0938-0872 EXPIRATION DATE: 12/31/2005
RESPS:156,480 HOURS:132,360 COSTS(000):$6,395
Minimum Data Set (MDS) for Swing Bed Hospitals and Supporting
Regulations in 42 CFR 483.20 and 413.337
FORMS: CMS-10064
OMB NO: 0938-0873 EXPIRATION DATE: 08/31/2005
RESPS:250 HOURS:2,000 COSTS(000):$0
Quality Assessment and Performance Improvement (QAPI) Project
Completion Report, 42 CFR 422.152
FORMS: CMS-10060
OMB NO: 0938-0874 EXPIRATION DATE: 09/30/2005
RESPS:2,550,000 HOURS:1,700,000 COSTS(000):$51,000
HIPAA Standard Unique Employer Identifier and Supporting
Regulations in 45 CFR Part 160 and 162
FORMS: CMS-R-220
OMB NO: 0938-0875 EXPIRATION DATE: 04/30/2003
RESPS:129,000 HOURS:32,250 COSTS(000):$0
Durable Medical Equipment Regional Carrier, Certificate of
Medical Necessity
FORMS: CMS-843
OMB NO: 0938-0876 EXPIRATION DATE: 09/30/2005
RESPS:2,084 HOURS:348 COSTS(000):$0
Evaluation of the MassHealth Insurance Partnership
FORMS: CMS-10051
OMB NO: 0938-0877 EXPIRATION DATE: 07/31/2005
RESPS:11,356 HOURS:5,465 COSTS(000):$0
Evaluation of Programs of Coordinated Care and Disease Management
FORMS: CMS-10061
OMB NO: 0938-0878 EXPIRATION DATE: 10/31/2005
RESPS:6,605,691 HOURS:18,877 COSTS(000):$0
Collection of Diagnostic Data from Medicare+Choice Organizations
for Risk Adjusted Payment Supporting Regulations CFR Part 422
Subpart F & G
FORMS: CMS-10062
OMB NO: 0938-0879 EXPIRATION DATE: 10/31/2005
RESPS:1,350 HOURS:1,012 COSTS(000):$0
Making Good Choices Survey
FORMS: CMS-10065
OMB NO: 0938-0880 EXPIRATION DATE: 05/31/2003
RESPS:75 HOURS:1,600 COSTS(000):$0
Medicare Waiver Demonstration Application
FORMS: CMS-10069
OMB NO: 0938-0882 EXPIRATION DATE: 11/30/2005
RESPS:15 HOURS:5,189 COSTS(000):$0
Medicare Endorsed Prescription Drug Card Assistance Initiative
FORMS: CMS-10070
OMB NO: 0938-0883 EXPIRATION DATE: 12/31/2005
RESPS:776,224,162 HOURS:2,210,715 COSTS(000):$0
Standards for Privacy of Individually Identifiable Health
Information and Supporting Regulations at 45 CFR Parts 160 and
164
FORMS: HCFA-10039
OMB NO: 0938-0885 EXPIRATION DATE: 06/30/2003
RESPS:15 HOURS:5,444 COSTS(000):$0
Medicare-Endorsed Prescription Drug Card Assistance Initiative
FORMS: CMS-10076
OMB NO: 0938-0887 EXPIRATION DATE: 06/30/2003
RESPS:20 HOURS:800 COSTS(000):$0
Matching Grants to States for the Operation of High Risk Pools
FORMS: CMS-10078
OMB NO: 0938-0889 EXPIRATION DATE: 07/31/2003
RESPS:25 HOURS:115 COSTS(000):$0
Pharmacy Plus Template Application
FORMS: CMS-10067
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
232 2,694,335,512 139,506,338 $205,863
Administration for Children and Families
OMB NO: 0970-0004 EXPIRATION DATE: 04/30/2005
RESPS:1 HOURS:13,746 COSTS(000):$0
Annual Statistical Report on Children in Foster Homes and
Children in Famillies Receiving Payment in Excess of the Poverty
Income Level from a Program Funded Under Part A of Title IV....
FORMS: ACF-4125
OMB NO: 0970-0017 EXPIRATION DATE: 09/30/2004
RESPS:54 HOURS:90 COSTS(000):$0
Revised Form OCSE-100, State Plan for Child Support Collection
and Establishment of Paternity Under Title IV-D of the Social
Security Act
FORMS: OCSE-100
OMB NO: 0970-0030 EXPIRATION DATE: 08/31/2004
RESPS:48 HOURS:24 COSTS(000):$0
Refugee Resettlement Program Estimates: CMA
FORMS: ORR-1
OMB NO: 0970-0033 EXPIRATION DATE: 12/31/2003
RESPS:2,000 HOURS:1,350 COSTS(000):$0
Annual Survey of Refugees
FORMS: ORR-9
OMB NO: 0970-0036 EXPIRATION DATE: 06/30/2003
RESPS:81,130 HOURS:3,011 COSTS(000):$0
Regulation -- Refugee Resettlement Program: Requirements for
Refugee Cash Assistance; and Refugee Medical Assistance (45 CFR
Part 400)
FORMS: NONE
OMB NO: 0970-0037 EXPIRATION DATE: 12/31/2004
RESPS:1 HOURS:14 COSTS(000):$0
LIHEAP Quarterly Allocation Estimates Form ACF-535
FORMS: ACF-535
OMB NO: 0970-0043 EXPIRATION DATE: 05/31/2003
RESPS:50 HOURS:217 COSTS(000):$0
Refugee State of Origin Report
FORMS: ORR-11
OMB NO: 0970-0060 EXPIRATION DATE: 10/31/2003
RESPS:236 HOURS:2,108 COSTS(000):$0
Low Income Home Energy Assistance Program (LIHEAP) Household
Report
FORMS: NONE
OMB NO: 0970-0062 EXPIRATION DATE: 01/31/2004
RESPS:940 HOURS:20,300 COSTS(000):$0
Information collection from applicants who will respond to
Request for Applications for funding of OCS competitive grants
FORMS: NONE
OMB NO: 0970-0075 EXPIRATION DATE: 02/28/2005
RESPS:180 HOURS:103 COSTS(000):$0
Application Requirements for the Low Income Home Energy
Assistance Program (LIHEAP) Model Plan
FORMS: NONE
OMB NO: 0970-0076 EXPIRATION DATE: 08/31/2004
RESPS:51 HOURS:178 COSTS(000):$0
The Low Income Home Energy Assistance Program (LIHEAP) Grantee
Survey
FORMS: ACF-284
OMB NO: 0970-0085 EXPIRATION DATE: 12/31/2003
RESPS:44,471 HOURS:593,226 COSTS(000):$0
Provision of Services in Interstate Child Support Enforcement:
Standard Forms
FORMS: NONE
OMB NO: 0970-0106 EXPIRATION DATE: 11/30/2004
RESPS:177 HOURS:531 COSTS(000):$0
Low Income Home Energy Assistance Program (LIHEAP) Carryover and
Reallotment Report
FORMS: NONE
OMB NO: 0970-0114 EXPIRATION DATE: 02/29/2004
RESPS:28 HOURS:4,552 COSTS(000):$0
Child Care and Development Fund Plan for States/Territories
FORMS: ACF-118
OMB NO: 0970-0121 EXPIRATION DATE: 07/31/2003
RESPS:70 HOURS:2,660 COSTS(000):$0
Low Income Home Energy Assistance Program (LIHEAP) Leveraging
Report
FORMS: ACF-119
OMB NO: 0970-0123 EXPIRATION DATE: 04/30/2004
RESPS:135,080 HOURS:62,012 COSTS(000):$330
Runaway and Homeless Youth Management Information System
FORMS: NONE
OMB NO: 0970-0139 EXPIRATION DATE: 12/31/2003
RESPS:2,838 HOURS:22,704 COSTS(000):$0
ACF Uniform Project Description (UPD)
FORMS: NONE
OMB NO: 0970-0140 EXPIRATION DATE: 04/30/2003
RESPS:200 HOURS:4,800 COSTS(000):$0
Head Start Fellows Program
FORMS: NONE
OMB NO: 0970-0142 EXPIRATION DATE: 04/30/2003
RESPS:4,800 HOURS:4,800 COSTS(000):$10
Federal Parent Locator Service
FORMS: NONE
OMB NO: 0970-0145 EXPIRATION DATE: 07/31/2005
RESPS:54 HOURS:1,782 COSTS(000):$0
Temporary Assistance for Needy Families (TANF) State Plan
FORMS: NONE
OMB NO: 0970-0148 EXPIRATION DATE: 08/31/2003
RESPS:2,472 HOURS:1,468,626 COSTS(000):$0
Head Start Program Performance Standards-Final Rule
FORMS: NONE
OMB NO: 0970-0150 EXPIRATION DATE: 06/30/2003
RESPS:56 HOURS:2,800 COSTS(000):$224
Child Care and Development Fund Annual Report
FORMS: ACF-800
OMB NO: 0970-0151 EXPIRATION DATE: 10/31/2004
RESPS:1,749 HOURS:5,439 COSTS(000):$0
Head Start Family and Child Experiences survey
FORMS: NONE
OMB NO: 0970-0152 EXPIRATION DATE: 03/31/2004
RESPS:24,694 HOURS:12,347 COSTS(000):$0
Administrative Subpoena
FORMS: N/A
OMB NO: 0970-0153 EXPIRATION DATE: 03/31/2004
RESPS:29,776 HOURS:7,444 COSTS(000):$0
Notice of Lien
FORMS: N/A
OMB NO: 0970-0154 EXPIRATION DATE: 03/31/2004
RESPS:54 HOURS:16,056 COSTS(000):$0
Order/Notice to Withhold Income for Child Support
FORMS: N/A
OMB NO: 0970-0155 EXPIRATION DATE: 04/30/2005
RESPS:52 HOURS:3,328 COSTS(000):$0
Community-Based Family Resource and Support Program
FORMS: NONE
OMB NO: 0970-0157 EXPIRATION DATE: 06/30/2004
RESPS:20 HOURS:1,080 COSTS(000):$0
Guidance for the Tribal Temporary Assistance for Needy Families
Program
FORMS: NONE
OMB NO: 0970-0159 EXPIRATION DATE: 05/31/2005
RESPS:1 HOURS:1,000 COSTS(000):$0
Statewide Automated Child Welfare Information System (SACWIS)
Assessment Review Guide
FORMS: NONE
OMB NO: 0970-0160 EXPIRATION DATE: 11/30/2003
RESPS:25 HOURS:500 COSTS(000):$0
Procedures for Requests to Use Child Care and Development Fund
for Construction or Major Renovation of Child Care Facilities
FORMS: NONE
OMB NO: 0970-0161 EXPIRATION DATE: 04/30/2004
RESPS:7,074 HOURS:2,535 COSTS(000):$128
Federal Tax Offset, Administrative Offest, and Passport Denial
Programs
FORMS: NONE
OMB NO: 0970-0163 EXPIRATION DATE: 12/31/2003
RESPS:4 HOURS:1,792 COSTS(000):$3
Child Care and Development Fund Quarterly Financial Report
FORMS: ACF-696
OMB NO: 0970-0166 EXPIRATION DATE: 01/31/2004
RESPS:60,000,000 HOURS:1,962,402 COSTS(000):$86,400
National Directory of New Hires
FORMS: NONE
OMB NO: 0970-0167 EXPIRATION DATE: 03/31/2006
RESPS:224 HOURS:4,480 COSTS(000):$224
Child Care Case-Level Report
FORMS: ACF-801
OMB NO: 0970-0171 EXPIRATION DATE: 07/31/2004
RESPS:448,600 HOURS:74,468 COSTS(000):$0
Required Data Elements for Paternity Establishment Affidavits
FORMS: NONE
OMB NO: 0970-0173 EXPIRATION DATE: 05/31/2004
RESPS:1 HOURS:1,120 COSTS(000):$0
Request for State Data Needed to Determine the Amount of a
Tribal Family Assistance Grant
FORMS: NONE
OMB NO: 0970-0174 EXPIRATION DATE: 03/31/2006
RESPS:79 HOURS:1,575 COSTS(000):$0
Native Employment Works (NEW) Program Plan Guidance and Program
Report
FORMS: NONE
OMB NO: 0970-0175 EXPIRATION DATE: 07/31/2004
RESPS:6,905,480 HOURS:76,059 COSTS(000):$0
Voluntary Establishment of Paternity
FORMS: NONE
OMB NO: 0970-0177 EXPIRATION DATE: 06/30/2004
RESPS:54 HOURS:216 COSTS(000):$0
The OCSE-157 Child Support Enforcement Annual Data Report
FORMS: NONE
OMB NO: 0970-0181 EXPIRATION DATE: 09/30/2004
RESPS:432 HOURS:3,456 COSTS(000):$2,000
Child Support Enforcement Program Financial Report Child Support
Enforcement Program Quarterly Report of Collections
FORMS: OCSE-396A OCSE-34A
OMB NO: 0970-0183 EXPIRATION DATE: 01/31/2005
RESPS:144 HOURS:288 COSTS(000):$0
Project 1099
FORMS: NONE
OMB NO: 0970-0186 EXPIRATION DATE: 02/28/2005
RESPS:1 HOURS:15,552 COSTS(000):$0
Information Collection for the Methodology for Determining
Whether an Increase in a State's Child Poverty Rate Is the
Result of the TANF Program(s) in the State
FORMS: NONE
OMB NO: 0970-0193 EXPIRATION DATE: 01/31/2006
RESPS:200 HOURS:8,200 COSTS(000):$0
45 C.F.R. 1309 Head Start Grants Administration
FORMS: NONE
OMB NO: 0970-0195 EXPIRATION DATE: 03/31/2005
RESPS:232 HOURS:1,856 COSTS(000):$0
Child Care and Development Fund Annual Financial Report for
Tribes
FORMS: ACF-696T
OMB NO: 0970-0196 EXPIRATION DATE: 08/31/2004
RESPS:17,173 HOURS:8,586 COSTS(000):$157
Financial Institution Data Match
FORMS: NONE
OMB NO: 0970-0198 EXPIRATION DATE: 06/30/2005
RESPS:262 HOURS:4,978 COSTS(000):$0
Child Care and Development Fund Tribal Plan
FORMS: ACF-118-A
OMB NO: 0970-0199 EXPIRATION DATE: 04/30/2003
RESPS:208 HOURS:586,864 COSTS(000):$13,500
TANF Data Report (Includes TANF Sampling and Statistical Methods
Manual), SSP-MOE Data report (Includes TANF Sampling and
Statistical Methods Manual
FORMS: ACF-199 ACF-209
OMB NO: 0970-0202 EXPIRATION DATE: 09/30/2005
RESPS:15,839 HOURS:20,948 COSTS(000):$0
National Survey of Child and Adolescent Well-Being (Child
Welfare Longitudinal Study)
FORMS: NONE
OMB NO: 0970-0205 EXPIRATION DATE: 05/31/2004
RESPS:4 HOURS:5,200 COSTS(000):$0
IV-E Foster Care and Adoption Assistance Financial Report
FORMS: ACF-IV-E-1
OMB NO: 0970-0207 EXPIRATION DATE: 04/30/2003
RESPS:1,513 HOURS:49,929 COSTS(000):$998
Head Start Program Grant Application
FORMS: NONE
OMB NO: 0970-0209 EXPIRATION DATE: 01/31/2006
RESPS:972 HOURS:292 COSTS(000):$0
Online Interstate Referral Guide (IRG)
FORMS: NONE
OMB NO: 0970-0214 EXPIRATION DATE: 04/30/2003
RESPS:39 HOURS:17,621 COSTS(000):$0
Title IV-E Foster Care Eligibility Reviews, Child and Family
Services Reviews, Section 471(a)(18) Compliance Reviews
FORMS: NONE
OMB NO: 0970-0215 EXPIRATION DATE: 05/31/2003
RESPS:216 HOURS:68,544 COSTS(000):$198
Final Tribal TANF Data Report
FORMS: ACF-343
OMB NO: 0970-0218 EXPIRATION DATE: 09/30/2003
RESPS:990 HOURS:29,464 COSTS(000):$0
Tribal Child Support Enforcement Direct Funding Request and
Reports -- Notice of Proposed Rulemaking and Interim Final Rule
FORMS: NONE
OMB NO: 0970-0221 EXPIRATION DATE: 11/30/2003
RESPS:216 HOURS:216 COSTS(000):$0
State Systems Profiles
FORMS: NONE
OMB NO: 0970-0222 EXPIRATION DATE: 12/31/2003
RESPS:2,234 HOURS:120,653 COSTS(000):$22
National Medical Support Notice - Final Rule
FORMS: NONE
OMB NO: 0970-0223 EXPIRATION DATE: 01/31/2004
RESPS:54 HOURS:208,764 COSTS(000):$450
State Self-Assessemtn Review and Report
FORMS: NONE
OMB NO: 0970-0226 EXPIRATION DATE: 09/30/2004
RESPS:1,404 HOURS:975 COSTS(000):$0
Study of the TANF Application Process
FORMS: NONE
OMB NO: 0970-0228 EXPIRATION DATE: 09/30/2004
RESPS:540 HOURS:360 COSTS(000):$0
Assets for Independence Act (AFIA) Participant Survey
FORMS: NONE
OMB NO: 0970-0229 EXPIRATION DATE: 09/30/2005
RESPS:19,237 HOURS:13,745 COSTS(000):$0
Head Start Impact Study (HSIS)
FORMS: NONE
OMB NO: 0970-0230 EXPIRATION DATE: 07/31/2005
RESPS:108 HOURS:1,728 COSTS(000):$0
TANF High Performance Bonus for Fiscal Year 2002, Electronic
Transmission File Layouts and Federal System Edits on Work
Measures
FORMS: ACF-300
OMB NO: 0970-0232 EXPIRATION DATE: 03/31/2005
RESPS:264 HOURS:150 COSTS(000):$0
Tribal TANF (Temporary Assistance for Needy Families)
Experience: Problems, Solutions, and Lessons Learned
FORMS: NONE
OMB NO: 0970-0234 EXPIRATION DATE: 03/31/2005
RESPS:56 HOURS:6,160 COSTS(000):$157
Social Services Block Grant Post-Expenditure Report
FORMS: NONE
OMB NO: 0970-0238 EXPIRATION DATE: 06/30/2005
RESPS:195 HOURS:820 COSTS(000):$0
Emerging Practices in Child Abuse and Neglect Prevention
FORMS: NONE
OMB NO: 0970-0239 EXPIRATION DATE: 11/30/2005
RESPS:2 HOURS:45 COSTS(000):$0
Evaluation of the Early Head Start Fatherhood Demonstration
FORMS: NONE
OMB NO: 0970-0240 EXPIRATION DATE: 08/31/2003
RESPS:240 HOURS:240 COSTS(000):$0
Implementation of Promoting Safe and Stable Families by Indian
Tribes
FORMS: NONE
OMB NO: 0970-0242 EXPIRATION DATE: 09/30/2005
RESPS:4,025 HOURS:2,602 COSTS(000):$0
HHS/ACF Employment Retention and Advancement (ERA) Evaluation
12-Month Survey
FORMS: NONE
OMB NO: 0970-0245 EXPIRATION DATE: 02/28/2006
RESPS:52 HOURS:3,952 COSTS(000):$0
Court Improvement Program
FORMS: SF-424 424-A
OMB NO: 0970-0246 EXPIRATION DATE: 02/28/2006
RESPS:1,197 HOURS:1,016 COSTS(000):$0
Rural Welfare-to-Work Strategies Demonstration Evaluation Project
FORMS: NONE
OMB NO: 0970-0249 EXPIRATION DATE: 08/31/2003
RESPS:2,634 HOURS:3,584 COSTS(000):$0
Design and Field Testing of Head Start National Reporting System
on Child Outcomes
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
70 67,763,507 5,568,263 $104,801
Office of Human Development Services
OMB NO: 0980-0017 EXPIRATION DATE: 11/30/2004
RESPS:2,437 HOURS:9,748 COSTS(000):$0
Head Start Program Information Report
FORMS: NONE
OMB NO: 0980-0047 EXPIRATION DATE: 07/31/2005
RESPS:300 HOURS:112,500 COSTS(000):$0
Child and Family Services Plan (CFSP), Annual Progress and
Services Reprot (APSR), and Annual Budget Expenses Request and
Estimated Expenditures (CFS-101)
FORMS: CFS-101
OMB NO: 0980-0140 EXPIRATION DATE: 07/31/2004
RESPS:714,056 HOURS:1,872,392 COSTS(000):$0
Case Plan Requirements, Section 422(b); 471(a)(16), 475(5) and
475(6) of the Social Security Act (SSA); 45 CFR 1356.21(f)(g)
FORMS: NONE
OMB NO: 0980-0141 EXPIRATION DATE: 10/31/2005
RESPS:12 HOURS:180 COSTS(000):$0
State Plan for Title IV-E of the Social Security Act: Foster
Care, Independent Living Services and Adoption Assistance
FORMS: NONE
OMB NO: 0980-0160 EXPIRATION DATE: 08/31/2005
RESPS:57 HOURS:2,508 COSTS(000):$2
Developmental Disabilities Protection and Advocacy Program
Performance Report
FORMS: NONE
OMB NO: 0980-0162 EXPIRATION DATE: 09/30/2005
RESPS:1 HOURS:4,400 COSTS(000):$1,650
Developmental Disabilities State Plan
FORMS: NONE
OMB NO: 0980-0172 EXPIRATION DATE: 09/30/2005
RESPS:1 HOURS:2,420 COSTS(000):$2
State Council on Developmental Disabilities Program Performance
Report
FORMS: NONE
OMB NO: 0980-0196 EXPIRATION DATE: 04/30/2005
RESPS:52 HOURS:3,120 COSTS(000):$0
Application and Program Reporting Requirements for Children's
Justice Act Grants
FORMS: NONE
OMB NO: 0980-0204 EXPIRATION DATE: 04/30/2003
RESPS:650 HOURS:18,200 COSTS(000):$0
Program Narrative Objective Work Plan (OWP)
FORMS: NONE
OMB NO: 0980-0212 EXPIRATION DATE: 09/30/2005
RESPS:110 HOURS:990 COSTS(000):$0
Financial Status Reporting Form (SF-269) with Supplemental Form
(ADD-02) for porogam of state council on developmental
disabilities
FORMS: ADD02/SF269
OMB NO: 0980-0229 EXPIRATION DATE: 06/30/2003
RESPS:52 HOURS:4,780 COSTS(000):$63
National Child Abuse and Neglect Data System (NCANDS)
FORMS: NONE
OMB NO: 0980-0241 EXPIRATION DATE: 11/30/2004
RESPS:257 HOURS:8,995 COSTS(000):$0
Child Care and Development Fund Tribal Annual Report
FORMS: ACF-700
OMB NO: 0980-0243 EXPIRATION DATE: 01/31/2006
RESPS:2,500 HOURS:5,000 COSTS(000):$0
45 C.F.R. 1301 Head Start Grants Administration
FORMS: NONE
OMB NO: 0980-0266 EXPIRATION DATE: 08/31/2004
RESPS:1,505 HOURS:496 COSTS(000):$0
Voluntary Survey of Program Partners to implement Executive
Order 12862 within the Administration for Children Families
FORMS: NONE
OMB NO: 0980-0270 EXPIRATION DATE: 09/30/2003
RESPS:1 HOURS:2,508 COSTS(000):$2
Developmental Disabilities Protection and Advocacy Statement of
Goals and Priorities
FORMS: NONE
OMB NO: 0980-0271 EXPIRATION DATE: 10/31/2004
RESPS:4,021,364 HOURS:221,325 COSTS(000):$259
Computerized Support Enforcement Systems - Final Rule
FORMS: NONE
OMB NO: 0980-0272 EXPIRATION DATE: 06/30/2003
RESPS:560 HOURS:31,120 COSTS(000):$0
Child Welfare Demonstration Project Information Collection
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
17 4,743,915 2,300,682 $1,978
Administration on Aging
OMB NO: 0985-0004 EXPIRATION DATE: 08/31/2004
RESPS:112 HOURS:112 COSTS(000):$1,426
Supplemental Form to the Financial Status Report (SF269), Title
III of the Older Americans Act, Grants for State and Community
Programs on Aging
FORMS: NONE
OMB NO: 0985-0005 EXPIRATION DATE: 12/31/2005
RESPS:52 HOURS:7,620 COSTS(000):$58,068
State Annual Long-Term Care Ombudsman Report
FORMS: NONE
OMB NO: 0985-0006 EXPIRATION DATE: 08/31/2004
RESPS:398 HOURS:7,960 COSTS(000):$0
Performance Progress Reports for Title IV Grantees
FORMS: NONE
OMB NO: 0985-0007 EXPIRATION DATE: 07/31/2003
RESPS:2 HOURS:681 COSTS(000):$0
Program Performance Report, Title VI of the Older Americans Act.
(Grants for Native Americans for Nutritional and Supportive
Services)
FORMS: NONE
OMB NO: 0985-0008 EXPIRATION DATE: 01/31/2006
RESPS:1 HOURS:141,132 COSTS(000):$0
State Program Report for Title III and VII of the Older
Americans Act
FORMS: NONE
OMB NO: 0985-0009 EXPIRATION DATE: 07/31/2005
RESPS:56 HOURS:28 COSTS(000):$748
Certification of Maintenance of Effort
FORMS: NONE
OMB NO: 0985-0012 EXPIRATION DATE: 02/28/2005
RESPS:50 HOURS:1,000 COSTS(000):$0
Alzheimer's Disease Demonstration Grants to States Program
Semi-Annual Report and Instructions
FORMS: NONE
OMB NO: 0985-0013 EXPIRATION DATE: 02/28/2005
RESPS:9,250 HOURS:1,713 COSTS(000):$0
Alzheimer's Disease Demonstration Grants to States Program
Evaluation Data Collection
FORMS: NONE
OMB NO: 0985-0014 EXPIRATION DATE: 05/31/2003
RESPS:3,708 HOURS:2,046 COSTS(000):$0
National Survey of Older American Act Participants
FORMS: NONE
OMB NO: 0985-0015 EXPIRATION DATE: 09/30/2003
RESPS:1,600 HOURS:267 COSTS(000):$0
National Family Caregiver Support Program Survey: Grandparents
and Other Relatives Raising Children
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
10 15,229 162,559 $60,242
Departmental Management
OMB NO: 0990-0001 EXPIRATION DATE: 04/30/2003
RESPS:200 HOURS:1,200 COSTS(000):$150
Application for Waiver of the 2-Year Foreign Residence
Requirement of the Exchange Visitor Program
FORMS: HHS-426
OMB NO: 0990-0115 EXPIRATION DATE: 09/30/2004
RESPS:4,269 HOURS:986,280 COSTS(000):$0
Procurement - Solicitation and Contracts
FORMS: NONE
OMB NO: 0990-0124 EXPIRATION DATE: 05/31/2004
RESPS:2,600 HOURS:41,600 COSTS(000):$0
Self-Evaluation & Recordkeeping Required by Regulations
Implementing Section 504 of the Rehabilitation Act of 1973
FORMS: NONE
OMB NO: 0990-0128 EXPIRATION DATE: 05/31/2004
RESPS:122 HOURS:1,102 COSTS(000):$0
HHS Acquisition Regulations: HHSAR Section 352.270-9 and Section
252.223-70
FORMS: NONE
OMB NO: 0990-0129 EXPIRATION DATE: 01/31/2006
RESPS:1,242 HOURS:10,556 COSTS(000):$0
Special Programs Affecting Acquisiiton (HHSAR Part 370)
FORMS: NONE
OMB NO: 0990-0130 EXPIRATION DATE: 01/31/2006
RESPS:1,921 HOURS:3,842 COSTS(000):$0
Solicitation Provisions and Contract Clauses (HHSAR Part 352)
FORMS: NONE
OMB NO: 0990-0131 EXPIRATION DATE: 12/31/2005
RESPS:110 HOURS:2,200 COSTS(000):$0
HHS Acquisition Regulation - HHSAR Part 342 - Contract
Administration
FORMS: NONE
OMB NO: 0990-0133 EXPIRATION DATE: 12/31/2005
RESPS:80 HOURS:40 COSTS(000):$0
HHS Acquisition Regulation - HHSAR Part 333 - Disputes and
Appeals
FORMS: NONE
OMB NO: 0990-0136 EXPIRATION DATE: 01/31/2006
RESPS:430 HOURS:3,440 COSTS(000):$0
HHS Acquisition Regulation - HHSAR Part 324 - Protection of
Privacy and Freedom of Information
FORMS: NONE
OMB NO: 0990-0139 EXPIRATION DATE: 06/30/2003
RESPS:6,645 HOURS:13,290 COSTS(000):$0
HHS Acquisition Regulation - HHSAR Subpart 315.4 - Solicitation
and Receipt of Proposals and Quotations
FORMS: NONE
OMB NO: 0990-0150 EXPIRATION DATE: 04/30/2004
RESPS:1 HOURS:1 COSTS(000):$0
Uniform Relocation and Real Property Acquisition Under Federal
and Federally Assisted Program
FORMS: NONE
OMB NO: 0990-0169 EXPIRATION DATE: 12/31/2005
RESPS:4,000 HOURS:280,000 COSTS(000):$0
Uniform Administrative Requirements for Grantrs and Cooperative
Agreements to State and Local Governments
FORMS: NONE
OMB NO: 0990-0208 EXPIRATION DATE: 03/31/2004
RESPS:30,000 HOURS:10,333 COSTS(000):$0
Applicant Background Survey
FORMS: NONE
OMB NO: 0990-0220 EXPIRATION DATE: 12/31/2003
RESPS:2,400 HOURS:480 COSTS(000):$0
Voluntary Industry Partner Surveys to Implement E.O. 12862
FORMS: NONE
OMB NO: 0990-0221 EXPIRATION DATE: 09/30/2004
RESPS:85 HOURS:1,870 COSTS(000):$47
Title X Family Planning Annual Report
FORMS: NONE
OMB NO: 0990-0223 EXPIRATION DATE: 12/31/2003
RESPS:7,350 HOURS:3,496 COSTS(000):$0
Evaluation of the Cash and Counseling Demonstration
FORMS: NONE
OMB NO: 0990-0230 EXPIRATION DATE: 06/30/2003
RESPS:780 HOURS:930 COSTS(000):$0
Site Visit Protocols for the Multi-site Evaluation of the
Welfare-to-Work Grants Program
FORMS: NONE
OMB NO: 0990-0232 EXPIRATION DATE: 10/31/2003
RESPS:1,157 HOURS:503 COSTS(000):$0
Cash and Counseling Demonstration--Additional Survey Instruments
FORMS: NONE
OMB NO: 0990-0236 EXPIRATION DATE: 02/29/2004
RESPS:620 HOURS:620 COSTS(000):$0
Financial Summary of Obligation and Expenditure of Block Grant
Funds (45 CFR 96.30)
FORMS: SF-269A
OMB NO: 0990-0237 EXPIRATION DATE: 05/31/2003
RESPS:7,220 HOURS:6,138 COSTS(000):$0
First Follow-up Survey of Youth - Federal Evaluation of
Initiatives Funded Under Section 510 of the Maternal and Child
Health Block Grant Program
FORMS: NONE
OMB NO: 0990-0238 EXPIRATION DATE: 06/30/2003
RESPS:12,750 HOURS:9,819 COSTS(000):$0
Follow-up Survey for the Multi-site Evaluation of the
Welfare-to-Work Grants Program
FORMS: NONE
OMB NO: 0990-0239 EXPIRATION DATE: 06/30/2003
RESPS:136 HOURS:46 COSTS(000):$0
Empowerment Zone and Enterprise Community Health Improvement
Capacity Survey
FORMS: NONE
OMB NO: 0990-0240 EXPIRATION DATE: 07/31/2003
RESPS:3,555 HOURS:666 COSTS(000):$0
Survey of Grant Recipients
FORMS: NONE
OMB NO: 0990-0243 EXPIRATION DATE: 10/31/2003
RESPS:3,000 HOURS:48,000 COSTS(000):$0
OCR Pre-grant Automation Project
FORMS: NONE
OMB NO: 0990-0244 EXPIRATION DATE: 03/31/2004
RESPS:3,000 HOURS:1,000 COSTS(000):$0
National Centers of Excellence in Women's Health Program
Quantitative Evaluation Survey
FORMS: NONE
OMB NO: 0990-0250 EXPIRATION DATE: 10/31/2004
RESPS:600 HOURS:150 COSTS(000):$0
National Centers of Excellence in Women's Health Program
Supplemental Quantiative Community Survey
FORMS: NONE
OMB NO: 0990-0253 EXPIRATION DATE: 06/30/2004
RESPS:1,104 HOURS:1,288 COSTS(000):$0
National Study of Child Protective Services Systems and Reform
Efforts
FORMS: NONE
OMB NO: 0990-0255 EXPIRATION DATE: 06/30/2003
RESPS:720 HOURS:300 COSTS(000):$0
National Study of Culturally and Linguistically Appropriate
Services in Managed Care Organization
FORMS: NONE
OMB NO: 0990-0256 EXPIRATION DATE: 02/28/2005
RESPS:21,600 HOURS:12,744 COSTS(000):$0
Survey of SCHIP Enrollees and Disenrollees for the
Congressionally Mandated Evaluation of the State Children's
Health Insurance Program
FORMS: NONE
OMB NO: 0990-0257 EXPIRATION DATE: 05/31/2005
RESPS:2,872 HOURS:1,436 COSTS(000):$0
Wave Three Survey of Youth for the Evaluation of Initiatives
Funded Under Section 510 of the Maternal & Child Health Block
Grant
FORMS: NONE
OMB NO: 0990-0258 EXPIRATION DATE: 05/31/2005
RESPS:2,044 HOURS:1,515 COSTS(000):$0
A Study of Stroke Post-Acute Care Outcomes
FORMS: NONE
OMB NO: 0990-0260 EXPIRATION DATE: 05/31/2005
RESPS:88,566 HOURS:194,376 COSTS(000):$0
Protection of Human Subjects: Common Rule (56 FR 28003)
FORMS: NONE
OMB NO: 0990-0262 EXPIRATION DATE: 06/30/2003
RESPS:1 HOURS:1,250 COSTS(000):$0
Survey of Research Integrity Measures Utilized in Biomedical
Research Laboratories
FORMS: NONE
OMB NO: 0990-0263 EXPIRATION DATE: 07/31/2005
RESPS:17,000 HOURS:1 COSTS(000):$0
Protection of Human Subjects Assurance Identification/IRB
Certification/Declaration of Exemption
FORMS: NONE
OMB NO: 0990-0264 EXPIRATION DATE: 06/30/2005
RESPS:6,640 HOURS:4,378 COSTS(000):$0
State Studies on TANF Caseload
FORMS: NONE
OMB NO: 0990-0265 EXPIRATION DATE: 12/31/2003
RESPS:120 HOURS:480 COSTS(000):$0
Assessment of State Laws, Regulations, and Practice Affecting
the Collection and Reporting of Racial/Ethnic Health Data
FORMS: NONE
OMB NO: 0990-0267 EXPIRATION DATE: 02/28/2006
RESPS:1,252 HOURS:1,138 COSTS(000):$0
Study of Fathers' Involvement in Permanency Planning and Child
Welfare Casework
FORMS: NONE
OMB NO: 0990-0268 EXPIRATION DATE: 09/30/2005
RESPS:6,755 HOURS:3,720 COSTS(000):$0
Service Use and Transition of Private Long-term Care Insurance
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
38 242,947 1,650,228 $197
Office of Family Assistance
OMB NO: 0992-0005 EXPIRATION DATE: 05/31/2003
RESPS:260 HOURS:5,752 COSTS(000):$0
45 CFR Part 95, Subpart F -- Automatic Data Processing Equipment
and Services--Conditions for Federal Financial Participation
FORMS: NONE
OMB NO: 0992-0007 EXPIRATION DATE: 07/31/2004
RESPS:216 HOURS:4,320 COSTS(000):$0
TANF High Performance Bonus Report, Assessment of Medicaid and
SCHIP Enrollment Among Individuals After Leaving TANF Assistance
FORMS: ACF-210
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 476 10,072 $0
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
828 3,003,402,939 231,714,026 $1,285,272
Department of Homeland Security
Bureau of Citizenship and Immigration Services
OMB NO: 1615-0001 EXPIRATION DATE: 11/30/2004
RESPS:200,000 HOURS:100,000 COSTS(000):$19,000
Petition for Alien Fiance(e)
FORMS: I-129F
OMB NO: 1615-0002 EXPIRATION DATE: 11/30/2005
RESPS:400,000 HOURS:400,000 COSTS(000):$126,000
LIFE Legalization Supplement to Form I-485 Instructions
FORMS: I-485
OMB NO: 1615-0003 EXPIRATION DATE: 07/31/2004
RESPS:683,210 HOURS:512,407 COSTS(000):$81,985
Application to Extend/Change Nonimmigrant Status
FORMS: I-539
OMB NO: 1615-0004 EXPIRATION DATE: 11/30/2004
RESPS:427,000 HOURS:213,500 COSTS(000):$0
Supplement A to form I-539 (Filing Instructions for V
Nonimmigrant Status)
FORMS: I-539-SUPP.A
OMB NO: 1615-0005 EXPIRATION DATE: 11/30/2004
RESPS:40,000 HOURS:100,000 COSTS(000):$6,600
Application for Benefits Under the Family Unity Program
FORMS: I-817
OMB NO: 1615-0006 EXPIRATION DATE: 04/30/2003
RESPS:15,000 HOURS:16,200 COSTS(000):$5,250
Checklist for On-Site Review of Schools
FORMS: NONE
OMB NO: 1615-0007 EXPIRATION DATE: 10/31/2004
RESPS:250,000 HOURS:20,750 COSTS(000):$0
Alien Change of Address Card
FORMS: AR-11
OMB NO: 1615-0008 EXPIRATION DATE: 01/31/2005
RESPS:1,144,994 HOURS:286,249 COSTS(000):$0
Biographic Information
FORMS: G-325
OMB NO: 1615-0009 EXPIRATION DATE: 06/30/2003
RESPS:368,948 HOURS:1,014,607 COSTS(000):$168,676
Petition for Nonimmigrant Worker
FORMS: I-129
OMB NO: 1615-0010 EXPIRATION DATE: 09/30/2005
RESPS:250,000 HOURS:145,750 COSTS(000):$0
Nonimmigrant Petition Based on Blanket L Petition
FORMS: I-129S
OMB NO: 1615-0011 EXPIRATION DATE: 02/28/2006
RESPS:64,046 HOURS:64,046 COSTS(000):$128,092
H-1B Data Collection and Filing Fee Exemption
FORMS: I-129W
OMB NO: 1615-0012 EXPIRATION DATE: 05/31/2003
RESPS:506,358 HOURS:253,179 COSTS(000):$0
Petition for Alien relative
FORMS: I-130
OMB NO: 1615-0013 EXPIRATION DATE: 06/30/2004
RESPS:453,318 HOURS:407,986 COSTS(000):$43,065
Application for Travel Document
FORMS: I-131
OMB NO: 1615-0014 EXPIRATION DATE: 06/30/2003
RESPS:44,000 HOURS:14,652 COSTS(000):$0
Affidavit of Support
FORMS: I-134
OMB NO: 1615-0015 EXPIRATION DATE: 08/31/2004
RESPS:96,000 HOURS:96,000 COSTS(000):$11,040
Immigrant Petition for Alien Workers
FORMS: I-140
OMB NO: 1615-0016 EXPIRATION DATE: 06/30/2003
RESPS:300 HOURS:75 COSTS(000):$51
Application for Advance Permission to Return to Unrelinquished
Domicile
FORMS: I-191
OMB NO: 1615-0017 EXPIRATION DATE: 01/31/2005
RESPS:12,000 HOURS:3,000 COSTS(000):$2,040
Application for Advance Permission to Enter as Nonimmigrant
(Pusuant to 212(d)(3) of the Immigration and Nationality Act)
FORMS: FORM-I-192
OMB NO: 1615-0018 EXPIRATION DATE: 11/30/2005
RESPS:4,200 HOURS:8,400 COSTS(000):$819
Application for Permission to reapply for Admission into the
United States after Deportation or Removal
FORMS: I-212
OMB NO: 1615-0019 EXPIRATION DATE: 02/28/2005
RESPS:41 HOURS:7 COSTS(000):$0
Application for Removal
FORMS: I-243
OMB NO: 1615-0020 EXPIRATION DATE: 02/28/2005
RESPS:8,397 HOURS:16,794 COSTS(000):$1,071
Petition ofr Amerasian, Widow or Special Immigrant
FORMS: I-360
OMB NO: 1615-0021 EXPIRATION DATE: 12/31/2005
RESPS:50 HOURS:25 COSTS(000):$0
Affidavit of Financial Support and Intent to Petition for Legal
Custody for Public Law 97-359 Amerasian
FORMS: I-361
OMB NO: 1615-0022 EXPIRATION DATE: 10/31/2004
RESPS:50 HOURS:25 COSTS(000):$0
Request to Enforce Affidavit of Financial Support and Intent to
Petition for custody for Pub.L. 97-359 Amerasian
FORMS: I-363
OMB NO: 1615-0023 EXPIRATION DATE: 05/31/2005
RESPS:635,500 HOURS:2,781,321 COSTS(000):$193,256
Application to Register Permanent Residence or Adjust Status,
and Supplement A to Form I-485
FORMS: I-485 SUPP.A-I-485
OMB NO: 1615-0024 EXPIRATION DATE: 12/31/2005
RESPS:50,000 HOURS:25,000 COSTS(000):$0
HRIFA Supplement to Form I-485 Instructions
FORMS: I-485-SUPP.C
OMB NO: 1615-0025 EXPIRATION DATE: 06/30/2005
RESPS:1,800 HOURS:150 COSTS(000):$0
Waiver of Rights, Privileges, Exemptions and Immunities
FORMS: I-508
OMB NO: 1615-0026 EXPIRATION DATE: 02/28/2005
RESPS:1,368 HOURS:1,710 COSTS(000):$547
Immigrant Petition by Alien Entrepreneur
FORMS: I-526
OMB NO: 1615-0027 EXPIRATION DATE: 05/31/2003
RESPS:4,400 HOURS:1,100 COSTS(000):$0
Inter-Agency Record of Individual Requesting Change/Adjustment
to or form A or g Status; or Requesting A, G. or NATO Dependent
Employment Authorization
FORMS: I-566
OMB NO: 1615-0028 EXPIRATION DATE: 06/30/2005
RESPS:34,000 HOURS:17,000 COSTS(000):$15,640
Petition to Classify Orphan as an Immediate Relative and
Application for Advance Processing of Orphan Petition
FORMS: I-600 I-600A
OMB NO: 1615-0029 EXPIRATION DATE: 06/30/2003
RESPS:3,000 HOURS:1,500 COSTS(000):$510
Application for Waiver of Ground of Excludability
FORMS: I-601
OMB NO: 1615-0030 EXPIRATION DATE: 06/30/2005
RESPS:1,300 HOURS:432 COSTS(000):$253
Application for Waiver of the Foreign Residence Requirement of
Section 212(e) of the Immigration and Nationality Act
FORMS: I-612
OMB NO: 1615-0031 EXPIRATION DATE: 07/31/2005
RESPS:3,000 HOURS:249 COSTS(000):$0
Supplementary Statement for Graduate Medical Trainees
FORMS: I-644
OMB NO: 1615-0032 EXPIRATION DATE: 09/30/2005
RESPS:85 HOURS:21 COSTS(000):$3
Application for Waiver of Grounds of Excludability
FORMS: I-690
OMB NO: 1615-0033 EXPIRATION DATE: 04/30/2005
RESPS:800,000 HOURS:1,200,000 COSTS(000):$0
Medical Examination of Aliens Seeking Adjustment of Status
FORMS: I-693
OMB NO: 1615-0034 EXPIRATION DATE: 06/30/2005
RESPS:1,192 HOURS:596 COSTS(000):$60
Notice of Appeal of Decision Under Section 210 or 245A of the
Immigration and Nationality Act
FORMS: I-694
OMB NO: 1615-0035 EXPIRATION DATE: 11/30/2004
RESPS:1,179 HOURS:1,179 COSTS(000):$141
Application to Adjust Status from Temporary to Permanent Resident
FORMS: I-698
OMB NO: 1615-0036 EXPIRATION DATE: 12/31/2005
RESPS:100,000 HOURS:16,600 COSTS(000):$0
Certificate of Satisfactory Pursuit
FORMS: I-699
OMB NO: 1615-0037 EXPIRATION DATE: 04/30/2005
RESPS:86,400 HOURS:50,371 COSTS(000):$0
Refugee/Asylee Relative Position
FORMS: I-730
OMB NO: 1615-0038 EXPIRATION DATE: 01/31/2005
RESPS:118,008 HOURS:156,951 COSTS(000):$17,111
Petition to Remove the Conditions on Residence
FORMS: I-751
OMB NO: 1615-0039 EXPIRATION DATE: 06/30/2005
RESPS:5 HOURS:1 COSTS(000):$0
Guam Visa Waiver Agreement
FORMS: I-760
OMB NO: 1615-0040 EXPIRATION DATE: 04/30/2005
RESPS:1,873,296 HOURS:4,083,785 COSTS(000):$224,795
Application for Employment Authorization
FORMS: FORM-I-765
OMB NO: 1615-0041 EXPIRATION DATE: 06/30/2003
RESPS:15,000 HOURS:26,250 COSTS(000):$0
Liberian Deferred Enforced Departure (DED) Supplement to Form
I-765
FORMS: I-765D
OMB NO: 1615-0042 EXPIRATION DATE: 03/31/2004
RESPS:100 HOURS:50 COSTS(000):$2
Application for Issuance or Replacement of Nothern Mariana Card
FORMS: I-777
OMB NO: 1615-0043 EXPIRATION DATE: 03/31/2004
RESPS:181,000 HOURS:90,500 COSTS(000):$8,800
Application for Temporary Protected Status
FORMS: I-821 I-821A
OMB NO: 1615-0044 EXPIRATION DATE: 03/31/2004
RESPS:43,772 HOURS:18,209 COSTS(000):$5,253
Application for Action on an Approved Application or Petition
FORMS: I-824
OMB NO: 1615-0045 EXPIRATION DATE: 12/31/2005
RESPS:200 HOURS:216 COSTS(000):$79
Petition by Entrepreneur to Remove Conditions
FORMS: I-829
OMB NO: 1615-0046 EXPIRATION DATE: 09/30/2005
RESPS:125 HOURS:531 COSTS(000):$0
Interagency Alien
