# INSTRUCTIONS FOR COMPLETING PUBLICATION PLANNING AND CLEARANCE FORM 615

This form is to be used for the production of any publication (as
defines in the Public Affairs Management Manual). OASPA approval of this
form is mandatory before print production may proceed. OASPA will
determine, at the time of approval, whether or not the completion of the
Publication Evaluation Form 615A will be required. For periodicals, this
form (HHS 615) must be submitted annually to OASPA, during the first
quarter of the fiscal year, and no later than December 15, to reflect
any new costs.

1.  Self-explanatory

2.  Self-explanatory

3.  \(b\) The term "Reprint" indicates that no changes are to be made to
    the existing publication.

4.  If the target audience is "general public," the term "general
    public" is defined as an individual, group, or organization outside
    of the Department of HHS. Contractors, grantees, and intermediaries,
    whether funded or not funded by the Government, are considered to be
    "general public."

5.  Self-explanatory

6.  Examples might be: meetings, mail, exhibits, public publication
    racks, etc.

7.  Do not include the number of recommended sales copies with the
    number your organization plans to print for free distribution.

8.  If you cannot answer all the questions, seek help from your printing
    officer and postal representative.

9.  Justification must include:

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(a) Clear statement of purpose

(b) Evidence of need

(c) Clear statement of utility (how the recipient is expected to use the
    publication)

(d) Evidence that publication clearly supports a mandatory program,
    Departmental initiative, or public law.

(e) Evidence that publication is not duplicative of another
    public/private sector communication effort.

(f) Evidence that the publication is cost-effective and/or
    cost-beneficial.

(g) Justification for the number of free copies and justification as to
    why intended recipients cannot or should not be required to purchase
    copies.

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10. Self-explanatory

11. Approvals normally will not be made for fiscal year funds not yet
    appropriated.

12. In-house production costs should be expressed in terms of salaries
    and benefits or portions of salaries and benefits.

13. Self-explanatory

14. Signatures of persons with approval authority only.

> GPO 906-280

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<tbody>
<tr class="odd">
<td colspan="38"><p><strong>OFFICE OF THE ASSISTANT SECRETARY FOR PUBLIC
AFFAIRS</strong></p>
<p><strong>PUBLICATION PLANNING AND CLEARANCE REQUEST</strong></p>
<h2 id="see-the-back-of-this-form-for-instructions">SEE THE BACK OF THIS
FORM FOR INSTRUCTIONS<br />
</h2></td>
</tr>
<tr class="even">
<td colspan="24"><strong>NIH Publication No.</strong>      </td>
<td colspan="14"><strong>CSD REC’D</strong>      </td>
</tr>
<tr class="odd">
<td><strong>1.</strong></td>
<td colspan="37"><strong>PUBLICATION TITLE</strong>      </td>
</tr>
<tr class="even">
<td><strong>2.</strong></td>
<td colspan="14"><strong>OP/DIV</strong>      </td>
<td colspan="14"><strong>AGENCY</strong>      </td>
<td colspan="9"><strong>PROGRAM OFFICE</strong>      </td>
</tr>
<tr class="odd">
<td></td>
<td colspan="30"><strong>CONTACT PERSON</strong>      </td>
<td colspan="7"><strong>TELEPHONE</strong>      </td>
</tr>
<tr class="even">
<td></td>
<td colspan="37"><strong>ADMINISTRATIVE CODE</strong>      </td>
</tr>
<tr class="odd">
<td></td>
<td colspan="37"><strong>CATEGORY OF PUBLICATION:</strong></td>
</tr>
<tr class="even">
<td><strong>3.</strong></td>
<td><strong>a.</strong></td>
<td colspan="9"> <strong>PAMPHLET</strong></td>
<td colspan="14"> <strong>BOOKLET</strong></td>
<td colspan="13"> <strong>PERIODICAL</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="9"> <strong>BROCHURE</strong></td>
<td colspan="14"> <strong>FLYER</strong></td>
<td colspan="13"> <strong>POSTER</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="9"> <strong>MANUAL</strong></td>
<td colspan="27"> <strong>OTHER <em>(Explain</em></strong><em>)</em>
     </td>
</tr>
<tr class="odd">
<td></td>
<td><strong>b.</strong></td>
<td colspan="5"> <strong>NEW</strong></td>
<td colspan="10"> <strong>REPRINT</strong></td>
<td colspan="21"> <strong>REVISION</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="36"><em><strong>(if reprint or revision, attach a copy of
latest printing)</strong></em></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="19"><strong>DATE OF ORIGINAL PRINTING</strong>      </td>
<td colspan="17"><strong>DATE OF LATEST PRINTING</strong>      </td>
</tr>
<tr class="even">
<td></td>
<td><strong>c.</strong></td>
<td colspan="11"> <strong>SINGLE ISSUANCE</strong></td>
<td colspan="25"> <strong>SERIES OR PART OF A SERIES</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="18"><strong>TOTAL NUMBER IN SERIES</strong>      </td>
<td colspan="18"><strong>FREQUENCY OF SERIES</strong>      </td>
</tr>
<tr class="even">
<td></td>
<td><strong>d.</strong></td>
<td colspan="25"><strong>SPECIFICALLY DESCRIBED IN AND MANDATED BY
LAW?</strong></td>
<td colspan="5"> <strong>YES</strong></td>
<td colspan="6"> <strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="36"><em><strong>If yes, cite the specific Public law and
sections of that law</strong></em>      </td>
</tr>
<tr class="even">
<td><strong>4.</strong></td>
<td colspan="37"><strong>TARGET AUDIENCES <em>(list all)</em></strong>
     </td>
</tr>
<tr class="odd">
<td><strong>5.</strong></td>
<td colspan="5"><strong>TRANSLATION:</strong></td>
<td colspan="4"> <strong>YES</strong></td>
<td colspan="9"> <strong>NO</strong></td>
<td colspan="19"><strong>LANGUAGE</strong>      </td>
</tr>
<tr class="even">
<td><strong>6.</strong></td>
<td colspan="37"><strong>DISTRIBUTION METHODS
<em>(describe</em></strong><em>)</em>      </td>
</tr>
<tr class="odd">
<td><strong>7.</strong></td>
<td colspan="32"><strong>RECOMMENDATION FOR SALE VIA SUPERINTENDENT OF
DOCUMENTS, GPO?</strong></td>
<td colspan="2"> <strong>YES</strong></td>
<td colspan="3"> <strong>NO</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="37"><strong>ESTIMATED NUMBER OF SALE COPIES</strong>
     </td>
</tr>
<tr class="odd">
<td><strong>8.</strong></td>
<td colspan="37"><strong>SPECIFICATIONS:</strong></td>
</tr>
<tr class="even">
<td></td>
<td><strong>a.</strong></td>
<td colspan="12"><strong>NUMBER OF COPIES</strong>      </td>
<td colspan="24"><strong>NUMBER OF DOUBLE-SPACED MANUSCRIPT
PAGES</strong>      </td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="36"><strong>NUMBER OF PRINTED PAGES</strong>      
<strong>OR, (if folded) NUMBER OF PANELS</strong>      </td>
</tr>
<tr class="even">
<td></td>
<td><strong>b.</strong></td>
<td colspan="36"><strong>TRIM SIZE</strong>      </td>
</tr>
<tr class="odd">
<td></td>
<td><strong>c.</strong></td>
<td colspan="3"><strong>COVER:</strong></td>
<td colspan="7"> <strong>SELF</strong></td>
<td colspan="26"> <strong>SEPARATE</strong></td>
</tr>
<tr class="even">
<td colspan="38"><strong>OFFICE OF THE ASSISTANT SECRETARY FOR PUBLIC
AFFAIRS<br />
PUBLICATION PLANNING AND CLEARANCE REQUEST</strong></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>d.</strong></td>
<td colspan="14"><strong>PAPER STOCK AND WEIGHT:</strong></td>
<td colspan="14"><strong>COVER</strong>      </td>
<td colspan="8"><strong>TEXT</strong>      </td>
</tr>
<tr class="even">
<td></td>
<td><strong>e.</strong></td>
<td colspan="36"><strong>NO. OF INK COLORS</strong>      </td>
</tr>
<tr class="odd">
<td></td>
<td><strong>f.</strong></td>
<td colspan="6"><strong>SELF-MAILER?</strong></td>
<td colspan="7"> <strong>YES</strong></td>
<td colspan="23"> <strong>NO</strong></td>
</tr>
<tr class="even">
<td></td>
<td><strong>g.</strong></td>
<td colspan="7"><strong>ILLUSTRATIONS:</strong></td>
<td colspan="13"> <strong>HALFTONES</strong></td>
<td colspan="8"> <strong>DUOTONES</strong></td>
<td colspan="8"> <strong>TABLES</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="7"> <strong>CHARTS</strong></td>
<td colspan="13"> <strong>DRAWINGS</strong></td>
<td colspan="8"></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>h.</strong></td>
<td><strong>MAIL:</strong></td>
<td colspan="15"> <strong>FIRST CLASS</strong></td>
<td colspan="11"> <strong>THIRD CLASS</strong></td>
<td colspan="9"> <strong>FOURTH CLASS</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="27"><strong>PIECE RATE @ $</strong>       <strong>EACH OR
BULK RATE @ $</strong>      </td>
<td colspan="9"><strong>OTHER</strong>      </td>
</tr>
<tr class="even">
<td><strong>9.</strong></td>
<td colspan="37"><strong>JUSTIFICATION <em>(see instructions and use
page 3 or a separate sheet of paper)</em></strong></td>
</tr>
<tr class="odd">
<td><strong>10.</strong></td>
<td colspan="37"><strong>PROPOSED PUBLICATION DATE</strong>      </td>
</tr>
<tr class="even">
<td><strong>11.</strong></td>
<td colspan="37"><strong>PUBLICATION PRODUCTION, PRINTING, AND
DISTRIBUTION COSTS WILL BE CHARGE TO FISCAL YEAR</strong>      <u><br />
</u><strong>APPROPRIATE CODE</strong>      </td>
</tr>
<tr class="odd">
<td><strong>12.</strong></td>
<td colspan="25"><strong>PRODUCTION COSTS:</strong></td>
<td colspan="8"><strong>IN-HOUSE</strong></td>
<td colspan="3"><strong>PROCURED</strong></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>a.</strong></td>
<td colspan="24"><strong>RESEARCH, WRITING,
EDITING……………………………..</strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>b.</strong></td>
<td colspan="24"><strong>GRAPHICS……………………………………………………….</strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>c.</strong></td>
<td colspan="24"><strong>PHOTOGRAPHY………………………………………………...</strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>d.</strong></td>
<td colspan="24"><strong>COMPOSITION
<em>(typesetting)………………………………….</em></strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>e.</strong></td>
<td colspan="24"><strong>PRINTING…………………………………………………………</strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>f.</strong></td>
<td colspan="24"><strong>MAILING…………………………………………………………..</strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>g.</strong></td>
<td colspan="24"><strong>OTHER
DISTRIBUTION/PROMOTION……………………….</strong></td>
<td colspan="8">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="23"><strong>TOTALS</strong></td>
<td colspan="8">$ 0.00</td>
<td colspan="3">$ 0.00</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="23"><strong>GRAND TOTAL</strong></td>
<td colspan="8">$ 0.00</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="23"><strong>UNIT COSTS</strong></td>
<td colspan="8">     </td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td><strong>13.</strong></td>
<td colspan="37"><strong>CONTRACT JUSTIFICATION: <em>Attach the
OASPA-approved request for contract and scope of work</em></strong></td>
</tr>
<tr class="odd">
<td><strong>14.</strong></td>
<td colspan="37"><strong>APPROVALS:</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"></td>
<td colspan="19"><strong>TITLE</strong></td>
<td colspan="13"><strong>SIGNATURE</strong></td>
<td colspan="2"><strong>DATE</strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"><strong>AGENCY</strong></td>
<td colspan="19">     </td>
<td colspan="13"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"><strong>OP/DIV</strong></td>
<td colspan="19">     </td>
<td colspan="13"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"><strong>OASPA</strong></td>
<td colspan="19">     </td>
<td colspan="13"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="22"><strong>OASPA: EVALUATION FORM 615A
REQUIRED?</strong></td>
<td colspan="5"> <strong>YES</strong></td>
<td colspan="10"> <strong>NO</strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="37"><strong>A signed copy of this form must be submitted
with the Printing Requisition. Printing Officers will not accept
requests for composition and/or printing unless accompanied by an
OASPA-approved form HHS-615.</strong></td>
</tr>
</tbody>
</table>