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PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET 

Part II: Information Collection Detail 

IMPORTANT: 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 separate Part II document for each IC. For more information see OEI’s ICR website at 

http://intranet.epa.gov/icrintra/. There you will find information on completing this form (see OEI’s ICRAS instructions under the Prepare an 

ICR tab) and information on how break your 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: Group I Polymers and Resins 

4. Frequency of reporting (only to be completed if 

there are reporting requirements, check all that 

apply): 

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 selection may be made. If multiple 

categories apply, you must create additional ICs to 

account for the burden associated with each 

category.

 Hourly 

 Daily 

 Weekly 

 Monthly 

 Yearly 

 Every Decade 

 Quarterly 

 Semi-Annually 

 Biennially 

 Once 

 Occasionally

5. CFR Citation(s) for the information collection under review (if applicable):

Title National Emission Standards for Hazardous Air Pollutants Emissions: Group I Polymers and Resins Part 40 CFR 63 Section 480 

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. 
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7. Federal Enterprise Architecture Business Reference Model: 

Line of Business (check one) : Subfunction (check one) : 

 Environmental Management Environmental Monitoring and Forecasting 

 Environmental Remediation 

 Pollution Prevention and Control 

 Health Illness Prevention 

 Immunization Management 

 Public Health Monitoring 

 Health Care Services 

 Consumer Health and Safety 

 Natural Resources Water 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 Act System of Records (if applicable) : 

Title: 

Federal Register Citation: Volume Page Number Publication Date 

9. Respondents 

Total Number: 19

Small Entity Number: 0

Percentage of responses collected electronically: 0

Affected Public (check one) : 

 Individuals or Households 

 Private Sector (if private sector, check all that apply)

 Business or other for-profit 

 Not-for-profit institutions 

 Farms 

 State, Local, or Tribal Governments 

 Federal Government 

Note: Only one selection may be made. If multiple categories apply, you 

must 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 respondent respond 

to the Information Collection? 

Number of Respondents 19 per 

 

 

 Year 

 Hour Business hour

 Day Business Day

 Week Month

 Decade Quarter 

 Half-year 

Calculated Annual Frequency: 5 

 (responses per respondent per year) 

Calculated Annual Number of Responses: 101

11. Hour and Cost 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 30 3,052 $84 $8,447 

Recordkeeping 207 20,910 $0.00 $0.00 

Third Party Disclosure 

Total 237 23,963 $85 $8,447 

IMPORTANT: “Cost per Response” and “Total Annual Cost Burden” should include Capital/Startup and O&M costs only. 
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12. Annual Responses and Burden Change 

Total Requested 

Program Change 

due to New 

Statute 

Program Change 

due to Agency 

Discretion 

Change due to 

Adjustment in 

Agency Estimate 

Change due to 

Violation of the 

PRA 

Currently 

Approved 

Annual 

Responses 101 

Annual Hour 

Burden 23,963 

Annual Cost 

Burden 8,446