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PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

PART I: Information Collection Request

This worksheet replaces the previous OMB 83-I form for Information Collection Requests (ICRs). This worksheet is intended to help ICR 

preparers transition between the paper 83-I system and use of the Information Collection Request, Review and Approval System (ICRAS) 

for submitting ICRs to OMB. This form is not intended for submission to OMB. For additional guidance on completing this worksheet, 

please see EPA’s ICR website at http://intranet.epa.gov/icrintra/. There you will find the following documents: OEI’s ICRAS Instructions 

(under Prepare ICR Package tab) and OMB’s ROCIS IC Q&A (located under the Download Guidance tab), as well as the contact information 

for your appropriate ICR desk officer.

1. Agency/Subagency originating request: US EPA 

2. Title: National Emission Standards for Hazardous Air Pollutant Emissions: Group IV Polymers and Resins 

3. Type of Information Collection (check one):

 New collection

 Extension of a currently approved collection

 Revision of a currently approved collection

 Nonmaterial or non-substantive change to a currently approved collection 

 (formerly called the 83-C)

4. OMB Control Number (OCN): 2060-0351 

 EPA ICR Number: 1737.01

5. Type of review requested (check one):

 Regular

 Emergency – Approval Requested by: (mm/dd/yy)

 Delegated

(If emergency, please submit justification as a separate attachment)

6. Requested expiration date (check one):

 Three years from approval date

 Six Months from approval date (maximum for emergency)

 Other, please specify: (mm/yy)

7. Abstract (4000 characters maximum, attach additional sheets as necessary): EPA is promulgating revisions for the National Emission 

Standards for Hazardous Air Pollutants (NESHAP) for Group IV Polymers and Resins. Potential respondents subject to the proposed 

requirements of the NESHAP include an estimated 30 existing facilities that produce polyether polyols. The total annual responses 

attributable to this ICR consist of additional information pertaining to emissions discharges from pressure release devices, which is 

prohibited in the proposed amendments, and reports submitted to satisfy affirmative defense provisions. There are also proposed 

amendments to the requirments for equipment leaks and process contact cooling towers for the one facility in the continuous TPA high 

viscosity multiple end finisher subcategory. No burden estimates are provided for new sources because no new facilities are expected to 

be affected sources during the next 3 years.
Revised 1/30/2007 2

8. Citations for Authorizing Statute(s):

a. Public Law

 Name of law: 

 Citation: - Sec 

b. US Code 

 Name of Law: Clean Air Act 

 Citation: 42 USC: 7401

c. Executive Order

 Name/Subject of EO: 

 Citation: EO 

 

d. Statute at Large

 Name of Statute: 

 Citation: Stat 

9. Associated Rulemaking Information (For Rule Related ICRs Only):

 RIN: 2060 – AR02 SAN: 5566 Stage of Rulemaking (check one): 

 Proposed Rule 

 Interim Final or Final Rule 

 

For a Proposed Rule, OMB will not consider an ICR complete until the Notice of Proposed Rulemaking has been published. OEI will enter this 

information into ICRAS.

For ICRs associated with Interim Finals that are not significant under EO 12866, please attach a draft of the rule.

10. Federal Register Notices & Comments:

Federal Register Citation (For Non-Rule Related and Renewal ICRs Only):

60-day Notice: Volume: Page number: Publication Date: 

(30-day Notice: Volume: Page number: Publication Date )

Did the Agency receive public comments on this ICR? Yes No

Unless submitted as an Emergency ICR or Associated with a Rulemaking, OMB will not consider an ICR complete until the 30-day notice

has been published. The second notice will be published following OEI review and approval of the ICR. OEI will enter this information into ICRAS.

11. Annual Cost to Federal Government: 0.00

12. Does this ICR contain surveys, censuses, or employ statistical methods? Yes No

(If Yes, please attach Supporting Statement, Part B)

13. Is a Privacy Impact Assessment required by the E-Government Act of 2002 for this ICR? Yes No

(A PIA is needed for a new, electronic collection of information.)

14. Agency Contact:

 

 Name: Nick Parsons

 

 Phone: 919-541-5372

 

 E-mail: parsons.nick@epa.gov
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15. Change in Burden:

 

A. Program Change Due to a New Statute

If change in burden is a Program Change Due to a New Statute, identify the Citations for the New Statutory Requirements:

a. Public Law

 Name of law: 

 Citation: - Sec 

b. US Code 

 Name of Law: 

 Citation: USC: 

c. Executive Order

 Name/Subject of EO: 

 Citation: EO 

 

d. Statute at Large

 Name of Statute: 

 Citation: Stat 

B. Program Change Due to Agency Discretion

If change in burden is a DECREASE because of a Program Change due to Agency Discretion, please categorize the decrease (select one):

 Cutting Redundancy

 Using Information Technology

 Changing Regulations

 Changing Forms

 Miscellaneous Actions

If change in burden is a INCREASE because of a Program Change due to Agency Discretion, please categorize the increase (select one):

 Changing Regulations 

 Miscellaneous Actions 

C. Explanation of Change in Burden

Explain the reasons for any program changes or adjustments reported; that is, provide a short statement addressing how the reduction in burden 

was achieved or why the increase in burden occurred. (If you need more space, provide a short summary here and elaborate in the Supporting 

Statement.)

This is a new data collection due to amendments to the rule. The estimated burden has increased because additional recordkeeping and reporting 

requirements are included in the rule amendments. 
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PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part III: Information Collection Request Completeness Check 

Complete this checklist prior to submitting the information collection package to the Clearance Officer. The Clearance Officer 

will use the information contained in this checklist, along with other information, to certify the information collection prior to 

submission to OMB. 

The supporting statement (check all that apply):

a. Identifies the statute or regulation authorizing the collection of the information

b. Describes efforts taken to avoid the collection of similar information already available, or collected 

under a different information collection

c. Describes, if applicable, methods to minimize the burden on small businesses or other small entities

d. Is written using plain English, and all terminology used is unambiguous and understandable to those 

required to respond to the collection

e. Indicates how long records specified in the collection are to be maintained by persons required to 

maintain the records

f. Has dedicated resources to ensure the proper use and processing of the information being collected to 

enhance (as appropriate) the value of the information to agencies and the public.

g. Indicates the use of a statistical survey method (if applicable) that produces valid and reliable results 

while minimizing undue burden.

h. Describes the intended use of information technology to reduce burden and where possible avoid 

unnecessary system and technology costs.
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PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part IV: Certification

Certification for Paperwork Reduction Act Submissions

On behalf of this Federal agency, 1 certify that the collection of information encompassed by this request complies with'

5 CFR 1320.9.

NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the instructions. The 

certification is to be made with reference to those regulatory provisions as set forth in the instructions.

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous terminology that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):

(I) Why the information is being collected’

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management 

 and use of the information to be collected (see note in Item 19 of the instructions);

(I) It uses effective and efficient statistical survey methodology; and

(j) It makes appropriate use of information technology.

Signature of Program Official

Peter Tsirigotis, Director

Sector Policies and Programs Division

Office of Air Quality Planning and Standards

Date

Signature of Senior Official or designee 

Oscar Morales, Director 

 Collection Strategies Division

 Office of Environmental Information

Date
Revised 1/30/2007 6

5 CFR 1320.9 reads “As part of the agency submission to OMB of a proposed collection of information, the agency (through the head of 

the agency, the Senior Official or their designee) shall certify (and provide a record supporting such certification) that the proposed 

collection of information --

 “(a) is necessary for the proper performance of the functions of the agency, including that the information to be collected will have 

practical utility;

 “(b) is not unnecessarily duplicative of information otherwise reasonably accessible to the agency;

 “(c) reduces to the extent practicable and appropriate the burden on persons who shall provide information to or for the agency, 

including with respect to small entities, as defined in the Regulatory Flexibility Act 5 U.S.C § 601(6)), the use of such techniques as:

“(1) establishing differing compliance or reporting requirements or timetables that take into account the resources available 

to those who are to respond;

“(2) the clarification, consolidation, or simplification of compliance and reporting requirements; or collection of information , 

or any part thereof;

“(3) an exemption from coverage of the collection of information, or any part thereof;

 “(d) is written using plain, coherent, and unambiguous terminology and is understandable to those who are to respond;

 “(e) is to be implemented in ways consistent and compatible, to the maximum extent practicable, with the existing reporting and 

recordkeeping practices of those who are to respond;

 “(f) indicates for each recordkeeping requirement the length of time persons are required to maintain the records specified;

 “(g) informs potential respondents of the information called for under § 1320.8(b)(3); [see below]

 “(h) has been developed by an office that has planned and allocated resources for the efficient and effective management and use of 

the information to be collected, including the processing of the information in a manner which shall enhance, where appropriate, the 

utility of the information to agencies and the public;

 “(I) uses effective and efficient statistical survey methodology appropriate to the purpose for which the information is to be collected; 

and

 “(j) to the maximum extent practicable, uses appropriate information technology to reduce burden and improve data quality, agency 

efficiency and responsiveness to the public.”

NOTE: 5 CFR 1320.8(b)(3) requires that each collection of information:

 “(3) informs and provides reasonable notice to the potential persons to whom the collection of information is addressed of:

“(I) the reasons the information is planned to be and/or has been used to further the proper performance of the functions of 

the agency;

“(ii) the way such information is planned to be and/or has been used to further the proper performance of the functions of 

the agency;

“(iii) an estimate, to the extent practicable, of the average burden of the collection (together with a request that the public 

direct to the agency any comments concerning the accuracy of this burden estimate and any suggestions for reducing this 

burden);

“(iv) whether responses to the collection of information are voluntary, required to obtain or retain a benefit (citing authority), 

or mandatory (citing authority);

“(v) the nature and extent of confidentiality to be provided, if any (citing authority); and

“(vi) the fact that any agency may not conduct or sponsor, and a person is not required to respond to, a collection of 

information unless it displays a currently valid OMB control number.”