Agency for International Development
OMB NO: 0412-0004 EXPIRATION DATE: 08/31/2002
RESPS:750 HOURS:375 COSTS(000):$4
Application for Approval of Commodity Eligibility
FORMS: FORM-AID-11
OMB NO: 0412-0011 EXPIRATION DATE: 12/31/2003
RESPS:85 HOURS:1,020 COSTS(000):$0
Application for Assistance - American Schools and Hospitals
FORMS: AID-1010-2
OMB NO: 0412-0012 EXPIRATION DATE: 05/31/2004
RESPS:2,400 HOURS:1,200 COSTS(000):$0
Supplier's Certificate Agreement With the U.S. Agency for
International Development-In voice and contract abstract.
FORMS: AID-282
OMB NO: 0412-0017 EXPIRATION DATE: 06/30/2003
RESPS:216 HOURS:126 COSTS(000):$0
Contractor's Certificate with the Agency for International
Development--Contractor's Invoice--Contract Abstract
FORMS: FORM-AID-1440-3
OMB NO: 0412-0020 EXPIRATION DATE: 06/30/2003
RESPS:300 HOURS:196 COSTS(000):$0
Supplier's Certificate and Agreement with the Agency for
International Development for Project Commodities/Invoice--and--
Contract
FORMS: FORM-AID-1450-4
OMB NO: 0412-0035 EXPIRATION DATE: 07/31/2003
RESPS:442 HOURS:1,320 COSTS(000):$0
USAID FOrm 1550-2 Private and Voluntary Organization Annual
Return
FORMS: 1550-2
OMB NO: 0412-0510 EXPIRATION DATE: 04/30/2005
RESPS:1,100 HOURS:37,400 COSTS(000):$0
Administration of Assistance Awards to U.S. Non-Governmental
Organizations - 22 CFR 226 and USAID ADS Chapter 303
FORMS: NONE
OMB NO: 0412-0514 EXPIRATION DATE: 09/30/2003
RESPS:1,991 HOURS:869 COSTS(000):$0
AID Regulation 1-Rules and Procedures Applicable to Commodity
Transactions
FORMS: NONE
OMB NO: 0412-0520 EXPIRATION DATE: 09/30/2004
RESPS:53,270 HOURS:74,620 COSTS(000):$0
Information collection elements in the USAID Acquisition
Regulation (AIDAR), 48 CFR Chapter 7
FORMS: FORM-1420-17
OMB NO: 0412-0536 EXPIRATION DATE: 08/31/2002
RESPS:1,460 HOURS:8,760 COSTS(000):$249
USAID Contractor Employee Physical Examination Form
FORMS: AID-1420-62
OMB NO: 0412-0542 EXPIRATION DATE: 09/30/2004
RESPS:1,140 HOURS:2,280 COSTS(000):$0
Request for Advance or Reimbursement
FORMS: AID-1558-2
OMB NO: 0412-0543 EXPIRATION DATE: 09/30/2004
RESPS:760 HOURS:5,320 COSTS(000):$0
Exception to the Financial Status Report (SF-269) and Supplement
to the Financial Status Report (worksheet)
FORMS: 1558-1 1558-1A
OMB NO: 0412-0554 EXPIRATION DATE: 09/30/2004
RESPS:15,720 HOURS:2,630 COSTS(000):$0
Training Results and Information Network (TraiNet)
FORMS: NONE
OMB NO: 0412-0555 EXPIRATION DATE: 06/30/2002
RESPS:240 HOURS:24 COSTS(000):$0
Monthly Commodity Status Report/Monthly Recipient Status Report
FORMS: NONE
OMB NO: 0412-0556 EXPIRATION DATE: 06/30/2002
RESPS:20 HOURS:240 COSTS(000):$0
Monetization Report
FORMS: NONE
OMB NO: 0412-0557 EXPIRATION DATE: 06/30/2002
RESPS:20 HOURS:480 COSTS(000):$0
Annual Results Report
FORMS: NONE
OMB NO: 0412-0559 EXPIRATION DATE: 08/31/2002
RESPS:500 HOURS:4,800 COSTS(000):$235
Mexico City Policy Certification
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
17 80,414 141,660 $488
Committee for Purchase from the Blind and Other Severely Handicapped
OMB NO: 3037-0001 EXPIRATION DATE: 11/30/2002
RESPS:71 HOURS:142 COSTS(000):$0
Annual Certification, Qualified Nonprofit Agency Serving People
Who Are Blind
FORMS: 403
OMB NO: 3037-0002 EXPIRATION DATE: 11/30/2002
RESPS:552 HOURS:1,656 COSTS(000):$0
Annual Certification, Qualified Nonprofit Agency Servicing
People Who Are Severely Disabled
FORMS: 404
OMB NO: 3037-0003 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:50 COSTS(000):$0
Committee Form 402 -- Initial Certification - Qualified
Nonprofit Agency Serving People Who Are Severely Disabled
FORMS: 402
OMB NO: 3037-0004 EXPIRATION DATE: 03/31/2005
RESPS:5 HOURS:5 COSTS(000):$0
Committee form 401 -- Initial Certification - Qualified
Nonprofit Agency Serving Peiple Who Are Blind
FORMS: 401
OMB NO: 3037-0005 EXPIRATION DATE: 09/30/2002
RESPS:650 HOURS:1,950 COSTS(000):$0
Nonprofit Agency Responsibilities
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 1,328 3,803 $0
Corporation for National and Community Service
OMB NO: 3045-0004 EXPIRATION DATE: 10/31/2003
RESPS:100,000 HOURS:5,000 COSTS(000):$0
AmeriCorps National Referral Card
FORMS: NONE
OMB NO: 3045-0005 EXPIRATION DATE: 10/31/2004
RESPS:500 HOURS:1,000 COSTS(000):$0
AmericCorps*NCCC Team Leader Application
FORMS: NONE
OMB NO: 3045-0006 EXPIRATION DATE: 11/30/2003
RESPS:48,000 HOURS:5,600 COSTS(000):$0
Corporation for National Service, Enrollment Form
FORMS: NONE
OMB NO: 3045-0010 EXPIRATION DATE: 12/31/2003
RESPS:900 HOURS:7,200 COSTS(000):$108,000
AmeriCorps*National Civilian Community Corps Service Project
Application
FORMS: NONE
OMB NO: 3045-0014 EXPIRATION DATE: 06/30/2004
RESPS:55,000 HOURS:4,583 COSTS(000):$0
Voucher and Payment Request Form
FORMS: NONE
OMB NO: 3045-0015 EXPIRATION DATE: 11/30/2003
RESPS:48,000 HOURS:5,600 COSTS(000):$0
Corporation for National Service EXIT FORM
FORMS: NONE
OMB NO: 3045-0020 EXPIRATION DATE: 10/31/2002
RESPS:3,310 HOURS:2,364 COSTS(000):$47
AmeriCorps*VISTA Accomplishment Review
FORMS: NONE
OMB NO: 3045-0029 EXPIRATION DATE: 06/30/2002
RESPS:650 HOURS:4,338 COSTS(000):$11
Project Profile and Volunteer Activity Survey (PPVA); RSVP, FGP,
SCP
FORMS: 1021-RSVP 1021-FGP 1021-SCP
OMB NO: 3045-0030 EXPIRATION DATE: 05/31/2005
RESPS:1,300 HOURS:2,166 COSTS(000):$0
Forbearance Request for National Service Form
FORMS: NONE
OMB NO: 3045-0033 EXPIRATION DATE: 05/31/2003
RESPS:2,104 HOURS:12,576 COSTS(000):$3
National Senior Service Corps Project Progress Report
FORMS: A-1020
OMB NO: 3045-0035 EXPIRATION DATE: 09/30/2002
RESPS:1,513 HOURS:20,027 COSTS(000):$6
National Senior Service Corps Grant Application
FORMS: 424-NSSC
OMB NO: 3045-0038 EXPIRATION DATE: 04/30/2003
RESPS:2,200 HOURS:9,200 COSTS(000):$10
AmeriCorps "VISTA Project Application, Part A and Part B
FORMS: 1421 1421B
OMB NO: 3045-0043 EXPIRATION DATE: 05/31/2005
RESPS:4,800 HOURS:9,600 COSTS(000):$0
AmeriCorps*VISTA Project Progress Report
FORMS: CNCS-1433
OMB NO: 3045-0045 EXPIRATION DATE: 02/28/2003
RESPS:1 HOURS:2,250 COSTS(000):$0
The 2000 Application Guidelines for Learn and Serve America
School- and Community-Based Programs
FORMS: NONE
OMB NO: 3045-0046 EXPIRATION DATE: 02/28/2003
RESPS:400 HOURS:2,400 COSTS(000):$0
The 2000 Application Guidelines for Learn and Serve America
Higher Education
FORMS: NONE
OMB NO: 3045-0047 EXPIRATION DATE: 02/28/2003
RESPS:1 HOURS:20,000 COSTS(000):$0
The 2000 Application Guidelines for AmeriCorps National, State
and Indian Tribes, and U.S. Territories
FORMS: NONE
OMB NO: 3045-0048 EXPIRATION DATE: 03/31/2004
RESPS:290,000 HOURS:11,667 COSTS(000):$0
AmeriCorps*VISTA Alumni Locator Card Part A, B, and C
FORMS: NONE
OMB NO: 3045-0053 EXPIRATION DATE: 05/31/2005
RESPS:13,000 HOURS:1,083 COSTS(000):$0
Interest Accrual Form (Interest Accrued During National SVC)
FORMS: NONE
OMB NO: 3045-0054 EXPIRATION DATE: 09/30/2002
RESPS:60,000 HOURS:45,000 COSTS(000):$0
AmeriCorps Member Application
FORMS: NONE
OMB NO: 3045-0055 EXPIRATION DATE: 07/31/2002
RESPS:18,000 HOURS:9,000 COSTS(000):$0
Corporation for National Service Generic Customer Survey
Clearance
FORMS: NONE
OMB NO: 3045-0056 EXPIRATION DATE: 07/31/2002
RESPS:2,100 HOURS:2,100 COSTS(000):$46
Learn and Serve America Project Description Form
FORMS: NONE
OMB NO: 3045-0057 EXPIRATION DATE: 08/31/2002
RESPS:7,800 HOURS:1,492 COSTS(000):$0
Senior Companion Program Quality of Care Evaluation -- Parts 1-5
FORMS: NONE
OMB NO: 3045-0060 EXPIRATION DATE: 09/30/2002
RESPS:7,835 HOURS:2,671 COSTS(000):$0
Longitudinal Research on Member Outcomes
FORMS: NONE
OMB NO: 3045-0061 EXPIRATION DATE: 10/31/2002
RESPS:6,610 HOURS:5,130 COSTS(000):$0
Outcome Evaluation of Literacy and Tutoring Programs
FORMS: NONE
OMB NO: 3045-0062 EXPIRATION DATE: 10/31/2002
RESPS:68 HOURS:272 COSTS(000):$0
Program Development Assistance and Training (PDAT) Budget Form
FORMS: NONE
OMB NO: 3045-0064 EXPIRATION DATE: 02/28/2003
RESPS:14 HOURS:4,760 COSTS(000):$0
State Administrative Standards
FORMS: NONE
OMB NO: 3045-0065 EXPIRATION DATE: 02/28/2003
RESPS:300 HOURS:2,400 COSTS(000):$0
AmeriCorps Education Awards Program 2000 Application Guidelines
FORMS: NONE
OMB NO: 3045-0067 EXPIRATION DATE: 05/31/2003
RESPS:1,304 HOURS:978 COSTS(000):$0
National Senior Service Corps (NSSC) Government Performance and
Results Act (GPRA) Project Data Report
FORMS: NONE
OMB NO: 3045-0068 EXPIRATION DATE: 06/30/2003
RESPS:319 HOURS:156 COSTS(000):$0
Evaluation of the Accomplishments and Outcomes of
AmeriCorps*NCCC Projects
FORMS: NONE
OMB NO: 3045-0070 EXPIRATION DATE: 08/31/2003
RESPS:3,456 HOURS:3,831 COSTS(000):$0
Long-term Study of Member Outcomes
FORMS: NONE
OMB NO: 3045-0071 EXPIRATION DATE: 09/30/2003
RESPS:100 HOURS:1,000 COSTS(000):$2
Outreach to Individuals with a Disability to Increase their
Participation in National Service Application Guidelines
FORMS: NONE
OMB NO: 3045-0072 EXPIRATION DATE: 05/31/2004
RESPS:470 HOURS:470 COSTS(000):$0
Evaluation of the Effectiveness of Learn and Serve America
Grants in Promoting Institutuionalization of Service-Learning
FORMS: NONE
OMB NO: 3045-0073 EXPIRATION DATE: 05/31/2004
RESPS:90 HOURS:2,520 COSTS(000):$0
2001 AmeriCorps Promise Fellows Application Instructions
FORMS: NONE
OMB NO: 3045-0077 EXPIRATION DATE: 09/30/2002
RESPS:10,000 HOURS:500 COSTS(000):$0
Volunteer Service Hour Tracking Tool
FORMS: NONE
OMB NO: 3045-0078 EXPIRATION DATE: 09/30/2002
RESPS:11,700,000 HOURS:413,400 COSTS(000):$0
"Join Senior Service Now" Senior Service Web-based Recruitment
System
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
35 12,390,145 622,334 $108,125
Equal Employment Opportunity Commission
OMB NO: 3046-0003 EXPIRATION DATE: 07/31/2002
RESPS:5,000 HOURS:12,000 COSTS(000):$100
Elementary-Secondary Staff Information -- EEO-5
FORMS: 168A
OMB NO: 3046-0006 EXPIRATION DATE: 02/28/2003
RESPS:3,000 HOURS:4,500 COSTS(000):$0
Local Union Report (EEO-3)
FORMS: 274
OMB NO: 3046-0007 EXPIRATION DATE: 11/30/2002
RESPS:170,000 HOURS:402,700 COSTS(000):$0
Employer Information Report -- EEO-1
FORMS: 100
OMB NO: 3046-0008 EXPIRATION DATE: 07/31/2003
RESPS:10,000 HOURS:40,000 COSTS(000):$0
State and Local Government (EEO-4)
FORMS: 164
OMB NO: 3046-0017 EXPIRATION DATE: 06/30/2002
RESPS:666,000 HOURS:1,450,000 COSTS(000):$0
Uniform Guidelines on Employee Selection Procedures
FORMS: NONE
OMB NO: 3046-0040 EXPIRATION DATE: 08/31/2003
RESPS:627,000 HOURS:16,677 COSTS(000):$0
Recordkeeping and Reporting under Title VII and the ADA
FORMS: NONE
OMB NO: 3046-0043 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:41,000 COSTS(000):$0
Waiver of Rights and Claims Under the Age Discrimination in
Employment Act (ADEA)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 1,481,001 1,966,877 $100
Export-Import Bank of the United States
OMB NO: 3048-0003 EXPIRATION DATE: 02/29/2004
RESPS:600 HOURS:1,200 COSTS(000):$0
U.S. Small Business Administration Export-Import Bank of the
United States Joint Application for Working Capital Guarantee
FORMS: EIB-SBAFORM84-1
OMB NO: 3048-0004 EXPIRATION DATE: 02/28/2005
RESPS:50 HOURS:50 COSTS(000):$0
Annual Competitiveness Report Survey of Exporters and Bankers
FORMS: 00-02
OMB NO: 3048-0005 EXPIRATION DATE: 10/31/2004
RESPS:960 HOURS:310 COSTS(000):$0
Ex-Im Bank Letter of Interest Application
FORMS: EIB-95-9
OMB NO: 3048-0009 EXPIRATION DATE: 06/30/2002
RESPS:2,262 HOURS:2,262 COSTS(000):$0
Application forms for export credit insurance program.
FORMS: EIB-92-34 EIB-92-41 EIB-92-45 EIB-92-48 EIB-92-50 EIB-92-64
EIB-92-72 EIB-92-79
OMB NO: 3048-0012 EXPIRATION DATE: 08/31/2004
RESPS:2 HOURS:1,200 COSTS(000):$0
Foreign Content Aggregate/Cause Report
FORMS: EIB-FORM-01-02 EIB-FORM-01-02A
OMB NO: 3048-0013 EXPIRATION DATE: 11/30/2004
RESPS:225 HOURS:337 COSTS(000):$0
Export-Import Bank of the United States Preliminary Commitment
and Final Commitment
FORMS: 95-10
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
6 4,099 5,359 $0
Federal Emergency Management Agency
OMB NO: 3067-0001 EXPIRATION DATE: 03/31/2003
RESPS:50 HOURS:25 COSTS(000):$0
National Defense Executive Reserve Personal Qualification
Statement
FORMS: FEMA-85-3
OMB NO: 3067-0009 EXPIRATION DATE: 02/28/2003
RESPS:460,900 HOURS:171,148 COSTS(000):$0
Disaster Assistance Registration; Applicant
Statement/Authorization; Declaration of Applicant
FORMS: FEMA-90-69 FEMA-90-69A FEMA-90-69B FEMA-90-69C FEMA-90-69D
FEMA-90-69E
OMB NO: 3067-0018 EXPIRATION DATE: 06/30/2002
RESPS:9,098 HOURS:7,546 COSTS(000):$5,977
National Flood Insurance Program Biennial Report
FORMS: FORMS-81-28 81-29 81-29A
OMB NO: 3067-0020 EXPIRATION DATE: 06/30/2002
RESPS:100 HOURS:400 COSTS(000):$0
Application for Participation in the National Flood Insurance
Program
FORMS: FEMA-81-64
OMB NO: 3067-0021 EXPIRATION DATE: 12/31/2003
RESPS:77,634 HOURS:310,536 COSTS(000):$0
Claims for National Flood Insurance Program (NFIP)
FORMS: 81-40 81-41 81-41A 81-42 81-42A 81-43 81-44 81-57 81-58 81-59
OMB NO: 3067-0022 EXPIRATION DATE: 02/28/2003
RESPS:317,601 HOURS:31,718 COSTS(000):$16,856
National Flood Insurance Policy Forms
FORMS: 81-16 81-17 81-18 81-25 81-67
OMB NO: 3067-0024 EXPIRATION DATE: 07/31/2003
RESPS:65,000 HOURS:8,500 COSTS(000):$0
General Admissions Applications and General Admissions
Application Short Form
FORMS: FEMA-FORM-75-5 FEMA-FORM-75-5A
OMB NO: 3067-0066 EXPIRATION DATE: 08/31/2002
RESPS:27 HOURS:138 COSTS(000):$1,654
Request for Fire Suppression Assistance
FORMS: SF-424 SF-269A SF-270 FEMA90-58 FEMA90-91
OMB NO: 3067-0077 EXPIRATION DATE: 07/31/2002
RESPS:73,650 HOURS:166,362 COSTS(000):$0
Post Construction Elevation Certificate/Floodproofing Certificate
FORMS: 81-31 81-65
OMB NO: 3067-0113 EXPIRATION DATE: 11/30/2002
RESPS:174 HOURS:13,224 COSTS(000):$0
The Declaration Process: Request for Damage Assessment, Federal
Disaster Assistance, Cost Share Adjustment, and Loans of the
Non-Federal Share
FORMS: NONE
OMB NO: 3067-0120 EXPIRATION DATE: 11/30/2004
RESPS:60 HOURS:90 COSTS(000):$0
Implementation of Coastal Barrier Resources Act
FORMS: NONE
OMB NO: 3067-0122 EXPIRATION DATE: 10/31/2004
RESPS:600 HOURS:450 COSTS(000):$0
Debt Collection Financial Statement
FORMS: 22-13
OMB NO: 3067-0125 EXPIRATION DATE: 09/30/2003
RESPS:520 HOURS:86 COSTS(000):$0
Request for Loan Information Verification
FORMS: FEMA-FORM-90-68
OMB NO: 3067-0127 EXPIRATION DATE: 06/30/2002
RESPS:20 HOURS:100 COSTS(000):$0
Exemption of State-Owned Properties under Self-Insurance Plan
FORMS: NONE
OMB NO: 3067-0141 EXPIRATION DATE: 08/31/2002
RESPS:16 HOURS:24 COSTS(000):$0
Reimbursement for Cost of Firefighting on Federal Property
FORMS: NONE
OMB NO: 3067-0146 EXPIRATION DATE: 06/30/2002
RESPS:56 HOURS:168 COSTS(000):$0
State Administrative Plans for the Individual Family Grant
Program
FORMS: NONE
OMB NO: 3067-0147 EXPIRATION DATE: 06/30/2002
RESPS:5,400 HOURS:22,788 COSTS(000):$0
Report to Submit Technical or Scientific Data to Correct Mapping
Deficiencies Unrelated to Community-Wide Elevation
Determinations (Amendments & Revisions to National Flood
Insurance Program Map)
FORMS: 81-87 81-87A 81-87B 81-87C 81-87D 81-87E
OMB NO: 3067-0148 EXPIRATION DATE: 06/30/2002
RESPS:900 HOURS:7,074 COSTS(000):$0
Consultation with Local Officials to Assure Compliance with
Sections 110 and 206 of the Flood Disaster Protection Act of
1973 (Revisions to National Flood Insurance Program Maps)
FORMS: 81-89/81-89A 81-89B/81-89C 81-89D/81-89E 81-89F/81-89G
81-89H/81-89I 81-89J/81-89K
OMB NO: 3067-0151 EXPIRATION DATE: 06/30/2002
RESPS:100 HOURS:125 COSTS(000):$0
Progress Report
FORMS: NONE
OMB NO: 3067-0166 EXPIRATION DATE: 06/30/2002
RESPS:92 HOURS:4,896 COSTS(000):$0
Crisis Counseling Assistance and Training Program
FORMS: SF-424
OMB NO: 3067-0167 EXPIRATION DATE: 06/30/2002
RESPS:7 HOURS:7 COSTS(000):$0
Claims of Federal Personnel for Personal Property Damage or Loss
FORMS: NONE
OMB NO: 3067-0169 EXPIRATION DATE: 06/30/2002
RESPS:1,440 HOURS:792 COSTS(000):$0
Write Your Own (WYO) Program
FORMS: NONE
OMB NO: 3067-0194 EXPIRATION DATE: 08/31/2004
RESPS:300 HOURS:300 COSTS(000):$0
National Fire Academy Executive Fire Officer Program Application
Form
FORMS: FORM-95-22
OMB NO: 3067-0195 EXPIRATION DATE: 02/28/2005
RESPS:940 HOURS:9,260 COSTS(000):$0
Community Rating System (CRS) Program - Application Worksheets
and Commentary
FORMS: FIMA-15 FIMA-15A
OMB NO: 3067-0198 EXPIRATION DATE: 08/31/2002
RESPS:3,800 HOURS:15,200 COSTS(000):$0
Efectiveness of a Community's Implementation of the NFIP,
Community Assistance Contact Report and Community Assistance
Visit Report
FORMS: FEMA-81-68 FEMA-81-69
OMB NO: 3067-0201 EXPIRATION DATE: 07/31/2002
RESPS:1 HOURS:160 COSTS(000):$0
Federal Assistance for Offsite Radiological Emergency Planning
and Preparedness under Executive Order 12657
FORMS: NONE
OMB NO: 3067-0206 EXPIRATION DATE: 02/29/2004
RESPS:4,936 HOURS:31,775 COSTS(000):$600
FEMA Grant Administration Forms
FORMS: FORMS-20-10 20-15 20-16A/B/C 20-17 20-18 20-19 20-20 76-10A
OMB NO: 3067-0208 EXPIRATION DATE: 12/31/2003
RESPS:26 HOURS:205 COSTS(000):$0
State Administrative Plan for the Hazardous Mitigation Grant
Program
FORMS: NONE
OMB NO: 3067-0212 EXPIRATION DATE: 09/30/2003
RESPS:26 HOURS:4,160 COSTS(000):$106
Hazard Mitigation Planning/State Hazard Mitigation Plan
FORMS: NONE
OMB NO: 3067-0213 EXPIRATION DATE: 08/31/2004
RESPS:10 HOURS:30 COSTS(000):$0
FEMA Contract Clause-Accessibility of Meetings to Persons with
Disabilities
FORMS: NONE
OMB NO: 3067-0219 EXPIRATION DATE: 12/31/2003
RESPS:1,200 HOURS:130 COSTS(000):$3,000
Approval and Coordination of Requirements to use the NETC for
Extracurricular Training Activities
FORMS: 75-10 75-11
OMB NO: 3067-0222 EXPIRATION DATE: 07/31/2002
RESPS:1,000 HOURS:333 COSTS(000):$0
Request for Site Inspection, Landowners Authorization/Ingress/
Engress Agreement
FORMS: 90-1 90-31
OMB NO: 3067-0233 EXPIRATION DATE: 06/30/2002
RESPS:25,000 HOURS:6,250 COSTS(000):$0
National Fire Academy Field Course Evaluation Form
FORMS: FEMA-FORM-95-45
OMB NO: 3067-0234 EXPIRATION DATE: 12/31/2003
RESPS:5,500 HOURS:1,375 COSTS(000):$0
National Fire Academy Resident Course Evaluation Form
FORMS: FEMA-FORM-95-20
OMB NO: 3067-0235 EXPIRATION DATE: 09/30/2003
RESPS:50 HOURS:163 COSTS(000):$0
Residential Basement Floodproofing Certificate
FORMS: FEMA-FORM-81-78
OMB NO: 3067-0248 EXPIRATION DATE: 11/30/2004
RESPS:3,112 HOURS:4,668 COSTS(000):$90
Emergency Management Exercise Reporting System (EMERS)
FORMS: FORM-95-44
OMB NO: 3067-0256 EXPIRATION DATE: 08/31/2004
RESPS:96,720 HOURS:24,180 COSTS(000):$0
FEMA Response and Recovery Program Evaluation and Customer
Satisfaction Surveys
FORMS: NONE
OMB NO: 3067-0257 EXPIRATION DATE: 05/31/2005
RESPS:9,000 HOURS:21,600 COSTS(000):$1,080
Application Form for Single Lot or Structure Amendments to
National Flood Insurance Program Maps
FORMS: 81-92 81-92A
OMB NO: 3067-0259 EXPIRATION DATE: 07/31/2002
RESPS:5 HOURS:35 COSTS(000):$0
Write You Own (WYO) Company Participation Criteria; New
Applicants
FORMS: NONE
OMB NO: 3067-0260 EXPIRATION DATE: 06/30/2002
RESPS:1,500 HOURS:375 COSTS(000):$0
National Fire Academy Long-Term Course Evaluation Forms
FORMS: NETC-F-8872 NETC-F-8873
OMB NO: 3067-0264 EXPIRATION DATE: 06/30/2002
RESPS:12,000,000 HOURS:4,000,000 COSTS(000):$0
Standard Flood Hazard Determination
FORMS: 81-93
OMB NO: 3067-0267 EXPIRATION DATE: 06/30/2004
RESPS:6,490 HOURS:2,164 COSTS(000):$44
Federal Emergency Management Agency/Federal Insurance
FORMS: NONE
OMB NO: 3067-0268 EXPIRATION DATE: 07/31/2003
RESPS:7,500 HOURS:2,500 COSTS(000):$0
Make Your Mark on the Floodplain-High Water Mark Form
FORMS: FORM-81-101
OMB NO: 3067-0271 EXPIRATION DATE: 07/31/2002
RESPS:616 HOURS:116,624 COSTS(000):$0
Flood Mitigation Assistance, Flood Mitigation Plan
FORMS: NONE
OMB NO: 3067-0272 EXPIRATION DATE: 10/31/2003
RESPS:56 HOURS:3,360 COSTS(000):$0
Capability Assessment for Readiness (CAR)
FORMS: NONE
OMB NO: 3067-0273 EXPIRATION DATE: 10/31/2004
RESPS:2,320 HOURS:580 COSTS(000):$0
Emergency Management Institute Follow-up Evaluation Survey
FORMS: 95-56
OMB NO: 3067-0275 EXPIRATION DATE: 07/31/2002
RESPS:1,100 HOURS:3,300 COSTS(000):$72
Inspection of Insured Structures by Communities
FORMS: NONE
OMB NO: 3067-0277 EXPIRATION DATE: 02/29/2004
RESPS:90,000 HOURS:1,500 COSTS(000):$26
EMI Independent Study Course Enrollment Application
FORMS: FEMA-FORM-95-23
OMB NO: 3067-0278 EXPIRATION DATE: 02/29/2004
RESPS:56 HOURS:182 COSTS(000):$0
Request for Federal Assistance Form - How to Process Mission
Assignments in Federal Disaster Operations
FORMS: FORM-90-129
OMB NO: 3067-0279 EXPIRATION DATE: 05/31/2004
RESPS:30,445 HOURS:60,182 COSTS(000):$1,021
Supplemental Property Acquisition and Elevation Assistance
FORMS: SF-424 FEMA-20-10 FEMA-20-15 FEMA-20-16 FEMA-20-16B FEMA-20-16C
SF-LLL
OMB NO: 3067-0280 EXPIRATION DATE: 02/28/2005
RESPS:22,000 HOURS:17,000 COSTS(000):$0
Notice of Loss- Cerro Grande Fire Assistance Act
FORMS: FFCG-1
OMB NO: 3067-0281 EXPIRATION DATE: 12/31/2003
RESPS:300 HOURS:235 COSTS(000):$0
Closed-Basin Lake Endorsement
FORMS: 81-42 81-42A 81-43
OMB NO: 3067-0282 EXPIRATION DATE: 05/31/2004
RESPS:18,000 HOURS:405,000 COSTS(000):$0
Proof of Loss Form - Cerro Grande Fire Assistance Claims
FORMS: CG-2
OMB NO: 3067-0283 EXPIRATION DATE: 12/31/2003
RESPS:178 HOURS:356 COSTS(000):$9
Project Impact Baseline Report and Progress Report
FORMS: NONE
OMB NO: 3067-0284 EXPIRATION DATE: 05/31/2004
RESPS:12.000 HOURS:18,000 COSTS(000):$0
Subrogration Notice and Proff of Loss - Cerro Grande Fire
Assistance Act
FORMS: CG-3
OMB NO: 3067-0285 EXPIRATION DATE: 08/31/2002
RESPS:25,000 HOURS:378,540 COSTS(000):$0
Assistance to Firefighters Grant Program Application-Grant
Application Supplemental Information
FORMS: 20-20 20-16 20-10
OMB NO: 3067-0286 EXPIRATION DATE: 08/31/2003
RESPS:800 HOURS:2,400 COSTS(000):$0
Request for Mitigation Assistance-Cerro Grande Mitigation
Proposal
FORMS: FFCG-4
OMB NO: 3067-0287 EXPIRATION DATE: 09/30/2002
RESPS:33,000 HOURS:13,860 COSTS(000):$0
National Fire Department Census
FORMS: NONE
OMB NO: 3067-0288 EXPIRATION DATE: 02/28/2005
RESPS:400 HOURS:400 COSTS(000):$0
Small Business Notice and Proof of Loss
FORMS: FFCG-8
OMB NO: 3067-0289 EXPIRATION DATE: 08/31/2004
RESPS:555 HOURS:420 COSTS(000):$0
Chemical Stockpile Emergency Preparedness Program (CSEPP)
Program Evaluation and Customer Satisfaction Baseline Survey
FORMS: NONE
OMB NO: 3067-0290 EXPIRATION DATE: 11/30/2004
RESPS:1,009 HOURS:2,085 COSTS(000):$0
Fire Management Assistance Grant Program
FORMS: 90-58 SF-424 90-91 20-10 270
OMB NO: 3067-0293 EXPIRATION DATE: 10/31/2004
RESPS:78,448 HOURS:3,915 COSTS(000):$0
National Flood Insurance Telephone Response Center (TRC) and
Leads Application Program
FORMS: 81-95
OMB NO: 3067-0295 EXPIRATION DATE: 02/28/2005
RESPS:125 HOURS:157 COSTS(000):$0
Review of Local Mitigation Planning Intiatives and Practices
FORMS: NONE
OMB NO: 3067-0296 EXPIRATION DATE: 03/31/2005
RESPS:40,168 HOURS:29,948 COSTS(000):$0
Federal Assistance to Individuals and Households Program
FORMS: NONE
OMB NO: 3067-0297 EXPIRATION DATE: 08/31/2002
RESPS:556 HOURS:160,460 COSTS(000):$0
State/Local/Tribal Hazard Mitigation Plans under Section 322 of
the Disaster mitigation Act of 2000
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
65 13,525,705 6,089,564 $30,535
Appraisal Subcommittee of the FFIEC
OMB NO: 3139-0005 EXPIRATION DATE: 09/30/2002
RESPS:2 HOURS:120 COSTS(000):$0
Rules of Practice for Proceedings -- 12 CFR Part 1102, Subpart B
FORMS: NONE
OMB NO: 3139-0006 EXPIRATION DATE: 12/31/2002
RESPS:11 HOURS:4 COSTS(000):$0
Description of Office, Procedures, Public Information 12 CFR
Part 102, Subpart D
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 13 124 $0
Federal Mediation and Conciliation Service
OMB NO: 3076-0006 EXPIRATION DATE: 11/30/2002
RESPS:404 HOURS:251 COSTS(000):$0
FMCS Grants Program and Grant Evaluation Package
FORMS: SF-424 SF-269A(LM-6) (LM-8) SF-270A(LM-7) (LM-9) (LM-3)
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 404 251 $0
General Services Administration
OMB NO: 3090-0006 EXPIRATION DATE: 05/31/2005
RESPS:15,496 HOURS:15,496 COSTS(000):$0
Qualifications of Employees, GSAR Reference 537.110(b)
FORMS: GSA-176
OMB NO: 3090-0007 EXPIRATION DATE: 01/31/2005
RESPS:2,767 HOURS:6,917 COSTS(000):$0
Contractor's Qualifications and Financial Information
FORMS: GSA-527
OMB NO: 3090-0014 EXPIRATION DATE: 03/31/2005
RESPS:63,000 HOURS:18,900 COSTS(000):$0
Transfer Order - Surplus Personal Property and Continuation Sheet
FORMS: SF-123/123-A
OMB NO: 3090-0021 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:250 COSTS(000):$0
Profit and Loss Statement - Operating Statement
FORMS: GSA-2817
OMB NO: 3090-0023 EXPIRATION DATE: 05/31/2005
RESPS:12,000 HOURS:996 COSTS(000):$0
Surplus Personal Property Mailing List Application
FORMS: GSA-2170
OMB NO: 3090-0027 EXPIRATION DATE: 01/31/2005
RESPS:116,869 HOURS:7,830 COSTS(000):$0
GSAM, Part 542, Contract Administration - Part 546, Quality
Assurance
FORMS: GSA-1678 GSA-250 GSA-308
OMB NO: 3090-0040 EXPIRATION DATE: 06/30/2004
RESPS:3,000 HOURS:1,000 COSTS(000):$0
Application for Shipping Instructions and Notice of Availability
FORMS: GSA-1611
OMB NO: 3090-0043 EXPIRATION DATE: 01/31/2005
RESPS:1,300 HOURS:2,080 COSTS(000):$0
Appraisal of Fair Annual parking Rate Per Space for Standard
Level User Charge
FORMS: GSA-3357
OMB NO: 3090-0044 EXPIRATION DATE: 09/30/2002
RESPS:8,000 HOURS:400 COSTS(000):$0
Application/Permit for Use of Space in Public Buildings and
Grounds
FORMS: GSA-3453
OMB NO: 3090-0057 EXPIRATION DATE: 01/31/2005
RESPS:500 HOURS:125 COSTS(000):$0
Deposit Bond Individual - Sale of Government Personal Property
FORMS: SF-150
OMB NO: 3090-0058 EXPIRATION DATE: 01/31/2005
RESPS:1,000 HOURS:250 COSTS(000):$6,600
Deposit Bond - Annual Sale of Government Personal Property
FORMS: SF-151
OMB NO: 3090-0080 EXPIRATION DATE: 01/31/2005
RESPS:2,000 HOURS:200 COSTS(000):$0
General Services Administration Acquisition Manual (GSAM) Part
532, Contract Financing
FORMS: GSA-1142
OMB NO: 3090-0086 EXPIRATION DATE: 03/31/2005
RESPS:5,016 HOURS:25,183 COSTS(000):$0
GSA Form 1364, Proposal to Lease Space
FORMS: GSA-1364
OMB NO: 3090-0093 EXPIRATION DATE: 11/30/2004
RESPS:1,434 HOURS:1,434 COSTS(000):$0
Transportation Discrepancy Report, SF 361
FORMS: SF-361
OMB NO: 3090-0112 EXPIRATION DATE: 05/31/2005
RESPS:220 HOURS:330 COSTS(000):$0
State Agency Monthly Donation Report of Surplus Personal Property
FORMS: GSA-3040
OMB NO: 3090-0118 EXPIRATION DATE: 01/31/2005
RESPS:874 HOURS:291 COSTS(000):$0
Statement of Witness, Standard Form 94
FORMS: SF-94
OMB NO: 3090-0121 EXPIRATION DATE: 01/31/2005
RESPS:184,280 HOURS:1,530 COSTS(000):$0
GSAM, Part 538.2 Establishing and Administering Schedules
FORMS: GSA-72A
OMB NO: 3090-0163 EXPIRATION DATE: 11/30/2004
RESPS:172,500 HOURS:68,900 COSTS(000):$0
Information Specific to a Contract
FORMS: NONE
OMB NO: 3090-0197 EXPIRATION DATE: 01/31/2005
RESPS:6,722 HOURS:6,722 COSTS(000):$0
GSAR 537.110(a) (Insert 552.237-70, Qualification of Offerors)
FORMS: NONE
OMB NO: 3090-0200 EXPIRATION DATE: 01/31/2005
RESPS:10 HOURS:5 COSTS(000):$0
General Services Administration Acquisition Manual Part 514,
Sealed Bidding
FORMS: NONE
OMB NO: 3090-0204 EXPIRATION DATE: 02/28/2005
RESPS:10,305 HOURS:2,669 COSTS(000):$0
GSAR Part 552.211.-82 Notice of Shipment & Part 552.211-78
Commercial Delivery Schedule (Multiple Award Schedule)
FORMS: NONE
OMB NO: 3090-0221 EXPIRATION DATE: 01/31/2004
RESPS:55 HOURS:6 COSTS(000):$0
GSA Board of Contract Appeals Subpoena, GSA Board of Contract
Appeals Forms 4 and 5 (Certificates of Finality)
FORMS: GSA-9534
OMB NO: 3090-0235 EXPIRATION DATE: 04/30/2005
RESPS:19,094 HOURS:143,205 COSTS(000):$0
Price Reductions Clause
FORMS: NONE
OMB NO: 3090-0246 EXPIRATION DATE: 01/31/2005
RESPS:931,219 HOURS:7,760 COSTS(000):$0
General Services Administration Acquisition Regulation (GSAR)
Packing List Clause
FORMS: NONE
OMB NO: 3090-0248 EXPIRATION DATE: 08/31/2002
RESPS:260 HOURS:260 COSTS(000):$0
48 CFR 552.216-73 Placement of Orders 48 CFR 552.216-74 Ordering
Information
FORMS: NONE
OMB NO: 3090-0250 EXPIRATION DATE: 07/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Zero Burden Information Collection Reports
FORMS: NONE
OMB NO: 3090-0252 EXPIRATION DATE: 07/31/2002
RESPS:1,350 HOURS:16,200 COSTS(000):$0
Preparation, Submission, and Negotiation of Subcontracting Plans
FORMS: NONE
OMB NO: 3090-0259 EXPIRATION DATE: 06/30/2002
RESPS:25 HOURS:60 COSTS(000):$0
Market Research Questionnaire
FORMS: NONE
OMB NO: 3090-0262 EXPIRATION DATE: 03/31/2005
RESPS:9,200 HOURS:46,000 COSTS(000):$0
Idenfitication of Products with Environmental Attributes
FORMS: NONE
OMB NO: 3090-0270 EXPIRATION DATE: 08/31/2002
RESPS:100,000 HOURS:250,000 COSTS(000):$0
Access Certificates for Electronic Services (ACES)
FORMS: NONE
OMB NO: 3090-0271 EXPIRATION DATE: 04/30/2003
RESPS:23,400 HOURS:3,900 COSTS(000):$0
American Customer Satisfaction Index (ACSI)
FORMS: NONE
OMB NO: 3090-0273 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:50 COSTS(000):$0
Questionnaire: CD-ROM of the Ctalog of Federal Domestic
Assistance and Federal Assistance Award Data System
FORMS: NONE
OMB NO: 3090-0274 EXPIRATION DATE: 05/31/2003
RESPS:360 HOURS:90 COSTS(000):$2
Art-in-Architecture Program National Artist Registry
FORMS: GSA-7437
OMB NO: 3090-0275 EXPIRATION DATE: 10/31/2003
RESPS:50 HOURS:1,250 COSTS(000):$0
Child Care Subsidy Application - Main Provider
FORMS: GSA-3674A
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
34 1,693,308 630,290 $6,602
International Trade Commission
OMB NO: 3117-0016 EXPIRATION DATE: 07/31/2002
RESPS:4,375 HOURS:175,000 COSTS(000):$13,125
Information Collections for Import Injury Investigations
Questionnaires and Institution Notices for 5-Year Reviews)
FORMS: NONE
OMB NO: 3117-0188 EXPIRATION DATE: 11/30/2002
RESPS:1,500 HOURS:375 COSTS(000):$0
ITC Reader Satisfaction Survey
FORMS: NONE
OMB NO: 3117-0190 EXPIRATION DATE: 01/31/2003
RESPS:2,000 HOURS:66 COSTS(000):$0
ITC DataWeb: User Registration Forms
FORMS: NONE
OMB NO: 3117-0192 EXPIRATION DATE: 08/31/2002
RESPS:50 HOURS:50 COSTS(000):$0
Survey for Participants in Commission Import Injury
Investigations
FORMS: NONE
OMB NO: 3117-0196 EXPIRATION DATE: 09/30/2002
RESPS:1 HOURS:37 COSTS(000):$0
Survey Regarding Outstanding Sec. 337 Exclusion Orders
FORMS: NONE
OMB NO: 3117-0198 EXPIRATION DATE: 08/31/2003
RESPS:12 HOURS:240 COSTS(000):$0
U.S. Producers Questionnaire - Competitive Assessment of the
U.S. Large Civil Aircraft Aerostructures Industry
FORMS: NONE
OMB NO: 3117-0200 EXPIRATION DATE: 07/31/2002
RESPS:56 HOURS:1,245 COSTS(000):$0
U.S. Market Conditions for Certain Wool Products
FORMS: 332-427
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 7,994 177,013 $13,125
M.K. Udall Foundation U.S. Institute for Environmental Conflict Resolution
OMB NO: 3320-0001 EXPIRATION DATE: 06/30/2004
RESPS:80 HOURS:187 COSTS(000):$0
Application for National Roster of Environmental Dispute
Resolution and Consensus Building Professionals. Sub-Roster of
Transportation Mediators and Facilitors.
FORMS: NONE
OMB NO: 3320-0002 EXPIRATION DATE: 03/31/2005
RESPS:15 HOURS:160 COSTS(000):$0
Application for support from the US Institute for Environmental
Conflict Resolution for Environmental Conflict Resolution (ECR)
Participation Program
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 95 347 $0
Merit Systems Protection Board
OMB NO: 3124-0009 EXPIRATION DATE: 12/31/2003
RESPS:9,000 HOURS:4,500 COSTS(000):$0
U.S. Merit Systems Protection Board Appeal Form (OF-283)
FORMS: NONE
OMB NO: 3124-0012 EXPIRATION DATE: 08/31/2004
RESPS:1,500 HOURS:375 COSTS(000):$0
Customer Surveys
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 10,500 4,875 $0
National Aeronautics and Space Administration
OMB NO: 2700-0003 EXPIRATION DATE: 11/30/2002
RESPS:10,200 HOURS:91,500 COSTS(000):$0
NASA Contractor Financial Management Reports
FORMS: 533M 533Q
OMB NO: 2700-0009 EXPIRATION DATE: 09/30/2004
RESPS:930 HOURS:895 COSTS(000):$0
AST-Technology Utilization
FORMS: NONE
OMB NO: 2700-0010 EXPIRATION DATE: 09/30/2003
RESPS:60 HOURS:30 COSTS(000):$0
Patent License Report
FORMS: NONE
OMB NO: 2700-0039 EXPIRATION DATE: 09/30/2003
RESPS:80 HOURS:640 COSTS(000):$0
Application for a Patent License
FORMS: NONE
OMB NO: 2700-0048 EXPIRATION DATE: 09/30/2003
RESPS:9,347 HOURS:17,276 COSTS(000):$0
Patents
FORMS: NONE
OMB NO: 2700-0049 EXPIRATION DATE: 10/31/2003
RESPS:37,696 HOURS:284,792 COSTS(000):$0
Financial Monitoring and Control, Grants
FORMS: NONE
OMB NO: 2700-0052 EXPIRATION DATE: 11/30/2004
RESPS:2,386 HOURS:7,276 COSTS(000):$0
NASA FAR Supplement, Part 1827, Patents, Data and Copyrights
FORMS: NONE
OMB NO: 2700-0057 EXPIRATION DATE: 05/31/2005
RESPS:30 HOURS:20 COSTS(000):$0
Application for Volunteer Program
FORMS: NONE
OMB NO: 2700-0063 EXPIRATION DATE: 05/31/2003
RESPS:75 HOURS:19 COSTS(000):$0
NASA Safety Reporting System
FORMS: NONE
OMB NO: 2700-0064 EXPIRATION DATE: 10/31/2003
RESPS:8,456 HOURS:702 COSTS(000):$0
Locator and Information Services Tracking System (LISTS) Form
FORMS: GSFC-24-27
OMB NO: 2700-0078 EXPIRATION DATE: 09/30/2003
RESPS:96 HOURS:140 COSTS(000):$0
Small Business and Small Disadvantaged Business Concerns
FORMS: NONE
OMB NO: 2700-0080 EXPIRATION DATE: 09/30/2003
RESPS:650 HOURS:2,113 COSTS(000):$0
Uncompensated Overtime
FORMS: NONE
OMB NO: 2700-0085 EXPIRATION DATE: 11/30/2003
RESPS:1,496 HOURS:663,816 COSTS(000):$0
NASA Acquisition Process, bids and proposals for contracts with
an estimated value mor than $500,000.
FORMS: NONE
OMB NO: 2700-0086 EXPIRATION DATE: 11/30/2003
RESPS:250,865 HOURS:73,380 COSTS(000):$0
NASA Acquisition Process, Purchase orders for goods and services
with an estimated value of $100,000 or less
FORMS: NONE
OMB NO: 2700-0087 EXPIRATION DATE: 11/30/2003
RESPS:11,000 HOURS:2,790,000 COSTS(000):$0
NASA Acquisition Process, bids and proposals for contracts with
an estimated value less than $500,000.
FORMS: NONE
OMB NO: 2700-0088 EXPIRATION DATE: 05/31/2005
RESPS:38,460 HOURS:1,065,600 COSTS(000):$0
NASA Acquisition Process - Reports Required on Contracts Valued
at less than $500 K
FORMS: NONE
OMB NO: 2700-0089 EXPIRATION DATE: 11/30/2003
RESPS:76,160 HOURS:609,280 COSTS(000):$0
NASA Acquisiiton Process, reports required for contracts with an
estimated value more than $500,000.
FORMS: NONE
OMB NO: 2700-0092 EXPIRATION DATE: 05/31/2005
RESPS:658 HOURS:4,592 COSTS(000):$0
Cooperative Agreements with Commercial Firms
FORMS: NONE
OMB NO: 2700-0095 EXPIRATION DATE: 03/31/2003
RESPS:200 HOURS:200 COSTS(000):$0
NASA Small Business Innovative Research Commercial Metrics
FORMS: NONE
OMB NO: 2700-0097 EXPIRATION DATE: 12/31/2002
RESPS:10,120 HOURS:5,060 COSTS(000):$0
Required Central Contractor Registration
FORMS: NONE
OMB NO: 2700-0098 EXPIRATION DATE: 03/31/2003
RESPS:400 HOURS:188,000 COSTS(000):$0
Security Requirements for Unclassified Information Technology
Resources
FORMS: NONE
OMB NO: 2700-0099 EXPIRATION DATE: 06/30/2002
RESPS:8,000 HOURS:5,907 COSTS(000):$0
National Aviation Operations Monitoring Service
FORMS: NONE
OMB NO: 2700-0101 EXPIRATION DATE: 02/28/2005
RESPS:720 HOURS:180 COSTS(000):$0
NASA Procurement Customer Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
23 468,085 5,811,418 $0
National Archives and Records Administration
OMB NO: 3095-0002 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:7 COSTS(000):$0
Statistical Research in Archival Records Containing Personal
Information
FORMS: NONE
OMB NO: 3095-0004 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:552 COSTS(000):$8
NHPRC Budget Form and Instructions
FORMS: NA-17001
OMB NO: 3095-0007 EXPIRATION DATE: 02/29/2004
RESPS:1,925 HOURS:160 COSTS(000):$0
Customer Comment Form
FORMS: NA-14045
OMB NO: 3095-0012 EXPIRATION DATE: 10/31/2002
RESPS:25 HOURS:37 COSTS(000):$0
Application for Attendance at the Institute for the Editing of
Historical Documents
FORMS: NONE
OMB NO: 3095-0013 EXPIRATION DATE: 10/31/2002
RESPS:134 HOURS:7,636 COSTS(000):$0
National Historical Publications and Records Commission Grant
Program
FORMS: NONE
OMB NO: 3095-0014 EXPIRATION DATE: 10/31/2002
RESPS:9 HOURS:72 COSTS(000):$0
Application for Archival Administration or Historical
Documentary Editing Fellowships
FORMS: NONE
OMB NO: 3095-0015 EXPIRATION DATE: 10/31/2002
RESPS:9 HOURS:153 COSTS(000):$0
Application for Host Institutions of Archival Administration or
Historical Documentary Editing Fellowships
FORMS: NONE
OMB NO: 3095-0016 EXPIRATION DATE: 03/31/2003
RESPS:22,728 HOURS:3,030 COSTS(000):$0
Researcher Application
FORMS: NA-14003 NA-14003A
OMB NO: 3095-0017 EXPIRATION DATE: 05/31/2003
RESPS:1 HOURS:50 COSTS(000):$0
Request to Microfilm Records
FORMS: NONE
OMB NO: 3095-0021 EXPIRATION DATE: 02/29/2004
RESPS:36 HOURS:216 COSTS(000):$0
National Historical Publications and Records Commission (NHPRC)
Subvention Grant Guidelines and Aplications
FORMS: NONE
OMB NO: 3095-0022 EXPIRATION DATE: 12/31/2003
RESPS:36 HOURS:36 COSTS(000):$0
National Historical Publications & Records Commission (NHPRC)
Annual Sales Report for Subvention Grants
FORMS: NONE
OMB NO: 3095-0023 EXPIRATION DATE: 03/31/2003
RESPS:6,400 HOURS:533 COSTS(000):$0
NARA Class Evaluation Form
FORMS: NA-2019
OMB NO: 3095-0024 EXPIRATION DATE: 08/31/2004
RESPS:1,000 HOURS:333 COSTS(000):$0
Application and Permit for Use of Space in Presidential
FORMS: NA-16011
OMB NO: 3095-0025 EXPIRATION DATE: 06/30/2004
RESPS:2,816 HOURS:704 COSTS(000):$0
Item Approval Request List
FORMS: NA-14110 NA-14110A
OMB NO: 3095-0026 EXPIRATION DATE: 08/31/2004
RESPS:1,266 HOURS:63 COSTS(000):$0
Request for and Record of Pass
FORMS: NA-6006
OMB NO: 3095-0027 EXPIRATION DATE: 03/31/2005
RESPS:97,600 HOURS:16,267 COSTS(000):$0
Order Forms for Genealogical Reserach in the National Archives
FORMS: NATF-81 NATF-82 NATF-83 NATF-84 NATF-85 NATF-86
OMB NO: 3095-0029 EXPIRATION DATE: 07/31/2002
RESPS:850,100 HOURS:172,300 COSTS(000):$0
Request Pertaining to Military Records
FORMS: SF-180
OMB NO: 3095-0033 EXPIRATION DATE: 04/30/2003
RESPS:10,000 HOURS:1,667 COSTS(000):$0
National Archives Order for Land Entry Files
FORMS: NATF-84
OMB NO: 3095-0035 EXPIRATION DATE: 11/30/2004
RESPS:1 HOURS:15 COSTS(000):$0
Request to use Paper-to-Paper Copiers at the National Archives
at the College Park Facility
FORMS: NONE
OMB NO: 3095-0036 EXPIRATION DATE: 04/30/2005
RESPS:1 HOURS:31 COSTS(000):$1
Presidential Library Facilities
FORMS: NONE
OMB NO: 3095-0037 EXPIRATION DATE: 08/31/2002
RESPS:4,500 HOURS:375 COSTS(000):$0
Returned request Form, Reply to Request Involving Relief
FORMS: NA-13022 NA-13064 NA-13068
OMB NO: 3095-0038 EXPIRATION DATE: 12/31/2002
RESPS:5,000 HOURS:1,250 COSTS(000):$0
Court Order Requirements
FORMS: NA-FORM-13027
OMB NO: 3095-0039 EXPIRATION DATE: 12/31/2002
RESPS:79,800 HOURS:6,650 COSTS(000):$0
Authorization for Release of Military Medical Patient Records,
for Information Needed to Reconstruct Medical Data, Questionnaire
FORMS: NA-FORMS-13036 13042 13055 13075
OMB NO: 3095-0040 EXPIRATION DATE: 05/31/2003
RESPS:660 HOURS:110 COSTS(000):$0
Request to film, photograph, or videotape at a NARA facility for
news purposes
FORMS: NONE
OMB NO: 3095-0042 EXPIRATION DATE: 08/31/2003
RESPS:4,000 HOURS:667 COSTS(000):$0
Military Personnel Records (MPR) Custmer Satisfaction Survey
FORMS: NONE
OMB NO: 3095-0043 EXPIRATION DATE: 05/31/2003
RESPS:52 HOURS:52 COSTS(000):$0
Request to use NARA facilities for events
FORMS: NA-16008
OMB NO: 3095-0045 EXPIRATION DATE: 10/31/2003
RESPS:13,300 HOURS:1,108 COSTS(000):$0
Applicant Background Survey
FORMS: NA-3035
OMB NO: 3095-0046 EXPIRATION DATE: 02/29/2004
RESPS:5,200 HOURS:867 COSTS(000):$0
Microfilm Order Form
FORMS: NATF-36
OMB NO: 3095-0047 EXPIRATION DATE: 04/30/2005
RESPS:130,000 HOURS:10,833 COSTS(000):$0
Customer Request for Information and Order Forms
FORMS: NA-14116
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
29 1,236,601 225,774 $9
National Commission on Libraries and Information Science
OMB NO: 3130-0005 EXPIRATION DATE: 04/30/2005
RESPS:325 HOURS:2 COSTS(000):$0
Assessment of NCLIS Sister Libraries Millennium project
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 325 2 $0
Institute of Museum and Library Services
OMB NO: 3137-0029 EXPIRATION DATE: 12/31/2003
RESPS:2,664 HOURS:36,432 COSTS(000):$0
Generic Clearance Grant Application Guidelines, Instructions and
Reporting Forms
FORMS: NONE
OMB NO: 3137-0040 EXPIRATION DATE: 01/31/2004
RESPS:1 HOURS:1,605 COSTS(000):$50,686
Technology Survey for Libraries and Museums
FORMS: NONE
OMB NO: 3137-0042 EXPIRATION DATE: 05/31/2004
RESPS:400 HOURS:78 COSTS(000):$0
Evaluation Professional Services Program
FORMS: NONE
OMB NO: 3137-0043 EXPIRATION DATE: 06/30/2004
RESPS:1 HOURS:2,250 COSTS(000):$33,533
Museum/School Program Research
FORMS: NONE
OMB NO: 3137-0044 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:135 COSTS(000):$0
Survey on the Partnerships in Museums in the Community Grant
Program
FORMS: NONE
OMB NO: 3137-0046 EXPIRATION DATE: 03/31/2004
RESPS:1 HOURS:116 COSTS(000):$0
Survey on User Need Assessments in Digitization Projects
FORMS: NONE
OMB NO: 3137-0047 EXPIRATION DATE: 03/31/2005
RESPS:1,500 HOURS:750 COSTS(000):$73,585
Evaluation of IMLS General Operating Support Grant Program for
Museums
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 4,568 41,366 $157,804
National Endowment for the Arts
OMB NO: 3135-0094 EXPIRATION DATE: 08/31/2004
RESPS:40 HOURS:1,800 COSTS(000):$0
Application for Indemnification
FORMS: NONE
OMB NO: 3135-0098 EXPIRATION DATE: 08/31/2003
RESPS:271 HOURS:54 COSTS(000):$0
National Endowment for the Arts Panelist Profile Form
FORMS: NONE
OMB NO: 3135-0112 EXPIRATION DATE: 07/31/2003
RESPS:4,805 HOURS:120,407 COSTS(000):$0
FY 2001 - FY 2004 Blanket Justification for NEA Funding
Application Guidelines and Reporting Requirements
FORMS: NONE
OMB NO: 3135-0114 EXPIRATION DATE: 04/30/2005
RESPS:40 HOURS:550 COSTS(000):$0
Customer Service Information Collection
FORMS: NONE
OMB NO: 3135-0116 EXPIRATION DATE: 05/31/2003
RESPS:1,062 HOURS:2,124 COSTS(000):$0
Civil Rights Compliance and Section 504 Accessibility Checklists
FORMS: NONE
OMB NO: 3135-0118 EXPIRATION DATE: 08/31/2002
RESPS:3,125 HOURS:1,239 COSTS(000):$0
Jazz Musician Survey
FORMS: NONE
OMB NO: 3135-0119 EXPIRATION DATE: 12/31/2002
RESPS:26,500 HOURS:4,417 COSTS(000):$0
2002 Survey of Public Participation in the Arts (SPPA)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 35,843 130,591 $0
National Endowment for the Humanities
OMB NO: 3136-0134 EXPIRATION DATE: 06/30/2003
RESPS:20,569 HOURS:91,301 COSTS(000):$3,378
Generic Clearance Authority for the National Endowment for the
Humanities
FORMS: NONE
OMB NO: 3136-0136 EXPIRATION DATE: 12/31/2002
RESPS:100,000 HOURS:100,000 COSTS(000):$0
My History is America's History Website
FORMS: NONE
OMB NO: 3136-0137 EXPIRATION DATE: 11/30/2004
RESPS:1,224 HOURS:612 COSTS(000):$0
General Clearance Authority to Develop Evaluation Instruments
for the National Endowment for the Humanities
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 121,793 191,913 $3,378
National Mediation Board
OMB NO: 3140-0001 EXPIRATION DATE: 08/31/2002
RESPS:68 HOURS:31 COSTS(000):$0
Application for Investigation of Representation Dispute
FORMS: NMB-1
OMB NO: 3140-0002 EXPIRATION DATE: 08/31/2002
RESPS:123 HOURS:17 COSTS(000):$0
Application for Mediation Services
FORMS: NMB-2
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 191 48 $0
National Science Foundation
OMB NO: 3145-0001 EXPIRATION DATE: 02/28/2005
RESPS:150 HOURS:262 COSTS(000):$0
Application for NATO Advanced Study Institutes Travel Award and
NATO Advanced Study Institutes Travel Award Report Form
FORMS: 192 250
OMB NO: 3145-0019 EXPIRATION DATE: 05/31/2003
RESPS:42,683 HOURS:14,228 COSTS(000):$0
Survey of Earned Doctorates
FORMS: NONE
OMB NO: 3145-0020 EXPIRATION DATE: 04/30/2003
RESPS:34,000 HOURS:14,167 COSTS(000):$0
2001 Survey of Doctorate Recipients (SDR)
FORMS: NONE
OMB NO: 3145-0023 EXPIRATION DATE: 09/30/2002
RESPS:13,000 HOURS:156,000 COSTS(000):$0
Fellowship Applications and Award Forms
FORMS: NONE
OMB NO: 3145-0027 EXPIRATION DATE: 01/31/2005
RESPS:24,200 HOURS:51,400 COSTS(000):$0
Survey of Industrial Research and Development, 2001-2004
FORMS: RD-1 RD-1A
OMB NO: 3145-0034 EXPIRATION DATE: 07/31/2004
RESPS:25 HOURS:12 COSTS(000):$0
Antarctic Conservation Act Application and Permit Form
FORMS: NONE
OMB NO: 3145-0035 EXPIRATION DATE: 08/31/2002
RESPS:137 HOURS:1,242 COSTS(000):$0
National Science Foundation Science Honor Awards
FORMS: NSF-1122 NSF-1123 NSF-1124
OMB NO: 3145-0058 EXPIRATION DATE: 08/31/2004
RESPS:30,000 HOURS:3,600,000 COSTS(000):$0
National Science Foundation Proposal/Award Information - Grant
Proposal Guide
FORMS: NONE
OMB NO: 3145-0060 EXPIRATION DATE: 03/31/2005
RESPS:96,000 HOURS:480,000 COSTS(000):$0
National Science Foundation Proposal Evaluation Process
FORMS: NSF-FORM-1 NSF-FORM-428
OMB NO: 3145-0062 EXPIRATION DATE: 05/31/2005
RESPS:11,793 HOURS:28,796 COSTS(000):$0
Survey of Graduate Students and Postdoctorates in Science and
Engineering
FORMS: NSF-811 NSF-812
OMB NO: 3145-0077 EXPIRATION DATE: 05/31/2004
RESPS:11,475 HOURS:5,737 COSTS(000):$0
2001 National Survey of Recent College Graduates
FORMS: NONE
OMB NO: 3145-0080 EXPIRATION DATE: 07/31/2003
RESPS:270 HOURS:56,010 COSTS(000):$0
Request for Proposals
FORMS: NONE
OMB NO: 3145-0096 EXPIRATION DATE: 08/31/2002
RESPS:2,000 HOURS:100 COSTS(000):$0
Applicant Survey
FORMS: 1232
OMB NO: 3145-0101 EXPIRATION DATE: 08/31/2002
RESPS:976 HOURS:1,302 COSTS(000):$0
National Survey of Scientific and Engineering Research
FORMS: NONE
OMB NO: 3145-0136 EXPIRATION DATE: 11/30/2004
RESPS:13,607 HOURS:40,325 COSTS(000):$0
EHR Generic Clearance
FORMS: NONE
OMB NO: 3145-0153 EXPIRATION DATE: 04/30/2005
RESPS:364 HOURS:146 COSTS(000):$0
Impact on Industry of Interaction with Engineering Research
Centers
FORMS: NONE
OMB NO: 3145-0157 EXPIRATION DATE: 09/30/2002
RESPS:50,280 HOURS:4,213 COSTS(000):$0
NSF Surveys to Measure Customer Service Satisfaction (FastLane
FORMS: NONE
OMB NO: 3145-0161 EXPIRATION DATE: 06/30/2002
RESPS:14,040 HOURS:4,950 COSTS(000):$0
Cross-Project Evaluation of The National Science Foundation's
Local Systemic Change Through Teacher Enhancement Program (LSC)
FORMS: NONE
OMB NO: 3145-0167 EXPIRATION DATE: 02/28/2003
RESPS:255 HOURS:540 COSTS(000):$205
An Evaluation of FY 1989-90 Awards made under the National
Science Foundation's Design and Manufacturing Research Programs
FORMS: NONE
OMB NO: 3145-0174 EXPIRATION DATE: 12/31/2003
RESPS:1,620 HOURS:6,240 COSTS(000):$0
Generic Survey Clearance of the Science Resources Studies Survey
Improvement Projects and Quick Response Studies
FORMS: NONE
OMB NO: 3145-0175 EXPIRATION DATE: 11/30/2003
RESPS:1,040 HOURS:780 COSTS(000):$0
Evaluation of the NSF Summer Programs in Japan; NSF postdoctoral
Fellowships in Japan; and the NSF-CGP Fellowship Program.
FORMS: NONE
OMB NO: 3145-0176 EXPIRATION DATE: 04/30/2004
RESPS:500 HOURS:2,000 COSTS(000):$0
Generic Survey Clearance of the Science Resources Studies Quick
Response Capability
FORMS: NONE
OMB NO: 3145-0177 EXPIRATION DATE: 05/31/2004
RESPS:3,120 HOURS:29,617 COSTS(000):$0
Medical Clearance Process for Deployment to the Polar Regions
FORMS: 1421 1422 1423 1424 1425 1426 1427 1428 1429 1451
OMB NO: 3145-0178 EXPIRATION DATE: 05/31/2004
RESPS:3,750 HOURS:750 COSTS(000):$0
Information Technology Innovation Survey
FORMS: NONE
OMB NO: 3145-0180 EXPIRATION DATE: 08/31/2004
RESPS:12 HOURS:480 COSTS(000):$0
Response plan and educational materials for non-governmental
Antarctic expeditions.
FORMS: NONE
OMB NO: 3145-0182 EXPIRATION DATE: 06/30/2002
RESPS:880 HOURS:843 COSTS(000):$0
Emergency Clearance for Cross-Site Analysis of the NSF
Integrative Graudation Education and Research Traineeships
Program
FORMS: NONE
OMB NO: 3145-0183 EXPIRATION DATE: 06/30/2002
RESPS:4,003 HOURS:788 COSTS(000):$0
Evaluation of the Preparing Future Faculty (PFF) Program
FORMS: NONE
OMB NO: 3145-0184 EXPIRATION DATE: 02/28/2005
RESPS:6,500 HOURS:4,875 COSTS(000):$0
eRecruitment System
FORMS: NONE
OMB NO: 3145-0185 EXPIRATION DATE: 06/30/2002
RESPS:6,330 HOURS:1,760 COSTS(000):$0
Survey of Principal investigator and Institutional Views on NSF
Award Size and Duration
FORMS: NONE
OMB NO: 3145-0186 EXPIRATION DATE: 07/31/2002
RESPS:378 HOURS:270 COSTS(000):$0
Cross-Site Evaluation of USP Program
FORMS: NONE
OMB NO: 3145-0187 EXPIRATION DATE: 03/31/2005
RESPS:1 HOURS:1,253 COSTS(000):$0
Evaluation of NSF's Graduate teaching Fellows in K-12 Education
(GK-12)
FORMS: NONE
OMB NO: 3145-0188 EXPIRATION DATE: 04/30/2005
RESPS:150 HOURS:37 COSTS(000):$0
Survey of Colleges, Universities and Professional Development
Providers Regarding Evaluation Training Programs
FORMS: NONE
OMB NO: 3145-0189 EXPIRATION DATE: 05/31/2005
RESPS:1 HOURS:68 COSTS(000):$0
Outcomes and Impact of the NSF Minority Postdoctoral Research
Fellowships (MPRF) Program
FORMS: NONE
OMB NO: 3145-0190 EXPIRATION DATE: 05/31/2005
RESPS:795 HOURS:318 COSTS(000):$0
Evaluation of NSF's Louis Stokes Alliances for Minority
Participation (LSAMP) Program
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
34 374,335 4,509,509 $205
National Transportation Safety Board
OMB NO: 3147-0001 EXPIRATION DATE: 08/31/2004
RESPS:2,100 HOURS:2,100 COSTS(000):$0
Pilot/Operator Aircraft Accident/Incident Report
FORMS: FORM-6120.1
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2,100 2,100 $0
Office of Government Ethics
OMB NO: 3209-0001 EXPIRATION DATE: 03/31/2003
RESPS:260 HOURS:780 COSTS(000):$0
Executive Branch Personnel Public Financial Disclosure Report
FORMS: 278
OMB NO: 3209-0002 EXPIRATION DATE: 07/31/2002
RESPS:172 HOURS:29 COSTS(000):$0
Request to Inspect or Receive Copies of SF-278 Executive Branch
Personnel Public Financial Disclosure Report or Other Covered
Record
FORMS: 201
OMB NO: 3209-0006 EXPIRATION DATE: 07/31/2002
RESPS:10 HOURS:15 COSTS(000):$0
Executive Branch Confidential Financial Disclosure Report
FORMS: OGE-450
OMB NO: 3209-0007 EXPIRATION DATE: 03/31/2005
RESPS:294 HOURS:3,785 COSTS(000):$0
Executive Branch Qualified Trust Documents (see item #'s 1.-2.
of the Supporting Statement for precise title of all documents)
FORMS: NONE
OMB NO: 3209-0009 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:3 COSTS(000):$0
Public Financial Disclosure Access Customer Service Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 786 4,612 $0
Office of Management and Budget
OMB NO: 0348-0057 EXPIRATION DATE: 12/31/2003
RESPS:60,000 HOURS:1,036,800 COSTS(000):$0
Data Collection Form for Reporting on Audits of States, Local
Governments, and Non-Profit Organizations
FORMS: SF-SAC
OMB NO: 0348-0058 EXPIRATION DATE: 06/30/2003
RESPS:141 HOURS:514 COSTS(000):$0
A-21 Facilities and Administrative Proposal
FORMS: NONE
OMB NO: 0348-0059 EXPIRATION DATE: 06/30/2002
RESPS:150 HOURS:6,000 COSTS(000):$0
Emergency Air Carrier Loan Guarantee Program
FORMS: 001
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 60,291 1,043,314 $0
Office of National Drug Control Policy
OMB NO: 3201-0007 EXPIRATION DATE: 12/31/2004
RESPS:1,000 HOURS:250 COSTS(000):$0
Community Drug Prevention Campaign Tracking Study
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 1,000 250 $0
Office of Personnel Management
OMB NO: 3206-0001 EXPIRATION DATE: 07/31/2002
RESPS:1 HOURS:450 COSTS(000):$0
Application for 10-Point Veteran Preference
FORMS: SF-15
OMB NO: 3206-0005 EXPIRATION DATE: 12/31/2004
RESPS:252,310 HOURS:314,555 COSTS(000):$0
SF 85, Questionnaire for Non-Sensitive Positions; SF 85P,
Questionnaire for Public Trust Positions; SF 85PS, Supplemental
Questionnaire for Selected Positions, SF 86, Questionnaire for...
FORMS: SF-85 SF-85P SF-85PS SF-86 SF-86A SF-86C
OMB NO: 3206-0006 EXPIRATION DATE: 05/31/2003
RESPS:1,560 HOURS:3,120 COSTS(000):$2
Monthly Report of Federal Civilian Employment
FORMS: 113-A
OMB NO: 3206-0017 EXPIRATION DATE: 09/30/2002
RESPS:1 HOURS:17 COSTS(000):$0
Medicare Part B Certification
FORMS: RI-78-11
OMB NO: 3206-0032 EXPIRATION DATE: 11/30/2004
RESPS:14,000 HOURS:2,800 COSTS(000):$0
Self-Certification of Full-Time School Attendance
FORMS: RI-25-14
OMB NO: 3206-0033 EXPIRATION DATE: 03/31/2003
RESPS:1,000 HOURS:250 COSTS(000):$0
Marital Status Certification
FORMS: RI-25-7
OMB NO: 3206-0034 EXPIRATION DATE: 09/30/2003
RESPS:21,000 HOURS:12,250 COSTS(000):$0
Annuitant's Report of Earned Income
FORMS: 30-2
OMB NO: 3206-0036 EXPIRATION DATE: 08/31/2002
RESPS:21,200 HOURS:75,800 COSTS(000):$0
Establishment Information Form, Wage Data Collection Form, Wage
Data Collection Continuation Form
FORMS: DD-1918 DD-1919 DD-1919C
OMB NO: 3206-0040 EXPIRATION DATE: 08/31/2002
RESPS:500,000 HOURS:225,000 COSTS(000):$0
Qualifications and Availability Form
FORMS: 1203AW 1203FX
OMB NO: 3206-0042 EXPIRATION DATE: 03/31/2003
RESPS:1 HOURS:1,250 COSTS(000):$0
Notice of Change in Student's Status
FORMS: RI-25-15
OMB NO: 3206-0061 EXPIRATION DATE: 11/30/2004
RESPS:50 HOURS:13 COSTS(000):$0
Application for Minimum Annuity
FORMS: RI-20-1
OMB NO: 3206-0076 EXPIRATION DATE: 02/29/2004
RESPS:10 HOURS:4 COSTS(000):$0
Application to be Listed Under the Voting Rights of 1965
FORMS: OPMFORM805 SERIES
OMB NO: 3206-0082 EXPIRATION DATE: 07/31/2002
RESPS:2,000 HOURS:4,000 COSTS(000):$0
Presidential Management Intern Program Application
FORMS: PMI-01
OMB NO: 3206-0095 EXPIRATION DATE: 08/31/2002
RESPS:100,000 HOURS:8,333 COSTS(000):$0
Applicant Race and National Origin Questionnaire
FORMS: OPM-1386B
OMB NO: 3206-0099 EXPIRATION DATE: 08/31/2003
RESPS:1,200 HOURS:1,800 COSTS(000):$0
Initial Certification of Full-time School Attendance
FORMS: RI-25-41
OMB NO: 3206-0106 EXPIRATION DATE: 07/31/2004
RESPS:5,700 HOURS:570 COSTS(000):$0
Mail Reinterview Form
FORMS: IS-10
OMB NO: 3206-0121 EXPIRATION DATE: 09/30/2004
RESPS:3,000 HOURS:3,000 COSTS(000):$0
Application for Deferred Retirement (Separations before October
1, 1956) -- Application for Deferred Retirement (Separations on
or after October 1, 1956)
FORMS: OPM-1496 OPM-1496A
OMB NO: 3206-0128 EXPIRATION DATE: 07/31/2004
RESPS:60,990 HOURS:31,298 COSTS(000):$0
Application for Refund of Retirement Deductions (CSRS)
FORMS: SF-2802 SF-2802B
OMB NO: 3206-0131 EXPIRATION DATE: 01/31/2003
RESPS:1,400 HOURS:4,200 COSTS(000):$154
Combined Federal Campaign
FORMS: OPM-1647
OMB NO: 3206-0134 EXPIRATION DATE: 05/31/2003
RESPS:150 HOURS:75 COSTS(000):$0
Application to Make Deposit or Redeposit (CSRS) Application to
Make Service Credit Payment for Civilian Service (FERS)
FORMS: SF-2803 SF-3108
OMB NO: 3206-0136 EXPIRATION DATE: 12/31/2003
RESPS:41,000 HOURS:10,250 COSTS(000):$0
Designation of Beneficiary: Federal Employees' Group Life
Insurance Program
FORMS: SF-2823
OMB NO: 3206-0138 EXPIRATION DATE: 09/30/2003
RESPS:200 HOURS:200 COSTS(000):$0
Reinstatement of Disability Annuity Previously Terminated
Because of Restoration to Earning Capacity
FORMS: RI-30-9
OMB NO: 3206-0140 EXPIRATION DATE: 03/31/2004
RESPS:12,730 HOURS:6,490 COSTS(000):$0
RI 20-7 - Representative Payee Application RI 30-3 - Information
Necessary for a Competency Determination
FORMS: RI-20-7 RI-30-3
OMB NO: 3206-0141 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:16,667 COSTS(000):$0
Health Benefits Registration Form
FORMS: OPM-2809
OMB NO: 3206-0142 EXPIRATION DATE: 09/30/2004
RESPS:2,000 HOURS:500 COSTS(000):$0
Designation of Beneficiary (CSRS)
FORMS: SF-2808
OMB NO: 3206-0143 EXPIRATION DATE: 05/31/2004
RESPS:8,000 HOURS:8,000 COSTS(000):$0
Request to Disability Annuitant for Information on Physical
Condition and Employment
FORMS: RI-30-1
OMB NO: 3206-0144 EXPIRATION DATE: 09/30/2002
RESPS:1 HOURS:250 COSTS(000):$0
We Need the Social Security Number of the Person Named Below
FORMS: RI-38-45
OMB NO: 3206-0150 EXPIRATION DATE: 09/30/2004
RESPS:225,000 HOURS:18,750 COSTS(000):$0
Fingerprint Charts
FORMS: SF-87 SF-87A
OMB NO: 3206-0156 EXPIRATION DATE: 05/31/2005
RESPS:74,800 HOURS:56,100 COSTS(000):$0
Application for Death Benefits Under the Civil Service
Retirement System Documentation and Elections in Support of
Application for Death Benefits When the Deceased Was an Employee
at the Time of..
FORMS: SF-2800 SF-2800A
OMB NO: 3206-0160 EXPIRATION DATE: 06/30/2002
RESPS:9,000 HOURS:4,500 COSTS(000):$0
Employee Health Benefits Election Form
FORMS: SF-2809
OMB NO: 3206-0162 EXPIRATION DATE: 10/31/2004
RESPS:500 HOURS:750 COSTS(000):$0
Report of Medical Examination of Person Electing Survivor
Benefits Under the Civil Service Retirement System
FORMS: OPM-1530
OMB NO: 3206-0165 EXPIRATION DATE: 03/31/2005
RESPS:1,962,947 HOURS:162,924 COSTS(000):$0
Investigative Request for Employment Data & Supervisory
Information; Investigation Request for Personal Information;
Investigative Request for Educational Registrar and Dean of.....
FORMS: INV-41 INV-42 INV-43 INV-44
OMB NO: 3206-0167 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:2,081 COSTS(000):$0
Financial Resources Questionnaire Notice of Amount Due Because
of Annuity Overpayment
FORMS: RI-34-1 RI-34-3
OMB NO: 3206-0170 EXPIRATION DATE: 05/31/2005
RESPS:30,600 HOURS:9,633 COSTS(000):$0
Application for Refund of REtirement Deductions/Federal
Employees Retirement System (SF 3106) Current/Former Spouse's
Notification of Application for Refund of Retirement Deductions
Under the....
FORMS: SF-3106 SF-3106A
OMB NO: 3206-0172 EXPIRATION DATE: 12/31/2003
RESPS:8,061 HOURS:8,061 COSTS(000):$0
Application for Death Benefits/Federal Employees' Retirement
System Documentation and Elections in Support of Application for
Death Benefits when Deceased was an Employee at the Time of Death
FORMS: SF-3104 SF-3104B
OMB NO: 3206-0173 EXPIRATION DATE: 09/30/2002
RESPS:1,273 HOURS:318 COSTS(000):$0
Designation of Beneficiary (FERC)
FORMS: 3102
OMB NO: 3206-0174 EXPIRATION DATE: 05/31/2003
RESPS:2,400 HOURS:1,834 COSTS(000):$0
Survivor Annuity Election for a Spouse/Cover Letter for RI 20-63
Giving Information About the Cost to elect Less Than the Maximum
Survivor Annuity/Cover Letter for RI 20-63 Giving Information....
FORMS: RI-20-63 RI-20-116 RI-20-117
OMB NO: 3206-0179 EXPIRATION DATE: 07/31/2004
RESPS:2,500 HOURS:2,500 COSTS(000):$0
Disabled Dependent Questionnaire
FORMS: RI-30-10
OMB NO: 3206-0182 EXPIRATION DATE: 09/30/2003
RESPS:435,000 HOURS:108,750 COSTS(000):$0
Declaration for Federal Employment, Optional Form 306
FORMS: NONE
OMB NO: 3206-0187 EXPIRATION DATE: 02/28/2005
RESPS:8,000 HOURS:1,333 COSTS(000):$0
We Need More Information About Your Missing Payment
FORMS: RI-38-31
OMB NO: 3206-0190 EXPIRATION DATE: 08/31/2003
RESPS:1,272 HOURS:1,272 COSTS(000):$0
Application for Deferred or Postponed Retirement (FERS)
FORMS: RI-92-19 RI-92-19A
OMB NO: 3206-0193 EXPIRATION DATE: 02/28/2005
RESPS:360 HOURS:180 COSTS(000):$0
Campaign Results Report
FORMS: OPM-ONLINE-1417
OMB NO: 3206-0194 EXPIRATION DATE: 09/30/2003
RESPS:180 HOURS:45 COSTS(000):$0
Annuity Supplement Earnings Report
FORMS: RI-92-22
OMB NO: 3206-0197 EXPIRATION DATE: 05/31/2003
RESPS:25,400 HOURS:4,234 COSTS(000):$0
Verification of Who Is Getting Payments
FORMS: 38-107
OMB NO: 3206-0199 EXPIRATION DATE: 05/31/2005
RESPS:2,230 HOURS:262 COSTS(000):$0
Nonforeign Area COLA Price and Background Surveys
FORMS: NONE
OMB NO: 3206-0201 EXPIRATION DATE: 01/31/2004
RESPS:112,000 HOURS:18,666 COSTS(000):$0
Federal Employees Health Benefits (FEHB) Open Season Express
Interactive Voice Response (IVR) System
FORMS: NONE
OMB NO: 3206-0202 EXPIRATION DATE: 08/31/2004
RESPS:1,400 HOURS:20,250 COSTS(000):$0
Request to Change FEHB Enrollment or to receive Plan brochures
for Spouse Equity and Temporary Continuation of Coverage
Enrollees
FORMS: DPRS-2809
OMB NO: 3206-0204 EXPIRATION DATE: 03/31/2005
RESPS:19,000 HOURS:9,500 COSTS(000):$0
Court Orders Affecting Retirement Benefits - 5 CFR Sections
838.221, 838.421, and 838.721
FORMS: NONE
OMB NO: 3206-0206 EXPIRATION DATE: 06/30/2002
RESPS:250 HOURS:250 COSTS(000):$0
Evidence to Prove Dependency of a Child
FORMS: RI-25-37
OMB NO: 3206-0208 EXPIRATION DATE: 10/31/2003
RESPS:4,067 HOURS:1,356 COSTS(000):$0
Representative Payee Survey
FORMS: RI-38-115
OMB NO: 3206-0211 EXPIRATION DATE: 12/31/2003
RESPS:3,000 HOURS:350 COSTS(000):$0
Reemployment of Annuitants - 5 CFR Section 837.103
FORMS: NONE
OMB NO: 3206-0212 EXPIRATION DATE: 10/31/2004
RESPS:1,000 HOURS:500 COSTS(000):$0
Rollover Election
FORMS: RI-38-117 38-118 37-22
OMB NO: 3206-0213 EXPIRATION DATE: 07/31/2004
RESPS:2,600 HOURS:1,300 COSTS(000):$0
Marital Information Required of Refund Applicants
FORMS: RI-95-4
OMB NO: 3206-0215 EXPIRATION DATE: 09/30/2002
RESPS:1 HOURS:10,000 COSTS(000):$0
Verification of Full-Time School Attendance
FORMS: RI-25-49
OMB NO: 3206-0216 EXPIRATION DATE: 11/30/2002
RESPS:5,500 HOURS:458 COSTS(000):$0
We need important information about your eligibility for social
security benefits our records show that you have not received a
decision from the Social Security Administration
FORMS: RI-98-7
OMB NO: 3206-0218 EXPIRATION DATE: 10/31/2004
RESPS:1,850 HOURS:1,850 COSTS(000):$0
Death Benefit Payment Rollover Election Form
FORMS: RI-94-7
OMB NO: 3206-0219 EXPIRATION DATE: 08/31/2004
RESPS:431,600 HOURS:237,900 COSTS(000):$0
Applying for a Federal Job (OF 510) and Optional Application for
Federal Employment (OF 612)
FORMS: OF-510 OF-612
OMB NO: 3206-0224 EXPIRATION DATE: 08/31/2002
RESPS:245,000 HOURS:4,083 COSTS(000):$0
Federal Employment Information Customer Survey
FORMS: OPM-1593
OMB NO: 3206-0226 EXPIRATION DATE: 12/31/2003
RESPS:45,500 HOURS:22,750 COSTS(000):$0
It's Time to Sign Up for Direct Deposit
FORMS: RI-38-128
OMB NO: 3206-0228 EXPIRATION DATE: 12/31/2003
RESPS:12,775 HOURS:12,775 COSTS(000):$0
CSRS/FERS Documentation in Support of Disability Retirement
Application
FORMS: SF-3112
OMB NO: 3206-0229 EXPIRATION DATE: 05/31/2005
RESPS:100 HOURS:17 COSTS(000):$0
Application for Federal Employee Commercial Garnishment
FORMS: OF-311
OMB NO: 3206-0230 EXPIRATION DATE: 05/31/2003
RESPS:100 HOURS:25 COSTS(000):$0
Life Insurance Election
FORMS: SF-2817
OMB NO: 3206-0232 EXPIRATION DATE: 06/30/2004
RESPS:100 HOURS:100 COSTS(000):$0
Procedures for Submitting Compensation and Leave Claims
FORMS: NONE
OMB NO: 3206-0233 EXPIRATION DATE: 10/31/2004
RESPS:34,800 HOURS:17,400 COSTS(000):$0
Civil Service Retirement System Survivor Annuitant Express Pay
Apkication for Death Benefits
FORMS: RI-25-51
OMB NO: 3206-0234 EXPIRATION DATE: 12/31/2004
RESPS:3,000 HOURS:750 COSTS(000):$0
Claim for Unpaid Compensation of Decreased Civilian Employee
FORMS: SF-1153
OMB NO: 3206-0235 EXPIRATION DATE: 03/31/2005
RESPS:30 HOURS:23 COSTS(000):$0
Survivor Annuity Election for a Former Spouse
FORMS: RI-20-64
OMB NO: 3206-0236 EXPIRATION DATE: 08/31/2002
RESPS:7,333,355 HOURS:118,000 COSTS(000):$0
Generic Clearance Package for FY 1998, 1999, 2000
FORMS: NONE
OMB NO: 3206-0237 EXPIRATION DATE: 03/31/2005
RESPS:3,100 HOURS:2,325 COSTS(000):$0
Information and Instructions on Your Reconsideration Rights
FORMS: RI-38-47
OMB NO: 3206-0239 EXPIRATION DATE: 06/30/2002
RESPS:9,000 HOURS:4,500 COSTS(000):$0
Annuitant/OWCP Health Benefits Election Form
FORMS: 2809-1
OMB NO: 3206-0240 EXPIRATION DATE: 08/31/2004
RESPS:5,000 HOURS:833 COSTS(000):$0
Child Care Tuition Assistance Program-Provider Information
FORMS: OPM-1644
OMB NO: 3206-0242 EXPIRATION DATE: 08/31/2002
RESPS:1,560,000 HOURS:156,000 COSTS(000):$0
We're Listening - A Survey of the OHRD Website
FORMS: NONE
OMB NO: 3206-0243 EXPIRATION DATE: 08/31/2002
RESPS:1,800 HOURS:300 COSTS(000):$0
Customer Satisfaction Survey
FORMS: NONE
OMB NO: 3206-0244 EXPIRATION DATE: 11/30/2002
RESPS:300,000 HOURS:35,000 COSTS(000):$0
Website Customer Satisfaction Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
73 13,974,957 1,791,930 $156
Office of Special Counsel
OMB NO: 3255-0002 EXPIRATION DATE: 08/31/2003
RESPS:2,246 HOURS:2,689 COSTS(000):$0
(a) Complaint of Possible Prohibited Personnel Practice or Other
Prohibited Activity; (b) Disclosure of Information
FORMS: OSC-11 OSC-12
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2,246 2,689 $0
Office of Science and Technology Policy
OMB NO: 0349-0002 EXPIRATION DATE: 11/30/2002
RESPS:120 HOURS:60 COSTS(000):$0
OSTP Evaluation of Performance as Required under the Government
Performance and Results Act (GPRA)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 120 60 $0
Office of the United States Trade Representative
OMB NO: 0350-0010 EXPIRATION DATE: 07/31/2002
RESPS:30 HOURS:60 COSTS(000):$0
Applications for inclusion on NAFTA Chapter 20 dispute
settlement panelist roster.
FORMS: NONE
OMB NO: 0350-0011 EXPIRATION DATE: 10/31/2002
RESPS:600 HOURS:9,000 COSTS(000):$0
Questionnaire for Exclusion Requestors Under Section 203 of the
Trade Act
FORMS: NONE
OMB NO: 0350-0012 EXPIRATION DATE: 10/31/2002
RESPS:495 HOURS:3,960 COSTS(000):$0
Questionnair for Objectors under Section 203 of the Trade Act of
1974.
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 1,125 13,020 $0
Overseas Private Investment Corporation
OMB NO: 3420-0001 EXPIRATION DATE: 08/31/2004
RESPS:850 HOURS:425 COSTS(000):$0
Request for registration for political risk investment insurance
FORMS: OPIC-50
OMB NO: 3420-0004 EXPIRATION DATE: 10/31/2004
RESPS:25 HOURS:175 COSTS(000):$0
Project Information Report
FORMS: OPIC-71
OMB NO: 3420-0011 EXPIRATION DATE: 06/30/2003
RESPS:150 HOURS:975 COSTS(000):$0
Application for Political Risk Investment Insurance
FORMS: OPIC-52
OMB NO: 3420-0015 EXPIRATION DATE: 07/31/2004
RESPS:300 HOURS:900 COSTS(000):$0
Finance Application
FORMS: OPIC-115
OMB NO: 3420-0018 EXPIRATION DATE: 03/31/2003
RESPS:123 HOURS:735 COSTS(000):$0
Sponsor Disclosure Report in Support of an Application for
Financing
FORMS: OPIC-129
OMB NO: 3420-0019 EXPIRATION DATE: 07/31/2003
RESPS:200 HOURS:600 COSTS(000):$0
Self-Monitoring Questionnaire for Insurance and Finance Projects
FORMS: OPIC162
OMB NO: 3420-0020 EXPIRATION DATE: 08/31/2003
RESPS:30 HOURS:30 COSTS(000):$0
Expedited Screening Questionnaire -- Downstream Investments
FORMS: OPIC-168
OMB NO: 3420-0022 EXPIRATION DATE: 08/31/2003
RESPS:50 HOURS:200 COSTS(000):$0
Small Business Application for Political Risk Investment
Insurance
FORMS: OPIC-223
OMB NO: 3420-0023 EXPIRATION DATE: 07/31/2003
RESPS:190 HOURS:570 COSTS(000):$0
Self Monitoring Questionnaire for Investment Funds Projects
FORMS: OPIC-217
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 1,918 4,610 $0
Peace Corps
OMB NO: 0420-0001 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:2,500 COSTS(000):$27,062
National Agency Check Questionnaire for Peace Corps Volunteer
Background Investigation
FORMS: PC-5
OMB NO: 0420-0005 EXPIRATION DATE: 04/30/2005
RESPS:30,000 HOURS:240,000 COSTS(000):$104,954
Peace Corps Volunteer Application Form
FORMS: PC-1502
OMB NO: 0420-0006 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:13,692 COSTS(000):$0
Peace Corps Reference Form
FORMS: RMB-27
OMB NO: 0420-0007 EXPIRATION DATE: 04/30/2005
RESPS:35,000 HOURS:1,021 COSTS(000):$0
Request for Information Card
FORMS: PC-1741
OMB NO: 0420-0510 EXPIRATION DATE: 02/29/2004
RESPS:12,500 HOURS:4,625 COSTS(000):$16
Health Status Review/Report of Medical Exam
FORMS: PC-1789 PC-1790
OMB NO: 0420-0513 EXPIRATION DATE: 06/30/2002
RESPS:10,000 HOURS:833 COSTS(000):$0
Teacher Brochure/Enrollment Form
FORMS: NONE
OMB NO: 0420-0529 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:8,100 COSTS(000):$55
Peace Corps Day Brochure
FORMS: NONE
OMB NO: 0420-0531 EXPIRATION DATE: 04/30/2005
RESPS:5,000 HOURS:150 COSTS(000):$8,900
Peace Corps Career Information Consultants (CIC) Waiver Form
FORMS: CIC-11/00-RVS15
OMB NO: 0420-0533 EXPIRATION DATE: 08/31/2003
RESPS:1,000 HOURS:83 COSTS(000):$0
Peace Corps - Crisis Corps Application
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 93,503 271,004 $140,987
Pension Benefit Guaranty Corporation
OMB NO: 1212-0009 EXPIRATION DATE: 01/31/2005
RESPS:45,900 HOURS:2,540 COSTS(000):$9,657
Payment of Premiums (29 CFR Part 4007), Disclosure to
Participants (29 CFR Part 4011)
FORMS: FORM-1 FORM-1-EZ FORM-1-ES
OMB NO: 1212-0013 EXPIRATION DATE: 11/30/2002
RESPS:305 HOURS:1,249 COSTS(000):$187
Reportable Events
FORMS: 10 10-ADVANCE
OMB NO: 1212-0017 EXPIRATION DATE: 10/31/2004
RESPS:6 HOURS:72 COSTS(000):$72
Liability for Termination of Single-Employer Plans
FORMS: NONE
OMB NO: 1212-0020 EXPIRATION DATE: 11/30/2004
RESPS:1,411 HOURS:23 COSTS(000):$9
Termination of Multiemployer Plans (29 CFR Part 4041A)
FORMS: NONE
OMB NO: 1212-0021 EXPIRATION DATE: 11/30/2004
RESPS:24 HOURS:1 COSTS(000):$3
Variances for Sale of Assets (29 CFR Part 4204)
FORMS: NONE
OMB NO: 1212-0022 EXPIRATION DATE: 11/30/2004
RESPS:35 HOURS:8 COSTS(000):$5
Mergers and Transfers Between Multiemployer Plans (29 CFR Part
4231)
FORMS: NONE
OMB NO: 1212-0023 EXPIRATION DATE: 11/30/2004
RESPS:1 HOURS:1 COSTS(000):$3
Extension of Special Withdrawal Liability Rules (29 CFR Part
4203)
FORMS: NONE
OMB NO: 1212-0030 EXPIRATION DATE: 01/31/2003
RESPS:32 HOURS:32 COSTS(000):$0
Survey of Nonparticipating Single-Premium Group Annuity Rates
FORMS: NONE
OMB NO: 1212-0031 EXPIRATION DATE: 11/30/2004
RESPS:3 HOURS:1 COSTS(000):$0
Procedures for PBGC Approval of Plan Amendments (29 CFR Part
4220)
FORMS: NONE
OMB NO: 1212-0032 EXPIRATION DATE: 11/30/2004
RESPS:23,357 HOURS:1 COSTS(000):$115
Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part
4281)
FORMS: NONE
OMB NO: 1212-0033 EXPIRATION DATE: 11/30/2004
RESPS:838 HOURS:1 COSTS(000):$1
Notice of Insolvency (29 CFR Part 4245)
FORMS: NONE
OMB NO: 1212-0034 EXPIRATION DATE: 11/30/2004
RESPS:179 HOURS:4 COSTS(000):$5
Notice, Collection, and Redetermination of Withdrawal Liability
(29 CFR Part 4219)
FORMS: NONE
OMB NO: 1212-0035 EXPIRATION DATE: 11/30/2004
RESPS:5 HOURS:10 COSTS(000):$0
Allocating Unfunded Vested Benefits (29 CFR Part 4211)
FORMS: NONE
OMB NO: 1212-0036 EXPIRATION DATE: 05/31/2004
RESPS:1,564 HOURS:2,246 COSTS(000):$1,865
Termination of Single Employer Plans
FORMS: 500 501 600 601 602 SCHEDULES-EA-S REP-S EA-D MP
OMB NO: 1212-0039 EXPIRATION DATE: 11/30/2004
RESPS:2,001 HOURS:250 COSTS(000):$200
Reduction or Waiver of Partial Withdrawal Liability (29 CFR Part
4208)
FORMS: NONE
OMB NO: 1212-0041 EXPIRATION DATE: 10/31/2002
RESPS:25 HOURS:42 COSTS(000):$6
Notice of Failure to Make Required Contributions
FORMS: 200
OMB NO: 1212-0044 EXPIRATION DATE: 11/30/2004
RESPS:201 HOURS:25 COSTS(000):$20
Reduction or Waiver of Complete Withdrawal Liability (29 CFR
Part 4207)
FORMS: NONE
OMB NO: 1212-0049 EXPIRATION DATE: 03/31/2005
RESPS:70 HOURS:552 COSTS(000):$700
Annual Financial and Actuarial Information Reporting (29 CFR
Part 4010)
FORMS: NONE
OMB NO: 1212-0050 EXPIRATION DATE: 11/30/2004
RESPS:3,331 HOURS:8,878 COSTS(000):$355
Disclosure to Participants
FORMS: NONE
OMB NO: 1212-0053 EXPIRATION DATE: 06/30/2003
RESPS:9,500 HOURS:2,500 COSTS(000):$0
Customer Service Focus Groups and Surveys
FORMS: NONE
OMB NO: 1212-0054 EXPIRATION DATE: 08/31/2003
RESPS:300 HOURS:104 COSTS(000):$119
Qualified Domestic Relations Orders Submitted to the PBGC
FORMS: NONE
OMB NO: 1212-0055 EXPIRATION DATE: 11/30/2002
RESPS:133,750 HOURS:71,000 COSTS(000):$45
Locating and Paying Participants
FORMS: NONE
OMB NO: 1212-0057 EXPIRATION DATE: 12/31/2004
RESPS:37,700 HOURS:3,859 COSTS(000):$2,553
Annual Information Return/Report
FORMS: 5500-SERIES
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
23 260,538 93,399 $15,920
Railroad Retirement Board
OMB NO: 3220-0002 EXPIRATION DATE: 04/30/2004
RESPS:19,100 HOURS:11,634 COSTS(000):$0
Application for Employee Annuity Under the Railroad Retirement
Act
FORMS: AA-1 AA-1D G-204
OMB NO: 3220-0005 EXPIRATION DATE: 08/31/2004
RESPS:2,968 HOURS:474 COSTS(000):$0
Employer Reporting
FORMS: AA-12 G-88A.1 G.88A.2 BA-6A
OMB NO: 3220-0007 EXPIRATION DATE: 08/31/2004
RESPS:1,150 HOURS:382 COSTS(000):$0
Appeal Under the Railroad Retirement and Railroad Unemployment
Insurance Act
FORMS: HA-1
OMB NO: 3220-0008 EXPIRATION DATE: 02/28/2005
RESPS:1,028 HOURS:37,980 COSTS(000):$0
Railroad Service and Compensation Reports
FORMS: BA-3A BA-4
OMB NO: 3220-0012 EXPIRATION DATE: 02/28/2003
RESPS:2,200 HOURS:917 COSTS(000):$0
Employer's Quarterly Report of Contribution Under
FORMS: DC-1
OMB NO: 3220-0014 EXPIRATION DATE: 07/31/2003
RESPS:65 HOURS:33 COSTS(000):$0
Employee Representatives' Status and Compensation Reports
FORMS: DC-2A DC-2
OMB NO: 3220-0016 EXPIRATION DATE: 05/31/2005
RESPS:3,600 HOURS:360 COSTS(000):$0
Certification of Relinquishment of Rights
FORMS: G-88
OMB NO: 3220-0021 EXPIRATION DATE: 01/31/2003
RESPS:1,100 HOURS:196 COSTS(000):$0
Evidence of Marital Relationship; Living with Requirements
FORMS: G-124 G-124A G-237 G-238 G-238A
OMB NO: 3220-0022 EXPIRATION DATE: 06/30/2003
RESPS:78,700 HOURS:8,617 COSTS(000):$0
Application and Claim for Unemployment Benefits and Employment
Service
FORMS: UI-1 UI-3
OMB NO: 3220-0025 EXPIRATION DATE: 11/30/2003
RESPS:7,905 HOURS:1,622 COSTS(000):$0
RUIA Investigations and Continuing Entitlement
FORMS: UI-9 UI-23 ID-4F ID-4U ID-4X ID-4Y ID-20-1 ID-20-2 ID-20-4
ID-5I.........
OMB NO: 3220-0030 EXPIRATION DATE: 03/31/2004
RESPS:4,137 HOURS:1,718 COSTS(000):$0
Application for Survivor Insurance Annuities
FORMS: AA-17 AA-17B AA-17CERT AA-18 AA-19 AA-19A AA-20
OMB NO: 3220-0031 EXPIRATION DATE: 01/31/2003
RESPS:20,600 HOURS:5,150 COSTS(000):$0
Application for Survivor Death Benefits
FORMS: AA-21 G-273A AA-11A G-131 AA-21CERT
OMB NO: 3220-0032 EXPIRATION DATE: 06/30/2003
RESPS:8,000 HOURS:1,391 COSTS(000):$0
Survivor Questionnaire
FORMS: RL-94-F
OMB NO: 3220-0034 EXPIRATION DATE: 11/30/2002
RESPS:400 HOURS:40 COSTS(000):$0
Statement of Authority To Act for Employee
FORMS: SI-10
OMB NO: 3220-0036 EXPIRATION DATE: 02/28/2005
RESPS:28,500 HOURS:1,691 COSTS(000):$0
Supplemental Information on Accident and Insurance
FORMS: SI-1C SI-5 ID-3S ID-3S-1 ID-3U ID-30K ID-30K-1
OMB NO: 3220-0038 EXPIRATION DATE: 10/31/2002
RESPS:29,950 HOURS:12,417 COSTS(000):$0
Medical Reports
FORMS: G-3EMP G-250 G-250A G-260 RL-11B RL-11D
OMB NO: 3220-0039 EXPIRATION DATE: 02/29/2004
RESPS:271,900 HOURS:27,971 COSTS(000):$0
Railroad Unemployment Insurance Act Applications
FORMS: SI-1A SI-1B SI-3 SI-7 SI-8 ID-7H ID-11A ID-11B
OMB NO: 3220-0042 EXPIRATION DATE: 06/30/2003
RESPS:8,500 HOURS:4,714 COSTS(000):$0
Application for Spouse Annuity Under the Railroad Retirement Act
FORMS: AA-3
OMB NO: 3220-0052 EXPIRATION DATE: 03/31/2004
RESPS:20,300 HOURS:16,350 COSTS(000):$0
Railroad Retirement Act Continuing Entitlement
FORMS: AA-5 G-478 RB-5
OMB NO: 3220-0055 EXPIRATION DATE: 02/28/2003
RESPS:200 HOURS:23 COSTS(000):$0
Application and Claim for RUIA Benefits Due at Death
FORMS: UI-63
OMB NO: 3220-0057 EXPIRATION DATE: 07/31/2004
RESPS:27,000 HOURS:1,494 COSTS(000):$0
Placement Service
FORMS: ES-2 ES-20A ES-20B ES-21 ES-21C UI-35
OMB NO: 3220-0070 EXPIRATION DATE: 10/31/2004
RESPS:3,000 HOURS:400 COSTS(000):$0
Employer Service and Compensation Reports
FORMS: UI-41 UI-41A
OMB NO: 3220-0079 EXPIRATION DATE: 08/31/2004
RESPS:2,900 HOURS:487 COSTS(000):$0
Certification Regarding Rights to Unemployment Benefits
FORMS: UI-45
OMB NO: 3220-0082 EXPIRATION DATE: 09/30/2003
RESPS:1,040 HOURS:165 COSTS(000):$0
Medicare
FORMS: AA-6 AA-7 AA-8 RL-311-F
OMB NO: 3220-0083 EXPIRATION DATE: 11/30/2003
RESPS:290 HOURS:121 COSTS(000):$0
Evidence for Application of Overall Minimum
FORMS: G-319 G-320
OMB NO: 3220-0086 EXPIRATION DATE: 07/31/2002
RESPS:35 HOURS:6 COSTS(000):$0
Application for Reimbursement for Hospital Services in Canada
FORMS: AA-104
OMB NO: 3220-0089 EXPIRATION DATE: 11/30/2002
RESPS:2,240 HOURS:300 COSTS(000):$0
Pension Plan Reports
FORMS: G-88P G-88R G-88R.1
OMB NO: 3220-0097 EXPIRATION DATE: 10/31/2004
RESPS:750 HOURS:63 COSTS(000):$0
Pay Rate Report
FORMS: UI-LE
OMB NO: 3220-0099 EXPIRATION DATE: 06/30/2002
RESPS:100 HOURS:129 COSTS(000):$0
Statement Regarding Contributions and Support
FORMS: G-134
OMB NO: 3220-0100 EXPIRATION DATE: 11/30/2002
RESPS:4,100 HOURS:1,025 COSTS(000):$0
Request for Review of Part B Medicare Claim
FORMS: G-790 G-791
OMB NO: 3220-0107 EXPIRATION DATE: 01/31/2003
RESPS:300 HOURS:150 COSTS(000):$0
Request to Non-Railroad Employer for Information About
Annuitant's Work and Earnings
FORMS: RL-231-F
OMB NO: 3220-0123 EXPIRATION DATE: 11/30/2003
RESPS:1,230 HOURS:121 COSTS(000):$0
Student Beneficiary Monitoring
FORMS: G-315 G-315A G-315A.1
OMB NO: 3220-0127 EXPIRATION DATE: 05/31/2005
RESPS:1,200 HOURS:1,700 COSTS(000):$0
Financial Disclosure Statement
FORMS: G-423
OMB NO: 3220-0131 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Request for Medicare Payment
FORMS: G-740S HCFA-1500
OMB NO: 3220-0132 EXPIRATION DATE: 01/31/2003
RESPS:556 HOURS:345 COSTS(000):$0
Gross Earnings Report
FORMS: BA-11
OMB NO: 3220-0136 EXPIRATION DATE: 03/31/2004
RESPS:2,700 HOURS:475 COSTS(000):$0
Public Service Pension Questionnaires
FORMS: G-208 G-212
OMB NO: 3220-0138 EXPIRATION DATE: 04/30/2004
RESPS:600 HOURS:415 COSTS(000):$0
Self-Employment Questionnaire
FORMS: AA-4
OMB NO: 3220-0140 EXPIRATION DATE: 01/31/2003
RESPS:5,400 HOURS:450 COSTS(000):$0
Employee's Certification
FORMS: G-346
OMB NO: 3220-0141 EXPIRATION DATE: 11/30/2003
RESPS:6,000 HOURS:3,045 COSTS(000):$0
Vocational Report
FORMS: G-251
OMB NO: 3220-0145 EXPIRATION DATE: 06/30/2003
RESPS:1,500 HOURS:750 COSTS(000):$0
Nonresident Questionnaire
FORMS: RRB-1001
OMB NO: 3220-0149 EXPIRATION DATE: 07/31/2004
RESPS:25,000 HOURS:1 COSTS(000):$0
Withholding Certificate for Railroad Retirement Monthly Annuity
Payments
FORMS: RRBW-4P
OMB NO: 3220-0151 EXPIRATION DATE: 10/31/2004
RESPS:6,535 HOURS:2,032 COSTS(000):$0
Representative Payee Monitoring
FORMS: G-99A G-99C
OMB NO: 3220-0154 EXPIRATION DATE: 07/31/2002
RESPS:500 HOURS:55 COSTS(000):$0
Employee Noncovered Service Pension Questionnaire
FORMS: G-209
OMB NO: 3220-0155 EXPIRATION DATE: 07/31/2004
RESPS:100 HOURS:17 COSTS(000):$0
Supplement to Claim of Person Outside the United States
FORMS: G-45
OMB NO: 3220-0156 EXPIRATION DATE: 06/30/2003
RESPS:4,000 HOURS:133 COSTS(000):$0
Employer's Deemed Service Month Questionnaire
FORMS: GL-99
OMB NO: 3220-0164 EXPIRATION DATE: 07/31/2002
RESPS:7,600 HOURS:1,085 COSTS(000):$0
Availability for Work
FORMS: UI-38 UI-38S ID-8K
OMB NO: 3220-0169 EXPIRATION DATE: 06/30/2003
RESPS:300 HOURS:25 COSTS(000):$0
Repayment of Debt
FORMS: G-421F
OMB NO: 3220-0171 EXPIRATION DATE: 06/30/2002
RESPS:18,600 HOURS:460 COSTS(000):$0
RUIA Claims Notification System
FORMS: ID-4K
OMB NO: 3220-0173 EXPIRATION DATE: 05/31/2005
RESPS:1,009 HOURS:1,262 COSTS(000):$0
Railroad Separation Allowance or Severance Pay Report
FORMS: BA-9
OMB NO: 3220-0175 EXPIRATION DATE: 02/28/2005
RESPS:239 HOURS:219 COSTS(000):$0
Sick Pay and Miscellaneous Payments Report
FORMS: BA-10
OMB NO: 3220-0176 EXPIRATION DATE: 05/31/2005
RESPS:1,850 HOURS:154 COSTS(000):$0
Representative Payee Parental Custody Monitoring
FORMS: G-99D
OMB NO: 3220-0178 EXPIRATION DATE: 07/31/2002
RESPS:3,000 HOURS:300 COSTS(000):$0
Aged Monitoring Questionnaire
FORMS: G-19C
OMB NO: 3220-0179 EXPIRATION DATE: 08/31/2002
RESPS:5,000 HOURS:1,250 COSTS(000):$0
Annual Earnings Questionnaire for Annuitants in Last
Pre-Retirement Non-Railroad Employment
FORMS: G-19L
OMB NO: 3220-0183 EXPIRATION DATE: 10/31/2003
RESPS:900 HOURS:225 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: G-93
OMB NO: 3220-0184 EXPIRATION DATE: 10/31/2004
RESPS:1,500 HOURS:200 COSTS(000):$0
Earnings Information Request
FORMS: G-19-F
OMB NO: 3220-0185 EXPIRATION DATE: 11/30/2004
RESPS:600 HOURS:100 COSTS(000):$0
Report of Medicaid State Office on Beneficiary's Buy-In Status
FORMS: RL-380-F
OMB NO: 3220-0187 EXPIRATION DATE: 08/31/2002
RESPS:3,500 HOURS:790 COSTS(000):$0
Continuing Disability Report
FORMS: G-254 G-254A
OMB NO: 3220-0192 EXPIRATION DATE: 09/30/2003
RESPS:3,330 HOURS:945 COSTS(000):$0
Voluntary Customer Surveys in Accordance with E.O. 12862
FORMS: G-201 T-15 T-16
OMB NO: 3220-0193 EXPIRATION DATE: 11/30/2003
RESPS:430 HOURS:144 COSTS(000):$0
Job Information Report
FORMS: G-251A G-251B
OMB NO: 3220-0195 EXPIRATION DATE: 05/31/2005
RESPS:500 HOURS:500 COSTS(000):$0
Statement Regarding Contributions and Support of Children
FORMS: G-139
OMB NO: 3220-0196 EXPIRATION DATE: 08/31/2004
RESPS:80 HOURS:13 COSTS(000):$0
Investigation of Claim for Possible Days of Employment
FORMS: ID-5S(SUP)
OMB NO: 3220-0197 EXPIRATION DATE: 11/30/2004
RESPS:90 HOURS:180 COSTS(000):$0
Verification of Supplement Annuity
FORMS: G-88P.1 G-88P.2
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
62 655,908 155,412 $0
Selective Service System
OMB NO: 3240-0002 EXPIRATION DATE: 06/30/2002
RESPS:1,271,326 HOURS:42,335 COSTS(000):$0
Selective Service Registration Form
FORMS: SSS-1 SSS-1M SSS-1(SRS)
OMB NO: 3240-0003 EXPIRATION DATE: 08/31/2002
RESPS:682,781 HOURS:22,736 COSTS(000):$0
SSS Change of Information, SSS Registration Status Form, SSS
Acknowledgment and Correction/Change Form
FORMS: SSS-2 SSS-3A SSS-3B SSS-3C
OMB NO: 3240-0005 EXPIRATION DATE: 11/30/2004
RESPS:900 HOURS:225 COSTS(000):$0
Potential Board Member Information
FORMS: SSS-404
OMB NO: 3240-0006 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Registrant Claim Form
FORMS: SSS-FORM-9
OMB NO: 3240-0010 EXPIRATION DATE: 08/31/2002
RESPS:2,705 HOURS:89 COSTS(000):$0
Uncompensated Registrar Appointment
FORMS: SSS-402
OMB NO: 3240-0014 EXPIRATION DATE: 05/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Registrant Travel Reimbursement Request
FORMS: SSS-350
OMB NO: 3240-0015 EXPIRATION DATE: 05/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Application for Voluntary Induction
FORMS: SSS-254
OMB NO: 3240-0017 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Application by Alien for Relief from Training and Service in the
Armed Forces of the United States
FORMS: SSS-130
OMB NO: 3240-0018 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Student Certificate
FORMS: SSS-109
OMB NO: 3240-0022 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form, Alien or Dual National
FORMS: SSS-26
OMB NO: 3240-0023 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form, Minister of Religion
FORMS: SSS-25
OMB NO: 3240-0024 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form, Hardship to Dependents
FORMS: SSS-24
OMB NO: 3240-0025 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form, Administrative Classifications
FORMS: SSS-21
OMB NO: 3240-0026 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form, Divinity Student
FORMS: SSS-23
OMB NO: 3240-0027 EXPIRATION DATE: 08/31/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form, Postponement of Induction
FORMS: SSS-27
OMB NO: 3240-0028 EXPIRATION DATE: 05/31/2003
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form-Conscientious Objector
FORMS: SSS-FORM-22
OMB NO: 3240-0029 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Worker Travel Reimbursement Request
FORMS: SS-FORM-164
OMB NO: 3240-0030 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Claim for Reimbursement for Emergency Medical Care
FORMS: SSS-FORM-166
OMB NO: 3240-0031 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Employer Data Sheet
FORMS: SSS-153
OMB NO: 3240-0032 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Skills Questionnaire
FORMS: SSS-FORM-156
OMB NO: 3240-0033 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Job Data Form
FORMS: SSS-157
OMB NO: 3240-0034 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Request for Overseas Job Assignment
FORMS: SSS-FORM-160
OMB NO: 3240-0035 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Employment Verification Form
FORMS: SSS-163
OMB NO: 3240-0036 EXPIRATION DATE: 06/30/2002
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Employment Agreement
FORMS: SSS-152
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
24 1,957,732 65,405 $0
Small Business Administration
OMB NO: 3245-0007 EXPIRATION DATE: 08/31/2003
RESPS:195,930 HOURS:53,375 COSTS(000):$0
Surety Bond Guarantee Assistance
FORMS: SBA-FORMS-990 991 994 994B 994C 994F 994H
OMB NO: 3245-0009 EXPIRATION DATE: 06/30/2004
RESPS:4,200 HOURS:700 COSTS(000):$0
Size Status Declaration
FORMS: SBA-FORM-480
OMB NO: 3245-0012 EXPIRATION DATE: 05/31/2005
RESPS:5,000 HOURS:5,000 COSTS(000):$0
Requests from borrowers (Financial Statements)
FORMS: 770
OMB NO: 3245-0016 EXPIRATION DATE: 11/30/2004
RESPS:60,000 HOURS:1,200,000 COSTS(000):$0
Applications for Business Loans
FORMS: FORM-4 SCH.-A FORM-4-1 FORM-4-L
OMB NO: 3245-0017 EXPIRATION DATE: 05/31/2004
RESPS:11,540 HOURS:28,821 COSTS(000):$111
Disaster Business Loan Application
FORMS: FORM-5 FORM-739A FORM-1368
OMB NO: 3245-0018 EXPIRATION DATE: 09/30/2003
RESPS:53,975 HOURS:80,963 COSTS(000):$0
Disaster Home Loan Application
FORMS: SBA-FORM-5C SBA-FORM-739
OMB NO: 3245-0024 EXPIRATION DATE: 10/31/2002
RESPS:200,000 HOURS:50,000 COSTS(000):$0
Pro-Net
FORMS: SBA-1167
OMB NO: 3245-0063 EXPIRATION DATE: 07/31/2004
RESPS:1,040 HOURS:16,480 COSTS(000):$0
SBIC Financial Reports
FORMS: FORM-468
OMB NO: 3245-0071 EXPIRATION DATE: 04/30/2005
RESPS:5,200 HOURS:11,700 COSTS(000):$0
U.S. Small Business Administration Application for Section 504
Loan
FORMS: FORM-1244
OMB NO: 3245-0074 EXPIRATION DATE: 12/31/2003
RESPS:270 HOURS:7,560 COSTS(000):$108
CDC Annual Report Guide
FORMS: 1253 1253A
OMB NO: 3245-0076 EXPIRATION DATE: 05/31/2005
RESPS:486,000 HOURS:487,600 COSTS(000):$0
Notice to New SBA Borrowers
FORMS: 793
OMB NO: 3245-0078 EXPIRATION DATE: 07/31/2004
RESPS:2,100 HOURS:420 COSTS(000):$0
Portfolio Financing Report
FORMS: FORM-1031
OMB NO: 3245-0081 EXPIRATION DATE: 06/30/2002
RESPS:327 HOURS:507 COSTS(000):$0
Small Business Investment Company (SBIC) Leverage Application
Forms and Documents, Leverage Application Kits
FORMS: SBA-FORMS-25 33 34 1065
OMB NO: 3245-0084 EXPIRATION DATE: 06/30/2003
RESPS:53,478 HOURS:13,370 COSTS(000):$0
Disaster Home/Business Loan Inquiry Record
FORMS: SBA-FORM-700
OMB NO: 3245-0096 EXPIRATION DATE: 10/31/2002
RESPS:469 HOURS:3,752 COSTS(000):$0
Nomination for the Small Business Prime Contractor and
Nomination for the Small Business Subcontractor of the Year Award
FORMS: SBA-1375 SBA-883
OMB NO: 3245-0101 EXPIRATION DATE: 03/31/2003
RESPS:10,500 HOURS:42,000 COSTS(000):$0
Application for Small Business Size Determination
FORMS: SBA-FORM-355
OMB NO: 3245-0108 EXPIRATION DATE: 04/30/2004
RESPS:264,000 HOURS:132,000 COSTS(000):$0
SBDC Counseling Record
FORMS: FORM-1062
OMB NO: 3245-0109 EXPIRATION DATE: 05/31/2004
RESPS:2,160 HOURS:2,160 COSTS(000):$0
Request for Information Concerning Portfolio Financing
FORMS: 857
OMB NO: 3245-0110 EXPIRATION DATE: 03/31/2003
RESPS:30,020 HOURS:15,010 COSTS(000):$0
Borrower's Progress Certification
FORMS: SBA-FORM-1366
OMB NO: 3245-0116 EXPIRATION DATE: 05/31/2004
RESPS:1,500 HOURS:750 COSTS(000):$0
Financial Institution Confirmation Form
FORMS: 860
OMB NO: 3245-0121 EXPIRATION DATE: 06/30/2003
RESPS:57 HOURS:1,140 COSTS(000):$0
Governor's Request for Disaster Declaration
FORMS: NONE
OMB NO: 3245-0124 EXPIRATION DATE: 03/31/2004
RESPS:500 HOURS:83 COSTS(000):$0
U.S. Small Business Administration Advisory Committee
Membership- Nominee Information
FORMS: SBAFORM898
OMB NO: 3245-0132 EXPIRATION DATE: 03/31/2005
RESPS:5,000 HOURS:5,000 COSTS(000):$0
Lender Transcript of Account
FORMS: FORM-1149
OMB NO: 3245-0136 EXPIRATION DATE: 05/31/2004
RESPS:4,000 HOURS:332 COSTS(000):$0
Disaster Survey Worksheet
FORMS: SBA-FORM-987
OMB NO: 3245-0140 EXPIRATION DATE: 08/31/2004
RESPS:477 HOURS:34,191 COSTS(000):$0
SBA Form 1222-Notice of Award SBA Form 1224 Grant/Cooperative
Agreement Cost Sharing Proposal
FORMS: FORM-1222 FORM-1224
OMB NO: 3245-0141 EXPIRATION DATE: 10/31/2002
RESPS:63 HOURS:1,024 COSTS(000):$0
Prime Contracts Program Quarterly Report; Part A, Traditional
PCR and Part B, Breakout PCR
FORMS: SBA-FORM-843A FORM-843B
OMB NO: 3245-0169 EXPIRATION DATE: 09/30/2003
RESPS:114 HOURS:7,524 COSTS(000):$0
SBDC Program & Financial Reports
FORMS: SF-269 SF-272
OMB NO: 3245-0172 EXPIRATION DATE: 06/30/2004
RESPS:600 HOURS:600 COSTS(000):$0
Stockholder's Confirmation (Corporation); Ownership Confirmation
(Partnership)
FORMS: SBA-FORM-1405
OMB NO: 3245-0178 EXPIRATION DATE: 09/30/2003
RESPS:55,000 HOURS:13,750 COSTS(000):$0
Statement of Personal History
FORMS: SBA-FORM-912
OMB NO: 3245-0185 EXPIRATION DATE: 03/31/2004
RESPS:12,500 HOURS:46,875 COSTS(000):$0
Secondary Participation Guaranty Agreement
FORMS: SBA-FORM-1086
OMB NO: 3245-0188 EXPIRATION DATE: 11/30/2004
RESPS:187,027 HOURS:280,608 COSTS(000):$0
Personal Financial Statement
FORMS: SBA-FORM-413
OMB NO: 3245-0193 EXPIRATION DATE: 05/31/2005
RESPS:4,200 HOURS:4,200 COSTS(000):$0
Servicing Agent Agreement
FORMS: 1506
OMB NO: 3245-0200 EXPIRATION DATE: 03/31/2005
RESPS:39,988 HOURS:29,991 COSTS(000):$0
Settlement Sheet
FORMS: FORM-1050
OMB NO: 3245-0201 EXPIRATION DATE: 05/31/2005
RESPS:115,000 HOURS:9,584 COSTS(000):$0
7(a) Loan Closing Forms
FORMS: 159 160 160A
OMB NO: 3245-0212 EXPIRATION DATE: 02/28/2003
RESPS:5,000 HOURS:7,500 COSTS(000):$0
Secondary Market Assignment and Disclosure Form
FORMS: SBA-FORM-1088
OMB NO: 3245-0213 EXPIRATION DATE: 08/31/2004
RESPS:475 HOURS:1,425 COSTS(000):$63
Application For Pool of Guaranteed Interest Certificates
FORMS: FORM-1454
OMB NO: 3245-0225 EXPIRATION DATE: 02/28/2003
RESPS:300 HOURS:2,400 COSTS(000):$0
Small Business Administration, Application for Certificate of
Comptency
FORMS: SBA-FORM-1531
OMB NO: 3245-0298 EXPIRATION DATE: 08/31/2003
RESPS:1,806 HOURS:68 COSTS(000):$0
Business Information Center Customer Satisfaction Survey
FORMS: FORM-1916(9-94)
OMB NO: 3245-0301 EXPIRATION DATE: 07/31/2004
RESPS:293 HOURS:586 COSTS(000):$0
Financing Eligibility statement - social disadvantaged -
Economic Disadvantaged
FORMS: FORM-1941A FORM-1941B FORM-1941C
OMB NO: 3245-0312 EXPIRATION DATE: 01/31/2004
RESPS:33 HOURS:8 COSTS(000):$0
Survey of Job Creation and Retention in the DELTA Program
FORMS: SEB-1989
OMB NO: 3245-0313 EXPIRATION DATE: 12/31/2003
RESPS:200 HOURS:183 COSTS(000):$0
Federal Agency Appraisal Form
FORMS: 1993
OMB NO: 3245-0320 EXPIRATION DATE: 11/30/2002
RESPS:20,000 HOURS:20,000 COSTS(000):$0
HUBZone Empowerment Contracting Program Application
FORMS: SBA-2103
OMB NO: 3245-0324 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:60,000 COSTS(000):$0
Entrepreneurial Development Management Information System (EDMIS)
FORMS: SBA-641 SBA-641A
OMB NO: 3245-0326 EXPIRATION DATE: 12/31/2003
RESPS:2,500 HOURS:5,000 COSTS(000):$0
Pre-Disaster Mitigation Small Business Loan Application
FORMS: SBA-FORM-5M
OMB NO: 3245-0327 EXPIRATION DATE: 12/31/2003
RESPS:1 HOURS:1,244 COSTS(000):$0
Value of Worker Training Programs to Small Business
FORMS: NONE
OMB NO: 3245-0328 EXPIRATION DATE: 12/31/2003
RESPS:500 HOURS:250 COSTS(000):$0
7(j) Management and Technical Assistance Program Sponsored
Training Impact and Longitudinal Studies
FORMS: 2167 2168 2169 2170 2171
OMB NO: 3245-0329 EXPIRATION DATE: 05/31/2004
RESPS:500 HOURS:40,000 COSTS(000):$0
PRIME (Program for Investment in Microentrepreneurs)
FORMS: NONE
OMB NO: 3245-0330 EXPIRATION DATE: 01/31/2004
RESPS:2,500 HOURS:5,000 COSTS(000):$0
Military Reservist Economic Injury Disaster Loan Application
FORMS: SBA-FORM-5R
OMB NO: 3245-0331 EXPIRATION DATE: 07/31/2004
RESPS:6,103 HOURS:21,460 COSTS(000):$0
8(a)/SDB Paper and Electronic Application
FORMS: 1010 1010B 2065 1010C
OMB NO: 3245-0333 EXPIRATION DATE: 09/30/2004
RESPS:81 HOURS:4,200 COSTS(000):$0
BusinessLINC Program
FORMS: 01-1
OMB NO: 3245-0334 EXPIRATION DATE: 08/31/2004
RESPS:58 HOURS:29 COSTS(000):$0
Other Funding Under the SBDC Umbrella
FORMS: FORM-2186
OMB NO: 3245-0336 EXPIRATION DATE: 10/31/2004
RESPS:130 HOURS:120 COSTS(000):$0
Evaluation of State Efforts to Review and Alleviate State
Regulatory Burdens on Small Businesses
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
52 1,852,716 2,756,543 $282
Social Security Administration
OMB NO: 0960-0001 EXPIRATION DATE: 04/30/2004
RESPS:18,000 HOURS:4,500 COSTS(000):$0
Certification of Support
FORMS: SSA-760-F4
OMB NO: 0960-0002 EXPIRATION DATE: 06/30/2002
RESPS:3,000 HOURS:1,500 COSTS(000):$0
Statement Regarding the Inferred Death of an Individual By
Reason of Continued and Unexplained Absence
FORMS: SSA-723-F4
OMB NO: 0960-0003 EXPIRATION DATE: 09/30/2002
RESPS:45,000 HOURS:12,500 COSTS(000):$0
Application for Mother's or Father's Insurance Benefit
FORMS: SSA-5F6
OMB NO: 0960-0004 EXPIRATION DATE: 12/31/2002
RESPS:288,580 HOURS:72,145 COSTS(000):$0
Application for Widow's or Widower's Insurance Benefits
FORMS: SSA-10-BK
OMB NO: 0960-0007 EXPIRATION DATE: 04/30/2004
RESPS:1,460,692 HOURS:255,621 COSTS(000):$0
Application for Retirement Insurance Benefits
FORMS: SSA-1-F6
OMB NO: 0960-0008 EXPIRATION DATE: 01/31/2003
RESPS:700,000 HOURS:175,000 COSTS(000):$0
Application for Wife's or Husband's Insurance Benefits
FORMS: SSA-2-F6
OMB NO: 0960-0009 EXPIRATION DATE: 09/30/2002
RESPS:180,000 HOURS:15,000 COSTS(000):$0
Marriage Certification
FORMS: SSA-3
OMB NO: 0960-0010 EXPIRATION DATE: 04/30/2004
RESPS:1,740,000 HOURS:372,417 COSTS(000):$0
Application for Child's Insurance Benefits
FORMS: SSA-4-BK
OMB NO: 0960-0012 EXPIRATION DATE: 09/30/2002
RESPS:1,400 HOURS:350 COSTS(000):$0
Application for Parent's Insurance Benefits
FORMS: SSA-7
OMB NO: 0960-0013 EXPIRATION DATE: 01/31/2004
RESPS:877,000 HOURS:146,167 COSTS(000):$0
Application for Lump Sum Death Payment
FORMS: SSA-8
OMB NO: 0960-0014 EXPIRATION DATE: 06/30/2003
RESPS:2,121,686 HOURS:371,295 COSTS(000):$0
Request to be Selected as Payee
FORMS: SSA-11-BK
OMB NO: 0960-0015 EXPIRATION DATE: 09/30/2003
RESPS:100,000 HOURS:8,333 COSTS(000):$0
Request for Withdrawal of Application
FORMS: SSA-521
OMB NO: 0960-0016 EXPIRATION DATE: 08/31/2002
RESPS:1,200 HOURS:200 COSTS(000):$0
Statement Regarding Date of Birth and Citizenship
FORMS: SSA-702
OMB NO: 0960-0017 EXPIRATION DATE: 05/31/2005
RESPS:40,000 HOURS:6,000 COSTS(000):$0
Statement Regarding Marriage
FORMS: SSA-753
OMB NO: 0960-0019 EXPIRATION DATE: 04/30/2004
RESPS:14,000 HOURS:2,333 COSTS(000):$0
Certificate of Responsibility for Welfare and Care of Child Not
in Applicant's Custody
FORMS: SSA-781
OMB NO: 0960-0020 EXPIRATION DATE: 08/31/2003
RESPS:30,000 HOURS:7,500 COSTS(000):$0
Statement Regarding Contributions
FORMS: SSA-783
OMB NO: 0960-0024 EXPIRATION DATE: 03/31/2004
RESPS:120,000 HOURS:20,000 COSTS(000):$0
Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits
FORMS: SSA-787
OMB NO: 0960-0025 EXPIRATION DATE: 03/31/2003
RESPS:12,350 HOURS:6,175 COSTS(000):$0
Partnership Questionnaire
FORMS: SSA-7104
OMB NO: 0960-0029 EXPIRATION DATE: 10/31/2004
RESPS:375,000 HOURS:62,500 COSTS(000):$0
Request for Correction of Earnings Record
FORMS: SSA-7008
OMB NO: 0960-0030 EXPIRATION DATE: 05/31/2003
RESPS:925,000 HOURS:308,333 COSTS(000):$0
Statement of Employer
FORMS: SSA-7011
OMB NO: 0960-0034 EXPIRATION DATE: 01/31/2003
RESPS:150,000 HOURS:100,000 COSTS(000):$0
Letter to Employer Requesting Information about Wages Earned by
Beneficiary
FORMS: SSA-L725
OMB NO: 0960-0036 EXPIRATION DATE: 10/31/2004
RESPS:125,000 HOURS:37,500 COSTS(000):$0
Statement of Agricultural Employer (Year Prior to 1988);
Statement of Agricultural Employer (1988 & Later)
FORMS: SSA-1002 SSA-1003
OMB NO: 0960-0037 EXPIRATION DATE: 05/31/2004
RESPS:500,000 HOURS:1,000,000 COSTS(000):$0
Request for Waiver of Overpayment Recovery or Change in
Repayment Notice
FORMS: SSA-632-BK
OMB NO: 0960-0038 EXPIRATION DATE: 12/31/2002
RESPS:30,000 HOURS:15,000 COSTS(000):$0
Statement of Marital Relationship (By One of the Parties)
FORMS: SSA-754
OMB NO: 0960-0040 EXPIRATION DATE: 01/31/2004
RESPS:47,500 HOURS:19,792 COSTS(000):$0
Employment Relationship Questionnaire
FORMS: SSA-7160
OMB NO: 0960-0041 EXPIRATION DATE: 08/31/2002
RESPS:1,000 HOURS:50 COSTS(000):$0
State Contribution Form
FORMS: SSA-3961
OMB NO: 0960-0045 EXPIRATION DATE: 08/31/2003
RESPS:305,500 HOURS:76,375 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: SSA-795
OMB NO: 0960-0046 EXPIRATION DATE: 11/30/2003
RESPS:5,000 HOURS:417 COSTS(000):$0
Statement of Self-Employment Income
FORMS: SSA-766
OMB NO: 0960-0049 EXPIRATION DATE: 04/30/2003
RESPS:230,000 HOURS:24,167 COSTS(000):$0
Report to U.S. SSA by Person Receiving Benefits for a Child or
Adult Unable to Handle Funds; & Report to U.S. SSA
FORMS: SSA-7161-OCR-SM SSA-7162-OCR-SM
OMB NO: 0960-0050 EXPIRATION DATE: 02/29/2004
RESPS:20,000 HOURS:4,000 COSTS(000):$0
Questionnaire About Employment of Self-Employment Outside the
United States
FORMS: SSA-7163
OMB NO: 0960-0051 EXPIRATION DATE: 09/30/2003
RESPS:35,000 HOURS:2,917 COSTS(000):$0
Supplement to claim of Person Outside the United States
FORMS: SSA-221
OMB NO: 0960-0052 EXPIRATION DATE: 10/31/2004
RESPS:750,000 HOURS:375,000 COSTS(000):$0
Medical Report (General)
FORMS: SSA-3826-F4
OMB NO: 0960-0058 EXPIRATION DATE: 10/31/2002
RESPS:50,000 HOURS:30,000 COSTS(000):$0
Report on Individual with Mental Impairment
FORMS: SSA-824
OMB NO: 0960-0059 EXPIRATION DATE: 02/28/2003
RESPS:300,000 HOURS:225,000 COSTS(000):$0
Work Activity Report--Employee
FORMS: SSA-821-BK
OMB NO: 0960-0060 EXPIRATION DATE: 06/30/2003
RESPS:1,185,942 HOURS:395,314 COSTS(000):$0
Application for Disability Insurance Benefits
FORMS: SSA-16
OMB NO: 0960-0061 EXPIRATION DATE: 06/30/2004
RESPS:47,500 HOURS:7,917 COSTS(000):$0
Farm Self-Employment Questionnaire
FORMS: SSA-7156
OMB NO: 0960-0062 EXPIRATION DATE: 05/31/2005
RESPS:3,200 HOURS:800 COSTS(000):$0
Application for Survivors Benefits
FORMS: SSA-24
OMB NO: 0960-0064 EXPIRATION DATE: 08/31/2002
RESPS:38,000 HOURS:19,000 COSTS(000):$0
Farm Arrangement Questionnaire
FORMS: SSA-7157-F4
OMB NO: 0960-0066 EXPIRATION DATE: 03/31/2004
RESPS:18,026,800 HOURS:1,991,667 COSTS(000):$7,376,339
Application for a Social Security Card/Enumeration At Birth
FORMS: SS-5
OMB NO: 0960-0068 EXPIRATION DATE: 02/28/2005
RESPS:5,527,755 HOURS:1,381,939 COSTS(000):$0
Representative Payee Report
FORMS: SSA-623 SSA-6230
OMB NO: 0960-0069 EXPIRATION DATE: 10/31/2004
RESPS:252,000 HOURS:126,000 COSTS(000):$0
Representative Payee Evaluation Report
FORMS: SSA-624
OMB NO: 0960-0071 EXPIRATION DATE: 03/31/2003
RESPS:27,000 HOURS:2,250 COSTS(000):$0
Report of New Information in Disability Cases
FORMS: SSA-612
OMB NO: 0960-0072 EXPIRATION DATE: 03/31/2005
RESPS:852,000 HOURS:426,000 COSTS(000):$0
Report of Continuing Disability Interview
FORMS: SSA-454-BK
OMB NO: 0960-0073 EXPIRATION DATE: 01/31/2003
RESPS:70,000 HOURS:5,833 COSTS(000):$0
Reporting Changes That Affect Your Social Security Payment
FORMS: SSA-1425
OMB NO: 0960-0078 EXPIRATION DATE: 06/30/2002
RESPS:125,000 HOURS:10,417 COSTS(000):$0
Railroad Employment Questionnaire
FORMS: SSA-671
OMB NO: 0960-0086 EXPIRATION DATE: 08/31/2004
RESPS:20 HOURS:5 COSTS(000):$0
Chinese Custom Marriage Statement; Statement Regarding Chinese
Custom Marriage
FORMS: SSA-1344 SSA-1345
OMB NO: 0960-0088 EXPIRATION DATE: 12/31/2002
RESPS:75,000 HOURS:7,500 COSTS(000):$0
Student Reporting Form
FORMS: SSA-1383
OMB NO: 0960-0089 EXPIRATION DATE: 10/31/2002
RESPS:200,000 HOURS:33,333 COSTS(000):$0
Report of Student Beneficiary at End of School Year
FORMS: SSA-1388
OMB NO: 0960-0090 EXPIRATION DATE: 02/28/2005
RESPS:5,000 HOURS:833 COSTS(000):$0
SSA-1371, Statement by School Official About Student's
Attendance, and SSA-1371-FC, Statement to U.S. Social Security
Administration (SSA) By School Outside the United States......
FORMS: SSA-1371-BK SSA-1731-FC
OMB NO: 0960-0093 EXPIRATION DATE: 09/30/2003
RESPS:180 HOURS:45 COSTS(000):$0
Certification by Religious Group
FORMS: SSA-1458
OMB NO: 0960-0096 EXPIRATION DATE: 11/30/2003
RESPS:10 HOURS:3 COSTS(000):$0
Application for Special Age-72-or-Over
FORMS: SSA-19-F6
OMB NO: 0960-0097 EXPIRATION DATE: 11/30/2003
RESPS:18,000 HOURS:3,600 COSTS(000):$0
Application for Search of Census Record for Proof of Age
FORMS: SSA-1535
OMB NO: 0960-0098 EXPIRATION DATE: 06/30/2002
RESPS:140,000 HOURS:35,000 COSTS(000):$0
Request for Workers' Compensation/Public Disability Benefit
Information
FORMS: SSA-1709
OMB NO: 0960-0101 EXPIRATION DATE: 06/30/2003
RESPS:300,000 HOURS:50,000 COSTS(000):$0
Claim for Amounts Due in the Case of a Deceased Beneficiary
FORMS: SSA-1724
OMB NO: 0960-0102 EXPIRATION DATE: 01/31/2005
RESPS:12,000 HOURS:6,000 COSTS(000):$0
Medical Report (Individual with Childhood Impairment)
FORMS: SSA-3827
OMB NO: 0960-0103 EXPIRATION DATE: 07/31/2004
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Supplemental Statement Regarding Farming Activities of Persons
Living Outside the U.S.A.
FORMS: SSA-7163A-F4
OMB NO: 0960-0104 EXPIRATION DATE: 08/31/2002
RESPS:34,624 HOURS:17,312 COSTS(000):$0
Petition to Obtain Approval of a Fee for Representing a Claimant
Before the Social Security Administration
FORMS: SSA-1560-U4
OMB NO: 0960-0105 EXPIRATION DATE: 01/31/2004
RESPS:200,000 HOURS:33,333 COSTS(000):$0
Advance Notice of Termination of Child's Benefits, and Student's
Statement Regarding School Attendance
FORMS: SSA-1372
OMB NO: 0960-0109 EXPIRATION DATE: 09/30/2003
RESPS:130,000 HOURS:21,667 COSTS(000):$0
Statement of Care and Responsibility for Beneficiary
FORMS: SSA-788
OMB NO: 0960-0110 EXPIRATION DATE: 08/31/2002
RESPS:183 HOURS:183 COSTS(000):$0
State Mental Institution Policy Review
FORMS: SSA-9584
OMB NO: 0960-0112 EXPIRATION DATE: 04/30/2004
RESPS:8,000 HOURS:2,000 COSTS(000):$0
Report by Former Representative Payee
FORMS: SSA-625
OMB NO: 0960-0113 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:8 COSTS(000):$0
Statement Regarding Students' School Attendance
FORMS: SSA-2434
OMB NO: 0960-0116 EXPIRATION DATE: 02/29/2004
RESPS:50,000 HOURS:12,500 COSTS(000):$0
Child Relationship Statement
FORMS: SSA-519
OMB NO: 0960-0118 EXPIRATION DATE: 04/30/2004
RESPS:300 HOURS:165 COSTS(000):$0
Application for Benefits Under The Federal Mine Safety and and
Dependent's Claim
FORMS: SSA-47-F4 SSA-48-F4 SSA-49-F3
OMB NO: 0960-0120 EXPIRATION DATE: 04/30/2004
RESPS:12,000 HOURS:2,000 COSTS(000):$0
Pre-1957 Military Service Federal Benefit Questionnaire
FORMS: SSA-2512
OMB NO: 0960-0124 EXPIRATION DATE: 01/31/2003
RESPS:355,000 HOURS:147,917 COSTS(000):$0
Statement of Income and Resources
FORMS: SSA-8010-BK
OMB NO: 0960-0127 EXPIRATION DATE: 02/28/2005
RESPS:20,000 HOURS:3,333 COSTS(000):$0
Agreement to Sell Property
FORMS: SSA-8060-U3
OMB NO: 0960-0128 EXPIRATION DATE: 03/31/2005
RESPS:33,200 HOURS:2,767 COSTS(000):$0
Reporting Events - SSI
FORMS: SSA-8150-EV
OMB NO: 0960-0130 EXPIRATION DATE: 05/31/2005
RESPS:120 HOURS:120 COSTS(000):$0
Quarterly Statistical Report on Recipients and Payments Under
State-Administered Assistance Programs for Aged, Blind, and
Disabled (Individuals and Couples) Recipient
FORMS: SSA-9741
OMB NO: 0960-0133 EXPIRATION DATE: 03/31/2003
RESPS:15,000 HOURS:15,000 COSTS(000):$0
Supplemental Security Income (SSI) - Quality Review Case Analysis
FORMS: SSA-8508-BK
OMB NO: 0960-0138 EXPIRATION DATE: 05/31/2003
RESPS:133,000 HOURS:66,500 COSTS(000):$0
Letter to Employer Requesting Wage Information
FORMS: SSA-L4201
OMB NO: 0960-0140 EXPIRATION DATE: 08/31/2002
RESPS:2,134,100 HOURS:177,842 COSTS(000):$0
Record of SSI Inquiry
FORMS: SSA-3462
OMB NO: 0960-0142 EXPIRATION DATE: 05/31/2005
RESPS:1,059,400 HOURS:61,798 COSTS(000):$0
Statement of Death by Funeral Director
FORMS: SSA-721
OMB NO: 0960-0143 EXPIRATION DATE: 07/31/2004
RESPS:133,000 HOURS:13,300 COSTS(000):$0
Student's Statement Regarding Resumption of School Attendance
FORMS: SSA-1386
OMB NO: 0960-0144 EXPIRATION DATE: 02/28/2005
RESPS:400,000 HOURS:200,000 COSTS(000):$0
Reconsideration Disability Report
FORMS: SSA-3441
OMB NO: 0960-0145 EXPIRATION DATE: 10/31/2004
RESPS:1,720,000 HOURS:396,000 COSTS(000):$0
Statement For Determining Continuing Eligibility Supplemental
Security Income Payment(s)
FORMS: SSA-8202-F6 SSA-8202-OCR-SM
OMB NO: 0960-0160 EXPIRATION DATE: 06/30/2002
RESPS:76,000 HOURS:15,833 COSTS(000):$0
Government Pension Questionnaire
FORMS: SSA-3885
OMB NO: 0960-0174 EXPIRATION DATE: 12/31/2002
RESPS:438,400 HOURS:51,147 COSTS(000):$0
Statement of Living Arrangement, In-Kind Support and Maintenance
FORMS: SSA-8006-F4
OMB NO: 0960-0184 EXPIRATION DATE: 03/31/2003
RESPS:189 HOURS:2,646 COSTS(000):$0
Instructions for Completion of Federal Assistance Application
FORMS: SSA-96
OMB NO: 0960-0189 EXPIRATION DATE: 10/31/2004
RESPS:5,475 HOURS:2,521 COSTS(000):$0
RSI/DI Quality Review Case Analysis-Sampled Number Holder,
Auxiliaries/Survivors, Parent, Stewardship AET Workbook
FORMS: SSA-2930 2931 2932 4659
OMB NO: 0960-0229 EXPIRATION DATE: 01/31/2003
RESPS:1,002,773 HOURS:422,835 COSTS(000):$0
Application for Supplemental Security Income
FORMS: SSA-8000-BK
OMB NO: 0960-0240 EXPIRATION DATE: 11/30/2003
RESPS:71 HOURS:71 COSTS(000):$0
Subpart T--State Supplementation Provisions; Agreement;
Payments, 20 CFR 416.2099
FORMS: NONE
OMB NO: 0960-0247 EXPIRATION DATE: 11/30/2002
RESPS:100,000 HOURS:25,000 COSTS(000):$0
Worker's Compensation/Public Disability Benefit Questionnaire
FORMS: SSA-546
OMB NO: 0960-0267 EXPIRATION DATE: 01/31/2003
RESPS:60,000 HOURS:3,000 COSTS(000):$0
Medicaid Use Report -- 20 CFR 216.628
FORMS: NONE
OMB NO: 0960-0269 EXPIRATION DATE: 11/30/2004
RESPS:556,000 HOURS:92,666 COSTS(000):$0
Request for Hearing by Administrative Law Judge
FORMS: HA-501
OMB NO: 0960-0274 EXPIRATION DATE: 10/31/2004
RESPS:50,000 HOURS:4,167 COSTS(000):$0
Report of Student Beneficiary About to Attain Age 19
FORMS: SSA-1390
OMB NO: 0960-0277 EXPIRATION DATE: 02/28/2005
RESPS:80,000 HOURS:13,333 COSTS(000):$0
Request for Review of Hearing Decision/Order
FORMS: HA-520
OMB NO: 0960-0282 EXPIRATION DATE: 03/31/2003
RESPS:8,000 HOURS:2,000 COSTS(000):$0
Vocational Rehabilitation "301" Program Development
FORMS: 4290
OMB NO: 0960-0284 EXPIRATION DATE: 08/31/2004
RESPS:12,000 HOURS:400 COSTS(000):$0
Waiver of Your Right to Personal Appearance before an
Administrative Law Judge
FORMS: HA-4608
OMB NO: 0960-0288 EXPIRATION DATE: 04/30/2004
RESPS:10,548 HOURS:879 COSTS(000):$0
Notice Regarding Substitution of Party Upon Death of Claimant
FORMS: HA-539
OMB NO: 0960-0289 EXPIRATION DATE: 05/31/2003
RESPS:171,939 HOURS:42,985 COSTS(000):$0
Claimant's Medications
FORMS: HA-4632
OMB NO: 0960-0292 EXPIRATION DATE: 03/31/2003
RESPS:309,490 HOURS:51,582 COSTS(000):$0
Claimant's Recent Medical Treatment
FORMS: HA-4631
OMB NO: 0960-0293 EXPIRATION DATE: 10/31/2004
RESPS:500,000 HOURS:50,000 COSTS(000):$0
Authorization for SSA to Obtain Account Records from a Financial
Institution and Request for Records
FORMS: SSA-4641-U2
OMB NO: 0960-0300 EXPIRATION DATE: 09/30/2002
RESPS:120,000 HOURS:30,000 COSTS(000):$0
Claimant's Work Background
FORMS: HA-4633
OMB NO: 0960-0310 EXPIRATION DATE: 11/30/2003
RESPS:90 HOURS:9,048 COSTS(000):$0
Vocational Rehabilitation Provider Claim
FORMS: SSA-199-U2
OMB NO: 0960-0314 EXPIRATION DATE: 12/31/2002
RESPS:150 HOURS:16 COSTS(000):$0
Black Lung Student's Statement Regarding Resumption of School
Attendance; Report of Black Lung Student Beneficiary at End of
School Year
FORMS: SSA-2602 SSA-2613
OMB NO: 0960-0316 EXPIRATION DATE: 03/31/2004
RESPS:442,720 HOURS:110,680 COSTS(000):$0
Claimant's Statement When Request for Hearing is Filed and the
Issue is Disability
FORMS: HA-4486
OMB NO: 0960-0323 EXPIRATION DATE: 06/30/2003
RESPS:90,500 HOURS:7,542 COSTS(000):$0
Third Party Liability Information Statement
FORMS: SSA-8019-U2
OMB NO: 0960-0324 EXPIRATION DATE: 01/31/2003
RESPS:7,500 HOURS:1,250 COSTS(000):$0
Supplemental Security Income Claim Information Notice
FORMS: SSA-L8050
OMB NO: 0960-0341 EXPIRATION DATE: 03/31/2005
RESPS:2,400 HOURS:80 COSTS(000):$0
Request for Address Information from Motor Vehicles Records;
Request for Address Information from Employment Commissions
Records
FORMS: SSA-L711 SSA-L712
OMB NO: 0960-0347 EXPIRATION DATE: 07/31/2004
RESPS:1,925 HOURS:963 COSTS(000):$0
Response to Notice of Revised Determination
FORMS: SSSA-765
OMB NO: 0960-0348 EXPIRATION DATE: 10/31/2004
RESPS:7,483 HOURS:998 COSTS(000):$0
Request for Change in Time/Place of Disability Hearing
FORMS: SSA-769
OMB NO: 0960-0349 EXPIRATION DATE: 10/31/2004
RESPS:49,000 HOURS:9,800 COSTS(000):$0
Request for Reconsideration--Disability Cessation
FORMS: SSA-789
OMB NO: 0960-0350 EXPIRATION DATE: 05/31/2004
RESPS:100,000 HOURS:50,000 COSTS(000):$0
Reconsideration Report for Disability Cessation
FORMS: SSA-782-BK
OMB NO: 0960-0351 EXPIRATION DATE: 08/31/2004
RESPS:1,200 HOURS:100 COSTS(000):$0
Notice Regarding Substitution of Party Upon Death of Claimant
Reconsideration of Disability Cessation
FORMS: SSA-770
OMB NO: 0960-0369 EXPIRATION DATE: 12/31/2003
RESPS:225,000 HOURS:37,500 COSTS(000):$0
Annual Earnings Test--Direct Mail Follow-Up Program Notices
FORMS: SSA-L9778 SSA-L9779 SSA-L9781 SSA-L9784 SSA-L9785
OMB NO: 0960-0371 EXPIRATION DATE: 03/31/2005
RESPS:1,000 HOURS:250 COSTS(000):$0
Application for U.S. Benefits Under the Canada-U.S.
International Social Security Agreement
FORMS: SSA-1294
OMB NO: 0960-0384 EXPIRATION DATE: 09/30/2003
RESPS:208 HOURS:1,248 COSTS(000):$0
SSA/DDS Cost-Effectiveness Measurement System (CEMS) Data
Reporting form
FORMS: SSA-1461
OMB NO: 0960-0395 EXPIRATION DATE: 01/31/2005
RESPS:90,000 HOURS:12,000 COSTS(000):$0
Modified Benefit Formula Questionnaire
FORMS: SSA-150
OMB NO: 0960-0398 EXPIRATION DATE: 03/31/2003
RESPS:30,000 HOURS:1,000 COSTS(000):$0
Certificate of Election for Reduced Spouse's Benefits
FORMS: 25
OMB NO: 0960-0413 EXPIRATION DATE: 09/30/2003
RESPS:1,005,804 HOURS:251,451 COSTS(000):$0
Psychiatric Review Technique
FORMS: SSA-2506
OMB NO: 0960-0416 EXPIRATION DATE: 10/31/2004
RESPS:920,000 HOURS:276,000 COSTS(000):$0
Statement for Determining Continuing Eligibility for
Supplemental Security Income Payments
FORMS: SSA-8203-BK
OMB NO: 0960-0421 EXPIRATION DATE: 06/30/2004
RESPS:648 HOURS:756 COSTS(000):$0
State Agency Report of Obligations for SSA Disability Programs
and Addendum; Time Report of Personnel Services for Disability
Determination Services & State Agency Schedule of Equipment.....
FORMS: SSA-4514 SSA-871 SSA-4513
OMB NO: 0960-0425 EXPIRATION DATE: 08/31/2002
RESPS:484 HOURS:434 COSTS(000):$0
Coverage of Employees of State and Local Governments
FORMS: NONE
OMB NO: 0960-0428 EXPIRATION DATE: 07/31/2004
RESPS:36 HOURS:18 COSTS(000):$0
Subpoena--Disability Hearing
FORMS: SSA-1272-U4
OMB NO: 0960-0430 EXPIRATION DATE: 08/31/2004
RESPS:49,000 HOURS:12,250 COSTS(000):$0
Summary of Evidence
FORMS: SSA-887
OMB NO: 0960-0431 EXPIRATION DATE: 05/31/2004
RESPS:1,130,772 HOURS:376,924 COSTS(000):$0
Physical Residual Functional Capacity Assessment; Mental
Residual Functional Capacity Assessment
FORMS: SSA-4734-BK SSA-4734-F4-SUP
OMB NO: 0960-0432 EXPIRATION DATE: 10/31/2002
RESPS:360,000 HOURS:180,000 COSTS(000):$0
Missing and Discrepant Wage Reports Letter and Questionnaire
FORMS: SSA-L93 SSA-95 SSA-97
OMB NO: 0960-0434 EXPIRATION DATE: 10/31/2004
RESPS:50,000 HOURS:8,333 COSTS(000):$0
Travel Expense Reimbursement
FORMS: NONE
OMB NO: 0960-0437 EXPIRATION DATE: 01/31/2005
RESPS:2,860,859 HOURS:715,215 COSTS(000):$0
Disability Determination and Transmittal
FORMS: SSA-831-C3-U3
OMB NO: 0960-0440 EXPIRATION DATE: 10/31/2004
RESPS:100,000 HOURS:100,000 COSTS(000):$0
Disability Hearing Officer's Report of Disability Hearing
FORMS: SSA-1205-BK
OMB NO: 0960-0441 EXPIRATION DATE: 08/31/2004
RESPS:100,000 HOURS:75,000 COSTS(000):$0
Disability Hearing Officer's Decision
FORMS: SSA-1207 SSA-1207-SUP1 SUP3 SUP4 SUP5
OMB NO: 0960-0442 EXPIRATION DATE: 04/30/2005
RESPS:544,844 HOURS:272,422 COSTS(000):$0
Cessation or Continuance of Disability or Blindness
Determination and Transmittal
FORMS: SSA-833-C3/U3
OMB NO: 0960-0443 EXPIRATION DATE: 01/31/2005
RESPS:600,758 HOURS:300,379 COSTS(000):$0
Cessation or Continuance of Disability or Blindness
Determination and Transmittal
FORMS: SSA-832-C3-U3
OMB NO: 0960-0444 EXPIRATION DATE: 11/30/2002
RESPS:1,011,046 HOURS:252,762 COSTS(000):$0
Application for Supplemental Security Income
FORMS: SSA-8001
OMB NO: 0960-0445 EXPIRATION DATE: 09/30/2004
RESPS:200 HOURS:67 COSTS(000):$0
Application for Benefits under the Italy-US International Social
Security Agreement
FORMS: SSA-2528
OMB NO: 0960-0448 EXPIRATION DATE: 06/30/2002
RESPS:20,000 HOURS:10,000 COSTS(000):$0
Application for Benefits under a U.S. International Social
Security Agreement
FORMS: SSA-2490-BK
OMB NO: 0960-0451 EXPIRATION DATE: 01/31/2003
RESPS:9,000 HOURS:750 COSTS(000):$0
Permanent Residence under Color of Law (PRUCOL)
FORMS: NONE
OMB NO: 0960-0454 EXPIRATION DATE: 08/31/2002
RESPS:49,000 HOURS:8,167 COSTS(000):$0
Letter to Landlord Requesting Rental Information
FORMS: SSA-L5061
OMB NO: 0960-0456 EXPIRATION DATE: 02/29/2004
RESPS:400,000 HOURS:100,000 COSTS(000):$0
Statement of Household Expenses and Contributions
FORMS: SSA-8011-F3
OMB NO: 0960-0460 EXPIRATION DATE: 12/31/2002
RESPS:5,100 HOURS:425 COSTS(000):$0
Marital Relationship Questionnaire
FORMS: SSA-4178
OMB NO: 0960-0461 EXPIRATION DATE: 07/31/2004
RESPS:200,000 HOURS:23,333 COSTS(000):$0
Information about Joint Checking/Savings account
FORMS: SSA-2574
OMB NO: 0960-0462 EXPIRATION DATE: 11/30/2003
RESPS:19,000 HOURS:1,583 COSTS(000):$0
You Can Make Your Payment by Credit Card
FORMS: SSA-4588 SSA-4589
OMB NO: 0960-0466 EXPIRATION DATE: 05/31/2004
RESPS:1,100,000 HOURS:91,667 COSTS(000):$0
Request for Social Security Statement
FORMS: SSA-7004
OMB NO: 0960-0470 EXPIRATION DATE: 10/31/2004
RESPS:1,000 HOURS:50 COSTS(000):$0
Agency/Employer Government Pension Offset Questionnaire
FORMS: SSA-L4163
OMB NO: 0960-0471 EXPIRATION DATE: 07/31/2004
RESPS:5,438 HOURS:1,813 COSTS(000):$0
Real Property Current Market Value Estimate
FORMS: SSA-L2794
OMB NO: 0960-0472 EXPIRATION DATE: 06/30/2004
RESPS:50,000 HOURS:8,333 COSTS(000):$0
Employer Verification of Earnings After Death
FORMS: SSA-4112
OMB NO: 0960-0473 EXPIRATION DATE: 10/31/2004
RESPS:4,750 HOURS:792 COSTS(000):$1
Employee Identification Statement
FORMS: SSA-4156
OMB NO: 0960-0474 EXPIRATION DATE: 10/31/2004
RESPS:2,000 HOURS:167 COSTS(000):$0
Child-Care Dropout Questionnaire
FORMS: SSA-4162
OMB NO: 0960-0477 EXPIRATION DATE: 01/31/2005
RESPS:30,000 HOURS:10,000 COSTS(000):$0
Modified Benefits Formula Questionnaire, Employer
FORMS: SSA-58
OMB NO: 0960-0481 EXPIRATION DATE: 03/31/2003
RESPS:40,000 HOURS:6,667 COSTS(000):$0
Statement of Funds You Provided to Another, Statement of Funds
You Received
FORMS: 2854 2855
OMB NO: 0960-0483 EXPIRATION DATE: 06/30/2002
RESPS:12,500 HOURS:3,125 COSTS(000):$0
Employee Work Activity Report
FORMS: SSA-3033
OMB NO: 0960-0487 EXPIRATION DATE: 08/31/2002
RESPS:50,000 HOURS:16,667 COSTS(000):$0
Self-Employment Corporation Officer Questionnaire
FORMS: SSA-4184
OMB NO: 0960-0492 EXPIRATION DATE: 06/30/2004
RESPS:50,000 HOURS:4,167 COSTS(000):$0
Request for Supplemental Security Income Benefit Estimate
FORMS: SSA-3716
OMB NO: 0960-0499 EXPIRATION DATE: 04/30/2004
RESPS:272,000 HOURS:136,000 COSTS(000):$0
Questionnaire for Children Claiming SSI Benefits
FORMS: SSA-3881
OMB NO: 0960-0500 EXPIRATION DATE: 11/30/2002
RESPS:59,100 HOURS:9,850 COSTS(000):$0
Medical Report on Adult with Allegation of Human Immune
Deficiency Virus Infection and Medical Report on Child with
Allegation of Human Immune Deficiency Virus Infection
FORMS: SSA-4814-F5 SSA-4815-F6
OMB NO: 0960-0501 EXPIRATION DATE: 02/29/2004
RESPS:50 HOURS:13 COSTS(000):$0
Blood Donor Locator Service--Regulation 20 CFR 401.200
FORMS: NONE
OMB NO: 0960-0502 EXPIRATION DATE: 08/31/2004
RESPS:133,400 HOURS:11,117 COSTS(000):$0
Beneficiary Recontact Report
FORMS: SSA-1588-OCR-SM
OMB NO: 0960-0505 EXPIRATION DATE: 06/30/2004
RESPS:20,000 HOURS:3,333 COSTS(000):$0
Earning Record Information
FORMS: SSA-L3231-C1
OMB NO: 0960-0507 EXPIRATION DATE: 01/31/2005
RESPS:100,000 HOURS:100,000 COSTS(000):$0
Disability Hearing Officer's Report of Disability Hearing (DC)
FORMS: SSA-1204-BK
OMB NO: 0960-0508 EXPIRATION DATE: 10/31/2003
RESPS:3,000,000 HOURS:500,000 COSTS(000):$0
Requests for Self-Employment Information, Employee Information,
Employer Information
FORMS: SSA-L2765 SSA-L3365 SSA-L4002
OMB NO: 0960-0511 EXPIRATION DATE: 08/31/2002
RESPS:974,000 HOURS:243,500 COSTS(000):$0
Disability Update Report
FORMS: SSA-455 SSA-455-OCR-SM
OMB NO: 0960-0516 EXPIRATION DATE: 08/31/2002
RESPS:60,000 HOURS:5,000 COSTS(000):$0
Continuation of Full Benefit Standard for Persons
Institutionalized -- 20 CFR 416.212
FORMS: NONE
OMB NO: 0960-0517 EXPIRATION DATE: 09/30/2002
RESPS:246 HOURS:41 COSTS(000):$0
State Report of Incorrect Bendex Information
FORMS: SSA-1086-U5
OMB NO: 0960-0525 EXPIRATION DATE: 11/30/2004
RESPS:61,494 HOURS:11,274 COSTS(000):$0
Request for Social Security Earnings Information
FORMS: SSA-7050-F4
OMB NO: 0960-0526 EXPIRATION DATE: 12/31/2002
RESPS:31,514 HOURS:113,775 COSTS(000):$0
Voluntary Customer Surveys in Accordance with E.O. 12862
FORMS: NONE
OMB NO: 0960-0527 EXPIRATION DATE: 06/30/2003
RESPS:412,653 HOURS:68,776 COSTS(000):$0
Appointment of Representative
FORMS: SSA-1696-U4
OMB NO: 0960-0529 EXPIRATION DATE: 11/30/2003
RESPS:131,080 HOURS:21,847 COSTS(000):$0
Claimant's Statement About Loan of Food or Shelter & Statement
About Food or Shelter Provided to Another
FORMS: SSA-5062 SSA-L5063
OMB NO: 0960-0534 EXPIRATION DATE: 12/31/2003
RESPS:194 HOURS:49 COSTS(000):$0
Waiver of Right to Appear, Disability Hearing
FORMS: SSA-773-U4
OMB NO: 0960-0536 EXPIRATION DATE: 02/29/2004
RESPS:982,357 HOURS:49,118 COSTS(000):$0
Beneficiary Recontact Report
FORMS: SSA-1587-OCR-SM
OMB NO: 0960-0540 EXPIRATION DATE: 05/31/2004
RESPS:250,000 HOURS:62,500 COSTS(000):$0
Pain Report-Child
FORMS: SSA-3371-BK
OMB NO: 0960-0542 EXPIRATION DATE: 08/31/2004
RESPS:750,000 HOURS:250,000 COSTS(000):$0
Function Report, Child (Birth to 1st, Age 1 to 3rd, Age 3 to
6th, Age 6 to 12th, Age 12 to 18th Birthday)
FORMS: SSA-3375 3376 3377 3378 3379
OMB NO: 0960-0544 EXPIRATION DATE: 08/31/2002
RESPS:24,000 HOURS:400 COSTS(000):$0
Public Information Campaign
FORMS: NONE
OMB NO: 0960-0546 EXPIRATION DATE: 10/31/2002
RESPS:100,000 HOURS:16,666 COSTS(000):$0
Supplemental Security Income Notice of Interim Assistance
Reimbursement
FORMS: SSA-8125 SSA-L8125-F6
OMB NO: 0960-0547 EXPIRATION DATE: 08/31/2004
RESPS:600 HOURS:300 COSTS(000):$0
Wage Reports and Pension Information (20 CFR 422.122(b))
FORMS: NONE
OMB NO: 0960-0554 EXPIRATION DATE: 10/31/2004
RESPS:40,000 HOURS:20,000 COSTS(000):$0
Certificate of Coverage Request
FORMS: NONE
OMB NO: 0960-0555 EXPIRATION DATE: 06/30/2002
RESPS:13,779,700 HOURS:3,306,117 COSTS(000):$0
Generic Clearance of Information Collections Conducted by State
FORMS: NONE
OMB NO: 0960-0557 EXPIRATION DATE: 08/31/2002
RESPS:2,100 HOURS:105 COSTS(000):$0
Inquiry to File an SSI Child's Application
FORMS: SSRO-3-293
OMB NO: 0960-0559 EXPIRATION DATE: 10/31/2004
RESPS:7,000 HOURS:14,000 COSTS(000):$0
Plan for Achieving Self-Support
FORMS: SSA-545
OMB NO: 0960-0561 EXPIRATION DATE: 05/31/2004
RESPS:50,000 HOURS:8,333 COSTS(000):$0
Modified Benefit Formula Questionnaire-Foreign Pension
FORMS: SSA-308
OMB NO: 0960-0564 EXPIRATION DATE: 01/31/2003
RESPS:3,950,000 HOURS:197,500 COSTS(000):$0
QuickStart Enrollment Form
FORMS: NONE
OMB NO: 0960-0565 EXPIRATION DATE: 02/28/2005
RESPS:30,000 HOURS:10,010 COSTS(000):$0
Employer Report of Special Wage Payments
FORMS: SSA-131
OMB NO: 0960-0566 EXPIRATION DATE: 05/31/2003
RESPS:2,228,500 HOURS:119,133 COSTS(000):$0
Privacy and Disclosure of Official Records and Information;
Availability of Information and Records to the Public; 20-CFR
401 & 402
FORMS: SSA-3288
OMB NO: 0960-0568 EXPIRATION DATE: 11/30/2003
RESPS:750,000 HOURS:312,500 COSTS(000):$0
Childhood Disability Evaluation Form
FORMS: SSA-538
OMB NO: 0960-0575 EXPIRATION DATE: 03/31/2004
RESPS:550,000 HOURS:18,334 COSTS(000):$0
Request to Resolve Questionable Quarters of Coverage (QC);
Request for QC History Based on Relationship
FORMS: SSA-512 SSA-513
OMB NO: 0960-0576 EXPIRATION DATE: 03/31/2004
RESPS:30,000 HOURS:10,000 COSTS(000):$0
Representative Payee Report of Benefits and Dedicated Account
FORMS: SSA-6233
OMB NO: 0960-0577 EXPIRATION DATE: 07/31/2004
RESPS:523,000 HOURS:523,000 COSTS(000):$0
Disability Report - Child
FORMS: SSA-3820-BK
OMB NO: 0960-0578 EXPIRATION DATE: 08/31/2004
RESPS:1,000,000 HOURS:500,000 COSTS(000):$0
Work History Report
FORMS: SSA-3369-BK
OMB NO: 0960-0579 EXPIRATION DATE: 07/31/2004
RESPS:2,116,667 HOURS:2,116,667 COSTS(000):$0
Disability Report, Adult
FORMS: SSA-3368-BK
OMB NO: 0960-0581 EXPIRATION DATE: 12/31/2003
RESPS:100,000 HOURS:28,333 COSTS(000):$0
Application of Circuit Court Law
FORMS: 20CFR404.985(B) 20CFR416.1485B
OMB NO: 0960-0583 EXPIRATION DATE: 02/29/2004
RESPS:21,000 HOURS:525 COSTS(000):$0
Internet Request for Replacement SSA-1099/1042S
FORMS: NONE
OMB NO: 0960-0585 EXPIRATION DATE: 03/31/2004
RESPS:100 HOURS:100 COSTS(000):$0
Discrimination Complaint Form
FORMS: SSA-437
OMB NO: 0960-0588 EXPIRATION DATE: 02/28/2003
RESPS:1,690 HOURS:490 COSTS(000):$0
Payee Interview; Beneficiary Interview; Custodian Interview
FORMS: SSA-835 SSA-836 SSA-837
OMB NO: 0960-0595 EXPIRATION DATE: 04/30/2005
RESPS:133,920 HOURS:1,116 COSTS(000):$0
Electronic Benefit Verification Information (BEVE)
FORMS: NONE
OMB NO: 0960-0596 EXPIRATION DATE: 06/30/2003
RESPS:21,000 HOURS:525 COSTS(000):$0
Request for Internet Services - Authentication (RISA)
FORMS: NONE
OMB NO: 0960-0598 EXPIRATION DATE: 03/31/2005
RESPS:100,000 HOURS:50,000 COSTS(000):$0
Work Activity Report (Self-Employed)
FORMS: SSA-820-F4
OMB NO: 0960-0602 EXPIRATION DATE: 06/30/2002
RESPS:60,000 HOURS:2,000 COSTS(000):$0
Authorization to Obtain Earnings Data from the Social Security
Administration
FORMS: SSA-581
OMB NO: 0960-0605 EXPIRATION DATE: 06/30/2002
RESPS:10,000 HOURS:1,167 COSTS(000):$0
Organization Profile
FORMS: NONE
OMB NO: 0960-0606 EXPIRATION DATE: 04/30/2003
RESPS:88,000 HOURS:220,074 COSTS(000):$12,194
Annual Registration Statement Identifying Separated Participants
with Deferred Vested Benefits
FORMS: 1999-EDITION
OMB NO: 0960-0607 EXPIRATION DATE: 10/31/2002
RESPS:3,000 HOURS:1,500 COSTS(000):$0
Request for Information
FORMS: NONE
OMB NO: 0960-0608 EXPIRATION DATE: 07/31/2003
RESPS:210,000 HOURS:10,525 COSTS(000):$0
Request for Claimant Conference
FORMS: SSA-378
OMB NO: 0960-0609 EXPIRATION DATE: 01/31/2003
RESPS:960 HOURS:849 COSTS(000):$0
National Study of Health and Activity (NSHA)
FORMS: NONE
OMB NO: 0960-0610 EXPIRATION DATE: 11/30/2002
RESPS:12,042 HOURS:2,225 COSTS(000):$0
State Partnership Initiative Demonstration Project
FORMS: NONE
OMB NO: 0960-0612 EXPIRATION DATE: 01/31/2003
RESPS:16,000 HOURS:3,200 COSTS(000):$0
Survey of Adults to Determine Public Understanding of Social
Security Programs
FORMS: NONE
OMB NO: 0960-0614 EXPIRATION DATE: 02/28/2003
RESPS:200 HOURS:33 COSTS(000):$0
Worker's Compensation Letter; Worker's Compensation Questionnaire
FORMS: SSA-L1708 SSA-1708
OMB NO: 0960-0615 EXPIRATION DATE: 06/30/2003
RESPS:12,000 HOURS:4,000 COSTS(000):$0
Application for Special Benefits for World War II Veterans
FORMS: SSA-2000
OMB NO: 0960-0616 EXPIRATION DATE: 05/31/2003
RESPS:189 HOURS:1,137 COSTS(000):$0
Notice of Proposed Rulemaking, 20 CFR Part 435, Uniform
FORMS: NONE
OMB NO: 0960-0617 EXPIRATION DATE: 06/30/2003
RESPS:1,000 HOURS:17 COSTS(000):$0
Denial of Supplemental Security Income Benefits for Fugitive
Felons and Probation and Parole Violators
FORMS: NONE
OMB NO: 0960-0618 EXPIRATION DATE: 01/31/2005
RESPS:169,000 HOURS:59,875 COSTS(000):$0
Internet Social Security Benefits Application
FORMS: NONE
OMB NO: 0960-0619 EXPIRATION DATE: 09/30/2003
RESPS:40 HOURS:40 COSTS(000):$0
Testimony by Employees and the Production of Records and
FORMS: NONE
OMB NO: 0960-0621 EXPIRATION DATE: 12/31/2003
RESPS:200 HOURS:33 COSTS(000):$0
Representative Payee Report-Special Veterans
FORMS: SSA-2001
OMB NO: 0960-0622 EXPIRATION DATE: 09/30/2003
RESPS:1,455,000 HOURS:194,000 COSTS(000):$0
Request for Reconsideration
FORMS: SSA-561
OMB NO: 0960-0623 EXPIRATION DATE: 11/30/2003
RESPS:15,415,712 HOURS:770,876 COSTS(000):$0
Authorization for Source to Release Information to SSA
FORMS: SSA-837 SSA-827-OP1 SSA-827-OP2
OMB NO: 0960-0624 EXPIRATION DATE: 03/31/2004
RESPS:144 HOURS:144 COSTS(000):$0
Medical Parking Application
FORMS: SSA-3192
OMB NO: 0960-0625 EXPIRATION DATE: 02/28/2005
RESPS:55 HOURS:28 COSTS(000):$0
Electronic Death Registration Survey
FORMS: NONE
OMB NO: 0960-0626 EXPIRATION DATE: 11/30/2003
RESPS:250,000 HOURS:8,333 COSTS(000):$0
Integrated Registration for Employers and Submitters (IRES)
FORMS: NONE
OMB NO: 0960-0627 EXPIRATION DATE: 09/30/2003
RESPS:2,226 HOURS:446 COSTS(000):$0
Employment Support Representative Position (ESR): Survey of
Beneficiaries and Community Organizations
FORMS: NONE
OMB NO: 0960-0628 EXPIRATION DATE: 01/31/2004
RESPS:9,857 HOURS:9,519 COSTS(000):$0
Survey of Low-Income and Disabled Kids (SOLID KIDS)
FORMS: NONE
OMB NO: 0960-0629 EXPIRATION DATE: 01/31/2004
RESPS:500,000 HOURS:125,000 COSTS(000):$0
Benefits Planning, Assistance and Outreach (BPAO) Program,
Cooperative Agreement Announcement No. SSA-OESP-00-1
FORMS: NONE
OMB NO: 0960-0630 EXPIRATION DATE: 05/31/2004
RESPS:200 HOURS:50 COSTS(000):$0
Beneficiary Interview and Auditor's Observations
FORMS: SSA-322
OMB NO: 0960-0632 EXPIRATION DATE: 03/31/2004
RESPS:250,000 HOURS:41,667 COSTS(000):$0
Request for Internet Services - Password Authentication
FORMS: NONE
OMB NO: 0960-0633 EXPIRATION DATE: 05/31/2004
RESPS:2,720 HOURS:1,020 COSTS(000):$0
Site Review Questionnaire for Volume Payees; Site Review
Questionnaire for Fee-For-Service Payees; Site Review -
Beneficiary Interview Form
FORMS: SSA-637 SSA-638 SSA-639
OMB NO: 0960-0634 EXPIRATION DATE: 07/31/2004
RESPS:3,485 HOURS:581 COSTS(000):$0
Internet Direct Deposit Application
FORMS: NONE
OMB NO: 0960-0635 EXPIRATION DATE: 07/31/2004
RESPS:1,000,000 HOURS:500,000 COSTS(000):$0
Function Report - Adult Third Party
FORMS: SSA-3380
OMB NO: 0960-0637 EXPIRATION DATE: 08/31/2004
RESPS:12,000 HOURS:1 COSTS(000):$0
Quiz Show-Internet Edition
FORMS: NONE
OMB NO: 0960-0639 EXPIRATION DATE: 10/31/2004
RESPS:200 HOURS:50 COSTS(000):$0
Contact with Rep Payee, Contact with Beneficiary
FORMS: SSA-L4945U2 SSA-L4947U2
OMB NO: 0960-0641 EXPIRATION DATE: 06/30/2002
RESPS:31,492 HOURS:5,915 COSTS(000):$0
1. State Agency Ticket Assignment Form, 2. State Vocational 3.
Individual Work Plans (IWP) Information Sheet
FORMS: SSA-1365 SSA-1366 SSA-1367
OMB NO: 0960-0642 EXPIRATION DATE: 12/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Listing of Impairments, Part 404, Subpart P, Appendix 1
FORMS: NONE
OMB NO: 0960-0643 EXPIRATION DATE: 01/31/2005
RESPS:20,000 HOURS:6,667 COSTS(000):$0
Statement for Determining Continuing Eligibility for
Supplemental Security Income Payments - Adult; Statement for
Determining Continuing Eligibility for Supplemental Security
Income - Child
FORMS: SSA-3988 SSA-3989
OMB NO: 0960-0644 EXPIRATION DATE: 12/31/2004
RESPS:172,202 HOURS:201,680 COSTS(000):$0
The Ticket to Work and Self-Sufficiency Program
FORMS: NONE
OMB NO: 0960-0646 EXPIRATION DATE: 02/28/2005
RESPS:952,000 HOURS:277,416 COSTS(000):$0
National Teacher Questionnaire; Request for Administrative
Information
FORMS: SSA-5665-BK SSA-5666
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
221 113,735,882 24,889,961 $7,388,534
Tennessee Valley Authority
OMB NO: 3316-0002 EXPIRATION DATE: 11/30/2004
RESPS:2,054 HOURS:3,792 COSTS(000):$0
Power Distributors Monthly and Annual Reports to TVA
FORMS: 3957 4171
OMB NO: 3316-0008 EXPIRATION DATE: 08/31/2003
RESPS:100 HOURS:1,000 COSTS(000):$0
Foreign Line Crossing Data
FORMS: TVA-6573 TVA-6593
OMB NO: 3316-0009 EXPIRATION DATE: 02/29/2004
RESPS:175 HOURS:2,450 COSTS(000):$0
Salary Surveys for Salary Policy Bargaining Unit Employees
FORMS: NONE
OMB NO: 3316-0016 EXPIRATION DATE: 08/31/2003
RESPS:150 HOURS:40 COSTS(000):$0
Farmer Questionnaire - Vicinity of Nuclear Power Plants
FORMS: 9476
OMB NO: 3316-0019 EXPIRATION DATE: 02/29/2004
RESPS:20,000 HOURS:6,000 COSTS(000):$0
Energy Right Residential Program
FORMS: 6254B-1 6254B-3 6254D-4 6254E-1 6254F-1 6254F-2 6254G 6254S-1
6254T-1 6254T-S1
OMB NO: 3316-0062 EXPIRATION DATE: 02/29/2004
RESPS:24,252 HOURS:49,019 COSTS(000):$0
TVA Procurement Documents, Including Request for Offer; Solici-
tation, Offer and Acceptance; and other related procurement or
sales documents.
FORMS: 97 916 5050 9640 9650-1 9903 9903A 9903C 9903D 9910
OMB NO: 3316-0063 EXPIRATION DATE: 08/31/2003
RESPS:17,583 HOURS:15,913 COSTS(000):$0
Employment Application
FORMS: 1 9871 13045 13045A 17353
OMB NO: 3316-0096 EXPIRATION DATE: 11/30/2004
RESPS:1,700 HOURS:85 COSTS(000):$0
Customer Input Card for TVA Recreation Areas
FORMS: 17429
OMB NO: 3316-0099 EXPIRATION DATE: 04/30/2005
RESPS:800 HOURS:160 COSTS(000):$0
TVA Aquatic Plant Management
FORMS: NONE
OMB NO: 3316-0105 EXPIRATION DATE: 08/31/2004
RESPS:2,000 HOURS:167 COSTS(000):$0
TVA Police Customer Satisfaction Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
10 68,814 78,626 $0
FEDERAL ACQUISITION REGULATIONS
OMB NO: 9000-0001 EXPIRATION DATE: 10/31/2004
RESPS:715 HOURS:286 COSTS(000):$0
Standard Form 28, Affidavit of Individual Surety-FAR Sections
Affected: 28.106(e); 28.203(b); 53.228(e)
FORMS: 28
OMB NO: 9000-0002 EXPIRATION DATE: 10/31/2002
RESPS:800,000 HOURS:464,000 COSTS(000):$0
Solicitation Mailing Lisdt Application
FORMS: SF-129
OMB NO: 9000-0004 EXPIRATION DATE: 10/31/2003
RESPS:35,000 HOURS:35,000 COSTS(000):$2,450,000
Architect-Engineer and Related Services Questionnaire, SF 254 -
FAR Sections Affected: Subpart 36.6 and 36.7; 53.236-2
FORMS: NONE
OMB NO: 9000-0005 EXPIRATION DATE: 10/31/2003
RESPS:20,000 HOURS:24,000 COSTS(000):$1,680,000
Architect-Engineer and Related Services Questionnaire for
Specific Project, SF 255 - 36.702(b)(2) and 53.236-2
FORMS: SF-255
OMB NO: 9000-0006 EXPIRATION DATE: 06/30/2004
RESPS:14,631 HOURS:739,225 COSTS(000):$0
Subcontracting Plans/Subcontracting Report for Individual
Contracts (SF 294) Section Affected: Subpart 19.7; 52.219-9
FORMS: SF-294
OMB NO: 9000-0007 EXPIRATION DATE: 09/30/2003
RESPS:7,098 HOURS:112,864 COSTS(000):$0
Summary Subcontract Report FAR Sections Affected: Subpart
FORMS: SF-295 OF-312
OMB NO: 9000-0010 EXPIRATION DATE: 09/30/2002
RESPS:864,000 HOURS:318,384 COSTS(000):$19,958
Progress Payments -- SF-1443, FAR Sections Affected: Subpart
FORMS: SF-1443
OMB NO: 9000-0011 EXPIRATION DATE: 10/31/2003
RESPS:6,000 HOURS:144,000 COSTS(000):$0
Preaward Survey forms (SFs 1403, 1404, 1405, 1406, 1407, and
1408) FAR Sections Affected: 9.106-2 thru -4
FORMS: SFS-1403 1404 1405 1406 1407 1408
OMB NO: 9000-0012 EXPIRATION DATE: 06/30/2004
RESPS:2,074 HOURS:5,185 COSTS(000):$0
Termination Settlement Proposal Forms (SF's 1435 through 1440)
FAR Sections Affected: Subpart 49.6
FORMS: SF-1435 SF-1436 SF-1437 SF-1438 SF-1439 SF-1440
OMB NO: 9000-0013 EXPIRATION DATE: 12/31/2004
RESPS:199,992 HOURS:10,101,684 COSTS(000):$0
Cost or Pricing Data Exemption--FAR: Subparts 15.4; 42.7;
52.214-28; 52.215-12; 52.215-13; 52.215-20; 52.215-21
FORMS: NONE
OMB NO: 9000-0014 EXPIRATION DATE: 10/31/2004
RESPS:63,000 HOURS:3,150 COSTS(000):$0
Statement and Acknowledgment (SF 1413); FAR sections affected;
22.406-5, 22.407(a), 52.222-11(b), 53.222(e), 53.301-SF 1413
FORMS: NONE
OMB NO: 9000-0018 EXPIRATION DATE: 11/30/2004
RESPS:1,285,000 HOURS:12,850 COSTS(000):$0
Certification of Independent Price Determination and Parent
Company and Identifying Data - Sections Affected 3.103; 3.302
FORMS: NONE
OMB NO: 9000-0022 EXPIRATION DATE: 10/31/2004
RESPS:13,300 HOURS:6,650 COSTS(000):$0
Customs and Duties - FAR Sections Affected: 52.225-8
FORMS: NONE
OMB NO: 9000-0024 EXPIRATION DATE: 10/31/2004
RESPS:58,590 HOURS:9,785 COSTS(000):$0
Buy American Act-Balance of Payment Program Certificate -- FAR
Sections Affected: 52.225-2
FORMS: NONE
OMB NO: 9000-0025 EXPIRATION DATE: 10/31/2004
RESPS:11,400 HOURS:1,904 COSTS(000):$0
Buy American Act, Trade Agreements Act, Balance of Payments
Program - - FAR Sections Affected: 52.225-6
FORMS: NONE
OMB NO: 9000-0026 EXPIRATION DATE: 03/31/2003
RESPS:157,500 HOURS:26,355 COSTS(000):$555,660
Change Order Accounting - FAR Sections Affected: 43.205(f),
FORMS: NONE
OMB NO: 9000-0027 EXPIRATION DATE: 10/31/2004
RESPS:1,600 HOURS:48,000 COSTS(000):$0
Value Engineering Requirements FAR Sections Affected: Subparts
48.1 and 48.2; 2.248-1; 52.248-2; 52.248-3
FORMS: NONE
OMB NO: 9000-0028 EXPIRATION DATE: 11/30/2004
RESPS:2,920 HOURS:11,680 COSTS(000):$0
Termination Requirements - FAR Sections Affected: Subparts 49.1
thru 49.6
FORMS: NONE
OMB NO: 9000-0029 EXPIRATION DATE: 10/31/2004
RESPS:100 HOURS:1,600 COSTS(000):$0
Extraordinary Contractual Action Requests - FAR Sections
Affected: 50.403-3; 52.250-1
FORMS: NONE
OMB NO: 9000-0031 EXPIRATION DATE: 05/31/2005
RESPS:2,100 HOURS:525 COSTS(000):$22,050
Contractor Use of Government Supply Sources - FAR Sections
Affected: (Subpart 51.1 and 52.251-1)
FORMS: NONE
OMB NO: 9000-0032 EXPIRATION DATE: 05/31/2005
RESPS:140 HOURS:70 COSTS(000):$2,940
Contractor Use of Interagency Motor Pool Vehicles - FAR Sections
Affected: (Subpart 51.2 and 52.251-2)
FORMS: NONE
OMB NO: 9000-0033 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:82 COSTS(000):$0
Contractor's Signature Authority--FAR Sections Affected: 4.102
FORMS: NONE
OMB NO: 9000-0034 EXPIRATION DATE: 11/30/2003
RESPS:382,840 HOURS:63,934 COSTS(000):$0
Examination of Records by Comptroller General and Contract
Audit; 52.215-2; 52.212-5; 52.214-26
FORMS: NONE
OMB NO: 9000-0035 EXPIRATION DATE: 04/30/2005
RESPS:13,500 HOURS:13,500 COSTS(000):$567,000
Claims and Appeals - FAR Sections Affected: Parts 32 and 33 and
52.233-1
FORMS: NONE
OMB NO: 9000-0037 EXPIRATION DATE: 10/31/2004
RESPS:42,480 HOURS:7,094 COSTS(000):$0
Presolicitation Notice and Response, Standard form 1417: FAR
Sections Affected: 14.205-4(c); 15.201-c; 36.301; 36.701(a); and
53.236-1(a)
FORMS: NONE
OMB NO: 9000-0038 EXPIRATION DATE: 04/30/2005
RESPS:4,673 HOURS:2,337 COSTS(000):$98,154
Mistakes in Bids - FAR Section Affected: 14.407 through 14.407-4
FORMS: NONE
OMB NO: 9000-0039 EXPIRATION DATE: 04/30/2005
RESPS:7,509 HOURS:1,254 COSTS(000):$56,028
Description Literature - FAR Section Affected: 14.202-5
FORMS: NONE
OMB NO: 9000-0043 EXPIRATION DATE: 03/31/2005
RESPS:17,200 HOURS:2,872 COSTS(000):$120,624
Delivery Schedules - FAR Sections Affected: 52.211-8 and 52.211-9
FORMS: NONE
OMB NO: 9000-0044 EXPIRATION DATE: 05/31/2005
RESPS:12,320 HOURS:209 COSTS(000):$8,778
Bid/Offer Acceptance Period - Sections Affected: 52.214-15;
52.214-16; 52.215-1
FORMS: NONE
OMB NO: 9000-0045 EXPIRATION DATE: 10/31/2004
RESPS:56,520 HOURS:23,738 COSTS(000):$0
Bid, Performance, and Payments Bonds - FAR Sections Affected;
Subparts 28.1 and 28.2; 52-228-1; 53.228
FORMS: SF-24 SF-25 SF-25-A SF-25-B SF-34 SF-35 SF-273 SF-274/SF-275
SF-1416 SF-1418
OMB NO: 9000-0047 EXPIRATION DATE: 10/31/2003
RESPS:1,111,558 HOURS:77,810 COSTS(000):$3,268,020
Place of Performance - FAR Sections Affected: (14.201-6(b),
15.209(f), 52.214-14, and 52.215-6)
FORMS: NONE
OMB NO: 9000-0048 EXPIRATION DATE: 10/31/2003
RESPS:95,000 HOURS:8,415 COSTS(000):$353,430
Authorized Negotiators - FAR Sections Affected: 52.215-1(c)(2)
(iv)
FORMS: NONE
OMB NO: 9000-0053 EXPIRATION DATE: 06/30/2002
RESPS:3,318 HOURS:312 COSTS(000):$13,104
Permits, Authorities, or Franchises Certification -- FAR Sections
FORMS: NONE
OMB NO: 9000-0054 EXPIRATION DATE: 06/30/2002
RESPS:300 HOURS:75 COSTS(000):$3,150
U.S.-Flag Air Carriers Certification -- FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0055 EXPIRATION DATE: 06/30/2002
RESPS:7,920 HOURS:1,323 COSTS(000):$55,566
Freight Classification Description -- FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0056 EXPIRATION DATE: 05/31/2005
RESPS:1,000 HOURS:167 COSTS(000):$7,014
Report of Shipment - FAR Sections Affected: (42.1406-1,
42-1406-2, and 52.242-12)
FORMS: NONE
OMB NO: 9000-0057 EXPIRATION DATE: 06/30/2002
RESPS:400 HOURS:100 COSTS(000):$4,200
Evaluation of Export Offers -- FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0058 EXPIRATION DATE: 05/31/2005
RESPS:5,200 HOURS:5,200 COSTS(000):$218,400
Schedules for Construction Contracts - FAR Section Affected:
52.236-15
FORMS: NONE
OMB NO: 9000-0059 EXPIRATION DATE: 05/31/2005
RESPS:424 HOURS:72 COSTS(000):$3,024
North Carolina Sales Tax Certification - FAR Sections Affected
29.304(d); 29.401-2; and 52.229-2
FORMS: NONE
OMB NO: 9000-0060 EXPIRATION DATE: 05/31/2005
RESPS:4,212 HOURS:8,424 COSTS(000):$410,670
Accident Prevention Plans and Recordkeeping - FAR Section
Affected: 52.236-13
FORMS: NONE
OMB NO: 9000-0061 EXPIRATION DATE: 06/30/2002
RESPS:283,400 HOURS:65,182 COSTS(000):$2,737,644
Transportation Requirements -- FAR Sections Affected: -13;
47.507(a); 52.247-6, -29 thru -44, -48, -52, -57, and -64.
FORMS: NONE
OMB NO: 9000-0062 EXPIRATION DATE: 05/31/2005
RESPS:4,740 HOURS:1,185 COSTS(000):$41,475
Material and Workmanship - FAR Section Affected: 53.236-5
FORMS: NONE
OMB NO: 9000-0064 EXPIRATION DATE: 05/31/2005
RESPS:50 HOURS:38 COSTS(000):$1,330
Organization and Direction of Work - - Sections Affected:
36.519, 52.236.19
FORMS: NONE
OMB NO: 9000-0065 EXPIRATION DATE: 04/30/2005
RESPS:1,270 HOURS:318 COSTS(000):$13,356
Overtime - FAR Sections Affected: (22.103 and 52.222-2
FORMS: NONE
OMB NO: 9000-0066 EXPIRATION DATE: 05/31/2004
RESPS:6,193 HOURS:3,097 COSTS(000):$0
Professional Employee Compensation Plan; Subpart 22.11, 52.222-46
FORMS: NONE
OMB NO: 9000-0067 EXPIRATION DATE: 06/30/2002
RESPS:3,000 HOURS:3,000 COSTS(000):$131,250
Incentive Contracts -- Subpart 16.4, 52.216-10, 52.216-16, and
FORMS: NONE
OMB NO: 9000-0068 EXPIRATION DATE: 06/30/2002
RESPS:5,346 HOURS:1,337 COSTS(000):$56,154
Economic Price Adjustment -- FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0069 EXPIRATION DATE: 09/30/2002
RESPS:2,469 HOURS:2,469 COSTS(000):$103,698
Indirect Cost Rates -- FAR Sections Affected: Subpart 42.7,
FORMS: NONE
OMB NO: 9000-0070 EXPIRATION DATE: 06/30/2002
RESPS:9,600,000 HOURS:240,000 COSTS(000):$8,400,000
Payments -- FAR Sections Affected: 52.232-1 Through 52.232-11
FORMS: NONE
OMB NO: 9000-0071 EXPIRATION DATE: 06/30/2002
RESPS:7,000 HOURS:7,000 COSTS(000):$294,000
Price Redetermination -- FAR Sections Affected: 16.205,
FORMS: NONE
OMB NO: 9000-0073 EXPIRATION DATE: 06/30/2002
RESPS:500 HOURS:500 COSTS(000):$17,500
Advance Payments -- FAR Sections Affected: Subpart 32.4 and
FORMS: NONE
OMB NO: 9000-0074 EXPIRATION DATE: 06/30/2002
RESPS:53,456 HOURS:31,728 COSTS(000):$1,110,480
Limitation of Costs/Funds -- FAR Sections Affected: Subpart 32.7
FORMS: NONE
OMB NO: 9000-0075 EXPIRATION DATE: 09/30/2003
RESPS:13,624,122 HOURS:6,575,309 COSTS(000):$0
Government Property - Part 45, Clauses 52.245-2; -4; -5; -7 thru
-11; -17 thru 19
FORMS: 1426-THRU-1434
OMB NO: 9000-0076 EXPIRATION DATE: 05/31/2003
RESPS:1,000 HOURS:458 COSTS(000):$0
Novation/Change of Name Requirements FAR Section Affected:
Subpart 42.12
FORMS: NONE
OMB NO: 9000-0077 EXPIRATION DATE: 09/30/2004
RESPS:950 HOURS:39,719 COSTS(000):$0
Quality Assurance Requirements --FAR Sections Affected: Supbarts
46.1 thru 46.3; 52.246-2 thru 52.246-8; 52.246-10; 52.246-12;
52.246-15
FORMS: NONE
OMB NO: 9000-0078 EXPIRATION DATE: 10/31/2004
RESPS:450 HOURS:3,600 COSTS(000):$0
Make-or-Buy Program - FAR Sections Affected: 15-407-2; 52.215-9
FORMS: NONE
OMB NO: 9000-0079 EXPIRATION DATE: 06/30/2003
RESPS:3,000 HOURS:18,000 COSTS(000):$0
Corporate Aircraft Costs FAR Sections Affected: 31.205-46
FORMS: NONE
OMB NO: 9000-0080 EXPIRATION DATE: 09/30/2002
RESPS:10,000 HOURS:10,000 COSTS(000):$420
Integrity of Unit Prices -- FAR Sections Affected: 15.408(f) and
FORMS: NONE
OMB NO: 9000-0082 EXPIRATION DATE: 09/30/2002
RESPS:38,100 HOURS:31,623 COSTS(000):$1,328
Economic Purchase Quantities--Supplies -- FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0083 EXPIRATION DATE: 09/30/2002
RESPS:220,700 HOURS:55,175 COSTS(000):$2,317,350
Qualification Requirements -- FAR Sections Affected: Subpart 9.2
FORMS: NONE
OMB NO: 9000-0088 EXPIRATION DATE: 09/30/2004
RESPS:10 HOURS:14,500 COSTS(000):$0
Travel Costs--FAR Sections Affected: 31.205-46
FORMS: NONE
OMB NO: 9000-0090 EXPIRATION DATE: 05/31/2004
RESPS:1,100 HOURS:29,970 COSTS(000):$0
Rights in Data and Copyrights; Subpart 27.4; 52.227-14 thru
52.227-21
FORMS: NONE
OMB NO: 9000-0091 EXPIRATION DATE: 06/30/2002
RESPS:100 HOURS:100 COSTS(000):$4,200
Anti-Kickback Procedures -- 3.502, 52.203-7
FORMS: NONE
OMB NO: 9000-0094 EXPIRATION DATE: 01/31/2004
RESPS:1,150,000 HOURS:596,667 COSTS(000):$0
Debarment and Suspension. FAR Sections Affected: 9.103, 9.104,
9.404, 52.209-6, 52.212-3(h)
FORMS: NONE
OMB NO: 9000-0095 EXPIRATION DATE: 10/31/2004
RESPS:11,700 HOURS:45,630 COSTS(000):$0
Commerce Patent Regulations - FAR Sections Affected: 27.3;
52.227-11 thru -13; Pub. L. 98-620
FORMS: NONE
OMB NO: 9000-0096 EXPIRATION DATE: 09/30/2003
RESPS:30 HOURS:15 COSTS(000):$0
Patents FAR Sections Affected: 27.2; 52.227-2
FORMS: NONE
OMB NO: 9000-0097 EXPIRATION DATE: 10/31/2004
RESPS:3,000,000 HOURS:300,000 COSTS(000):$0
Information Reporting to the Internal Revenue Service (Taxpayer
Identification Number)-Secs. Affected: Subpart 4.9;52.204-3
FORMS: NONE
OMB NO: 9000-0101 EXPIRATION DATE: 05/31/2005
RESPS:600 HOURS:102 COSTS(000):$8,400
Drug-Free Workplace - FAR Section Affected: 52.223-6(b)(5)
FORMS: NONE
OMB NO: 9000-0102 EXPIRATION DATE: 09/30/2004
RESPS:420,134 HOURS:671,211 COSTS(000):$0
Prompt Payment--FAR Sections Affected: Subparts 32.9; 52.232-5;
52.232-26; 52.232-27; 52.212-4
FORMS: NONE
OMB NO: 9000-0107 EXPIRATION DATE: 07/31/2002
RESPS:2,500 HOURS:2,500 COSTS(000):$105,000
Notice of Radioactive Materials -- 23.602 and 52.223-7
FORMS: NONE
OMB NO: 9000-0108 EXPIRATION DATE: 06/30/2002
RESPS:1,000 HOURS:1,250 COSTS(000):$52,500
Bankruptcy -- 52.242-13
FORMS: NONE
OMB NO: 9000-0113 EXPIRATION DATE: 10/31/2004
RESPS:20 HOURS:20 COSTS(000):$0
Acquisition of Helium --FAR Section Affected 8.5
FORMS: NONE
OMB NO: 9000-0114 EXPIRATION DATE: 09/30/2003
RESPS:130 HOURS:440 COSTS(000):$30
Right of First Refusal of Employment FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0115 EXPIRATION DATE: 11/30/2003
RESPS:100 HOURS:125 COSTS(000):$0
Notification of Ownership Changes FAR Section Affected:
15.408(k); 52.215-19
FORMS: NONE
OMB NO: 9000-0122 EXPIRATION DATE: 05/31/2004
RESPS:5,140 HOURS:2,285 COSTS(000):$0
Scope and Duration of Contract -- FAR Sections Affected: 52.241-3
FORMS: NONE
OMB NO: 9000-0123 EXPIRATION DATE: 06/30/2004
RESPS:5,140 HOURS:2,285 COSTS(000):$0
Change in Rates or Terms and Condiitons of Service for Regulated
Services -- FAR Sections Affected: 52.241-7
FORMS: NONE
OMB NO: 9000-0124 EXPIRATION DATE: 06/30/2004
RESPS:450 HOURS:900 COSTS(000):$0
Capital Credits - FAR Clause 52.241-13 FAR Sections Affected:
52.241-13
FORMS: NONE
OMB NO: 9000-0125 EXPIRATION DATE: 06/30/2004
RESPS:50 HOURS:25 COSTS(000):$0
Written Refusal of a Utility Supplier to Execute a Utility
Contract FAR Sections Affected: 41.202(c)
FORMS: NONE
OMB NO: 9000-0126 EXPIRATION DATE: 06/30/2004
RESPS:500 HOURS:225 COSTS(000):$0
Electric Service Territory Compliance Representation -- FAR
Sections affected: 52.241
FORMS: NONE
OMB NO: 9000-0129 EXPIRATION DATE: 09/30/2003
RESPS:1,462 HOURS:293,650 COSTS(000):$0
Cost Accounting Standards Administration FAR Sections Affected:
Subpart 30.6; 52.230-5
FORMS: NONE
OMB NO: 9000-0130 EXPIRATION DATE: 03/31/2003
RESPS:5,700 HOURS:952 COSTS(000):$39,318
Buy American Act-north American Free Trade Agreement FAR
Sections Affected: 52.225-4
FORMS: NONE
OMB NO: 9000-0132 EXPIRATION DATE: 09/30/2003
RESPS:1,580 HOURS:26,860 COSTS(000):$0
Contractors' Purchasing systems Reviews FAR Sections Affected:
44-305-2(c); 44.305-3; 2.244-2(j)
FORMS: NONE
OMB NO: 9000-0133 EXPIRATION DATE: 11/30/2003
RESPS:18 HOURS:1,800 COSTS(000):$0
Defense Production Act Amendments FAR Sections Affected: 34.1
and 52.234-1
FORMS: NONE
OMB NO: 9000-0134 EXPIRATION DATE: 10/31/2004
RESPS:64,350 HOURS:32,175 COSTS(000):$0
Environmentally Sound Products - FAR Sections Affected: 23.405;
52.223-4
FORMS: NONE
OMB NO: 9000-0135 EXPIRATION DATE: 05/31/2004
RESPS:60,000 HOURS:30,000 COSTS(000):$0
Subcontractor Requests for Bonds; FAR 28.106-4; 52.228-12
FORMS: NONE
OMB NO: 9000-0136 EXPIRATION DATE: 10/31/2003
RESPS:1,427,800 HOURS:445,450 COSTS(000):$0
Commercial item Acquisitions-FAR Sections Affected: Part
FORMS: NONE
OMB NO: 9000-0138 EXPIRATION DATE: 09/30/2004
RESPS:11,000 HOURS:22,000 COSTS(000):$0
Contract Financing--FAR Sections Affected Subparts 32.0; 32.1,
32.2; 32.5, 32.10; 52.232-29 thru 32
FORMS: NONE
OMB NO: 9000-0139 EXPIRATION DATE: 12/31/2002
RESPS:167,487 HOURS:83,744 COSTS(000):$3,517,248
Federal Acquisition and Community Right-to-Know -- Subpart 23.9,
FORMS: NONE
OMB NO: 9000-0141 EXPIRATION DATE: 06/30/2002
RESPS:1,000 HOURS:2,500 COSTS(000):$55,000
Buy American Act--Construction (Grimberg Decision) -- FAR
FORMS: NONE
OMB NO: 9000-0142 EXPIRATION DATE: 08/31/2002
RESPS:600,000 HOURS:1,200,000 COSTS(000):$0
Past Performance Information -- FAR Sections Affected: 9.104-1,
9.105-1, 15.406, 15.604, 15.605, 15.608, 42.302, Subpart 42.15
FORMS: NONE
OMB NO: 9000-0144 EXPIRATION DATE: 09/30/2002
RESPS:140,000 HOURS:70,000 COSTS(000):$1,820
Payment by Electronic Fund Transfer -- FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0145 EXPIRATION DATE: 03/31/2003
RESPS:201,600 HOURS:4,147 COSTS(000):$106,494
use of data universal numbering system (DuNS) as Primary
52.204-6, 52.212-1)j)
FORMS: SF-294 SF-295
OMB NO: 9000-0147 EXPIRATION DATE: 05/31/2003
RESPS:19,500 HOURS:14,500 COSTS(000):$0
Pollution Prevention and Right-to-Know Information FAR Sections
Affected: Subpart 23.10 and 52.223-5
FORMS: NONE
OMB NO: 9000-0149 EXPIRATION DATE: 07/31/2003
RESPS:15,349 HOURS:13,384 COSTS(000):$0
Subcontract Consent FAR Sections Affected: 44.201, 52.244-2
FORMS: NONE
OMB NO: 9000-0150 EXPIRATION DATE: 06/30/2003
RESPS:183,257 HOURS:381,305 COSTS(000):$0
Small Disadvantaged Business Procurement Credit Programs FAR
Sections Affected: 19.11 Subpart 19,12, 52.219-22, -23,
52.219-24, 52.219-25, 52.219-26
FORMS: OF-312
OMB NO: 9000-0152 EXPIRATION DATE: 05/31/2003
RESPS:19,906 HOURS:9,953 COSTS(000):$0
Service Contracting - FAR Sections Affected: 52.237-10; 37.115-3
FORMS: NONE
OMB NO: 9000-0153 EXPIRATION DATE: 03/31/2005
RESPS:100 HOURS:100 COSTS(000):$0
OMB Circular A-119 FAR Parts Affected: Subparts 11.1; 11.2;
52.211-7
FORMS: NONE
OMB NO: 9000-0154 EXPIRATION DATE: 01/31/2003
RESPS:1 HOURS:81,000 COSTS(000):$2,187
Davis-Bacon Act--Price Adjustment (Actual Method)
FORMS: NONE
OMB NO: 9000-0155 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:250 COSTS(000):$6,750
Prohibition on Acquisition of Products Produced by Forced or
Indentured Child Labor (FAR 22.15)
FORMS: NONE
OMB NO: 9000-0156 EXPIRATION DATE: 10/31/2004
RESPS:75 HOURS:18 COSTS(000):$0
Trademarks for Government Products and Services - FAR Sections
Affected: Subpart 27.X; 52.227-XX
FORMS: NONE
OMB NO: 9000-0157 EXPIRATION DATE: 10/31/2003
RESPS:20,000 HOURS:580,000 COSTS(000):$0
Consolidated Form for Selection of Architect-Engineer Contracts
FORMS: SF-330
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
101 36,716,171 24,335,891 $29,042,702
National Institute for Literacy
OMB NO: 3430-0003 EXPIRATION DATE: 06/30/2004
RESPS:50 HOURS:1,000 COSTS(000):$0
Literacy Leader Fellowship Program
FORMS: NONE
OMB NO: 3430-0005 EXPIRATION DATE: 06/30/2002
RESPS:10 HOURS:800 COSTS(000):$0
Application for Cooperative Agreement for the Equipped for the
Future (EFF) Field-Based Center for Training, Technical
Assistance, and Materials Development
FORMS: NONE
OMB NO: 3430-0006 EXPIRATION DATE: 06/30/2003
RESPS:25 HOURS:108 COSTS(000):$0
Application for Cooperative Agreement for Content Development
Partners (Special Collections)
FORMS: NONE
OMB NO: 3430-0007 EXPIRATION DATE: 06/30/2003
RESPS:15 HOURS:120 COSTS(000):$0
Application for Cooperative Agreement for LINCS Regional
Technology Centers
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
4 100 2,028 $0
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