Revised 9/1/2006 

### 1 **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 instructi**  **ons 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:** Federal Implementation Plans Under t he Clean Air Act f or Indian Reservations i n ID, OR, a nd WA

**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 egorie s apply, you must create additional ICs to account for the burden associated with each category. **4. Frequency of reporting** (only to be completed if there are reporting requirements, check all that apply): Hourly Daily We ekly Monthly Yearly Every Decade Quarterly Semi
- Annually Biennially Once Occasionally

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

- Title V operating permits Part 40 Section 49.139 Title Part Section Title Part Section Title Part SectionRevised 9/1/2006 

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**6. Information Collection Instruments/Forms** (if applicable) **:**

Form Name: P ermit application Form Number: 7630
- 9 URL (required if electronic) : http://yosemite.epa.gov/R10/tribal.nsf/programs/farr
- nontitleV 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 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 Immunizati on 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 Bus iness 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: 3 5 Small Entity Number: 7 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 o ne 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 th en number of ICs required. **10. Frequency: How often on average will each respondent respond to the Information Collection?** Revised 9/1/2006 

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Number of Respondents 1 per Year Hour Business hour Day Business Day Week Month Decade Quarter Half year **Calculated Annual Frequency: 1**  (responses per respondent per year)
**Calculated Annual Number of Responses: 3**  **5**

**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 20 700 Recordkeeping 30 1050 Third Party Disclosure **Total** 50 1750

**IMPORTANT : “Cost per Response” and “Total Annual Cost Burden” should include Capital/Startup and O&M costs only.** Revised 9/1/2006 

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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 **35 5**  **30**
Annual Hour Burden **1750**
**- 750**  **2500**
Annual Cost Burden **0 0**  **0**