**PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET**

Part II: Information Collection Detail

+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 1. Title of       |                               |                 |
| Information       |                               |                 |
| Collection:**     |                               |                 |
| NESHAP for Area   |                               |                 |
| Source Standards: |                               |                 |
| Information for   |                               |                 |
| Acrylic and       |                               |                 |
| Modacrylic Fiber  |                               |                 |
| Production        |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               | **\                           | **\             |
| 2. Is this a      | 3. Obligation to respond**    | 4. Frequency of |
| common form?\     | *(check one):***\             | reporting**     |
| ** Yes\           | ** Voluntary                  | *(only to be    |
| No\               |                               | completed if    |
| **\               | Required to obtain or retain  | there are       |
| ***(Select, Yes,  | benefits                      | reporting       |
| to identify forms |                               | requirements,*  |
| that EPA is       | Mandatory                     | *check all that |
| willing to host   |                               | apply):*        |
| for potential use | Only one selection may be     |                 |
| by other Federal  | made.\                        | Hourly          |
| Agencies.)*       | If multiple categories apply, |                 |
|                   | you must create\              | Daily           |
|                   | additional ICs to account for |                 |
|                   | the burden associated\        | Weekly          |
|                   | with each category.           |                 |
|                   |                               | Monthly         |
|                   |                               |                 |
|                   |                               | Quarterly       |
|                   |                               |                 |
|                   |                               | Semi-annually   |
|                   |                               |                 |
|                   |                               | Annually        |
|                   |                               |                 |
|                   |                               | Every Decade    |
|                   |                               |                 |
|                   |                               | Biennially      |
|                   |                               |                 |
|                   |                               | On Occasion     |
|                   |                               |                 |
|                   |                               | Once            |
+-------------------+-------------------------------+-----------------+
| **5. CFR          |                               |                 |
| Citation(s) for   |                               |                 |
| the information   |                               |                 |
| collection under  |                               |                 |
| review** *(if     |                               |                 |
| applicable):*\    |                               |                 |
| \                 |                               |                 |
| Title: National   |                               |                 |
| Emission          |                               |                 |
| Standards for     |                               |                 |
| Hazardous Air     |                               |                 |
| Pollutants        |                               |                 |
|                   |                               |                 |
| for Acrylic and   |                               |                 |
| Modacrylic Fibers |                               |                 |
| Production        |                               |                 |
| Citation: 40 CFR  |                               |                 |
| 63.11397(a),(b)   |                               |                 |
|                   |                               |                 |
| Title: Citation:  |                               |                 |
| [\                |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|     Citation:     |                               |                 |
|      [\           |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
| Citation:         |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 6. Information    |                               |                 |
| Collection        |                               |                 |
| In                |                               |                 |
| struments/Forms** |                               |                 |
| *(if              |                               |                 |
| applicable):\     |                               |                 |
| Form/Instrument   |                               |                 |
| must be submitted |                               |                 |
| to OEI as a       |                               |                 |
| separate          |                               |                 |
| attachment.*      |                               |                 |
|                   |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
|   Form    EPA     |                               |                 |
|   URL *(required  |                               |                 |
| Is this           |                               |                 |
|  If yes, can this |                               |                 |
|   Name            |                               |                 |
| Form \# if        |                               |                 |
|       collection  |                               |                 |
|        collection |                               |                 |
|                   |                               |                 |
|    electronic)*   |                               |                 |
|  instrument/form  |                               |                 |
|   instrument/form |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|     available     |                               |                 |
|      be submitted |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|  electronically?  |                               |                 |
|   electronically? |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 7. Federal        |                               |                 |
| Enterprise        |                               |                 |
| Architecture      |                               |                 |
| Business          |                               |                 |
| Reference Model** |                               |                 |
|                   |                               |                 |
| Line of Business  |                               |                 |
| *(check one):*    |                               |                 |
| Subfunction       |                               |                 |
| *(check one):*    |                               |                 |
|                   |                               |                 |
| <table>           |                               |                 |
| <colgroup>        |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 43%" /> |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 56%" /> |                               |                 |
| </colgroup>       |                               |                 |
| <tbody>           |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td> None</td>    |                               |                 |
| <td></td>         |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td>              |                               |                 |
| Environmental     |                               |                 |
| Management</td>   |                               |                 |
| <td><p>           |                               |                 |
| Environmental     |                               |                 |
| Monitoring and    |                               |                 |
| Forecasting</p>   |                               |                 |
| <p>               |                               |                 |
| Environmental     |                               |                 |
| Remediation</p>   |                               |                 |
| <p> Pollution     |                               |                 |
| Prevention and    |                               |                 |
| Control</p>       |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td>              |                               |                 |
| Health</td>       |                               |                 |
| <td><p> Illness   |                               |                 |
| Prevention</p>    |                               |                 |
| <p>               |                               |                 |
| Immunization      |                               |                 |
| Management</p>    |                               |                 |
| <p> Public        |                               |                 |
| Health            |                               |                 |
| Monitoring</p>    |                               |                 |
| <p> Health Care   |                               |                 |
| Services</p>      |                               |                 |
| <p> Consumer      |                               |                 |
| Health and        |                               |                 |
| Safety</p>        |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td> Natural      |                               |                 |
| Resources</td>    |                               |                 |
| <td><p> Water     |                               |                 |
| Resource          |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Conservation,     |                               |                 |
| Marine and Land   |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Recreational      |                               |                 |
| Resource          |                               |                 |
| Management and    |                               |                 |
| Tourism</p>       |                               |                 |
| <p>               |                               |                 |
| Agricultural      |                               |                 |
| Innovation and    |                               |                 |
| Services</p>      |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| </tbody>          |                               |                 |
| </table>          |                               |                 |
+-------------------+-------------------------------+-----------------+

**\
IMPORTANT: Part II must be completed for each Information Collection
(IC) activity associated with the ICR. Please be sure that you copy this
portion of the template as many times as necessary so that each IC has
its own Part II submission. For more information on how to break your
ICR into ICs, please see OMB's ROCIS IC Q&A, located at:
<http://intranet.epa.gov/icrintra/download.html>. In addition, please
reference OEI's ROCIS instructions at:
<http://intranet.epa.gov/icrintra/download.html>**

+-------------------------------+-----+-------------------------------+
| > Note: Most EPA ICRs will be |     |                               |
| > aligned with the            |     |                               |
| > Environmental Management    |     |                               |
| > FEA Line of Business. Other |     |                               |
| > likely categories are also  |     |                               |
| > listed. For a full listing  |     |                               |
| > of the FEA Business         |     |                               |
| > Reference Model categories  |     |                               |
| > and definitions, see:       |     |                               |
| > http://www.whitehouse.go    |     |                               |
| v/omb/egov/documents/FY07_Ref |     |                               |
| _Model_Mapping_QuickGuide.pdf |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           |     |                               |
| 8. Privacy Act System of      |     |                               |
| Records** *(if applicable):*  |     |                               |
|                               |     |                               |
| > Title:                      |     |                               |
| >                             |     |                               |
| > Federal Register Citation:  |     |                               |
| > Volume:       Page number:  |     |                               |
| >       Publication date:     |     |                               |
| > /   /                       |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           | **\ |                               |
| 9. Respondents**              | Af  |                               |
|                               | fec |                               |
| Total number: 1     \         | ted |                               |
| Small entity number: 0     \  | Pu  |                               |
| Percentage of responses       | bli |                               |
| collected electronically: 0   | c** |                               |
|                               | *(  |                               |
|                               | cho |                               |
|                               | ose |                               |
|                               | one |                               |
|                               | ):* |                               |
|                               |     |                               |
|                               | In  |                               |
|                               | div |                               |
|                               | idu |                               |
|                               | als |                               |
|                               | or  |                               |
|                               | ho  |                               |
|                               | use |                               |
|                               | hol |                               |
|                               | ds\ |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | *   |                               |
|                               | (if |                               |
|                               | p   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | s   |                               |
|                               | ect |                               |
|                               | or, |                               |
|                               | ch  |                               |
|                               | eck |                               |
|                               | all |                               |
|                               | t   |                               |
|                               | hat |                               |
|                               | a   |                               |
|                               | ppl |                               |
|                               | y)\ |                               |
|                               | *   |                               |
|                               | Bu  |                               |
|                               | sin |                               |
|                               | ess |                               |
|                               | or  |                               |
|                               | ot  |                               |
|                               | her |                               |
|                               | fo  |                               |
|                               | r-p |                               |
|                               | rof |                               |
|                               | it\ |                               |
|                               | No  |                               |
|                               | t-f |                               |
|                               | or- |                               |
|                               | pro |                               |
|                               | fit |                               |
|                               | i   |                               |
|                               | nst |                               |
|                               | itu |                               |
|                               | tio |                               |
|                               | ns\ |                               |
|                               | Far |                               |
|                               | ms\ |                               |
|                               | Sta |                               |
|                               | te, |                               |
|                               | Loc |                               |
|                               | al, |                               |
|                               | or  |                               |
|                               | Tri |                               |
|                               | bal |                               |
|                               | Gov |                               |
|                               | ern |                               |
|                               | men |                               |
|                               | ts\ |                               |
|                               | F   |                               |
|                               | ede |                               |
|                               | ral |                               |
|                               | G   |                               |
|                               | ove |                               |
|                               | rnm |                               |
|                               | ent |                               |
|                               |     |                               |
|                               | O   |                               |
|                               | nly |                               |
|                               | one |                               |
|                               | sel |                               |
|                               | ect |                               |
|                               | ion |                               |
|                               | may |                               |
|                               | be  |                               |
|                               | ma  |                               |
|                               | de. |                               |
|                               | If  |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | c   |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | app |                               |
|                               | ly, |                               |
|                               | you |                               |
|                               | m   |                               |
|                               | ust |                               |
|                               | cre |                               |
|                               | ate |                               |
|                               | a   |                               |
|                               | ddi |                               |
|                               | tio |                               |
|                               | nal |                               |
|                               | ICs |                               |
|                               | to  |                               |
|                               | a   |                               |
|                               | cco |                               |
|                               | unt |                               |
|                               | for |                               |
|                               | the |                               |
|                               | bur |                               |
|                               | den |                               |
|                               | a   |                               |
|                               | sso |                               |
|                               | cia |                               |
|                               | ted |                               |
|                               | w   |                               |
|                               | ith |                               |
|                               | e   |                               |
|                               | ach |                               |
|                               | cat |                               |
|                               | ego |                               |
|                               | ry. |                               |
|                               | No  |                               |
|                               | te: |                               |
|                               | Sel |                               |
|                               | ect |                               |
|                               | ing |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | s   |                               |
|                               | ubc |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | wit |                               |
|                               | hin |                               |
|                               | the |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | w   |                               |
|                               | ill |                               |
|                               | not |                               |
|                               | aff |                               |
|                               | ect |                               |
|                               | the |                               |
|                               | num |                               |
|                               | ber |                               |
|                               | of  |                               |
|                               | ICs |                               |
|                               | req |                               |
|                               | uir |                               |
|                               | ed. |                               |
+-------------------------------+-----+-------------------------------+
| **10. Frequency: How often on |     | **Calculated: Annual          |
| average will each respondent  |     | Frequency** = 1\              |
| respond\                      |     | *(responses per respondent,   |
| to the Information            |     | per year)*                    |
| Collection?**                 |     |                               |
|                               |     | **Calculated: Annual Number   |
| **\                           |     | of Responses** = 1            |
| **Number of Responses per     |     |                               |
| Respondent: 2 one-time        |     |                               |
| notifications, written plan\  |     |                               |
| Per (select the most          |     |                               |
| appropriate time period for   |     |                               |
| this collection)\             |     |                               |
| Hour (24 per day, 8736 per    |     |                               |
| year)\                        |     |                               |
| Business Hour (40 per week,   |     |                               |
| 2080 per year)                |     |                               |
|                               |     |                               |
| Day ( 7 per week, 365 per     |     |                               |
| year)                         |     |                               |
|                               |     |                               |
| Business Day ( 5 per week,    |     |                               |
| 260 per year)\                |     |                               |
| Week (52 per year)\           |     |                               |
| Month (12 per year)\          |     |                               |
| Semi-Annual (2 per year)\     |     |                               |
| Year\                         |     |                               |
| Decade (.1 per year)          |     |                               |
+-------------------------------+-----+-------------------------------+
|                               |     |                               |
+-------------------------------+-----+-------------------------------+
| **11. Hour and Cost Burden    |     |                               |
| -** Enter the hours and cost  |     |                               |
| (per response) broken out by  |     |                               |
| reporting, record keeping,    |     |                               |
| and third-party disclosure.   |     |                               |
|                               |     |                               |
| <table>                       |     |                               |
| <colgroup>                    |     |                               |
| <col style="width: 19%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| </colgroup>                   |     |                               |
| <tbody>                       |     |                               |
| <tr class="odd">              |     |                               |
| <td></td>                     |     |                               |
| <td>Hours per Response</td>   |     |                               |
| <td>Total Annual Hour         |     |                               |
| Burden</td>                   |     |                               |
| <td><p>Cost per               |     |                               |
| Response</p>                  |     |                               |
| <p>(Capital/Startup and       |     |                               |
| O&amp;M Costs                 |     |                               |
| Only)</p></td>                |     |                               |
| <td><p>Total Annual Cost      |     |                               |
| Burden</p>                    |     |                               |
| <p>(Capital/Startup and</p>   |     |                               |
| <p>O&amp;M Costs              |     |                               |
| Only)</p></td>                |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Reporting</td>            |     |                               |
| <                             |     |                               |
| td><strong>4.50</strong></td> |     |                               |
| <                             |     |                               |
| td><strong>9.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Recordkeeping</td>        |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Third Party               |     |                               |
| Disclosure</td>               |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Total</td>                |     |                               |
| <                             |     |                               |
| td><strong>4.50</strong></td> |     |                               |
| <                             |     |                               |
| td><strong>9.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| </tbody>                      |     |                               |
| </table>                      |     |                               |
+-------------------------------+-----+-------------------------------+

+-----------------------------------------------------------------------+
| **\                                                                   |
| 12. Allocate the change in Burden:**                                  |
|                                                                       |
| +--------+--------+--------+--------+--------+--------+--------+      |
| |        | Total  | Change | Change | Due to | Change | Cur    |      |
| |        | Req    | Due to | Due to |        | due to | rently |      |
| |        | uested |        |        | Agency | Vio    | Ap     |      |
| |        |        | New    | Agency | Es     | lation | proved |      |
| |        |        | S      | Disc   | timate |        |        |      |
| |        |        | tatute | retion |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **     | **     | **     | **     | **     | **     |      |
| | Res    | 1.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | ponses |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | *      | **     | **     | **     | **     | **     |      |
| | Hour   | *9.0** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | *      | **     | **     | **     | **     | **     |      |
| | Cost   | *0.0** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| | (Cap   |        |        |        |        |        |        |      |
| | ital/S |        |        |        |        |        |        |      |
| | tartup |        |        |        |        |        |        |      |
| | and    |        |        |        |        |        |        |      |
| | O&M    |        |        |        |        |        |        |      |
| | costs  |        |        |        |        |        |        |      |
| | only)  |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
+-----------------------------------------------------------------------+

**PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET**

**Part II: Information Collec**tion Detail

+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 1. Title of       |                               |                 |
| Information       |                               |                 |
| Collection:**     |                               |                 |
| NESHAP for Area   |                               |                 |
| Source Standards: |                               |                 |
| Information       |                               |                 |
| Collection for    |                               |                 |
| Carbon Black      |                               |                 |
| Production        |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               | **\                           | **\             |
| 2. Is this a      | 3. Obligation to respond**    | 4. Frequency of |
| common form?\     | *(check one):***\             | reporting\      |
| ** Yes\           | ** Voluntary                  | ***(check all   |
| No\               |                               | that apply):*   |
| **\               | Required to obtain or retain  |                 |
| ***(Select, Yes,  | benefits                      | Hourly          |
| to identify forms |                               |                 |
| that EPA is       | Mandatory                     | Daily           |
| willing to host   |                               |                 |
| for potential use | Only one selection may be     | Weekly          |
| by other Federal  | made.\                        |                 |
| Agencies.)*       | If multiple categories apply, | Monthly         |
|                   | you must create\              |                 |
|                   | additional ICs to account for | Quarterly       |
|                   | the burden associated\        |                 |
|                   | with each category.           | Semi-annually   |
|                   |                               |                 |
|                   |                               | Annually        |
|                   |                               |                 |
|                   |                               | Every Decade    |
|                   |                               |                 |
|                   |                               | Biennially      |
|                   |                               |                 |
|                   |                               | On Occasion     |
|                   |                               |                 |
|                   |                               | Once            |
+-------------------+-------------------------------+-----------------+
| **5. CFR          |                               |                 |
| Citation(s) for   |                               |                 |
| the information   |                               |                 |
| collection under  |                               |                 |
| review** *(if     |                               |                 |
| applicable):*\    |                               |                 |
| \                 |                               |                 |
| Title: National   |                               |                 |
| Emission          |                               |                 |
| Standards for     |                               |                 |
| Hazardous Air     |                               |                 |
| Pollutants        |                               |                 |
|                   |                               |                 |
| for Carbon Black  |                               |                 |
| Production Area   |                               |                 |
| Sources Citation: |                               |                 |
| 40 CFR 63.11404   |                               |                 |
|                   |                               |                 |
| Title:            |                               |                 |
| Citation:         |                               |                 |
|  [\               |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|        Citation:  |                               |                 |
|       [\          |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|        Citation:  |                               |                 |
|                   |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 6. Information    |                               |                 |
| Collection        |                               |                 |
| In                |                               |                 |
| struments/Forms** |                               |                 |
| *(if              |                               |                 |
| applicable):\     |                               |                 |
| Form/Instrument   |                               |                 |
| must be submitted |                               |                 |
| to OEI as a       |                               |                 |
| separate          |                               |                 |
| attachment.*      |                               |                 |
|                   |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
|   Form    EPA     |                               |                 |
|   URL *(required  |                               |                 |
| Is this           |                               |                 |
|  If yes, can this |                               |                 |
|   Name            |                               |                 |
| Form \# if        |                               |                 |
|       collection  |                               |                 |
|        collection |                               |                 |
|                   |                               |                 |
|    electronic)*   |                               |                 |
|  instrument/form  |                               |                 |
|   instrument/form |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|     available     |                               |                 |
|      be submitted |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|  electronically?  |                               |                 |
|   electronically? |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 7. Federal        |                               |                 |
| Enterprise        |                               |                 |
| Architecture      |                               |                 |
| Business          |                               |                 |
| Reference Model** |                               |                 |
|                   |                               |                 |
| Line of Business  |                               |                 |
| *(check one):*    |                               |                 |
| Subfunction       |                               |                 |
| *(check one):*    |                               |                 |
|                   |                               |                 |
| <table>           |                               |                 |
| <colgroup>        |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 43%" /> |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 56%" /> |                               |                 |
| </colgroup>       |                               |                 |
| <tbody>           |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td> None</td>    |                               |                 |
| <td></td>         |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td>              |                               |                 |
| Environmental     |                               |                 |
| Management</td>   |                               |                 |
| <td><p>           |                               |                 |
| Environmental     |                               |                 |
| Monitoring and    |                               |                 |
| Forecasting</p>   |                               |                 |
| <p>               |                               |                 |
| Environmental     |                               |                 |
| Remediation</p>   |                               |                 |
| <p> Pollution     |                               |                 |
| Prevention and    |                               |                 |
| Control</p>       |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td>              |                               |                 |
| Health</td>       |                               |                 |
| <td><p> Illness   |                               |                 |
| Prevention</p>    |                               |                 |
| <p>               |                               |                 |
| Immunization      |                               |                 |
| Management</p>    |                               |                 |
| <p> Public        |                               |                 |
| Health            |                               |                 |
| Monitoring</p>    |                               |                 |
| <p> Health Care   |                               |                 |
| Services</p>      |                               |                 |
| <p> Consumer      |                               |                 |
| Health and        |                               |                 |
| Safety</p>        |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td> Natural      |                               |                 |
| Resources</td>    |                               |                 |
| <td><p> Water     |                               |                 |
| Resource          |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Conservation,     |                               |                 |
| Marine and Land   |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Recreational      |                               |                 |
| Resource          |                               |                 |
| Management and    |                               |                 |
| Tourism</p>       |                               |                 |
| <p>               |                               |                 |
| Agricultural      |                               |                 |
| Innovation and    |                               |                 |
| Services</p>      |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| </tbody>          |                               |                 |
| </table>          |                               |                 |
+-------------------+-------------------------------+-----------------+

**\
IMPORTANT: Part II must be completed for each Information Collection
(IC) activity associated with the ICR. Please be sure that you copy this
portion of the template as many times as necessary so that each IC has
its own Part II submission. For more information on how to break your
ICR into ICs, please see OMB's ROCIS IC Q&A, located at:
<http://intranet.epa.gov/icrintra/download.html>. In addition, please
reference OEI's ROCIS instructions at:
<http://intranet.epa.gov/icrintra/download.html>**

+-------------------------------+-----+-------------------------------+
| > Note: Most EPA ICRs will be |     |                               |
| > aligned with the            |     |                               |
| > Environmental Management    |     |                               |
| > FEA Line of Business. Other |     |                               |
| > likely categories are also  |     |                               |
| > listed. For a full listing  |     |                               |
| > of the FEA Business         |     |                               |
| > Reference Model categories  |     |                               |
| > and definitions, see:       |     |                               |
| > http://www.whitehouse.go    |     |                               |
| v/omb/egov/documents/FY07_Ref |     |                               |
| _Model_Mapping_QuickGuide.pdf |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           |     |                               |
| 8. Privacy Act System of      |     |                               |
| Records** *(if applicable):*  |     |                               |
|                               |     |                               |
| > Title:                      |     |                               |
| >                             |     |                               |
| > Federal Register Citation:  |     |                               |
| > Volume:       Page number:  |     |                               |
| >       Publication date:     |     |                               |
| > /   /                       |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           | **\ |                               |
| 9. Respondents**              | Af  |                               |
|                               | fec |                               |
| Total number: 1      \        | ted |                               |
| Small entity number:  0     \ | Pu  |                               |
| Percentage of responses       | bli |                               |
| collected electronically: 0   | c** |                               |
|                               | *(  |                               |
|                               | cho |                               |
|                               | ose |                               |
|                               | one |                               |
|                               | ):* |                               |
|                               |     |                               |
|                               | In  |                               |
|                               | div |                               |
|                               | idu |                               |
|                               | als |                               |
|                               | or  |                               |
|                               | ho  |                               |
|                               | use |                               |
|                               | hol |                               |
|                               | ds\ |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | *   |                               |
|                               | (if |                               |
|                               | p   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | s   |                               |
|                               | ect |                               |
|                               | or, |                               |
|                               | ch  |                               |
|                               | eck |                               |
|                               | all |                               |
|                               | t   |                               |
|                               | hat |                               |
|                               | a   |                               |
|                               | ppl |                               |
|                               | y)\ |                               |
|                               | *   |                               |
|                               | Bu  |                               |
|                               | sin |                               |
|                               | ess |                               |
|                               | or  |                               |
|                               | ot  |                               |
|                               | her |                               |
|                               | fo  |                               |
|                               | r-p |                               |
|                               | rof |                               |
|                               | it\ |                               |
|                               | No  |                               |
|                               | t-f |                               |
|                               | or- |                               |
|                               | pro |                               |
|                               | fit |                               |
|                               | i   |                               |
|                               | nst |                               |
|                               | itu |                               |
|                               | tio |                               |
|                               | ns\ |                               |
|                               | Far |                               |
|                               | ms\ |                               |
|                               | Sta |                               |
|                               | te, |                               |
|                               | Loc |                               |
|                               | al, |                               |
|                               | or  |                               |
|                               | Tri |                               |
|                               | bal |                               |
|                               | Gov |                               |
|                               | ern |                               |
|                               | men |                               |
|                               | ts\ |                               |
|                               | F   |                               |
|                               | ede |                               |
|                               | ral |                               |
|                               | G   |                               |
|                               | ove |                               |
|                               | rnm |                               |
|                               | ent |                               |
|                               |     |                               |
|                               | O   |                               |
|                               | nly |                               |
|                               | one |                               |
|                               | sel |                               |
|                               | ect |                               |
|                               | ion |                               |
|                               | may |                               |
|                               | be  |                               |
|                               | ma  |                               |
|                               | de. |                               |
|                               | If  |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | c   |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | app |                               |
|                               | ly, |                               |
|                               | you |                               |
|                               | m   |                               |
|                               | ust |                               |
|                               | cre |                               |
|                               | ate |                               |
|                               | a   |                               |
|                               | ddi |                               |
|                               | tio |                               |
|                               | nal |                               |
|                               | ICs |                               |
|                               | to  |                               |
|                               | a   |                               |
|                               | cco |                               |
|                               | unt |                               |
|                               | for |                               |
|                               | the |                               |
|                               | bur |                               |
|                               | den |                               |
|                               | a   |                               |
|                               | sso |                               |
|                               | cia |                               |
|                               | ted |                               |
|                               | w   |                               |
|                               | ith |                               |
|                               | e   |                               |
|                               | ach |                               |
|                               | cat |                               |
|                               | ego |                               |
|                               | ry. |                               |
|                               | No  |                               |
|                               | te: |                               |
|                               | Sel |                               |
|                               | ect |                               |
|                               | ing |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | s   |                               |
|                               | ubc |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | wit |                               |
|                               | hin |                               |
|                               | the |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | w   |                               |
|                               | ill |                               |
|                               | not |                               |
|                               | aff |                               |
|                               | ect |                               |
|                               | the |                               |
|                               | num |                               |
|                               | ber |                               |
|                               | of  |                               |
|                               | ICs |                               |
|                               | req |                               |
|                               | uir |                               |
|                               | ed. |                               |
+-------------------------------+-----+-------------------------------+
| **10. Frequency: How often on |     | **Calculated: Annual          |
| average will each respondent  |     | Frequency** = 1\              |
| respond\                      |     | *(responses per respondent,   |
| to the Information            |     | per year)*                    |
| Collection?**                 |     |                               |
|                               |     | **Calculated: Annual Number   |
| **\                           |     | of Responses** = 1            |
| **Number of Responses per     |     |                               |
| Respondent: 2 one-time        |     |                               |
| notifications\                |     |                               |
| Per (select the most          |     |                               |
| appropriate time period for   |     |                               |
| this collection)\             |     |                               |
| Hour (24 per day, 8736 per    |     |                               |
| year)\                        |     |                               |
| Business Hour (40 per week,   |     |                               |
| 2080 per year)                |     |                               |
|                               |     |                               |
| Day ( 7 per week, 365 per     |     |                               |
| year)                         |     |                               |
|                               |     |                               |
| Business Day ( 5 per week,    |     |                               |
| 260 per year)\                |     |                               |
| Week (52 per year)\           |     |                               |
| Month (12 per year)\          |     |                               |
| Semi-Annual (.5 per year)\    |     |                               |
| Year\                         |     |                               |
| Decade (.1 per year)          |     |                               |
+-------------------------------+-----+-------------------------------+
|                               |     |                               |
+-------------------------------+-----+-------------------------------+
| **11. Hour and Cost Burden    |     |                               |
| -** Enter the hours and cost  |     |                               |
| (per response) broken out by  |     |                               |
| reporting, record keeping,    |     |                               |
| and third-party disclosure.   |     |                               |
|                               |     |                               |
| <table>                       |     |                               |
| <colgroup>                    |     |                               |
| <col style="width: 19%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| </colgroup>                   |     |                               |
| <tbody>                       |     |                               |
| <tr class="odd">              |     |                               |
| <td></td>                     |     |                               |
| <td>Hours per Response</td>   |     |                               |
| <td>Total Annual Hour         |     |                               |
| Burden</td>                   |     |                               |
| <td><p>Cost per               |     |                               |
| Response</p>                  |     |                               |
| <p>(Capital/Startup and       |     |                               |
| O&amp;M Costs                 |     |                               |
| Only)</p></td>                |     |                               |
| <td><p>Total Annual Cost      |     |                               |
| Burden</p>                    |     |                               |
| <p>(Capital/Startup and</p>   |     |                               |
| <p>O&amp;M Costs              |     |                               |
| Only)</p></td>                |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Reporting</td>            |     |                               |
| <                             |     |                               |
| td><strong>4.50</strong></td> |     |                               |
| <                             |     |                               |
| td><strong>9.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Recordkeeping</td>        |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Third Party               |     |                               |
| Disclosure</td>               |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Total</td>                |     |                               |
| <                             |     |                               |
| td><strong>4.50</strong></td> |     |                               |
| <                             |     |                               |
| td><strong>9.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| </tbody>                      |     |                               |
| </table>                      |     |                               |
+-------------------------------+-----+-------------------------------+

+-----------------------------------------------------------------------+
| **\                                                                   |
| 12. Allocate the change in Burden:**                                  |
|                                                                       |
| +--------+--------+--------+--------+--------+--------+--------+      |
| |        | Total  | Change | Change | Due to | Change | Cur    |      |
| |        | Req    | Due to | Due to |        | due to | rently |      |
| |        | uested |        |        | Agency | Vio    | Ap     |      |
| |        |        | New    | Agency | Es     | lation | proved |      |
| |        |        | S      | Disc   | timate |        |        |      |
| |        |        | tatute | retion |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **     | **     | **     | **     | **     | **     |      |
| | Res    | 1.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | ponses |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **     | **     | **     | **     | **     | **     |      |
| | Hour   | 9.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **\$   | **     | **     | **     | **     | **\$   |      |
| | Cost   | 0.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| | (Cap   |        |        |        |        |        |        |      |
| | ital/S |        |        |        |        |        |        |      |
| | tartup |        |        |        |        |        |        |      |
| | and    |        |        |        |        |        |        |      |
| | O&M    |        |        |        |        |        |        |      |
| | costs  |        |        |        |        |        |        |      |
| | only)  |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
+-----------------------------------------------------------------------+

**PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET**

Part II: Information Collection Detail

+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 1. Title of       |                               |                 |
| Information       |                               |                 |
| Collection:**     |                               |                 |
| NESHAP for Area   |                               |                 |
| Source Standards: |                               |                 |
| Information       |                               |                 |
| Collection for    |                               |                 |
| Chemical          |                               |                 |
| Manufacturing:    |                               |                 |
| Chromium          |                               |                 |
| Compounds Area    |                               |                 |
| Sources           |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               | **\                           | **\             |
| 2. Is this a      | 3. Obligation to respond**    | 4. Frequency of |
| common form?\     | *(check one):***\             | reporting\      |
| ** Yes\           | ** Voluntary                  | ***(check all   |
| No\               |                               | that apply):*   |
| **\               | Required to obtain or retain  |                 |
| ***(Select, Yes,  | benefits                      | Hourly          |
| to identify forms |                               |                 |
| that EPA is       | Mandatory                     | Daily           |
| willing to host   |                               |                 |
| for potential use | Only one selection may be     | Weekly          |
| by other Federal  | made.\                        |                 |
| Agencies.)*       | If multiple categories apply, | Monthly         |
|                   | you must create\              |                 |
|                   | additional ICs to account for | Quarterly       |
|                   | the burden associated\        |                 |
|                   | with each category.           | Semi-annually   |
|                   |                               |                 |
|                   |                               | Annually        |
|                   |                               |                 |
|                   |                               | Every Decade    |
|                   |                               |                 |
|                   |                               | Biennially      |
|                   |                               |                 |
|                   |                               | On Occasion     |
|                   |                               |                 |
|                   |                               | Once            |
+-------------------+-------------------------------+-----------------+
| **5. CFR          |                               |                 |
| Citation(s) for   |                               |                 |
| the information   |                               |                 |
| collection under  |                               |                 |
| review** *(if     |                               |                 |
| applicable):*\    |                               |                 |
| \                 |                               |                 |
| Title:  National  |                               |                 |
| Emission          |                               |                 |
| Standards for     |                               |                 |
| Hazardous Air     |                               |                 |
| Pollutants for    |                               |                 |
| Chemical          |                               |                 |
| Manufacturing:    |                               |                 |
|                   |                               |                 |
| Chromium          |                               |                 |
| Compounds Area    |                               |                 |
| Sources Citation: |                               |                 |
|   40 CFR          |                               |                 |
| 63.11411(a),(b)   |                               |                 |
|                   |                               |                 |
| Title:            |                               |                 |
| Citation:         |                               |                 |
|  [\               |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|        Citation:  |                               |                 |
|       [\          |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|        Citation:  |                               |                 |
|                   |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 6. Information    |                               |                 |
| Collection        |                               |                 |
| In                |                               |                 |
| struments/Forms** |                               |                 |
| *(if              |                               |                 |
| applicable):\     |                               |                 |
| Form/Instrument   |                               |                 |
| must be submitted |                               |                 |
| to OEI as a       |                               |                 |
| separate          |                               |                 |
| attachment.*      |                               |                 |
|                   |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
|   Form    EPA     |                               |                 |
|   URL *(required  |                               |                 |
| Is this           |                               |                 |
|  If yes, can this |                               |                 |
|   Name            |                               |                 |
| Form \# if        |                               |                 |
|       collection  |                               |                 |
|        collection |                               |                 |
|                   |                               |                 |
|    electronic)*   |                               |                 |
|  instrument/form  |                               |                 |
|   instrument/form |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|     available     |                               |                 |
|      be submitted |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|  electronically?  |                               |                 |
|   electronically? |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 7. Federal        |                               |                 |
| Enterprise        |                               |                 |
| Architecture      |                               |                 |
| Business          |                               |                 |
| Reference Model** |                               |                 |
|                   |                               |                 |
| Line of Business  |                               |                 |
| *(check one):*    |                               |                 |
| Subfunction       |                               |                 |
| *(check one):*    |                               |                 |
|                   |                               |                 |
| <table>           |                               |                 |
| <colgroup>        |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 43%" /> |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 56%" /> |                               |                 |
| </colgroup>       |                               |                 |
| <tbody>           |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td> None</td>    |                               |                 |
| <td></td>         |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td>              |                               |                 |
| Environmental     |                               |                 |
| Management</td>   |                               |                 |
| <td><p>           |                               |                 |
| Environmental     |                               |                 |
| Monitoring and    |                               |                 |
| Forecasting</p>   |                               |                 |
| <p>               |                               |                 |
| Environmental     |                               |                 |
| Remediation</p>   |                               |                 |
| <p> Pollution     |                               |                 |
| Prevention and    |                               |                 |
| Control</p>       |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td>              |                               |                 |
| Health</td>       |                               |                 |
| <td><p> Illness   |                               |                 |
| Prevention</p>    |                               |                 |
| <p>               |                               |                 |
| Immunization      |                               |                 |
| Management</p>    |                               |                 |
| <p> Public        |                               |                 |
| Health            |                               |                 |
| Monitoring</p>    |                               |                 |
| <p> Health Care   |                               |                 |
| Services</p>      |                               |                 |
| <p> Consumer      |                               |                 |
| Health and        |                               |                 |
| Safety</p>        |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td> Natural      |                               |                 |
| Resources</td>    |                               |                 |
| <td><p> Water     |                               |                 |
| Resource          |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Conservation,     |                               |                 |
| Marine and Land   |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Recreational      |                               |                 |
| Resource          |                               |                 |
| Management and    |                               |                 |
| Tourism</p>       |                               |                 |
| <p>               |                               |                 |
| Agricultural      |                               |                 |
| Innovation and    |                               |                 |
| Services</p>      |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| </tbody>          |                               |                 |
| </table>          |                               |                 |
+-------------------+-------------------------------+-----------------+

**\
IMPORTANT: Part II must be completed for each Information Collection
(IC) activity associated with the ICR. Please be sure that you copy this
portion of the template as many times as necessary so that each IC has
its own Part II submission. For more information on how to break your
ICR into ICs, please see OMB's ROCIS IC Q&A, located at:
<http://intranet.epa.gov/icrintra/download.html>. In addition, please
reference OEI's ROCIS instructions at:
<http://intranet.epa.gov/icrintra/download.html>**

+-------------------------------+-----+-------------------------------+
| > Note: Most EPA ICRs will be |     |                               |
| > aligned with the            |     |                               |
| > Environmental Management    |     |                               |
| > FEA Line of Business. Other |     |                               |
| > likely categories are also  |     |                               |
| > listed. For a full listing  |     |                               |
| > of the FEA Business         |     |                               |
| > Reference Model categories  |     |                               |
| > and definitions, see:       |     |                               |
| > http://www.whitehouse.go    |     |                               |
| v/omb/egov/documents/FY07_Ref |     |                               |
| _Model_Mapping_QuickGuide.pdf |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           |     |                               |
| 8. Privacy Act System of      |     |                               |
| Records** *(if applicable):*  |     |                               |
|                               |     |                               |
| > Title:                      |     |                               |
| >                             |     |                               |
| > Federal Register Citation:  |     |                               |
| > Volume:       Page number:  |     |                               |
| >       Publication date:     |     |                               |
| > /   /                       |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           | **\ |                               |
| 9. Respondents**              | Af  |                               |
|                               | fec |                               |
| Total number:   2  \          | ted |                               |
| Small entity number:   0    \ | Pu  |                               |
| Percentage of responses       | bli |                               |
| collected electronically:     | c** |                               |
|                               | *(  |                               |
|                               | cho |                               |
|                               | ose |                               |
|                               | one |                               |
|                               | ):* |                               |
|                               |     |                               |
|                               | In  |                               |
|                               | div |                               |
|                               | idu |                               |
|                               | als |                               |
|                               | or  |                               |
|                               | ho  |                               |
|                               | use |                               |
|                               | hol |                               |
|                               | ds\ |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | *   |                               |
|                               | (if |                               |
|                               | p   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | s   |                               |
|                               | ect |                               |
|                               | or, |                               |
|                               | ch  |                               |
|                               | eck |                               |
|                               | all |                               |
|                               | t   |                               |
|                               | hat |                               |
|                               | a   |                               |
|                               | ppl |                               |
|                               | y)\ |                               |
|                               | *   |                               |
|                               | Bu  |                               |
|                               | sin |                               |
|                               | ess |                               |
|                               | or  |                               |
|                               | ot  |                               |
|                               | her |                               |
|                               | fo  |                               |
|                               | r-p |                               |
|                               | rof |                               |
|                               | it\ |                               |
|                               | No  |                               |
|                               | t-f |                               |
|                               | or- |                               |
|                               | pro |                               |
|                               | fit |                               |
|                               | i   |                               |
|                               | nst |                               |
|                               | itu |                               |
|                               | tio |                               |
|                               | ns\ |                               |
|                               | Far |                               |
|                               | ms\ |                               |
|                               | Sta |                               |
|                               | te, |                               |
|                               | Loc |                               |
|                               | al, |                               |
|                               | or  |                               |
|                               | Tri |                               |
|                               | bal |                               |
|                               | Gov |                               |
|                               | ern |                               |
|                               | men |                               |
|                               | ts\ |                               |
|                               | F   |                               |
|                               | ede |                               |
|                               | ral |                               |
|                               | G   |                               |
|                               | ove |                               |
|                               | rnm |                               |
|                               | ent |                               |
|                               |     |                               |
|                               | O   |                               |
|                               | nly |                               |
|                               | one |                               |
|                               | sel |                               |
|                               | ect |                               |
|                               | ion |                               |
|                               | may |                               |
|                               | be  |                               |
|                               | ma  |                               |
|                               | de. |                               |
|                               | If  |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | c   |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | app |                               |
|                               | ly, |                               |
|                               | you |                               |
|                               | m   |                               |
|                               | ust |                               |
|                               | cre |                               |
|                               | ate |                               |
|                               | a   |                               |
|                               | ddi |                               |
|                               | tio |                               |
|                               | nal |                               |
|                               | ICs |                               |
|                               | to  |                               |
|                               | a   |                               |
|                               | cco |                               |
|                               | unt |                               |
|                               | for |                               |
|                               | the |                               |
|                               | bur |                               |
|                               | den |                               |
|                               | a   |                               |
|                               | sso |                               |
|                               | cia |                               |
|                               | ted |                               |
|                               | w   |                               |
|                               | ith |                               |
|                               | e   |                               |
|                               | ach |                               |
|                               | cat |                               |
|                               | ego |                               |
|                               | ry. |                               |
|                               | No  |                               |
|                               | te: |                               |
|                               | Sel |                               |
|                               | ect |                               |
|                               | ing |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | s   |                               |
|                               | ubc |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | wit |                               |
|                               | hin |                               |
|                               | the |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | w   |                               |
|                               | ill |                               |
|                               | not |                               |
|                               | aff |                               |
|                               | ect |                               |
|                               | the |                               |
|                               | num |                               |
|                               | ber |                               |
|                               | of  |                               |
|                               | ICs |                               |
|                               | req |                               |
|                               | uir |                               |
|                               | ed. |                               |
+-------------------------------+-----+-------------------------------+
| **10. Frequency: How often on |     | **Calculated: Annual          |
| average will each respondent  |     | Frequency** = 1\              |
| respond\                      |     | *(responses per respondent,   |
| to the Information            |     | per year)*                    |
| Collection?**                 |     |                               |
|                               |     | **Calculated: Annual Number   |
| **\                           |     | of Responses** = 2            |
| **Number of Responses per     |     |                               |
| Respondent:  two one-time     |     |                               |
| notifications, written plan   |     |                               |
|      \                        |     |                               |
| Per (select the most          |     |                               |
| appropriate time period for   |     |                               |
| this collection)\             |     |                               |
| Hour (24 per day, 8736 per    |     |                               |
| year)\                        |     |                               |
| Business Hour (40 per week,   |     |                               |
| 2080 per year)                |     |                               |
|                               |     |                               |
| Day ( 7 per week, 365 per     |     |                               |
| year)                         |     |                               |
|                               |     |                               |
| Business Day ( 5 per week,    |     |                               |
| 260 per year)\                |     |                               |
| Week (52 per year)\           |     |                               |
| Month (12 per year)\          |     |                               |
| Semi-Annual (.5 per year)\    |     |                               |
| Year\                         |     |                               |
| Decade (.1 per year)          |     |                               |
+-------------------------------+-----+-------------------------------+
|                               |     |                               |
+-------------------------------+-----+-------------------------------+
| **11. Hour and Cost Burden    |     |                               |
| -** Enter the hours and cost  |     |                               |
| (per response) broken out by  |     |                               |
| reporting, record keeping,    |     |                               |
| and third-party disclosure.   |     |                               |
|                               |     |                               |
| <table>                       |     |                               |
| <colgroup>                    |     |                               |
| <col style="width: 19%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| </colgroup>                   |     |                               |
| <tbody>                       |     |                               |
| <tr class="odd">              |     |                               |
| <td></td>                     |     |                               |
| <td>Hours per Response</td>   |     |                               |
| <td>Total Annual Hour         |     |                               |
| Burden</td>                   |     |                               |
| <td><p>Cost per               |     |                               |
| Response</p>                  |     |                               |
| <p>(Capital/Startup and       |     |                               |
| O&amp;M Costs                 |     |                               |
| Only)</p></td>                |     |                               |
| <td><p>Total Annual Cost      |     |                               |
| Burden</p>                    |     |                               |
| <p>(Capital/Startup and</p>   |     |                               |
| <p>O&amp;M Costs              |     |                               |
| Only)</p></td>                |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Reporting</td>            |     |                               |
| <t                            |     |                               |
| d><strong>97.00</strong></td> |     |                               |
| <td                           |     |                               |
| ><strong>194.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Recordkeeping</td>        |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Third Party               |     |                               |
| Disclosure</td>               |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Total</td>                |     |                               |
| <t                            |     |                               |
| d><strong>97.00</strong></td> |     |                               |
| <td                           |     |                               |
| ><strong>194.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| </tbody>                      |     |                               |
| </table>                      |     |                               |
+-------------------------------+-----+-------------------------------+

+-----------------------------------------------------------------------+
| **\                                                                   |
| 12. Allocate the change in Burden:**                                  |
|                                                                       |
| +--------+--------+--------+--------+--------+--------+--------+      |
| |        | Total  | Change | Change | Due to | Change | Cur    |      |
| |        | Req    | Due to | Due to |        | due to | rently |      |
| |        | uested |        |        | Agency | Vio    | Ap     |      |
| |        |        | New    | Agency | Es     | lation | proved |      |
| |        |        | S      | Disc   | timate |        |        |      |
| |        |        | tatute | retion |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **     | **     | **     | **     | **     | **     |      |
| | Res    | 2.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | ponses |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **19   | **     | **     | **     | **     | **     |      |
| | Hour   | 4.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **\$   | **     | **     | **     | **     | **\$   |      |
| | Cost   | 0.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| | (Cap   |        |        |        |        |        |        |      |
| | ital/S |        |        |        |        |        |        |      |
| | tartup |        |        |        |        |        |        |      |
| | and    |        |        |        |        |        |        |      |
| | O&M    |        |        |        |        |        |        |      |
| | costs  |        |        |        |        |        |        |      |
| | only)  |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
+-----------------------------------------------------------------------+

**PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET**

Part II: Information Collection Detail

+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 1. Title of       |                               |                 |
| Information       |                               |                 |
| Collection:**     |                               |                 |
| NESHAP for Area   |                               |                 |
| Source Standards: |                               |                 |
| Information       |                               |                 |
| Collection for    |                               |                 |
| Flexible          |                               |                 |
| Polyurethane Foam |                               |                 |
| Production and    |                               |                 |
| Fabrication       |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               | **\                           | **\             |
| 2. Is this a      | 3. Obligation to respond**    | 4. Frequency of |
| common form?\     | *(check one):***\             | reporting\      |
| ** Yes\           | ** Voluntary                  | ***(check all   |
| No\               |                               | that apply):*   |
| **\               | Required to obtain or retain  |                 |
| ***(Select, Yes,  | benefits                      | Hourly          |
| to identify forms |                               |                 |
| that EPA is       | Mandatory                     | Daily           |
| willing to host   |                               |                 |
| for potential use | Only one selection may be     | Weekly          |
| by other Federal  | made.\                        |                 |
| Agencies.)*       | If multiple categories apply, | Monthly         |
|                   | you must create\              |                 |
|                   | additional ICs to account for | Quarterly       |
|                   | the burden associated\        |                 |
|                   | with each category.           | Semi-annually   |
|                   |                               |                 |
|                   |                               | Annually        |
|                   |                               |                 |
|                   |                               | Every Decade    |
|                   |                               |                 |
|                   |                               | Biennially      |
|                   |                               |                 |
|                   |                               | On Occasion     |
|                   |                               |                 |
|                   |                               | Once            |
+-------------------+-------------------------------+-----------------+
| **5. CFR          |                               |                 |
| Citation(s) for   |                               |                 |
| the information   |                               |                 |
| collection under  |                               |                 |
| review** *(if     |                               |                 |
| applicable):*\    |                               |                 |
| \                 |                               |                 |
| Title:  National  |                               |                 |
| Emission          |                               |                 |
| Standards for     |                               |                 |
| Hazardous Air     |                               |                 |
| Pollutants for    |                               |                 |
| Flexible          |                               |                 |
| Polyurethane Foam |                               |                 |
| Fabrication       |                               |                 |
|                   |                               |                 |
| and Production    |                               |                 |
| Area Sources      |                               |                 |
| Citation:   40    |                               |                 |
| CFR 63.11418      |                               |                 |
|                   |                               |                 |
| Title:            |                               |                 |
| Citation:         |                               |                 |
|  [\               |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|        Citation:  |                               |                 |
|       [\          |                               |                 |
| ]{                |                               |                 |
| .underline}Title: |                               |                 |
|        Citation:  |                               |                 |
|                   |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 6. Information    |                               |                 |
| Collection        |                               |                 |
| In                |                               |                 |
| struments/Forms** |                               |                 |
| *(if              |                               |                 |
| applicable):\     |                               |                 |
| Form/Instrument   |                               |                 |
| must be submitted |                               |                 |
| to OEI as a       |                               |                 |
| separate          |                               |                 |
| attachment.*      |                               |                 |
|                   |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
|   Form    EPA     |                               |                 |
|   URL *(required  |                               |                 |
| Is this           |                               |                 |
|  If yes, can this |                               |                 |
|   Name            |                               |                 |
| Form \# if        |                               |                 |
|       collection  |                               |                 |
|        collection |                               |                 |
|                   |                               |                 |
|    electronic)*   |                               |                 |
|  instrument/form  |                               |                 |
|   instrument/form |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|     available     |                               |                 |
|      be submitted |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|  electronically?  |                               |                 |
|   electronically? |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|                   |                               |                 |
|           Yes No  |                               |                 |
|            Yes No |                               |                 |
|   ------- ------- |                               |                 |
|  -------------- - |                               |                 |
| ----------------  |                               |                 |
| ----------------- |                               |                 |
+-------------------+-------------------------------+-----------------+
| **\               |                               |                 |
| 7. Federal        |                               |                 |
| Enterprise        |                               |                 |
| Architecture      |                               |                 |
| Business          |                               |                 |
| Reference Model** |                               |                 |
|                   |                               |                 |
| Line of Business  |                               |                 |
| *(check one):*    |                               |                 |
| Subfunction       |                               |                 |
| *(check one):*    |                               |                 |
|                   |                               |                 |
| <table>           |                               |                 |
| <colgroup>        |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 43%" /> |                               |                 |
| <col              |                               |                 |
| styl              |                               |                 |
| e="width: 56%" /> |                               |                 |
| </colgroup>       |                               |                 |
| <tbody>           |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td> None</td>    |                               |                 |
| <td></td>         |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td>              |                               |                 |
| Environmental     |                               |                 |
| Management</td>   |                               |                 |
| <td><p>           |                               |                 |
| Environmental     |                               |                 |
| Monitoring and    |                               |                 |
| Forecasting</p>   |                               |                 |
| <p>               |                               |                 |
| Environmental     |                               |                 |
| Remediation</p>   |                               |                 |
| <p> Pollution     |                               |                 |
| Prevention and    |                               |                 |
| Control</p>       |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="odd">      |                               |                 |
| <td>              |                               |                 |
| Health</td>       |                               |                 |
| <td><p> Illness   |                               |                 |
| Prevention</p>    |                               |                 |
| <p>               |                               |                 |
| Immunization      |                               |                 |
| Management</p>    |                               |                 |
| <p> Public        |                               |                 |
| Health            |                               |                 |
| Monitoring</p>    |                               |                 |
| <p> Health Care   |                               |                 |
| Services</p>      |                               |                 |
| <p> Consumer      |                               |                 |
| Health and        |                               |                 |
| Safety</p>        |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| <tr               |                               |                 |
| class="even">     |                               |                 |
| <td> Natural      |                               |                 |
| Resources</td>    |                               |                 |
| <td><p> Water     |                               |                 |
| Resource          |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Conservation,     |                               |                 |
| Marine and Land   |                               |                 |
| Management</p>    |                               |                 |
| <p>               |                               |                 |
| Recreational      |                               |                 |
| Resource          |                               |                 |
| Management and    |                               |                 |
| Tourism</p>       |                               |                 |
| <p>               |                               |                 |
| Agricultural      |                               |                 |
| Innovation and    |                               |                 |
| Services</p>      |                               |                 |
| <p>               |                               |                 |
| None</p></td>     |                               |                 |
| </tr>             |                               |                 |
| </tbody>          |                               |                 |
| </table>          |                               |                 |
+-------------------+-------------------------------+-----------------+

**\
IMPORTANT: Part II must be completed for each Information Collection
(IC) activity associated with the ICR. Please be sure that you copy this
portion of the template as many times as necessary so that each IC has
its own Part II submission. For more information on how to break your
ICR into ICs, please see OMB's ROCIS IC Q&A, located at:
<http://intranet.epa.gov/icrintra/download.html>. In addition, please
reference OEI's ROCIS instructions at:
<http://intranet.epa.gov/icrintra/download.html>**

+-------------------------------+-----+-------------------------------+
| > Note: Most EPA ICRs will be |     |                               |
| > aligned with the            |     |                               |
| > Environmental Management    |     |                               |
| > FEA Line of Business. Other |     |                               |
| > likely categories are also  |     |                               |
| > listed. For a full listing  |     |                               |
| > of the FEA Business         |     |                               |
| > Reference Model categories  |     |                               |
| > and definitions, see:       |     |                               |
| > http://www.whitehouse.go    |     |                               |
| v/omb/egov/documents/FY07_Ref |     |                               |
| _Model_Mapping_QuickGuide.pdf |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           |     |                               |
| 8. Privacy Act System of      |     |                               |
| Records** *(if applicable):*  |     |                               |
|                               |     |                               |
| > Title:                      |     |                               |
| >                             |     |                               |
| > Federal Register Citation:  |     |                               |
| > Volume:       Page number:  |     |                               |
| >       Publication date:     |     |                               |
| > /   /                       |     |                               |
+-------------------------------+-----+-------------------------------+
| **\                           | **\ |                               |
| 9. Respondents**              | Af  |                               |
|                               | fec |                               |
| Total number:   49    \       | ted |                               |
| Small entity number:       \  | Pu  |                               |
| Percentage of responses       | bli |                               |
| collected electronically:     | c** |                               |
|                               | *(  |                               |
|                               | cho |                               |
|                               | ose |                               |
|                               | one |                               |
|                               | ):* |                               |
|                               |     |                               |
|                               | In  |                               |
|                               | div |                               |
|                               | idu |                               |
|                               | als |                               |
|                               | or  |                               |
|                               | ho  |                               |
|                               | use |                               |
|                               | hol |                               |
|                               | ds\ |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | *   |                               |
|                               | (if |                               |
|                               | p   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | s   |                               |
|                               | ect |                               |
|                               | or, |                               |
|                               | ch  |                               |
|                               | eck |                               |
|                               | all |                               |
|                               | t   |                               |
|                               | hat |                               |
|                               | a   |                               |
|                               | ppl |                               |
|                               | y)\ |                               |
|                               | *   |                               |
|                               | Bu  |                               |
|                               | sin |                               |
|                               | ess |                               |
|                               | or  |                               |
|                               | ot  |                               |
|                               | her |                               |
|                               | fo  |                               |
|                               | r-p |                               |
|                               | rof |                               |
|                               | it\ |                               |
|                               | No  |                               |
|                               | t-f |                               |
|                               | or- |                               |
|                               | pro |                               |
|                               | fit |                               |
|                               | i   |                               |
|                               | nst |                               |
|                               | itu |                               |
|                               | tio |                               |
|                               | ns\ |                               |
|                               | Far |                               |
|                               | ms\ |                               |
|                               | Sta |                               |
|                               | te, |                               |
|                               | Loc |                               |
|                               | al, |                               |
|                               | or  |                               |
|                               | Tri |                               |
|                               | bal |                               |
|                               | Gov |                               |
|                               | ern |                               |
|                               | men |                               |
|                               | ts\ |                               |
|                               | F   |                               |
|                               | ede |                               |
|                               | ral |                               |
|                               | G   |                               |
|                               | ove |                               |
|                               | rnm |                               |
|                               | ent |                               |
|                               |     |                               |
|                               | O   |                               |
|                               | nly |                               |
|                               | one |                               |
|                               | sel |                               |
|                               | ect |                               |
|                               | ion |                               |
|                               | may |                               |
|                               | be  |                               |
|                               | ma  |                               |
|                               | de. |                               |
|                               | If  |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | c   |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | app |                               |
|                               | ly, |                               |
|                               | you |                               |
|                               | m   |                               |
|                               | ust |                               |
|                               | cre |                               |
|                               | ate |                               |
|                               | a   |                               |
|                               | ddi |                               |
|                               | tio |                               |
|                               | nal |                               |
|                               | ICs |                               |
|                               | to  |                               |
|                               | a   |                               |
|                               | cco |                               |
|                               | unt |                               |
|                               | for |                               |
|                               | the |                               |
|                               | bur |                               |
|                               | den |                               |
|                               | a   |                               |
|                               | sso |                               |
|                               | cia |                               |
|                               | ted |                               |
|                               | w   |                               |
|                               | ith |                               |
|                               | e   |                               |
|                               | ach |                               |
|                               | cat |                               |
|                               | ego |                               |
|                               | ry. |                               |
|                               | No  |                               |
|                               | te: |                               |
|                               | Sel |                               |
|                               | ect |                               |
|                               | ing |                               |
|                               | mu  |                               |
|                               | lti |                               |
|                               | ple |                               |
|                               | s   |                               |
|                               | ubc |                               |
|                               | ate |                               |
|                               | gor |                               |
|                               | ies |                               |
|                               | wit |                               |
|                               | hin |                               |
|                               | the |                               |
|                               | P   |                               |
|                               | riv |                               |
|                               | ate |                               |
|                               | Sec |                               |
|                               | tor |                               |
|                               | w   |                               |
|                               | ill |                               |
|                               | not |                               |
|                               | aff |                               |
|                               | ect |                               |
|                               | the |                               |
|                               | num |                               |
|                               | ber |                               |
|                               | of  |                               |
|                               | ICs |                               |
|                               | req |                               |
|                               | uir |                               |
|                               | ed. |                               |
+-------------------------------+-----+-------------------------------+
| **10. Frequency: How often on |     | **Calculated: Annual          |
| average will each respondent  |     | Frequency** = 0.37\           |
| respond\                      |     | *(responses per respondent,   |
| to the Information            |     | per year)*                    |
| Collection?**                 |     |                               |
|                               |     | **Calculated: Annual Number   |
| **\                           |     | of Responses** = 18           |
| **Number of Responses per     |     |                               |
| Respondent:  two one-time     |     |                               |
| notifications   \             |     |                               |
| Per (select the most          |     |                               |
| appropriate time period for   |     |                               |
| this collection)\             |     |                               |
| Hour (24 per day, 8736 per    |     |                               |
| year)\                        |     |                               |
| Business Hour (40 per week,   |     |                               |
| 2080 per year)                |     |                               |
|                               |     |                               |
| Day ( 7 per week, 365 per     |     |                               |
| year)                         |     |                               |
|                               |     |                               |
| Business Day ( 5 per week,    |     |                               |
| 260 per year)\                |     |                               |
| Week (52 per year)\           |     |                               |
| Month (12 per year)\          |     |                               |
| Semi-Annual (.5 per year)\    |     |                               |
| Year\                         |     |                               |
| Decade (.1 per year)          |     |                               |
+-------------------------------+-----+-------------------------------+
|                               |     |                               |
+-------------------------------+-----+-------------------------------+
| **11. Hour and Cost Burden    |     |                               |
| -** Enter the hours and cost  |     |                               |
| (per response) broken out by  |     |                               |
| reporting, record keeping,    |     |                               |
| and third-party disclosure.   |     |                               |
|                               |     |                               |
| <table>                       |     |                               |
| <colgroup>                    |     |                               |
| <col style="width: 19%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| <col style="width: 20%" />    |     |                               |
| </colgroup>                   |     |                               |
| <tbody>                       |     |                               |
| <tr class="odd">              |     |                               |
| <td></td>                     |     |                               |
| <td>Hours per Response</td>   |     |                               |
| <td>Total Annual Hour         |     |                               |
| Burden</td>                   |     |                               |
| <td><p>Cost per               |     |                               |
| Response</p>                  |     |                               |
| <p>(Capital/Startup and       |     |                               |
| O&amp;M Costs                 |     |                               |
| Only)</p></td>                |     |                               |
| <td><p>Total Annual Cost      |     |                               |
| Burden</p>                    |     |                               |
| <p>(Capital/Startup and</p>   |     |                               |
| <p>O&amp;M Costs              |     |                               |
| Only)</p></td>                |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Reporting</td>            |     |                               |
| <t                            |     |                               |
| d><strong>46.40</strong></td> |     |                               |
| <td                           |     |                               |
| ><strong>835.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Recordkeeping</td>        |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="even">             |     |                               |
| <td>Third Party               |     |                               |
| Disclosure</td>               |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>     </strong></td> |     |                               |
| </tr>                         |     |                               |
| <tr class="odd">              |     |                               |
| <td>Total</td>                |     |                               |
| <t                            |     |                               |
| d><strong>46.40</strong></td> |     |                               |
| <td                           |     |                               |
| ><strong>835.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| <t                            |     |                               |
| d><strong>$0.00</strong></td> |     |                               |
| </tr>                         |     |                               |
| </tbody>                      |     |                               |
| </table>                      |     |                               |
+-------------------------------+-----+-------------------------------+

+-----------------------------------------------------------------------+
| **\                                                                   |
| 12. Allocate the change in Burden:**                                  |
|                                                                       |
| +--------+--------+--------+--------+--------+--------+--------+      |
| |        | Total  | Change | Change | Due to | Change | Cur    |      |
| |        | Req    | Due to | Due to |        | due to | rently |      |
| |        | uested |        |        | Agency | Vio    | Ap     |      |
| |        |        | New    | Agency | Es     | lation | proved |      |
| |        |        | S      | Disc   | timate |        |        |      |
| |        |        | tatute | retion |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **1    | **     | **     | **     | **     | **     |      |
| | Res    | 8.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | ponses |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **83   | **     | **     | **     | **     | **     |      |
| | Hour   | 5.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
| | Annual | **\$   | **     | **     | **     | **     | **\$   |      |
| | Cost   | 0.00** |     ** |     ** |     ** |     ** | 0.00** |      |
| | Burden |        |        |        |        |        |        |      |
| | (Cap   |        |        |        |        |        |        |      |
| | ital/S |        |        |        |        |        |        |      |
| | tartup |        |        |        |        |        |        |      |
| | and    |        |        |        |        |        |        |      |
| | O&M    |        |        |        |        |        |        |      |
| | costs  |        |        |        |        |        |        |      |
| | only)  |        |        |        |        |        |        |      |
| +--------+--------+--------+--------+--------+--------+--------+      |
+-----------------------------------------------------------------------+