Revised 9/1/2006 

### 1 **PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET**

**Part II: Information Collection Detail**
**IMPORTA NT:**  **A separate**  **Part II must be completed for each Information Collection (IC) activity associated with the ICR.**  **If more than one Part II is required,**  **create a sep**  **arate Part II document for**  **each IC. For more information see OEI’s ICR website at http://intranet.epa.gov/icrintra/**  **. There y ou will find information on completing this form (see OEI’s ICRA**  **S instructions under the Prepare an**  **ICR tab) and information on how break y**  **our ICR into ICs (**  **see OMB’s ROCIS IC Q&A under the Download Guidance tab).** 
**1. Title of Information Collection:**  National Emission Standards for Hazardous Air Pollutants Emissions: Polye ther Polyols Production
**2. Is this a common form?** Yes No ( Select Yes to identify forms that EPA is willing to host for potential use by other Federal Agencies. ) **3. Obligation to respond** (check one): Voluntary Required to obtain or retain benefits Mandatory Note: Only one select

ion may be made. If multiple cat egories apply, you must create additional ICs to account for the burden associated w ith each category. **4. Frequency of reporting**  (only to be completed if there are reporting requirements, check all that apply): Hourly Daily We ekly Monthly Ye arly Every Decade Quarterly Semi

- Annually Biennially Once Occasionally **5. CFR Citation(s) for the information collection under review** (if applicable):
Title 40 Part 63 Section 1420

- 1439 Title Part Section Title Part Section Title Part Section
**6. Information Collection Instruments/Forms** (if applicable) **:**

Form Name: Form Number: URL (required if electronic) : Is this form available electronically? Yes No If yes, can this form be submitted electronically? Yes No

Form Name: Form Number: URL (required if electronic) : Is this form available electronically? Yes No If yes, can this form be submitted electronically? Yes No

Form Name: Form Number: URL (required if electronic) : Is this form available electronically? Yes No If yes, can this form be submitted electronically? Yes No Attach additional sheets if necessary. Note: Instruments/Forms must be submitted/uploaded as a separate attachment.Revised 9/1/2006 

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**7. Federal Enterprise Ar**  **chitecture Business Reference Model:** 
Line of Business (check one) : Subfunction (check one) : Environmental Management Environmental Monitoring and Forecasting Environmental Remediation Pollution Pre vention and Control Health Illness Prevention Immunization Management Public Health Monitoring Health Care Services Consumer Health and Safet y Natural Resources Wa ter Resource Management Conservation, Marine and Land Management Recreational Resource Management and Tourism Agricultural Innovation and Services 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.gov/omb/egov/documents/FY07_Ref_Model_Mapping_QuickGuide.pdf

. **8. Privacy**

**A ct Sy**  **stem of Records** (if applicable) : Title: Federal Register Citation: Volume Page Number Publication Date **9. Respondents**
Total Number: 23 Small Entity Number: 0 Percentage of responses col lected electronically: 2 0 Affected Public (check one) : Individuals or Households Private Sector (if private sector, check all that apply)

Business or other for

- profi t Not

- for

- profit institutions Farms State, Local, or Tribal Governments Federal Government Note: Only o ne selection may be made. If multiple cate gories apply, you mu st create additional ICs to account for the burden associated with each category. Selecting multiple subcategories within “Private Sector” will not affect then number of ICs required. **10. Frequency : How often on average will each resp**  **ondent respond to the Information Collection?** 

**Calculated A nnual Frequency**  **: 2.1**  (responses per respondent per year)
**Calculated A nnual Number of Responses:**  **48.7** Number of Respondents 23 per Year Hour Business hour Day Business Day We ek Month Decade Quarter Half

- year
**11. Hour and Co st Burden:**  Enter the hours and cost (per response) broken out by reporting, record keeping, and third party disclosure: Hours per Response Total Annual Hour Burden Cost per Response Total Annual Cost Burden Reporting 28 1,373 $12,711 $ 618,631 Recordkeeping 0 2,328 0 0 Third Party Disclosure 0 0 0 0 **Total** 28 3, 701 $12,711 $618,631

**IMPORTA NT**  **: “Cost per Response” and “Total A nnual Cost Burden” should include Capital/Startup and O&M costs only** 

**.**Revised 9/1/2006 

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**12. A nnual Responses and Burden Change** 

Total Requested Program Change due to New Stat ute Program Change

due to Agency Discretion Change due to

Adjustment in Agency Estimate Change due to

Violation of the PRA Currently

Approved Annual Responses **4 8**  **.7** Annual Hour Burden **3,701** Annual Cost Burden **$618,631**