Agency for International Development
OMB NO: 0412-0004 EXPIRATION DATE: 10/31/2008
RESPS:750 HOURS:375 COSTS(000):$0
Application for Approval of Commodity Eligibility
FORMS: 11
OMB NO: 0412-0011 EXPIRATION DATE: 06/30/2009
RESPS:85 HOURS:900 COSTS(000):$0
American Schools and Hospitals Abroad (ASHA), Application for
Assistance
FORMS: AID-1010-2
OMB NO: 0412-0012 EXPIRATION DATE: 10/31/2006
RESPS:2,400 HOURS:1,200 COSTS(000):$0
Supplier's Certificate and Agreement with U.S. Agency for
International Development/Invoice and Contract Abstract
FORMS: AID-282
OMB NO: 0412-0035 EXPIRATION DATE: 12/31/2007
RESPS:533 HOURS:1,599 COSTS(000):$0
AID Form 1550-2 Private Voluntary Organization
FORMS: AID-1550-2
OMB NO: 0412-0506 EXPIRATION DATE: 08/31/2007
RESPS:2,200 HOURS:550 COSTS(000):$110
USAID Small Business Resource Database (fomerly known as the
Vendor Database)
FORMS: NONE
OMB NO: 0412-0514 EXPIRATION DATE: 03/31/2009
RESPS:2,643 HOURS:1,042 COSTS(000):$0
USAID Regulation 1 - Rules and Procedures Applicable to
Commodity Transactions Financed by USAID (22 CFR 201)
FORMS: NONE
OMB NO: 0412-0554 EXPIRATION DATE: 11/30/2007
RESPS:15,720 HOURS:2,620 COSTS(000):$0
TraiNet Results and Information Network (TraiNet)
FORMS: NONE
OMB NO: 0412-0562 EXPIRATION DATE: 06/30/2007
RESPS:380 HOURS:30,600 COSTS(000):$0
Narrative/Time-Line (NTL) Report
FORMS: 1570-13
OMB NO: 0412-0563 EXPIRATION DATE: 06/30/2007
RESPS:1,120 HOURS:30,600 COSTS(000):$0
Report on Commodities
FORMS: 1570-14
OMB NO: 0412-0568 EXPIRATION DATE: 08/31/2006
RESPS:730 HOURS:2,980 COSTS(000):$0
Prostitution and Sex Trafficking Certification and Policy
Requirement
FORMS: NONE
OMB NO: 0412-0570 EXPIRATION DATE: 03/31/2009
RESPS:500 HOURS:1,750 COSTS(000):$0
USAID 22. CFR 226.91, Marking Requirements, "Branding Strategy"
and "Marking Plan."
FORMS: NONE
OMB NO: 0412-0571 EXPIRATION DATE: 02/28/2009
RESPS:351 HOURS:88 COSTS(000):$0
Minority Serving Institution Database (This new collection will
be a subset of the previously approved SBRD - OMB Control No.
0412)
FORMS: NONE
OMB NO: 0412-0572 EXPIRATION DATE: 05/31/2009
RESPS:300 HOURS:150 COSTS(000):$0
USAID Bureau for Africa Summer Internship Application System and
Procedures
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
13 27,712 74,454 $110
Broadcasting Board of Governors
OMB NO: 3112-0001 EXPIRATION DATE: 12/31/2006
RESPS:748 HOURS:542 COSTS(000):$0
Surveys and other audiences research for Radio and TV Marti
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 748 542 $0
Committee for Purchase from the Blind and Other Severely Handicapped
OMB NO: 3037-0001 EXPIRATION DATE: 03/31/2009
RESPS:77 HOURS:231 COSTS(000):$0
Annual Certification - Qualified Nonprofit Agency Serving People
Who Are Blind
FORMS: 403
OMB NO: 3037-0002 EXPIRATION DATE: 03/31/2009
RESPS:565 HOURS:1,695 COSTS(000):$0
Annual Certification - Qualified Nonprofit Agency Serving People
Who Are Severely Disabled
FORMS: 404
OMB NO: 3037-0003 EXPIRATION DATE: 10/31/2008
RESPS:30 HOURS:30 COSTS(000):$0
Initial Certification - Qualified Nonprofit Agency Serving
People Who Are Severely Disabled
FORMS: 402
OMB NO: 3037-0004 EXPIRATION DATE: 10/31/2008
RESPS:2 HOURS:2 COSTS(000):$0
Initial Certification - Qualified Nonprofit Agency Serving
People Who Are Blind
FORMS: 401
OMB NO: 3037-0005 EXPIRATION DATE: 03/31/2008
RESPS:650 HOURS:3,250 COSTS(000):$0
Nonprofit Agency Responsibilities, 41 CFR 51-2.4 and 51-4.3
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 1,324 5,208 $0
Corporation for National and Community Service
OMB NO: 3045-0005 EXPIRATION DATE: 12/31/2007
RESPS:700 HOURS:1,000 COSTS(000):$0
AmeriCorps*National Civilian Community Corps Team Leader
Application
FORMS: NONE
OMB NO: 3045-0006 EXPIRATION DATE: 04/30/2007
RESPS:50,000 HOURS:5,833 COSTS(000):$0
Corporation for National Service, Enrollment Form
FORMS: NONE
OMB NO: 3045-0010 EXPIRATION DATE: 01/31/2007
RESPS:1,200 HOURS:9,600 COSTS(000):$135,000
AmeriCorps*National Civilian Community Corps Service Project
Application
FORMS: NONE
OMB NO: 3045-0014 EXPIRATION DATE: 10/31/2007
RESPS:69,000 HOURS:2,875 COSTS(000):$0
Voucher and Payment Request Form
FORMS: NONE
OMB NO: 3045-0015 EXPIRATION DATE: 04/30/2007
RESPS:50,000 HOURS:5,833 COSTS(000):$0
Corporation for National Service EXIT FORM
FORMS: NONE
OMB NO: 3045-0030 EXPIRATION DATE: 07/31/2008
RESPS:16,000 HOURS:1,335 COSTS(000):$0
Forbearance Request for National Service Form
FORMS: NONE
OMB NO: 3045-0033 EXPIRATION DATE: 08/31/2007
RESPS:1,350 HOURS:12,045 COSTS(000):$2,000
Project Progress Report - National Senior Service Corps (Senior
Corps)
FORMS: NONE
OMB NO: 3045-0035 EXPIRATION DATE: 04/30/2008
RESPS:1,317 HOURS:17,121 COSTS(000):$4
Senior Corps Grant Application, formerly National Senior Service
Corps Grant Application
FORMS: 424-NSSC
OMB NO: 3045-0038 EXPIRATION DATE: 12/31/2007
RESPS:3,200 HOURS:16,050 COSTS(000):$0
AmeriCorps*VISTA Project Application and Instructions
FORMS: NONE
OMB NO: 3045-0043 EXPIRATION DATE: 10/31/2008
RESPS:5,200 HOURS:76,440 COSTS(000):$0
AmeriCorps*VISTA Project Progress Report
FORMS: NONE
OMB NO: 3045-0045 EXPIRATION DATE: 07/31/2008
RESPS:400 HOURS:4,000 COSTS(000):$160,000
Learn and Serve America School and Community-Based Application
Instructions
FORMS: NONE
OMB NO: 3045-0046 EXPIRATION DATE: 07/31/2008
RESPS:200 HOURS:2,000 COSTS(000):$80,000
Learn and Serve America Higher Education Grant Application
FORMS: NONE
OMB NO: 3045-0047 EXPIRATION DATE: 04/30/2009
RESPS:2,000 HOURS:32,000 COSTS(000):$0
All AmeriCorps Application Instructions: State, National Direct,
State Education Award Program, Direct Education Award Program,
National Professional Corps, Indian Tribes, State & Territories..
FORMS: NONE
OMB NO: 3045-0048 EXPIRATION DATE: 10/31/2007
RESPS:1 HOURS:800 COSTS(000):$0
AmeriCorps Alumni Profile Card
FORMS: NONE
OMB NO: 3045-0049 EXPIRATION DATE: 04/30/2007
RESPS:2,500 HOURS:1,875 COSTS(000):$48,825
Accomplishment Surveys for Senior Corps Programs
FORMS: NONE
OMB NO: 3045-0053 EXPIRATION DATE: 07/31/2008
RESPS:7,000 HOURS:583 COSTS(000):$0
Interest Accrual Form
FORMS: NONE
OMB NO: 3045-0054 EXPIRATION DATE: 01/31/2009
RESPS:225,000 HOURS:281,250 COSTS(000):$0
AmeriCorps Member Application
FORMS: NONE
OMB NO: 3045-0077 EXPIRATION DATE: 02/28/2009
RESPS:500,000 HOURS:25,000 COSTS(000):$0
Volunteer Service Hour Tracking Tool
FORMS: NONE
OMB NO: 3045-0078 EXPIRATION DATE: 12/31/2008
RESPS:456,526 HOURS:30,000 COSTS(000):$0
Senior Corps Web-Based Recruitment System "JASON"
www.joinseniorservice.org
FORMS: NONE
OMB NO: 3045-0086 EXPIRATION DATE: 02/28/2007
RESPS:100,000 HOURS:100,000 COSTS(000):$1,654,000
President's Volunteer Service Awards, Parts A, B, C, D, and E.
FORMS: NONE
OMB NO: 3045-0087 EXPIRATION DATE: 02/29/2008
RESPS:440 HOURS:4,400 COSTS(000):$0
2005 Next Generation Grants Concept Paper and Application
Instructions
FORMS: NONE
OMB NO: 3045-0088 EXPIRATION DATE: 03/31/2007
RESPS:6,000 HOURS:2,000 COSTS(000):$0
Presidential Freedom Scholarships
FORMS: NONE
OMB NO: 3045-0089 EXPIRATION DATE: 03/31/2007
RESPS:266 HOURS:532 COSTS(000):$15,960
Learn and Serve America Grantee Performance Report
FORMS: NONE
OMB NO: 3045-0090 EXPIRATION DATE: 10/31/2007
RESPS:2,000 HOURS:2,000 COSTS(000):$0
Peer Reviewer Application Instructions
FORMS: NONE
OMB NO: 3045-0091 EXPIRATION DATE: 10/31/2007
RESPS:200 HOURS:600 COSTS(000):$0
Spirit Service Awards Nomination Guidelines and Application -
Senior Corps
FORMS: NONE
OMB NO: 3045-0092 EXPIRATION DATE: 10/31/2007
RESPS:200 HOURS:600 COSTS(000):$0
Spirit Service Awards Nomination Guidelines and Application -
AmeriCorps
FORMS: NONE
OMB NO: 3045-0093 EXPIRATION DATE: 10/31/2007
RESPS:200 HOURS:600 COSTS(000):$0
Spirit of Service Awards Nomination Guidelines and Application -
Learn and Serve America
FORMS: NONE
OMB NO: 3045-0094 EXPIRATION DATE: 09/30/2007
RESPS:3,250 HOURS:708 COSTS(000):$9,900
Performance Measurement in AmeriCorps: Surveys of Members,
Organizations and End Beneficiaries
FORMS: NONE
OMB NO: 3045-0095 EXPIRATION DATE: 09/30/2007
RESPS:2,668 HOURS:2,542 COSTS(000):$0
Learn and Serve America Program and Performance Reporting System
FORMS: NONE
OMB NO: 3045-0096 EXPIRATION DATE: 07/31/2007
RESPS:3,290 HOURS:827 COSTS(000):$0
Parent Corps Evaluation
FORMS: NONE
OMB NO: 3045-0097 EXPIRATION DATE: 08/31/2007
RESPS:2,603 HOURS:1,470 COSTS(000):$39
Project Director and Station Supervisor Survey Components of the
Senior Corps Performance Surveys
FORMS: NONE
OMB NO: 3045-0098 EXPIRATION DATE: 05/31/2009
RESPS:4,500 HOURS:1,567 COSTS(000):$0
Volunteer and Service Recipient Surveys for Senior Corps Programs
FORMS: NONE
OMB NO: 3045-0099 EXPIRATION DATE: 04/30/2008
RESPS:55 HOURS:1,650 COSTS(000):$0
Administrative, Program Development Assistance & Training,
Disability Funds
FORMS: NONE
OMB NO: 3045-0101 EXPIRATION DATE: 05/31/2008
RESPS:44,564 HOURS:16,147 COSTS(000):$0
AmeriCorps Annual Progress Reporting Modules
FORMS: NONE
OMB NO: 3045-0102 EXPIRATION DATE: 01/31/2008
RESPS:35 HOURS:17 COSTS(000):$0
Financial Management Survey Form
FORMS: NONE
OMB NO: 3045-0103 EXPIRATION DATE: 07/31/2008
RESPS:1,464 HOURS:2,928 COSTS(000):$0
AmeriCorps Financial Status Report
FORMS: 269A
OMB NO: 3045-0104 EXPIRATION DATE: 02/29/2008
RESPS:1,400 HOURS:997 COSTS(000):$0
Study of Volunteers' Experience in the VISTA Program
FORMS: NONE
OMB NO: 3045-0105 EXPIRATION DATE: 07/31/2008
RESPS:170 HOURS:7,200 COSTS(000):$0
Application Instructions: Training and Technical Assistance
Cooperative Agreements
FORMS: NONE
OMB NO: 3045-0107 EXPIRATION DATE: 06/30/2008
RESPS:105 HOURS:315 COSTS(000):$0
Field Network Pilot Study Field Guidance
FORMS: NONE
OMB NO: 3045-0108 EXPIRATION DATE: 07/31/2008
RESPS:120 HOURS:600 COSTS(000):$0
Challenge Grant Application Instructions
FORMS: NONE
OMB NO: 3045-0109 EXPIRATION DATE: 07/31/2008
RESPS:143,140 HOURS:23,262 COSTS(000):$0
AmeriCorps Member Satisfaction Survey
FORMS: NONE
OMB NO: 3045-0110 EXPIRATION DATE: 07/31/2008
RESPS:80 HOURS:800 COSTS(000):$0
Martin Luther King, Jr. Day of Service Grant Application
Instructions
FORMS: NONE
OMB NO: 3045-0111 EXPIRATION DATE: 07/31/2008
RESPS:128 HOURS:21 COSTS(000):$0
VISTA-Points of Light Foundation Strenthening Communities
Initiative Volunteer Center and Community Partner Surveys
FORMS: NONE
OMB NO: 3045-0112 EXPIRATION DATE: 07/31/2008
RESPS:52 HOURS:1,040 COSTS(000):$0
AmeriCorps Member Activity Collection Form
FORMS: NONE
OMB NO: 3045-0113 EXPIRATION DATE: 06/30/2009
RESPS:111 HOURS:111 COSTS(000):$0
Requests for Budget Amendment Related to Disaster Relief Efforts
FORMS: NONE
OMB NO: 3045-0114 EXPIRATION DATE: 06/30/2009
RESPS:800 HOURS:400 COSTS(000):$0
CNCS Disaster Response Information Collection
FORMS: NONE
OMB NO: 3045-0115 EXPIRATION DATE: 01/31/2009
RESPS:200 HOURS:600 COSTS(000):$0
Spirit of Service Awards Nomination Guidelines and Application -
Corporate
FORMS: NONE
OMB NO: 3045-0116 EXPIRATION DATE: 01/31/2009
RESPS:4,000 HOURS:200 COSTS(000):$0
My Improvement Plan: On-line Survey and Planning Tool for
Training and Technical Assistance
FORMS: NONE
OMB NO: 3045-0117 EXPIRATION DATE: 02/28/2009
RESPS:54 HOURS:540 COSTS(000):$0
AmeriCorps Application Instructions for State Commissions
FORMS: NONE
OMB NO: 3045-0118 EXPIRATION DATE: 04/30/2009
RESPS:54 HOURS:1,296 COSTS(000):$0
State Service Plans
FORMS: NONE
OMB NO: 3045-0119 EXPIRATION DATE: 05/31/2009
RESPS:7,500 HOURS:4,375 COSTS(000):$0
Random Assignment Evaluation of Youth Corps
FORMS: NONE
OMB NO: 3045-0120 EXPIRATION DATE: 05/31/2009
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Application for the President's Higher Education Community
Service Honor Roll
FORMS: NONE
OMB NO: 3045-0121 EXPIRATION DATE: 07/31/2009
RESPS:1,557 HOURS:783 COSTS(000):$0
Field Network Pilot Study of Cost-Sharing in VISTA Field Guide
and Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
53 1,723,800 707,768 $2,105,728
Equal Employment Opportunity Commission
OMB NO: 3046-0003 EXPIRATION DATE: 09/30/2006
RESPS:5,000 HOURS:10,000 COSTS(000):$0
Elementary-Secondary Staff Information (EEO-5)
FORMS: EEOC-168A
OMB NO: 3046-0006 EXPIRATION DATE: 09/30/2006
RESPS:3,000 HOURS:4,500 COSTS(000):$0
Local Union Report (EEO-3)
FORMS: 274
OMB NO: 3046-0007 EXPIRATION DATE: 01/31/2009
RESPS:170,000 HOURS:599,000 COSTS(000):$0
Employer Information Report (EEO-1)
FORMS: 100
OMB NO: 3046-0008 EXPIRATION DATE: 09/30/2006
RESPS:10,000 HOURS:40,000 COSTS(000):$0
State and Local Government Information (EEO-4)
FORMS: EEOC-164
OMB NO: 3046-0017 EXPIRATION DATE: 09/30/2006
RESPS:666,000 HOURS:1,450,000 COSTS(000):$0
Uniform Guidelines on Employee Selection Procedures
FORMS: NONE
OMB NO: 3046-0040 EXPIRATION DATE: 11/30/2006
RESPS:627,000 HOURS:16,667 COSTS(000):$0
Recordkeeping Under Title VII and the ADA
FORMS: NONE
OMB NO: 3046-0042 EXPIRATION DATE: 10/31/2006
RESPS:13,700 HOURS:41,000 COSTS(000):$0
Waivers of Rights and Claims Under the ADEA; Informational
Requirements
FORMS: NONE
OMB NO: 3046-0044 EXPIRATION DATE: 09/30/2007
RESPS:100 HOURS:1,000 COSTS(000):$0
Nomination for the EEOC's "Freedom to Compete" Award
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
8 1,494,800 2,162,167 $0
Executive Office of the President
OMB NO: 0300-0012 EXPIRATION DATE: 08/31/2007
RESPS:317 HOURS:317 COSTS(000):$0
State/local budget information data collection for ONDCP's 25
cities project
FORMS: NONE
OMB NO: 0300-0014 EXPIRATION DATE: 10/31/2006
RESPS:500 HOURS:80 COSTS(000):$800
Helping America's Youth - Community Resource Inventory
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 817 397 $800
Export-Import Bank of the United States
OMB NO: 3048-0003 EXPIRATION DATE: 10/31/2008
RESPS:630 HOURS:1,260 COSTS(000):$0
U.S. Small Business Administration, Export-Import Bank of the
United States Joint Application for Working Capital Guarantee
FORMS: 84-1
OMB NO: 3048-0004 EXPIRATION DATE: 09/30/2006
RESPS:200 HOURS:200 COSTS(000):$0
Annual Competitiveness Report Survey of Exporters and Bankers
FORMS: EIB-00-02
OMB NO: 3048-0005 EXPIRATION DATE: 03/31/2008
RESPS:500 HOURS:165 COSTS(000):$0
Ex-Im Bank Letter of Interest Application
FORMS: 95-9
OMB NO: 3048-0009 EXPIRATION DATE: 04/30/2007
RESPS:1,762 HOURS:1,762 COSTS(000):$0
Application forms for export credit insurance program
FORMS: EIB-92-34 EIB-92-37 EIB-92-41 EIB-92-45 EIB-92-50 EIB-92-64
EIB-92-79
OMB NO: 3048-0012 EXPIRATION DATE: 11/30/2007
RESPS:2 HOURS:1,200 COSTS(000):$0
Content Report on Products, and Services in Ex-Im Bank
Transactions and Annual Aggregate Foreign Content Cause Report
FORMS: EIB-01-02 EIB-01-02A
OMB NO: 3048-0013 EXPIRATION DATE: 11/30/2006
RESPS:70 HOURS:105 COSTS(000):$0
Export-Import Bank of the U.S. Long-Term Preliminary Commitment
and Final Commitment Application
FORMS: 95-10
OMB NO: 3048-0014 EXPIRATION DATE: 12/31/2006
RESPS:989 HOURS:989 COSTS(000):$0
Application for Medium Term Insurance or Guarantee
FORMS: 03-02
OMB NO: 3048-0015 EXPIRATION DATE: 06/30/2009
RESPS:2,176 HOURS:1,088 COSTS(000):$0
Application for Special Buyer Credit Limit (SBCL) Under Multi-
Buyer Export Credit Insurance Policies
FORMS: EIB-92-51
OMB NO: 3048-0016 EXPIRATION DATE: 04/30/2009
RESPS:720 HOURS:240 COSTS(000):$0
Export-Import Bank of the U.S. Application for Issuing Bank
Credit Limit (IBCL) Under Bank Letter of Credit Policy
FORMS: EIB-92-36
OMB NO: 3048-0017 EXPIRATION DATE: 06/30/2009
RESPS:19,200 HOURS:9,600 COSTS(000):$0
Export-Import Bank Report of Premiums Payable for Exporters Only
FORMS: EIB-92-29
OMB NO: 3048-0018 EXPIRATION DATE: 07/31/2009
RESPS:160 HOURS:160 COSTS(000):$0
Application for Exporter Short-Term Single-Buyer Insurance
FORMS: EIB-92-64
OMB NO: 3048-0019 EXPIRATION DATE: 07/31/2009
RESPS:265 HOURS:265 COSTS(000):$0
Export-Import Bank of the United States Application for
Financial Institution Short-Term, Single-Buyer Insurance
FORMS: EIB-92-41
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 26,674 17,034 $0
Appraisal Subcommittee of the FFIEC
OMB NO: 3139-0003 EXPIRATION DATE: 12/31/2007
RESPS:1 HOURS:10 COSTS(000):$0
12 CFR part 1102, subpart A. Implements 12 U.S.C. 3348(b) by
prescribing rules of practice and procedure governing temporary
waiver proceedings.
FORMS: NONE
OMB NO: 3139-0004 EXPIRATION DATE: 12/31/2007
RESPS:4 HOURS:17 COSTS(000):$0
12 CFR part 1102, subpart C. Rules pertaining to the privacy of
individuals and systems of records mainained by the Appraisal
Subcommittee.
FORMS: NONE
OMB NO: 3139-0005 EXPIRATION DATE: 06/30/2009
RESPS:2 HOURS:120 COSTS(000):$0
Rules of Practice for Proceedings; 12 C.F.R. part 1102, subpart B
FORMS: NONE
OMB NO: 3139-0006 EXPIRATION DATE: 12/31/2007
RESPS:1 HOURS:5 COSTS(000):$0
12 CFR part 1102, subpart D. Implements the Freedom of Informa-
tion description of office, rule petitions, and confidential
treatment requests.
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
4 8 152 $0
Federal Mediation and Conciliation Service
OMB NO: 3076-0015 EXPIRATION DATE: 01/31/2009
RESPS:504 HOURS:42 COSTS(000):$0
On-Line Survey of Relationship-Development and Training (RDT)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 504 42 $0
General Services Administration
OMB NO: 3090-0007 EXPIRATION DATE: 03/31/2008
RESPS:3,528 HOURS:8,820 COSTS(000):$0
Contractor's Qualifications and Financial Information
FORMS: GSA-527
OMB NO: 3090-0014 EXPIRATION DATE: 04/30/2009
RESPS:45,413 HOURS:810 COSTS(000):$0
Transfer Order - Surplus Personal Property and Continuation Sheet
FORMS: SF-123 SF-123A
OMB NO: 3090-0027 EXPIRATION DATE: 07/31/2008
RESPS:116,869 HOURS:7,830 COSTS(000):$0
GSAM Part 542, Contract Administration and Part 546, Quality
Assurance
FORMS: GSA-1678 DD-250 GSA-308
OMB NO: 3090-0043 EXPIRATION DATE: 02/29/2008
RESPS:1,300 HOURS:2,080 COSTS(000):$0
Appraisal of Fair Annual Parking Rate Per Space for Standard
Level User Charge
FORMS: 3357
OMB NO: 3090-0044 EXPIRATION DATE: 04/30/2009
RESPS:8,000 HOURS:400 COSTS(000):$0
Application/Permit for Use of Space in Public Buildings and
Grounds
FORMS: 3453
OMB NO: 3090-0057 EXPIRATION DATE: 09/30/2008
RESPS:1,000 HOURS:250 COSTS(000):$0
Deposit Bond Individual - Sale of Government Personal Property
FORMS: SF-150
OMB NO: 3090-0058 EXPIRATION DATE: 06/30/2008
RESPS:1,000 HOURS:250 COSTS(000):$8,632
Deposit Bond Annual Sale of Government Personal Property
FORMS: SF-151
OMB NO: 3090-0080 EXPIRATION DATE: 06/30/2008
RESPS:2,000 HOURS:200 COSTS(000):$0
General Services Administration Acquisition Manuel (GSAM) Part
532, Contract Financing, 552.232-72, Final Payment
FORMS: NONE
OMB NO: 3090-0086 EXPIRATION DATE: 04/30/2008
RESPS:5,016 HOURS:25,183 COSTS(000):$0
GSA Form 1364, Proposal to Lease Space
FORMS: GSA-1364
OMB NO: 3090-0112 EXPIRATION DATE: 10/31/2008
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: 03/31/2008
RESPS:874 HOURS:291 COSTS(000):$0
Standard Form (SF) 94, Statement of Witness
FORMS: SF-94
OMB NO: 3090-0121 EXPIRATION DATE: 03/31/2008
RESPS:314,200 HOURS:26,173 COSTS(000):$0
GSAM, Part 538.2 Establishing and Administering Schedules,
552.238-74
FORMS: GSA-72A
OMB NO: 3090-0163 EXPIRATION DATE: 03/31/2008
RESPS:172,500 HOURS:68,900 COSTS(000):$0
Information Specific to a Cntract
FORMS: NONE
OMB NO: 3090-0197 EXPIRATION DATE: 04/30/2008
RESPS:6,794 HOURS:6,794 COSTS(000):$0
GSAR Provision 552.237-70, Qualifications of Offerors
FORMS: NONE
OMB NO: 3090-0200 EXPIRATION DATE: 04/30/2008
RESPS:10 HOURS:5 COSTS(000):$0
GSAM, Part 514, Sealed Bidding, Clause 552.214-71
FORMS: NONE
OMB NO: 3090-0204 EXPIRATION DATE: 03/31/2008
RESPS:10,305 HOURS:2,741 COSTS(000):$0
GSAR Part 552.211-82 Notice of Shipment & Part 552.211-78
Commercial Delivery Schedule Clause and Notice of Shipment
FORMS: NONE
OMB NO: 3090-0221 EXPIRATION DATE: 01/31/2007
RESPS:55 HOURS:6 COSTS(000):$0
GSA Board of Contract Appeals Subpoena, and Form 4 and 5
(Certificates of Finality)
FORMS: GSA-9534
OMB NO: 3090-0228 EXPIRATION DATE: 07/31/2009
RESPS:200 HOURS:400 COSTS(000):$0
NonDiscrimination in Federal Financial Assistance Programs
FORMS: NONE
OMB NO: 3090-0235 EXPIRATION DATE: 07/31/2008
RESPS:33,360 HOURS:250,200 COSTS(000):$0
Price Reductions Clause
FORMS: NONE
OMB NO: 3090-0246 EXPIRATION DATE: 04/30/2008
RESPS:931,219 HOURS:7,757 COSTS(000):$0
General Services Administration Regulation (GSAR) Packing List
Clause
FORMS: NONE
OMB NO: 3090-0248 EXPIRATION DATE: 11/30/2008
RESPS:6,493 HOURS:1,623 COSTS(000):$0
GSAR 516.506, Solicitation Provisions and Contract Clauses;
552.216-72, Placement of Orders; 552.216-73, Ordering Information
FORMS: NONE
OMB NO: 3090-0250 EXPIRATION DATE: 10/31/2006
RESPS:1 HOURS:1 COSTS(000):$0
Zero Burden Information Collection Reports
FORMS: NONE
OMB NO: 3090-0252 EXPIRATION DATE: 12/31/2008
RESPS:1,020 HOURS:12,240 COSTS(000):$0
Preparation, Submission, and Negotiation of Subcontracting Plans
FORMS: NONE
OMB NO: 3090-0259 EXPIRATION DATE: 10/31/2008
RESPS:25 HOURS:12 COSTS(000):$0
Market Research Questionnaire
FORMS: NONE
OMB NO: 3090-0262 EXPIRATION DATE: 10/31/2008
RESPS:16,941 HOURS:84,705 COSTS(000):$0
Identification of Products with Environmental Attributes
FORMS: NONE
OMB NO: 3090-0270 EXPIRATION DATE: 10/31/2006
RESPS:1,000,000 HOURS:250,000 COSTS(000):$0
Access Certificates for Electronic Services (ACES)
FORMS: NONE
OMB NO: 3090-0274 EXPIRATION DATE: 07/31/2009
RESPS:360 HOURS:90 COSTS(000):$0
General Services Administration, Art-in-Architecture Program
National Artist Registry
FORMS: GSA-7437
OMB NO: 3090-0277 EXPIRATION DATE: 04/30/2009
RESPS:190 HOURS:230 COSTS(000):$0
Market Research Collection for the Office of Citizen Services
and Communications
FORMS: NONE
OMB NO: 3090-0278 EXPIRATION DATE: 09/30/2006
RESPS:2,250 HOURS:112 COSTS(000):$0
National Contract Center Customer Evaluation Survey
FORMS: NONE
OMB NO: 3090-0280 EXPIRATION DATE: 04/30/2009
RESPS:7,041 HOURS:42,246 COSTS(000):$0
Tax Adjustment Clause 552.270-30
FORMS: NONE
OMB NO: 3090-0281 EXPIRATION DATE: 04/30/2009
RESPS:144 HOURS:12 COSTS(000):$0
GSA Child Care Specialist Feedback Form
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
31 2,688,328 800,691 $8,632
Grants.gov
OMB NO: 4040-0001 EXPIRATION DATE: 04/30/2008
RESPS:312,500 HOURS:12,500,000 COSTS(000):$0
SF-424 Research & Related (R&R)
FORMS: NONE
OMB NO: 4040-0002 EXPIRATION DATE: 08/31/2008
RESPS:22,186 HOURS:22,186 COSTS(000):$0
SF-424 Mandatory (M)
FORMS: NONE
OMB NO: 4040-0003 EXPIRATION DATE: 01/31/2007
RESPS:8,549 HOURS:3,652 COSTS(000):$0
SF-424 Short Organizational (Short)
FORMS: NONE
OMB NO: 4040-0004 EXPIRATION DATE: 01/31/2009
RESPS:142,223 HOURS:146,758 COSTS(000):$0
SF-424 Discretionary
FORMS: NONE
OMB NO: 4040-0005 EXPIRATION DATE: 01/31/2007
RESPS:6,949 HOURS:2,863 COSTS(000):$0
SF-424 Individual(I)
FORMS: NONE
OMB NO: 4040-0006 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-424B Budget Information -- Non-Construction
FORMS: SF-424B
OMB NO: 4040-0007 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-424B Assurances -- Non-construction Programs
FORMS: SF-424B
OMB NO: 4040-0008 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-424C Budget Information -- Construction Programs
FORMS: SF-424C
OMB NO: 4040-0009 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-424D Assurances -- Construction Programs
FORMS: SF-424D
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 492,411 12,675,463 $0
International Trade Commission
OMB NO: 3117-0016 EXPIRATION DATE: 06/30/2008
RESPS:4,267 HOURS:173,148 COSTS(000):$0
Information collections for import injury investigations
(producers, importers, purchasers, and foreign producer
questionnaires and institution notices for 5-year reviews)
FORMS: NONE
OMB NO: 3117-0190 EXPIRATION DATE: 08/31/2006
RESPS:10,000 HOURS:333 COSTS(000):$0
USITC DataWeb: User Registration Form
FORMS: NONE
OMB NO: 3117-0192 EXPIRATION DATE: 02/28/2009
RESPS:1 HOURS:50 COSTS(000):$0
User Survey for participants in Commission import injury
investigations
FORMS: NONE
OMB NO: 3117-0210 EXPIRATION DATE: 09/30/2006
RESPS:1 HOURS:54 COSTS(000):$3
Survey Regarding Outstanding Section 337 Exclusion Orders
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
4 14,269 173,585 $3
M.K. Udall Foundation U.S. Institute for Environmental Conflict Resolution
OMB NO: 3320-0003 EXPIRATION DATE: 06/30/2008
RESPS:425 HOURS:67 COSTS(000):$0
Program Evaluation Instruments - Situation/Conflict Assessment
Services (two instruments)
FORMS: NONE
OMB NO: 3320-0004 EXPIRATION DATE: 06/30/2008
RESPS:3,800 HOURS:1,000 COSTS(000):$0
Program Evalution Instruments - Mediation and Facilities
Services (ECR Services) (three questionnaires)
FORMS: NONE
OMB NO: 3320-0005 EXPIRATION DATE: 06/30/2008
RESPS:1,050 HOURS:92 COSTS(000):$0
Program Evaluation Instruments - Roster Program Services (three
instruments)
FORMS: NONE
OMB NO: 3320-0006 EXPIRATION DATE: 06/30/2008
RESPS:1,950 HOURS:195 COSTS(000):$0
Program Evaluation Instruments - Training and Workshop Services
(one instrument)
FORMS: NONE
OMB NO: 3320-0007 EXPIRATION DATE: 06/30/2008
RESPS:3,510 HOURS:351 COSTS(000):$0
Program Evaluation Instruments - Facilited Meeting Services (one
instrument)
FORMS: NONE
OMB NO: 3320-0008 EXPIRATION DATE: 10/31/2008
RESPS:155 HOURS:106 COSTS(000):$0
Application for National Roster of Environmental Disput
Resolution and Consensus Building Professionals
FORMS: NONE
OMB NO: 3320-0009 EXPIRATION DATE: 06/30/2008
RESPS:60 HOURS:6 COSTS(000):$0
Program Evaluation Instruments - Program Support and System
Design (one instrument)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 10,950 1,817 $0
Merit Systems Protection Board
OMB NO: 3124-0009 EXPIRATION DATE: 01/31/2007
RESPS:6,300 HOURS:6,300 COSTS(000):$0
E-Appeal/US Merit Systems Protection Board Appeal Form
FORMS: MSPB-185
OMB NO: 3124-0012 EXPIRATION DATE: 12/31/2007
RESPS:1,500 HOURS:375 COSTS(000):$0
Customer Surveys
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 7,800 6,675 $0
National Aeronautics and Space Administration
OMB NO: 2700-0003 EXPIRATION DATE: 04/30/2009
RESPS:10,200 HOURS:91,800 COSTS(000):$0
NASA Contractor Financial Management Reports
FORMS: NASA-533Q NASA-533M
OMB NO: 2700-0007 EXPIRATION DATE: 09/30/2008
RESPS:50 HOURS:10 COSTS(000):$493
Radioactive Material Transfer Receipt
FORMS: JSC-1625
OMB NO: 2700-0009 EXPIRATION DATE: 10/31/2007
RESPS:1,605 HOURS:1,545 COSTS(000):$0
AST - Technology Utilization
FORMS: NONE
OMB NO: 2700-0010 EXPIRATION DATE: 10/31/2006
RESPS:90 HOURS:45 COSTS(000):$0
Patient License Report
FORMS: NONE
OMB NO: 2700-0017 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:7,900 COSTS(000):$0
NASA Property in the Custody of Contractors
FORMS: NF-1018
OMB NO: 2700-0039 EXPIRATION DATE: 10/31/2006
RESPS:85 HOURS:680 COSTS(000):$0
Application for a Patent License
FORMS: NONE
OMB NO: 2700-0047 EXPIRATION DATE: 08/31/2008
RESPS:288 HOURS:1,432 COSTS(000):$0
NASA Inventory Report: Property Management and Control, Grants
FORMS: NONE
OMB NO: 2700-0048 EXPIRATION DATE: 04/30/2008
RESPS:8,128 HOURS:15,137 COSTS(000):$0
Ptents - Grants and Cooperative Agreements
FORMS: NONE
OMB NO: 2700-0049 EXPIRATION DATE: 03/31/2009
RESPS:47,710 HOURS:291,326 COSTS(000):$0
Financial Monitoring and Control - Grants and Cooperative
Agreements
FORMS: NONE
OMB NO: 2700-0052 EXPIRATION DATE: 04/30/2008
RESPS:2,821 HOURS:8,603 COSTS(000):$0
NASA FAR Suplement, Part 1827, Patents, Data, & Copyrights
FORMS: NONE
OMB NO: 2700-0054 EXPIRATION DATE: 08/31/2008
RESPS:165 HOURS:7,425 COSTS(000):$0
Contract Modifications, NASA FAR Supplement Part 18-43
FORMS: NONE
OMB NO: 2700-0063 EXPIRATION DATE: 10/31/2006
RESPS:75 HOURS:19 COSTS(000):$0
NASA Safety Reporting System
FORMS: NONE
OMB NO: 2700-0064 EXPIRATION DATE: 02/28/2007
RESPS:8,455 HOURS:702 COSTS(000):$0
Locator and Information Services Tracking System (LISTS) Form
FORMS: GSFC-24-27
OMB NO: 2700-0073 EXPIRATION DATE: 08/31/2008
RESPS:380 HOURS:4,560 COSTS(000):$0
Small Business and small disadvantaged business concerns and
related contract provisions, NASA FAR Supplement Part 18-19, SF
295.
FORMS: NONE
OMB NO: 2700-0078 EXPIRATION DATE: 01/31/2007
RESPS:52 HOURS:78 COSTS(000):$0
Mentor Protege Program Small Business and Small Disadvantaged
Business Concerns
FORMS: NONE
OMB NO: 2700-0080 EXPIRATION DATE: 10/31/2006
RESPS:300 HOURS:975 COSTS(000):$0
Uncompensated Overtime
FORMS: NONE
OMB NO: 2700-0085 EXPIRATION DATE: 04/30/2007
RESPS:1,313 HOURS:750,800 COSTS(000):$0
NASA acquisition process, bids and proposals for contracts with
an estimated value more than $500,000
FORMS: NONE
OMB NO: 2700-0086 EXPIRATION DATE: 04/30/2007
RESPS:242,955 HOURS:73,152 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: 04/30/2007
RESPS:7,900 HOURS:2,560,000 COSTS(000):$0
NASA acquisition process, bids and propsals for contracts with
an estimated value less than $500,000
FORMS: NONE
OMB NO: 2700-0088 EXPIRATION DATE: 06/30/2008
RESPS:28,680 HOURS:803,040 COSTS(000):$0
NASA Acquisition Process - Reports Required under Contracts with
a Value of Less than $500K
FORMS: NONE
OMB NO: 2700-0089 EXPIRATION DATE: 04/30/2007
RESPS:85,904 HOURS:601,328 COSTS(000):$0
NASA acquisition process, reports required for contracts with an
estimated value more than $500,000
FORMS: NONE
OMB NO: 2700-0092 EXPIRATION DATE: 06/30/2008
RESPS:520 HOURS:3,488 COSTS(000):$0
Cooperative Agreements with Commercial Firms
FORMS: NONE
OMB NO: 2700-0093 EXPIRATION DATE: 08/31/2008
RESPS:525 HOURS:2,505 COSTS(000):$0
Grants & Cooperative Agreements with State and Local Governments
FORMS: NONE
OMB NO: 2700-0095 EXPIRATION DATE: 08/31/2006
RESPS:200 HOURS:200 COSTS(000):$11
NASA Small Business Innovation Research Commercial Metrics
FORMS: NONE
OMB NO: 2700-0099 EXPIRATION DATE: 09/30/2008
RESPS:8,000 HOURS:5,455 COSTS(000):$1,075,000
National Aviation Operations Monitoring Service
FORMS: NONE
OMB NO: 2700-0101 EXPIRATION DATE: 04/30/2009
RESPS:500 HOURS:125 COSTS(000):$8
NASA Procurement Vendor Customer Survey
FORMS: NONE
OMB NO: 2700-0103 EXPIRATION DATE: 01/31/2009
RESPS:40,000 HOURS:3,334 COSTS(000):$0
NASA Voluntary On-Line Job Applicant Racial and Ethnic Data
Collection
FORMS: NONE
OMB NO: 2700-0106 EXPIRATION DATE: 04/30/2009
RESPS:93 HOURS:425 COSTS(000):$0
Federal Automotive Statistical Tool (FAST) Collection
FORMS: NONE
OMB NO: 2700-0107 EXPIRATION DATE: 08/31/2006
RESPS:50 HOURS:25 COSTS(000):$0
BOREAS Data User Satisfaction Survey
FORMS: NONE
OMB NO: 2700-0109 EXPIRATION DATE: 10/31/2006
RESPS:917 HOURS:459 COSTS(000):$0
Title IX Recipient Request
FORMS: NONE
OMB NO: 2700-0112 EXPIRATION DATE: 02/28/2007
RESPS:250 HOURS:62 COSTS(000):$0
Evaluating the Effectiveness of the 2003-2004 NASA Science Files
/ Connect Program Series
FORMS: NONE
OMB NO: 2700-0113 EXPIRATION DATE: 02/28/2007
RESPS:2,300 HOURS:900 COSTS(000):$0
Effective Messaging Research
FORMS: NONE
OMB NO: 2700-0114 EXPIRATION DATE: 04/30/2007
RESPS:499 HOURS:373 COSTS(000):$0
GLOBE Program Evaluation
FORMS: NONE
OMB NO: 2700-0117 EXPIRATION DATE: 01/31/2008
RESPS:60 HOURS:20 COSTS(000):$0
Earth Science Software Reuse
FORMS: NONE
OMB NO: 2700-0119 EXPIRATION DATE: 05/31/2009
RESPS:300 HOURS:75 COSTS(000):$0
NASA Centennial Callenges Idea Submission Web Forms
FORMS: NONE
OMB NO: 2700-0122 EXPIRATION DATE: 03/31/2009
RESPS:9,900 HOURS:4,950 COSTS(000):$0
NASA Foreign National Access Information
FORMS: NONE
OMB NO: 2700-0124 EXPIRATION DATE: 05/31/2009
RESPS:484 HOURS:242 COSTS(000):$29,040
Small Business Innovative Research/Small Business Technology
Transfer Contractor Re-certification of Program Compliance
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
37 511,755 5,243,195 $1,104,552
National Archives and Records Administration
OMB NO: 3095-0002 EXPIRATION DATE: 12/31/2007
RESPS:1 HOURS:7 COSTS(000):$0
Statistical Research in Archival Records Containing Personal
Information
FORMS: NONE
OMB NO: 3095-0007 EXPIRATION DATE: 04/30/2007
RESPS:9,600 HOURS:800 COSTS(000):$0
Customer Comment Form
FORMS: NA-14045
OMB NO: 3095-0012 EXPIRATION DATE: 01/31/2009
RESPS:25 HOURS:37.5 COSTS(000):$0
Application for Attendance at the Institute for the Editing of
Historical Documents
FORMS: NONE
OMB NO: 3095-0013 EXPIRATION DATE: 01/31/2009
RESPS:148 HOURS:8,392 COSTS(000):$0
National Historical Publications and Records Commission Grant
Program
FORMS: NONE
OMB NO: 3095-0016 EXPIRATION DATE: 08/31/2008
RESPS:22,728 HOURS:3,030 COSTS(000):$0
Researcher Application
FORMS: NA-14003
OMB NO: 3095-0017 EXPIRATION DATE: 08/31/2006
RESPS:5 HOURS:50 COSTS(000):$0
Request to Microfilm Records
FORMS: NONE
OMB NO: 3095-0023 EXPIRATION DATE: 08/31/2006
RESPS:4,340 HOURS:362 COSTS(000):$0
Class Evaluation
FORMS: NA-2019
OMB NO: 3095-0024 EXPIRATION DATE: 12/31/2007
RESPS:1,000 HOURS:333 COSTS(000):$0
Application and Permit for Use of Space in Presidential
Libraries and Grounds
FORMS: NA-16011
OMB NO: 3095-0025 EXPIRATION DATE: 08/31/2007
RESPS:2,816 HOURS:704 COSTS(000):$0
Item Approval Request List
FORMS: 14110 14110A
OMB NO: 3095-0027 EXPIRATION DATE: 04/30/2008
RESPS:97,600 HOURS:16,267 COSTS(000):$0
Order Forms for Genealogical Research in the National Archives
FORMS: NATF-81 NATF-82 NATF-83 NATF-84 NATF-85 NATF-86
OMB NO: 3095-0029 EXPIRATION DATE: 09/30/2008
RESPS:889,065 HOURS:74,089 COSTS(000):$0
Request Pertaining to Military Records
FORMS: SF-180
OMB NO: 3095-0035 EXPIRATION DATE: 01/31/2008
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: 06/30/2008
RESPS:1 HOURS:31 COSTS(000):$1
Presidential Library Facilities
FORMS: NONE
OMB NO: 3095-0037 EXPIRATION DATE: 12/31/2006
RESPS:32,060 HOURS:2,671 COSTS(000):$0
Forms Relating to Civilian Service Records
FORMS: 13022 13064 13068
OMB NO: 3095-0038 EXPIRATION DATE: 03/31/2007
RESPS:5,000 HOURS:1,250 COSTS(000):$0
Court Order Requirements
FORMS: NA-13027
OMB NO: 3095-0039 EXPIRATION DATE: 03/31/2007
RESPS:79,800 HOURS:6,650 COSTS(000):$0
Forms Relating to Military Service Records
FORMS: NA-13036 NA-13042 NA-13055 NA-13075
OMB NO: 3095-0040 EXPIRATION DATE: 08/31/2006
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: 05/31/2009
RESPS:1,000 HOURS:167 COSTS(000):$0
Military Personnel Records (MPR) Customer Satisfaction Survey
FORMS: NONE
OMB NO: 3095-0043 EXPIRATION DATE: 10/31/2006
RESPS:52 HOURS:52 COSTS(000):$0
Requests to Use NARA Facilities for Events
FORMS: NA-16008
OMB NO: 3095-0045 EXPIRATION DATE: 02/28/2007
RESPS:2,593 HOURS:216 COSTS(000):$0
Applicant Background Survey
FORMS: NA-3035
OMB NO: 3095-0046 EXPIRATION DATE: 04/30/2007
RESPS:5,200 HOURS:867 COSTS(000):$0
Microfilm Publication Order Form
FORMS: NATF-36
OMB NO: 3095-0047 EXPIRATION DATE: 06/30/2008
RESPS:36,000 HOURS:3,000 COSTS(000):$0
Customer Request for Information and Order Forms
FORMS: 14116
OMB NO: 3095-0052 EXPIRATION DATE: 11/30/2008
RESPS:10 HOURS:3 COSTS(000):$0
Use of NARA Official Seals
FORMS: NONE
OMB NO: 3095-0054 EXPIRATION DATE: 08/31/2006
RESPS:100 HOURS:15 COSTS(000):$0
Independent Researcher Listing Application Form
FORMS: NA-14115
OMB NO: 3095-0057 EXPIRATION DATE: 02/28/2007
RESPS:600 HOURS:30 COSTS(000):$0
Contractor / Agency Reviewer Identification Badge Authorization
FORMS: NA-6000B
OMB NO: 3095-0058 EXPIRATION DATE: 06/30/2009
RESPS:25,897 HOURS:51,794 COSTS(000):$0
Financial Disclosure Report
FORMS: SF-714
OMB NO: 3095-0059 EXPIRATION DATE: 08/31/2007
RESPS:5,200 HOURS:867 COSTS(000):$0
Microfilm Rental Order Form
FORMS: NA-14127
OMB NO: 3095-0060 EXPIRATION DATE: 11/30/2006
RESPS:2,300 HOURS:575 COSTS(000):$0
Volunteer Service Application Form
FORMS: NA-6045
OMB NO: 3095-0061 EXPIRATION DATE: 01/31/2008
RESPS:4,200 HOURS:700 COSTS(000):$0
National Archives Experience (NAE) - Visitors Survey
FORMS: NONE
OMB NO: 3095-0062 EXPIRATION DATE: 05/31/2008
RESPS:1,050 HOURS:175 COSTS(000):$0
National Archives Public Vaults Survey
FORMS: NONE
OMB NO: 3095-0063 EXPIRATION DATE: 11/30/2008
RESPS:76,222 HOURS:12,704 COSTS(000):$0
Order Forms for U.S. Court Records in the National Archives
FORMS: NATF-FORMS-90 91 92 93
OMB NO: 3095-0064 EXPIRATION DATE: 03/31/2009
RESPS:13,270 HOURS:2,680 COSTS(000):$0
Online Reproduction Orders for National Archives Records
FORMS: NONE
OMB NO: 3095-0065 EXPIRATION DATE: 05/31/2009
RESPS:1,000 HOURS:167 COSTS(000):$0
National Archives Public Research Facility Customer Satisfaction
Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
33 1,319,544 188,810 $1
Institute of Museum and Library Services
OMB NO: 3137-0029 EXPIRATION DATE: 01/31/2007
RESPS:3,062 HOURS:38,332 COSTS(000):$689
Generic Clearance Grant Application Guidelines, Instructions and
Reporting Forms
FORMS: NONE
OMB NO: 3137-0049 EXPIRATION DATE: 04/30/2008
RESPS:60 HOURS:2,400 COSTS(000):$0
Librarians for the 21st Century Grant Application Guidelines
FORMS: NONE
OMB NO: 3137-0051 EXPIRATION DATE: 09/30/2006
RESPS:154 HOURS:146 COSTS(000):$0
Digital Collections and Content
FORMS: NONE
OMB NO: 3137-0055 EXPIRATION DATE: 11/30/2007
RESPS:130 HOURS:65 COSTS(000):$268
Digital Collections and Content - Collection Registry Entry/Edit
Form
FORMS: NONE
OMB NO: 3137-0056 EXPIRATION DATE: 04/30/2008
RESPS:1,220 HOURS:545 COSTS(000):$0
Reviewer Forms, State Program Financial Report, Native American
Native Hawaiian Library Services Grant Report
FORMS: NONE
OMB NO: 3137-0057 EXPIRATION DATE: 01/31/2008
RESPS:150 HOURS:3,800 COSTS(000):$50
Native American/Native Hawaiian Museum Services and 21st Century
Museum Professionals Grant Application Guidelines
FORMS: NONE
OMB NO: 3137-0060 EXPIRATION DATE: 11/30/2008
RESPS:140 HOURS:40 COSTS(000):$12
National Leadership Grant Partnership for a National of Learners
FORMS: NONE
OMB NO: 3137-0061 EXPIRATION DATE: 02/28/2007
RESPS:96 HOURS:67 COSTS(000):$1,680
Digital Collections and Content - Collection Registry User Survey
FORMS: NONE
OMB NO: 3137-0062 EXPIRATION DATE: 01/31/2007
RESPS:6,000 HOURS:1,500 COSTS(000):$488
National Survey of Users and Potential Users of Online
Information
FORMS: NONE
OMB NO: 3137-0063 EXPIRATION DATE: 12/31/2007
RESPS:77,000 HOURS:77,000 COSTS(000):$1,552
IMLS Library Workforce Study
FORMS: NONE
OMB NO: 3137-0064 EXPIRATION DATE: 04/30/2007
RESPS:442 HOURS:183 COSTS(000):$195
Museums and Libraries Engaging America's Youth Study
FORMS: NONE
OMB NO: 3137-0065 EXPIRATION DATE: 06/30/2009
RESPS:50 HOURS:1,750 COSTS(000):$33
Museum Grants for African American History and Culture
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 88,504 125,828 $4,967
National Endowment for the Arts
OMB NO: 3135-0094 EXPIRATION DATE: 03/31/2008
RESPS:40 HOURS:1,800 COSTS(000):$0
Application for Indemnification
FORMS: NONE
OMB NO: 3135-0098 EXPIRATION DATE: 08/31/2006
RESPS:250 HOURS:25 COSTS(000):$0
National Endowment for the Arts Panelist Profile Form
FORMS: NONE
OMB NO: 3135-0112 EXPIRATION DATE: 11/30/2007
RESPS:5,845 HOURS:148,505 COSTS(000):$0
Blanket Justification for NEA Funding Application Guidelines and
Reporting Requirements
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 6,135 150,330 $0
National Endowment for the Humanities
OMB NO: 3136-0134 EXPIRATION DATE: 06/30/2009
RESPS:8,762 HOURS:74,979 COSTS(000):$0
Generic Clearance Authority for the National Endowment for the
Humanities
FORMS: NONE
OMB NO: 3136-0138 EXPIRATION DATE: 08/31/2008
RESPS:250 HOURS:125 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)
2 9,012 75,104 $0
National Mediation Board
OMB NO: 3140-0001 EXPIRATION DATE: 04/30/2009
RESPS:68 HOURS:17 COSTS(000):$0
Application for Investigation of Representative Dispute
FORMS: NONE
OMB NO: 3140-0002 EXPIRATION DATE: 10/31/2008
RESPS:70 HOURS:17 COSTS(000):$0
Application for Mediation Services
FORMS: NONE
OMB NO: 3140-0009 EXPIRATION DATE: 07/31/2007
RESPS:45 HOURS:9 COSTS(000):$0
Application for Alternative Dispute Resolutin (ADR) Services
FORMS: NMB-9
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
3 183 43 $0
National Science Foundation
OMB NO: 3145-0001 EXPIRATION DATE: 05/31/2008
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: 05/31/2009
RESPS:39,364 HOURS:12,465 COSTS(000):$0
Survey of Earned Doctorates
FORMS: NONE
OMB NO: 3145-0020 EXPIRATION DATE: 02/28/2009
RESPS:34,400 HOURS:15,229 COSTS(000):$0
2006 Survey of Doctorate Recipients (SDR)
FORMS: NONE
OMB NO: 3145-0023 EXPIRATION DATE: 08/31/2008
RESPS:13,000 HOURS:60,000 COSTS(000):$0
Fellowship Applications and Award Forms
FORMS: NONE
OMB NO: 3145-0034 EXPIRATION DATE: 09/30/2007
RESPS:25 HOURS:12 COSTS(000):$0
Antarctic Conservation Act Application and Permit Form
FORMS: NONE
OMB NO: 3145-0035 EXPIRATION DATE: 07/31/2008
RESPS:137 HOURS:2,580 COSTS(000):$0
National Science Foundation Science Honor Awards
FORMS: NSF-1122 NSF-1123 NSF-1124
OMB NO: 3145-0058 EXPIRATION DATE: 07/31/2007
RESPS:40,000 HOURS:4,800,000 COSTS(000):$0
National Science Foundation Proposal/Award Information - Grant
Proposal Guide
FORMS: NONE
OMB NO: 3145-0060 EXPIRATION DATE: 03/31/2008
RESPS:120,000 HOURS:600,000 COSTS(000):$0
National Science Foundation Proposal Evaluation Process
FORMS: 1 428
OMB NO: 3145-0062 EXPIRATION DATE: 07/31/2008
RESPS:12,052 HOURS:39,235 COSTS(000):$0
Survey of Graduate Students and Postdoctorates in Science and
Engineering
FORMS: NSF-811 NSF-812
OMB NO: 3145-0077 EXPIRATION DATE: 02/28/2009
RESPS:21,600 HOURS:9,000 COSTS(000):$0
2006 National Survey of Recent College Graduates (NSRCG)
FORMS: NONE
OMB NO: 3145-0080 EXPIRATION DATE: 06/30/2009
RESPS:75 HOURS:41,850 COSTS(000):$0
Request for Proposals
FORMS: NONE
OMB NO: 3145-0096 EXPIRATION DATE: 07/31/2008
RESPS:8,000 HOURS:133 COSTS(000):$0
Applicant Survey
FORMS: NSF-1232
OMB NO: 3145-0100 EXPIRATION DATE: 05/31/2009
RESPS:665 HOURS:14,513 COSTS(000):$0
Survey of Research and Development Expenditures at Universities
and Colleges, FY 2006 through FY 2008
FORMS: NSF-411
OMB NO: 3145-0121 EXPIRATION DATE: 04/30/2008
RESPS:2,900 HOURS:1,450 COSTS(000):$0
Follow-up Research on Undergraduate Research Opportunities
(URO-2)
FORMS: NONE
OMB NO: 3145-0136 EXPIRATION DATE: 01/31/2008
RESPS:19,582 HOURS:40,388 COSTS(000):$0
EHR Generic Clearance
FORMS: NONE
OMB NO: 3145-0141 EXPIRATION DATE: 02/28/2009
RESPS:61,200 HOURS:25,500 COSTS(000):$0
2006 National Survey of College Graduates (NSCG)
FORMS: NONE
OMB NO: 3145-0157 EXPIRATION DATE: 06/30/2008
RESPS:31,500 HOURS:5,250 COSTS(000):$0
National Science Foundation Surveys to Measure Customer
Satisfaction
FORMS: NONE
OMB NO: 3145-0161 EXPIRATION DATE: 09/30/2008
RESPS:5,650 HOURS:1,870 COSTS(000):$0
Cross-Project Evaluation of the National Science Foundation's
Local Systemic Change Through Teacher Enhancement Program (LSC)
FORMS: NONE
OMB NO: 3145-0174 EXPIRATION DATE: 12/31/2006
RESPS:23,820 HOURS:14,950 COSTS(000):$0
SRS-Generic Clearance of Survey Improvement Projects for the
Division of Science Resources Statistics
FORMS: NONE
OMB NO: 3145-0177 EXPIRATION DATE: 09/30/2007
RESPS:3,120 HOURS:29,617 COSTS(000):$0
Medical Clearance Process for Deployment to the Polar Regions
FORMS: 1421-1429 1451-1456 1461-1469
OMB NO: 3145-0180 EXPIRATION DATE: 11/30/2007
RESPS:12 HOURS:480 COSTS(000):$0
Response Plan and Educational Materials for Non-Governmental
Antarctic Expeditions
FORMS: NONE
OMB NO: 3145-0184 EXPIRATION DATE: 02/28/2009
RESPS:7,104 HOURS:5,328 COSTS(000):$0
eRecruit System
FORMS: NONE
OMB NO: 3145-0194 EXPIRATION DATE: 02/28/2009
RESPS:17 HOURS:1,700 COSTS(000):$0
Grantee Reporting Requirements for Science and Technology
Centers (STC): Integrative Partnerships
FORMS: NONE
OMB NO: 3145-0196 EXPIRATION DATE: 08/31/2006
RESPS:100 HOURS:100 COSTS(000):$0
Survey of IGERT Recipients
FORMS: NONE
OMB NO: 3145-0197 EXPIRATION DATE: 03/31/2007
RESPS:2,050 HOURS:512 COSTS(000):$0
Data Collection on Public Understanding of Science and Technology
FORMS: NONE
OMB NO: 3145-0198 EXPIRATION DATE: 02/28/2009
RESPS:456 HOURS:206 COSTS(000):$0
Evaluation of the Research Experiences for Teachers (RET) Program
FORMS: NONE
OMB NO: 3145-0199 EXPIRATION DATE: 09/30/2008
RESPS:1,848 HOURS:34,382 COSTS(000):$0
NSF Math and Science Partnership Program Monitoring System
FORMS: NONE
OMB NO: 3145-0200 EXPIRATION DATE: 06/30/2009
RESPS:288 HOURS:608 COSTS(000):$0
Math and Science Partnership Program Evaluation (MSP-PE)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
28 449,115 5,757,620 $0
Office of Government Ethics
OMB NO: 3209-0001 EXPIRATION DATE: 11/30/2006
RESPS:449 HOURS:1,347 COSTS(000):$2
Executive Branch Personnel Public Financial Disclosure Report
FORMS: 278
OMB NO: 3209-0002 EXPIRATION DATE: 08/31/2006
RESPS:222 HOURS:37 COSTS(000):$0
Request to Inspect or Receive Copies of SF 278 Executive Branch
Personnel Public Financial Disclosure Reports or Other Covered
Records
FORMS: OGE-201
OMB NO: 3209-0006 EXPIRATION DATE: 05/31/2007
RESPS:21,068 HOURS:31,602 COSTS(000):$0
Executive Branch Confidential Financial Disclosure Report
FORMS: OGE-450
OMB NO: 3209-0007 EXPIRATION DATE: 06/30/2007
RESPS:5 HOURS:3,785 COSTS(000):$1
Executive Branch Qualified Trust Documents (see items 1. and 2.
in Supporting Statement for precise titles of all documents)
FORMS: NONE
OMB NO: 3209-0009 EXPIRATION DATE: 04/30/2008
RESPS:30 HOURS:2 COSTS(000):$0
Public Financial Disclosure Access Customer Service Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 21,774 36,773 $3
Office of Management and Budget
OMB NO: 0348-0002 EXPIRATION DATE: 10/31/2006
RESPS:1 HOURS:1 COSTS(000):$0
SF-271: Outlay Report and Request for Reimbursement for
Construction Programs
FORMS: SF-271
OMB NO: 0348-0003 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-272 and SF-272A Federal Cash Transactions Report and
Continuation Sheet
FORMS: SF-272 SF-272A
OMB NO: 0348-0004 EXPIRATION DATE: 10/31/2006
RESPS:1 HOURS:1 COSTS(000):$0
SF-270: Request for Advance or Reimbursement
FORMS: 270
OMB NO: 0348-0038 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-269A Financial Status Report (Short Form)
FORMS: SF-269A
OMB NO: 0348-0039 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
SF-269 Financial Status Report (Long Form)
FORMS: SF-269
OMB NO: 0348-0046 EXPIRATION DATE: 10/31/2006
RESPS:300 HOURS:50 COSTS(000):$0
Disclosure of Lobbying Activities
FORMS: SF-LLL
OMB NO: 0348-0057 EXPIRATION DATE: 04/30/2007
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
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 60,305 1,036,855 $0
Office of National Drug Control Policy
OMB NO: 3201-0006 EXPIRATION DATE: 09/30/2008
RESPS:12,600 HOURS:2,145 COSTS(000):$800,000
National Youth Anti-Drug Media Campaign (NYADMC) - Parent and
Youth Advertising Copy Testing
FORMS: NONE
OMB NO: 3201-0010 EXPIRATION DATE: 09/30/2008
RESPS:10,000 HOURS:2,500 COSTS(000):$545
National Youth Anti-Drug Media Campaign (NYADMC) - Parent and
Youth Tracking Studies
FORMS: NONE
OMB NO: 3201-0011 EXPIRATION DATE: 09/30/2008
RESPS:912 HOURS:1,368 COSTS(000):$1,045
National Youth Anti-Drug Media Campaign Qualitative Research
FORMS: NONE
OMB NO: 3201-0012 EXPIRATION DATE: 11/30/2008
RESPS:2 HOURS:892 COSTS(000):$714,000
Drug Free Communities Support Program National Evaluation
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
4 23,514 6,905 $1,515,590
Office of Personnel Management
OMB NO: 3206-0001 EXPIRATION DATE: 05/31/2007
RESPS:4,500 HOURS:750 COSTS(000):$0
Application for 10-Point Veteran Preference
FORMS: SF-15
OMB NO: 3206-0005 EXPIRATION DATE: 08/31/2006
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: 3206-0017 EXPIRATION DATE: 10/31/2008
RESPS:100 HOURS:17 COSTS(000):$0
Medicare Part B Certification
FORMS: RI-78-11
OMB NO: 3206-0032 EXPIRATION DATE: 01/31/2008
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: 07/31/2009
RESPS:2,500 HOURS:625 COSTS(000):$0
Marital Status Certification Survey
FORMS: RI-25-7
OMB NO: 3206-0034 EXPIRATION DATE: 11/30/2006
RESPS:21,000 HOURS:12,250 COSTS(000):$0
Annuitant's Report of Earned Income
FORMS: RI-30-2
OMB NO: 3206-0036 EXPIRATION DATE: 11/30/2008
RESPS:21,200 HOURS:75,800 COSTS(000):$0
Establishment Information Form, Wage Data Collection Form, and
Wage Data Collection Continuation Form
FORMS: DD-1918 DD-1919 DD-1919C
OMB NO: 3206-0040 EXPIRATION DATE: 09/30/2006
RESPS:500,000 HOURS:195,000 COSTS(000):$0
Occupational Questionnaire
FORMS: 1203-AW 1203-FX 1203-EZ
OMB NO: 3206-0042 EXPIRATION DATE: 08/31/2006
RESPS:2,500 HOURS:835 COSTS(000):$0
Notice of Change in Student's Status
FORMS: RI-25-15
OMB NO: 3206-0099 EXPIRATION DATE: 10/31/2006
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: 06/30/2008
RESPS:5,600 HOURS:560 COSTS(000):$0
Mail Reinterview Form
FORMS: OFI-10
OMB NO: 3206-0121 EXPIRATION DATE: 12/31/2007
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: 1496 1496A
OMB NO: 3206-0128 EXPIRATION DATE: 09/30/2007
RESPS:7,130 HOURS:4,588 COSTS(000):$0
Application for Refund of Retirement Deductions (CSRS)
Current/Former Spouse's Notification of Application for Refund
FORMS: SF-2802 SF-2802A
OMB NO: 3206-0131 EXPIRATION DATE: 10/31/2006
RESPS:1,400 HOURS:5,550 COSTS(000):$0
Combined Federal Campaign
FORMS: OPM-1647
OMB NO: 3206-0134 EXPIRATION DATE: 09/30/2006
RESPS:150 HOURS:75 COSTS(000):$0
Application to Make Deposit or Redeposit (CSRS) Application to
Make Service Credit Payment fo Civilian Service (FERS)
FORMS: SF-2803 SF-3108
OMB NO: 3206-0136 EXPIRATION DATE: 06/30/2007
RESPS:48,000 HOURS:12,000 COSTS(000):$0
Designation of Beneficiary - Federal Employees' Group Life
Insurance Program (FEGLI)
FORMS: SF-2823
OMB NO: 3206-0138 EXPIRATION DATE: 11/30/2006
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: 08/31/2007
RESPS:12,480 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: 12/31/2008
RESPS:30,000 HOURS:16,667 COSTS(000):$0
Health Benefits Election Form
FORMS: OPM-2809
OMB NO: 3206-0142 EXPIRATION DATE: 01/31/2008
RESPS:2,000 HOURS:500 COSTS(000):$0
Designation of Beneficiary (CSRS)
FORMS: 2808
OMB NO: 3206-0143 EXPIRATION DATE: 08/31/2007
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: 07/31/2008
RESPS:3,000 HOURS:250 COSTS(000):$0
We Need the Social Security Number of the Person Names Below
FORMS: RI-38-45
OMB NO: 3206-0150 EXPIRATION DATE: 04/30/2008
RESPS:363,500 HOURS:28,630 COSTS(000):$0
Fingerprint Charts
FORMS: SF-87 SF-87A
OMB NO: 3206-0156 EXPIRATION DATE: 10/31/2008
RESPS:56,100 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 Deceased Was an...
FORMS: SF-2800 SF-2800A
OMB NO: 3206-0160 EXPIRATION DATE: 08/31/2007
RESPS:18,000 HOURS:9,000 COSTS(000):$0
Health Benefits Election Form
FORMS: SF-2809
OMB NO: 3206-0162 EXPIRATION DATE: 01/31/2008
RESPS:500 HOURS:750 COSTS(000):$0
Report of Medical Examination of Person Electing Survivor
Benefits Under the Civil Service Retirement System
FORMS: 1530
OMB NO: 3206-0165 EXPIRATION DATE: 02/28/2009
RESPS:4,001,000 HOURS:333,350 COSTS(000):$0
General Request for Investigative Information, Investigation
Request for Employment Data and Supervisor Information,
Investigative Request for Personal Information, Investigative...
FORMS: INV-40 INV-41 INV-42 INV-43 INV-44
OMB NO: 3206-0167 EXPIRATION DATE: 10/31/2008
RESPS:2,081 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: 3206-0168 EXPIRATION DATE: 10/31/2008
RESPS:200 HOURS:67 COSTS(000):$0
Alternative annuity election
FORMS: RI-20-80
OMB NO: 3206-0170 EXPIRATION DATE: 09/30/2006
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: 05/31/2007
RESPS:10,847 HOURS:10,847 COSTS(000):$0
Application for Death Benefits (FERS); Documentation and
Elections in Support of Application for Death Benefits when
Deceased was an Employee at the Time of Death
FORMS: 3104 3104A 3104B
OMB NO: 3206-0173 EXPIRATION DATE: 11/30/2008
RESPS:2,893 HOURS:723 COSTS(000):$0
Designation of Beneficiary (FERS)
FORMS: 3102
OMB NO: 3206-0174 EXPIRATION DATE: 12/31/2006
RESPS:2,400 HOURS:1,834 COSTS(000):$0
Survivor Annuity Election for a Spouse/Cover Letter Giving
Information About the Cost to Elect Less Than the Maximum
Survivor Annuity/Cover Letter Giving Information About the....
FORMS: RI-20-63 RI-20-116 RI-20-117
OMB NO: 3206-0179 EXPIRATION DATE: 09/30/2007
RESPS:2,500 HOURS:2,500 COSTS(000):$0
Disabled Dependent Questionnaire
FORMS: RI-30-10
OMB NO: 3206-0187 EXPIRATION DATE: 02/29/2008
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: 08/31/2007
RESPS:1,539 HOURS:1,539 COSTS(000):$0
Application for Deferred or Postponed Retirement (FERS)
FORMS: RI-92-19
OMB NO: 3206-0193 EXPIRATION DATE: 05/31/2008
RESPS:320 HOURS:107 COSTS(000):$0
Combined Federal Campaign Results Form
FORMS: OPM-1417
OMB NO: 3206-0194 EXPIRATION DATE: 02/28/2007
RESPS:700 HOURS:175 COSTS(000):$0
Annuity Supplement Earnings Report
FORMS: RI-92-22
OMB NO: 3206-0197 EXPIRATION DATE: 07/31/2009
RESPS:25,400 HOURS:4,234 COSTS(000):$0
Verification of Who Is Getting Payments
FORMS: RI-38-107
OMB NO: 3206-0199 EXPIRATION DATE: 08/31/2008
RESPS:2,100 HOURS:211 COSTS(000):$0
Nonforeign Area COLA Price and Background Surveys
FORMS: NONE
OMB NO: 3206-0201 EXPIRATION DATE: 07/31/2007
RESPS:215,000 HOURS:35,833 COSTS(000):$0
Federal Employee Health Benefits (FEHB) Open Season Express
Interactive Response (IVR) System
FORMS: NONE
OMB NO: 3206-0202 EXPIRATION DATE: 03/31/2008
RESPS:27,000 HOURS:20,250 COSTS(000):$0
Request to Change FEHB Enrollment or to Receive Plan Brochures
for Spouse Equity/Temporary Continuation of Coverage
Enrollees/Direct Pay Annuitants
FORMS: DPRS-2809
OMB NO: 3206-0204 EXPIRATION DATE: 06/30/2008
RESPS:19,000 HOURS:9,500 COSTS(000):$0
Court Orders Affecting Retirement Benefits - 5 CFR 838.221,
838.421, and 838.721
FORMS: NONE
OMB NO: 3206-0206 EXPIRATION DATE: 06/30/2008
RESPS:250 HOURS:250 COSTS(000):$0
Evidence to Prove Dependency of a Child
FORMS: RI-25-37
OMB NO: 3206-0208 EXPIRATION DATE: 06/30/2007
RESPS:11,000 HOURS:3,667 COSTS(000):$0
Representative Payee Survey
FORMS: RI-38-115
OMB NO: 3206-0211 EXPIRATION DATE: 05/31/2007
RESPS:3,000 HOURS:250 COSTS(000):$0
Reemployment of Annuitants - 5 CFR Section 837.103
FORMS: NONE
OMB NO: 3206-0212 EXPIRATION DATE: 07/31/2009
RESPS:1,500 HOURS:750 COSTS(000):$0
Rollover Election
FORMS: RI-38-117
OMB NO: 3206-0215 EXPIRATION DATE: 11/30/2008
RESPS:10,000 HOURS:10,000 COSTS(000):$0
Verification of Full-Time School Attendance
FORMS: RI-25-49
OMB NO: 3206-0216 EXPIRATION DATE: 12/31/2007
RESPS:3,000 HOURS:250 COSTS(000):$0
We Need Important Information About Your Eligibility for Social
Security Disability Benefits
FORMS: RI-98-7
OMB NO: 3206-0218 EXPIRATION DATE: 01/31/2008
RESPS:2,000 HOURS:2,000 COSTS(000):$0
Death Benefit Payment Rollover Election Form
FORMS: RI-94-7
OMB NO: 3206-0219 EXPIRATION DATE: 03/31/2009
RESPS:3,755,600 HOURS:5,633,400 COSTS(000):$0
OPM OF 612 Optional Application for Federal Employment, resume
builder; and USAJOBS web site
FORMS: OF-612
OMB NO: 3206-0226 EXPIRATION DATE: 03/31/2007
RESPS:20,000 HOURS:10,000 COSTS(000):$0
It's Time To Sign Up for Direct Deposit
FORMS: RI-38-128
OMB NO: 3206-0228 EXPIRATION DATE: 05/31/2007
RESPS:13,450 HOURS:12,775 COSTS(000):$0
CSRS/FERS Documentation in Support of Disability Retirement
Application
FORMS: SF-3112
OMB NO: 3206-0230 EXPIRATION DATE: 12/31/2008
RESPS:150 HOURS:25 COSTS(000):$0
Life Insurance Election
FORMS: SF-2817
OMB NO: 3206-0232 EXPIRATION DATE: 07/31/2008
RESPS:40 HOURS:40 COSTS(000):$0
Procedures for Submitting Compensation and Leave Claims
FORMS: 1673
OMB NO: 3206-0233 EXPIRATION DATE: 12/31/2007
RESPS:34,800 HOURS:17,400 COSTS(000):$0
Civil Service Retirement System Survivor Annuitant Express Pay
Application for Death Benefits
FORMS: RI-25-51
OMB NO: 3206-0234 EXPIRATION DATE: 07/31/2008
RESPS:3,000 HOURS:750 COSTS(000):$0
Claim for Unpaid Compensation of Deceased Civilian Employee
FORMS: SF-1153
OMB NO: 3206-0235 EXPIRATION DATE: 06/30/2008
RESPS:38 HOURS:24 COSTS(000):$0
Letter Reply to Request for Information. Former Spouse Survivor
Annuity Election/Information on Electing a Survivor for Your
Former Spouse
FORMS: RI20-64 RI20-64A RI20-64B
OMB NO: 3206-0236 EXPIRATION DATE: 10/31/2006
RESPS:4,802,275 HOURS:706,360 COSTS(000):$0
Agency Generic Survey Plan
FORMS: NONE
OMB NO: 3206-0237 EXPIRATION DATE: 06/30/2008
RESPS:3,100 HOURS:2,325 COSTS(000):$0
Information and Instructions on Your Reconsideration Rights
FORMS: RI-38-47
OMB NO: 3206-0240 EXPIRATION DATE: 03/31/2008
RESPS:2,000 HOURS:333 COSTS(000):$0
Child Care Tuition Assistance Program Provider Information
FORMS: OPM-1644
OMB NO: 3206-0245 EXPIRATION DATE: 06/30/2009
RESPS:5,000 HOURS:2,500 COSTS(000):$0
Request for Change to Unreduced Annuity
FORMS: RI-20-120
OMB NO: 3206-0246 EXPIRATION DATE: 12/31/2006
RESPS:200 HOURS:200 COSTS(000):$0
Scholarship For Service (SFS) Program Internet Site
FORMS: NONE
OMB NO: 3206-0247 EXPIRATION DATE: 05/31/2007
RESPS:8,300 HOURS:1,066 COSTS(000):$0
General Population Rental Equivalence Survey (GPRES)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
64 14,408,653 7,595,374 $0
Office of Special Counsel
OMB NO: 3255-0002 EXPIRATION DATE: 08/31/2006
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
OMB NO: 3255-0003 EXPIRATION DATE: 09/30/2008
RESPS:600 HOURS:109 COSTS(000):$0
OSC SURVEY: Prohibited Personnel Practice (PPP), Hatch Act
Advisory Opinion (HA), USERRA
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 2,846 2,798 $0
Office of the United States Trade Representative
OMB NO: 0350-0009 EXPIRATION DATE: 11/30/2006
RESPS:70 HOURS:140 COSTS(000):$0
Application for inclusion on NAFTA Chapter 19 roster
FORMS: NONE
OMB NO: 0350-0014 EXPIRATION DATE: 04/30/2009
RESPS:150 HOURS:450 COSTS(000):$0
Request for Applications to Serve on Free Trade Agreement
Dispute Settlement Panelist
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
2 220 590 $0
Overseas Private Investment Corporation
OMB NO: 3420-0001 EXPIRATION DATE: 08/31/2007
RESPS:343 HOURS:171 COSTS(000):$0
Request for Registration for Political Risk Investment Insurance
FORMS: OPIC-50
OMB NO: 3420-0004 EXPIRATION DATE: 10/31/2007
RESPS:30 HOURS:1,200 COSTS(000):$0
Project Information Report
FORMS: OPIC-71
OMB NO: 3420-0011 EXPIRATION DATE: 12/31/2007
RESPS:150 HOURS:1,050 COSTS(000):$0
Application for Political Risk Investment Insurance
FORMS: OPIC-52
OMB NO: 3420-0015 EXPIRATION DATE: 05/31/2008
RESPS:300 HOURS:1,200 COSTS(000):$0
Application for Financing
FORMS: OPIC-115
OMB NO: 3420-0018 EXPIRATION DATE: 07/31/2009
RESPS:300 HOURS:1,500 COSTS(000):$0
Sponsor Disclosure Report
FORMS: OPIC-129
OMB NO: 3420-0019 EXPIRATION DATE: 01/31/2008
RESPS:300 HOURS:2,550 COSTS(000):$0
Self-Monitoring Questionnaire for Insurance and Finance Projects
FORMS: 162
OMB NO: 3420-0020 EXPIRATION DATE: 08/31/2006
RESPS:90 HOURS:90 COSTS(000):$0
Expedited Screening Questionnaire for Downstream Investments
FORMS: OPIC-168
OMB NO: 3420-0023 EXPIRATION DATE: 07/31/2008
RESPS:189 HOURS:1,606 COSTS(000):$0
Self-Monitoring Questionnaire for Investment Funds' Sub-Projects
FORMS: 217
OMB NO: 3420-0029 EXPIRATION DATE: 12/31/2006
RESPS:100 HOURS:50 COSTS(000):$0
OPIC Client Satisfaction Survey
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
9 1,802 9,417 $0
Peace Corps
OMB NO: 0420-0001 EXPIRATION DATE: 08/31/2007
RESPS:10,000 HOURS:2,500 COSTS(000):$0
Peace Corps National Agency Check (NAC) Questionnaire Form for
Peace Corps Volunteer Background Investigations
FORMS: 5
OMB NO: 0420-0005 EXPIRATION DATE: 03/31/2009
RESPS:13,000 HOURS:39,000 COSTS(000):$0
Volunteer Application
FORMS: PC-1502
OMB NO: 0420-0510 EXPIRATION DATE: 03/31/2007
RESPS:21,700 HOURS:13,275 COSTS(000):$564
Health Status Review; Report of Medical Exam; Report of Dental
Exam
FORMS: PC-1789 PC-1790S PC-1790
OMB NO: 0420-0529 EXPIRATION DATE: 10/31/2007
RESPS:10,000 HOURS:500 COSTS(000):$0
Peace Corps Week Brochure
FORMS: NONE
OMB NO: 0420-0533 EXPIRATION DATE: 09/30/2006
RESPS:650 HOURS:54 COSTS(000):$0
Peace Corps Crisis Corps Volunteer Application Form
FORMS: NONE
OMB NO: 0420-0537 EXPIRATION DATE: 06/30/2009
RESPS:1 HOURS:80 COSTS(000):$0
Peace Corps Fellows/USA Program Improvement Survey
FORMS: PC-425-1
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
6 55,351 55,409 $564
Pension Benefit Guaranty Corporation
OMB NO: 1212-0009 EXPIRATION DATE: 04/30/2008
RESPS:35,220 HOURS:3,478 COSTS(000):$18,173
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: 02/28/2009
RESPS:705 HOURS:2,974 COSTS(000):$817
Reportabale Events
FORMS: 10 10-ADVANCE
OMB NO: 1212-0017 EXPIRATION DATE: 02/29/2008
RESPS:5 HOURS:60 COSTS(000):$16
Liability for Termination of Single-Employer Plans
FORMS: NONE
OMB NO: 1212-0020 EXPIRATION DATE: 03/31/2008
RESPS:1,011 HOURS:19 COSTS(000):$13
Termination of Multiemployer Plans (29 CFR Part 4041A)
FORMS: NONE
OMB NO: 1212-0021 EXPIRATION DATE: 03/31/2008
RESPS:24 HOURS:1 COSTS(000):$5
Variances for Sale of Assets (29 CFR Part 4204)
FORMS: NONE
OMB NO: 1212-0022 EXPIRATION DATE: 03/31/2008
RESPS:35 HOURS:8 COSTS(000):$8
Mergers and Transfer Between Multiemployer Plans (29 CFR Part
4231)
FORMS: NONE
OMB NO: 1212-0023 EXPIRATION DATE: 03/31/2008
RESPS:1 HOURS:1 COSTS(000):$4
Extension of Special Withdrawal Liability Rules (29 CFR Part
4203)
FORMS: NONE
OMB NO: 1212-0030 EXPIRATION DATE: 03/31/2009
RESPS:44 HOURS:41 COSTS(000):$0
Survey of Nonparticipating Single-Premium Group Annuity Rates
FORMS: NONE
OMB NO: 1212-0031 EXPIRATION DATE: 03/31/2008
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: 03/31/2008
RESPS:97,482 HOURS:1 COSTS(000):$553
Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part
4281)
FORMS: NONE
OMB NO: 1212-0033 EXPIRATION DATE: 03/31/2008
RESPS:2,598 HOURS:1 COSTS(000):$4
Notice of Insolvency (29 CFR Part 4245)
FORMS: NONE
OMB NO: 1212-0034 EXPIRATION DATE: 03/31/2008
RESPS:179 HOURS:4 COSTS(000):$7
Notice, Collection, and Redetermination of Withdrawal Liability
(29 CFR Part 4219)
FORMS: NONE
OMB NO: 1212-0035 EXPIRATION DATE: 03/31/2008
RESPS:5 HOURS:10 COSTS(000):$0
Allocating Unfunded Vested Benefits (29 CFR Part 4211)
FORMS: NONE
OMB NO: 1212-0036 EXPIRATION DATE: 09/30/2007
RESPS:1,175 HOURS:1,743 COSTS(000):$1,973
Terminationof Single Employer Plans
FORMS: 500 501 600 601 602 SCHED.-EA-S REP-S EA-D MP
OMB NO: 1212-0039 EXPIRATION DATE: 03/31/2008
RESPS:2,001 HOURS:250 COSTS(000):$275
Reduction or Waiver of Partial Withdrawal Liability (29 CFR Part
4208)
FORMS: NONE
OMB NO: 1212-0041 EXPIRATION DATE: 02/28/2009
RESPS:78 HOURS:160 COSTS(000):$44
Notice of Failure to Make Required Contributions
FORMS: 200
OMB NO: 1212-0044 EXPIRATION DATE: 03/31/2008
RESPS:201 HOURS:25 COSTS(000):$28
Reduction or Waiver of Complete Withdrawal Liability (29 CFR
Part 4207)
FORMS: NONE
OMB NO: 1212-0049 EXPIRATION DATE: 02/29/2008
RESPS:400 HOURS:3,480 COSTS(000):$5,500
Annual Financial and Actuarial Information Reporting (29 CFR
Part 4010)
FORMS: NONE
OMB NO: 1212-0050 EXPIRATION DATE: 12/31/2006
RESPS:3,917 HOURS:8,428 COSTS(000):$579
Disclosure to Participants
FORMS: NONE
OMB NO: 1212-0053 EXPIRATION DATE: 10/31/2006
RESPS:9,500 HOURS:2,500 COSTS(000):$0
Customer Service Focus Groups and Surveys
FORMS: NONE
OMB NO: 1212-0054 EXPIRATION DATE: 12/31/2006
RESPS:664 HOURS:234 COSTS(000):$483
Qualified Domestic Relations Orders Submitted to the PBGC
FORMS: NONE
OMB NO: 1212-0055 EXPIRATION DATE: 08/31/2008
RESPS:225,600 HOURS:118,475 COSTS(000):$78
Locating and Paying Participants
FORMS: 700-701 702-703 704-705 706-707 708-709 710 713 714-715 718-719
720-722
OMB NO: 1212-0057 EXPIRATION DATE: 12/31/2007
RESPS:28,900 HOURS:2,373 COSTS(000):$1,737
Annual Information Return/Report
FORMS: 5500
OMB NO: 1212-0059 EXPIRATION DATE: 10/31/2006
RESPS:1 HOURS:1 COSTS(000):$0
Filing, Issuance, Computation of Time, and Record Retention
FORMS: NONE
OMB NO: 1212-0060 EXPIRATION DATE: 12/31/2007
RESPS:750 HOURS:188 COSTS(000):$5
Research Survey/Frozen Defined Benefit Plans
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
25 410,499 144,456 $30,302
Railroad Retirement Board
OMB NO: 3220-0002 EXPIRATION DATE: 10/31/2006
RESPS:19,100 HOURS:10,083 COSTS(000):$0
Approval for Employee Annuity Under the Railroad Retirement Act
FORMS: AA-1 AA-1-CERT AA-1D G-204
OMB NO: 3220-0005 EXPIRATION DATE: 09/30/2006
RESPS:3,418 HOURS:570 COSTS(000):$0
Employer Reporting
FORMS: AA-12 G-88A.1 G.88A.2 BA-6A BA-6A(INTERNET)
OMB NO: 3220-0007 EXPIRATION DATE: 07/31/2007
RESPS:860 HOURS:285 COSTS(000):$0
Appeal Under the Railraod Retirement and Railraod Unemployment
Insurance Act
FORMS: HA-1
OMB NO: 3220-0008 EXPIRATION DATE: 03/31/2008
RESPS:2,167 HOURS:38,126 COSTS(000):$0
Railroad Service and Compensation Reports/System Access
Application
FORMS: BA-3A BA-4 BA-4-INTERNET BA-12
OMB NO: 3220-0012 EXPIRATION DATE: 03/31/2009
RESPS:2,160 HOURS:900 COSTS(000):$0
Employer's Quarterly Report of Contributions Under the RUIA
FORMS: DC-1
OMB NO: 3220-0014 EXPIRATION DATE: 07/31/2009
RESPS:65 HOURS:33 COSTS(000):$0
Employee Representatives' Status and Compensation Reports
FORMS: DC-2A DC-2
OMB NO: 3220-0016 EXPIRATION DATE: 06/30/2008
RESPS:3,600 HOURS:360 COSTS(000):$0
Certification of Termination of Service and Relinquishment of
Rights
FORMS: G-88
OMB NO: 3220-0021 EXPIRATION DATE: 12/31/2008
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: 10/31/2007
RESPS:127,200 HOURS:13,467 COSTS(000):$0
Application and Claim for Unemployment Benefits and Employment
Service
FORMS: UI-1 UI-1(INTERNET) UI-3 UI-3(INTERNET)
OMB NO: 3220-0025 EXPIRATION DATE: 02/28/2007
RESPS:7,905 HOURS:1,622 COSTS(000):$0
RUIA Investigations and Continuing Entitlement
FORMS: UI-9-UI-23 UI-44-ID-4F ID-4U-ID-4X ID-4Y-ID-20-1 ID-20-2-ID-20-4
ID-51- ID-5R(SUP) ID-49R UI-48
OMB NO: 3220-0030 EXPIRATION DATE: 04/30/2007
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: 05/31/2009
RESPS:20,600 HOURS:5,150 COSTS(000):$0
Application for Survivor Death Benefits
FORMS: AA-21 AA-21CERT G-273A AA-11A G-131
OMB NO: 3220-0032 EXPIRATION DATE: 06/30/2009
RESPS:8,000 HOURS:1,391 COSTS(000):$0
Survivor Questinnaire
FORMS: RL-94-F
OMB NO: 3220-0034 EXPIRATION DATE: 07/31/2008
RESPS:400 HOURS:40 COSTS(000):$0
Statement of Authority to Act for Employee
FORMS: SI-10
OMB NO: 3220-0036 EXPIRATION DATE: 01/31/2009
RESPS:28,500 HOURS:1,693 COSTS(000):$0
Supplemental Information on Accident and Insurance
FORMS: SI-1C SI-5 ID-3S-1 ID-3U ID-30K ID-30K-1 ID-3S
OMB NO: 3220-0038 EXPIRATION DATE: 09/30/2008
RESPS:35,000 HOURS:10,001 COSTS(000):$0
Medical Reports
FORMS: G-3EMP G-197 G-250 G-250A G-260 RL-11B RL-11D RL-250
OMB NO: 3220-0039 EXPIRATION DATE: 03/31/2007
RESPS:260,900 HOURS:26,321 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: 09/30/2006
RESPS:8,500 HOURS:4,297 COSTS(000):$0
Application for Spouse Annuity Under the Railroad Retirement Act
FORMS: AA-3 AA-3CERT
OMB NO: 3220-0052 EXPIRATION DATE: 04/30/2007
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: 12/31/2008
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: 08/31/2007
RESPS:23,000 HOURS:1,452 COSTS(000):$0
Placement Service
FORMS: ES-2 ES-21 ES-21C UI-35
OMB NO: 3220-0070 EXPIRATION DATE: 07/31/2007
RESPS:3,000 HOURS:400 COSTS(000):$0
Employer_Service and Compensation Reports
FORMS: UI-41 UI-41A
OMB NO: 3220-0079 EXPIRATION DATE: 08/31/2007
RESPS:2,900 HOURS:487 COSTS(000):$0
Certification Regarding Rights to Unemployment Benefits
FORMS: UI-45
OMB NO: 3220-0082 EXPIRATION DATE: 12/31/2008
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: 12/31/2008
RESPS:475 HOURS:170 COSTS(000):$0
Evidence for Application of Overall Minimum
FORMS: G-319 G-320
OMB NO: 3220-0086 EXPIRATION DATE: 08/31/2008
RESPS:50 HOURS:8 COSTS(000):$0
Application for Reimbursement for Hospital Services in Canada
FORMS: AA-104
OMB NO: 3220-0089 EXPIRATION DATE: 05/31/2009
RESPS:765 HOURS:103 COSTS(000):$0
Pension Plan Reports
FORMS: G-88P G-88R G-88R.1
OMB NO: 3220-0097 EXPIRATION DATE: 08/31/2007
RESPS:350 HOURS:29 COSTS(000):$0
Pay Rate Report
FORMS: UI-1E
OMB NO: 3220-0099 EXPIRATION DATE: 07/31/2008
RESPS:100 HOURS:259 COSTS(000):$0
Statement Regarding Contributions and Support
FORMS: G-134
OMB NO: 3220-0107 EXPIRATION DATE: 01/31/2009
RESPS:300 HOURS:150 COSTS(000):$0
Request to Non-Railroad Employer for Information About
Annuitants Work and Earnings
FORMS: RL-231-F
OMB NO: 3220-0123 EXPIRATION DATE: 10/31/2008
RESPS:900 HOURS:217 COSTS(000):$0
Student Beneficiary Monitoring
FORMS: G-315 G-315A G-315A.1
OMB NO: 3220-0127 EXPIRATION DATE: 02/29/2008
RESPS:1,200 HOURS:1,700 COSTS(000):$0
Financial Disclosure Statement
FORMS: DR-423
OMB NO: 3220-0131 EXPIRATION DATE: 10/31/2006
RESPS:1 HOURS:1 COSTS(000):$0
Request for Medicare Payment
FORMS: G-740S CMS-1500
OMB NO: 3220-0132 EXPIRATION DATE: 06/30/2009
RESPS:499 HOURS:202 COSTS(000):$0
Gross Earnings Report
FORMS: BA-11
OMB NO: 3220-0136 EXPIRATION DATE: 07/31/2007
RESPS:1,170 HOURS:294 COSTS(000):$0
Public Service Pension Questionnaires
FORMS: G-208 G-212
OMB NO: 3220-0138 EXPIRATION DATE: 07/31/2007
RESPS:600 HOURS:415 COSTS(000):$0
Self-Employment Questionnaire
FORMS: AA-4
OMB NO: 3220-0140 EXPIRATION DATE: 12/31/2008
RESPS:7,560 HOURS:630 COSTS(000):$0
Employee's Certification
FORMS: G-346
OMB NO: 3220-0141 EXPIRATION DATE: 11/30/2006
RESPS:6,000 HOURS:3,045 COSTS(000):$0
Vocational Report
FORMS: G-251
OMB NO: 3220-0145 EXPIRATION DATE: 07/31/2009
RESPS:1,300 HOURS:650 COSTS(000):$0
Nonresident Questionnaire
FORMS: RRB-1001
OMB NO: 3220-0149 EXPIRATION DATE: 05/31/2007
RESPS:20,000 HOURS:1 COSTS(000):$0
Withholding Certificate for Railroad Retirement Monthly Annuity
Payments
FORMS: RRB-W-4P
OMB NO: 3220-0151 EXPIRATION DATE: 11/30/2007
RESPS:6,535 HOURS:2,032 COSTS(000):$0
Representative Payee Monitoring
FORMS: G-99A G-99C
OMB NO: 3220-0154 EXPIRATION DATE: 08/31/2008
RESPS:500 HOURS:55 COSTS(000):$0
Employee Noncovered Service Pension Questionnaire
FORMS: G-209
OMB NO: 3220-0155 EXPIRATION DATE: 06/30/2007
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: 07/31/2009
RESPS:4,000 HOURS:133 COSTS(000):$0
Employer's Deemed Service Month Questionnaire
FORMS: GL-99
OMB NO: 3220-0164 EXPIRATION DATE: 08/31/2008
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: 08/31/2006
RESPS:300 HOURS:25 COSTS(000):$0
Repayment of Debt
FORMS: G-421F
OMB NO: 3220-0171 EXPIRATION DATE: 09/30/2008
RESPS:18,700 HOURS:339 COSTS(000):$0
RUIA Claims Notification System
FORMS: ID-4K ID-4K(INTERNET) ID-4E ID-4E(INTERNET)
OMB NO: 3220-0173 EXPIRATION DATE: 06/30/2008
RESPS:2,030 HOURS:2,537 COSTS(000):$0
Railroad Separation Allowance or Severance Pay Report
FORMS: BA-9
OMB NO: 3220-0175 EXPIRATION DATE: 02/29/2008
RESPS:239 HOURS:219 COSTS(000):$0
Sick Pay and Miscellaneous Payments Report
FORMS: BA-10
OMB NO: 3220-0176 EXPIRATION DATE: 04/30/2008
RESPS:1,230 HOURS:103 COSTS(000):$0
Representative Payee Parental Custody Monitoring
FORMS: G-99D
OMB NO: 3220-0179 EXPIRATION DATE: 12/31/2008
RESPS:300 HOURS:75 COSTS(000):$0
Annual Earnings Questionnaire for Annuitants in Last
Pre-Retirement Non-Railroad Employment
FORMS: G-19L
OMB NO: 3220-0183 EXPIRATION DATE: 07/31/2009
RESPS:900 HOURS:225 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: G-93
OMB NO: 3220-0184 EXPIRATION DATE: 07/31/2007
RESPS:1,000 HOURS:133 COSTS(000):$0
Earnings Information Request
FORMS: G-19-F
OMB NO: 3220-0185 EXPIRATION DATE: 12/31/2007
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: 12/31/2008
RESPS:3,000 HOURS:748 COSTS(000):$0
Continuing Disability Report
FORMS: G-254 G-254A
OMB NO: 3220-0192 EXPIRATION DATE: 12/31/2006
RESPS:2,050 HOURS:742 COSTS(000):$0
Voluntary Customer Surveys in Accordance with E.O. 12862
FORMS: G-201
OMB NO: 3220-0193 EXPIRATION DATE: 11/30/2006
RESPS:430 HOURS:144 COSTS(000):$0
Job Information Report
FORMS: G-251A G-251B
OMB NO: 3220-0195 EXPIRATION DATE: 04/30/2008
RESPS:500 HOURS:500 COSTS(000):$0
Statement Regarding Contributions and Support of Children
FORMS: G-139
OMB NO: 3220-0196 EXPIRATION DATE: 07/31/2007
RESPS:80 HOURS:13 COSTS(000):$0
Invetigation of Claim for Possible Days of Employment
FORMS: ID-5S(SUP)
OMB NO: 3220-0198 EXPIRATION DATE: 04/30/2007
RESPS:23,520 HOURS:1,274 COSTS(000):$0
Request for Internet Services
FORMS: NONE
OMB NO: 3220-0200 EXPIRATION DATE: 07/31/2007
RESPS:100 HOURS:25 COSTS(000):$0
Designation of Contact Officials
FORMS: G-117A
OMB NO: 3220-0201 EXPIRATION DATE: 03/31/2009
RESPS:800 HOURS:67 COSTS(000):$0
Applicant Background Survey
FORMS: EEO-44
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
62 699,836 153,595 $0
Selective Service System
OMB NO: 3240-0002 EXPIRATION DATE: 08/31/2008
RESPS:601,418 HOURS:20,047 COSTS(000):$0
Selective Service Registration Form
FORMS: SSS-FORM-1 SSS-FORM-1M
OMB NO: 3240-0003 EXPIRATION DATE: 09/30/2008
RESPS:267,824 HOURS:24,305 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: 10/31/2007
RESPS:900 HOURS:225 COSTS(000):$0
Potential Board Member Information
FORMS: SSS-404
OMB NO: 3240-0006 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Registrant Claim Form
FORMS: SSS-9
OMB NO: 3240-0010 EXPIRATION DATE: 09/30/2008
RESPS:450 HOURS:89 COSTS(000):$0
Uncompensated Registrar Appointments
FORMS: SSS-402
OMB NO: 3240-0014 EXPIRATION DATE: 05/31/2007
RESPS:1 HOURS:1 COSTS(000):$0
Registrant Travel Reimbursement Request
FORMS: SSS-350
OMB NO: 3240-0015 EXPIRATION DATE: 05/31/2007
RESPS:1 HOURS:1 COSTS(000):$0
Application for Voluntary Induction
FORMS: SSS-254
OMB NO: 3240-0017 EXPIRATION DATE: 08/31/2008
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: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Student Certificate
FORMS: SSS-109
OMB NO: 3240-0022 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Alien or Dual National
FORMS: SSS-26
OMB NO: 3240-0023 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Minister of Religion
FORMS: SSS-25
OMB NO: 3240-0024 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Hardship to Dependents
FORMS: SSS-24
OMB NO: 3240-0025 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Administrative
FORMS: SSS-21
OMB NO: 3240-0026 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form - Divinity Student
FORMS: SSS-23
OMB NO: 3240-0027 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form Postponement of Induction
FORMS: SSS-27
OMB NO: 3240-0028 EXPIRATION DATE: 10/31/2006
RESPS:1 HOURS:1 COSTS(000):$0
Claim Documentation Form - Conscientious Objector
FORMS: SSS-22
OMB NO: 3240-0029 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Worker Travel Reimbursement Request
FORMS: SSS-164
OMB NO: 3240-0030 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Claim for Reimbursement for Emergency Medical Care
FORMS: SSS-166
OMB NO: 3240-0031 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Employer Data Sheet
FORMS: SSS-153
OMB NO: 3240-0032 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Skills Questionnaire
FORMS: SSS-156
OMB NO: 3240-0033 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Alternative Service Job Data Form
FORMS: SSS-157
OMB NO: 3240-0034 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Request for Overseas Job Assignment
FORMS: SSS-160
OMB NO: 3240-0035 EXPIRATION DATE: 08/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Employment Verification Form
FORMS: SSS-163
OMB NO: 3240-0036 EXPIRATION DATE: 08/31/2008
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)
24 870,612 44,686 $0
Small Business Administration
OMB NO: 3245-0007 EXPIRATION DATE: 03/31/2007
RESPS:31,113 HOURS:15,071 COSTS(000):$0
Surety Bond Guarantee Assistance
FORMS: 990 991 994 994B 994C 994F 994H
OMB NO: 3245-0009 EXPIRATION DATE: 08/31/2007
RESPS:4,200 HOURS:700 COSTS(000):$0
Size Status Declaration
FORMS: 480
OMB NO: 3245-0012 EXPIRATION DATE: 09/30/2008
RESPS:5,000 HOURS:2,500 COSTS(000):$0
Financial Statement of Debtor
FORMS: 770
OMB NO: 3245-0016 EXPIRATION DATE: 04/30/2008
RESPS:51,000 HOURS:520,000 COSTS(000):$0
Applications for Business Loans
FORMS: SBA-FORM-4 SCHEDULE-A SBA-FORM-4-1 SBA-FORM-4-SF (SHORT-FORM
OMB NO: 3245-0017 EXPIRATION DATE: 07/31/2007
RESPS:12,742 HOURS:29,754 COSTS(000):$0
Disaster Business Loan Application
FORMS: 5 1368
OMB NO: 3245-0018 EXPIRATION DATE: 09/30/2006
RESPS:47,962 HOURS:71,943 COSTS(000):$0
Disaster Home Loan Application
FORMS: 5C 739
OMB NO: 3245-0024 EXPIRATION DATE: 02/28/2007
RESPS:10,000 HOURS:2,500 COSTS(000):$0
Pro-Net
FORMS: NONE
OMB NO: 3245-0062 EXPIRATION DATE: 04/30/2007
RESPS:680 HOURS:10,880 COSTS(000):$4,280
SBIC Management Assessment Questionnaire & License Application;
Exhibits to SBIC License App./Mgmt. Assessement Questionnaire
FORMS: 2181 2182 2183
OMB NO: 3245-0063 EXPIRATION DATE: 10/31/2007
RESPS:1,265 HOURS:19,855 COSTS(000):$6,600
SBIC Financial Reports
FORMS: 468 468.1 468.2 468.3 468.4
OMB NO: 3245-0071 EXPIRATION DATE: 12/31/2006
RESPS:10,000 HOURS:20,800 COSTS(000):$0
U.S. Small Business Administration Application for Section 504
Loan
FORMS: 1244
OMB NO: 3245-0074 EXPIRATION DATE: 08/31/2007
RESPS:1 HOURS:7,560 COSTS(000):$151
CDC Annual Report Guide
FORMS: 1253
OMB NO: 3245-0075 EXPIRATION DATE: 03/31/2007
RESPS:200,000 HOURS:40,000 COSTS(000):$0
Training Program Evaluation
FORMS: 20
OMB NO: 3245-0077 EXPIRATION DATE: 09/30/2006
RESPS:14 HOURS:1,120 COSTS(000):$120
Reports to SBA; Provisions of 13 CFR 120.472
FORMS: NONE
OMB NO: 3245-0078 EXPIRATION DATE: 09/30/2007
RESPS:4,000 HOURS:800 COSTS(000):$0
Portfolio Financing Report
FORMS: SBA-1031
OMB NO: 3245-0080 EXPIRATION DATE: 12/31/2006
RESPS:200 HOURS:100 COSTS(000):$0
Statement of Personal History
FORMS: 1081
OMB NO: 3245-0081 EXPIRATION DATE: 08/31/2008
RESPS:50 HOURS:45 COSTS(000):$1
25-Model Corp. Resol. or GP Certif., 33-Model Letter to Selling
Agent, 34-Bank ID, 1065-Appl. Lic. Assure. of Compliance
FORMS: 25 33 34 1065
OMB NO: 3245-0084 EXPIRATION DATE: 09/30/2006
RESPS:42,196 HOURS:10,549 COSTS(000):$0
Disaster Home/Business Loan Inquiry Record
FORMS: 700
OMB NO: 3245-0096 EXPIRATION DATE: 03/31/2009
RESPS:161 HOURS:402 COSTS(000):$0
Nomination for the Small Business Prime Contractor of the year,
Nomination for the Small Business Subcontrator of the year
FORMS: 1375(PRIME) 883(SUB)
OMB NO: 3245-0101 EXPIRATION DATE: 08/31/2006
RESPS:10,500 HOURS:42,000 COSTS(000):$0
Application for Small Business Size Determination
FORMS: 355
OMB NO: 3245-0109 EXPIRATION DATE: 08/31/2006
RESPS:2,160 HOURS:2,160 COSTS(000):$0
Request for Information Concerning Portfolio Financing
FORMS: 857
OMB NO: 3245-0110 EXPIRATION DATE: 09/30/2006
RESPS:24,156 HOURS:12,078 COSTS(000):$0
Borrower's Progress Certification
FORMS: 1366
OMB NO: 3245-0116 EXPIRATION DATE: 08/31/2006
RESPS:1,500 HOURS:750 COSTS(000):$0
Financial Institution Confirmation Form
FORMS: 860
OMB NO: 3245-0118 EXPIRATION DATE: 02/28/2009
RESPS:350 HOURS:162 COSTS(000):$0
Disclosure Statement-Leveraged Licensees; Disclosure Statement
Non-leveraged Licensees
FORMS: 856 856A
OMB NO: 3245-0121 EXPIRATION DATE: 04/30/2009
RESPS:40 HOURS:800 COSTS(000):$0
Governor's Request for Disaster Declaration
FORMS: NONE
OMB NO: 3245-0124 EXPIRATION DATE: 08/31/2008
RESPS:100 HOURS:100 COSTS(000):$0
U.S. Small Business Advisory Committee Membership - Nominee
Information
FORMS: 898
OMB NO: 3245-0131 EXPIRATION DATE: 06/30/2009
RESPS:20,112 HOURS:3,352 COSTS(000):$0
Transaction Report on Loans Serviced by Lendes
FORMS: FORM-172
OMB NO: 3245-0132 EXPIRATION DATE: 06/30/2008
RESPS:3,600 HOURS:3,600 COSTS(000):$0
Lender's Transcript of Account
FORMS: 1149
OMB NO: 3245-0136 EXPIRATION DATE: 03/31/2007
RESPS:3,000 HOURS:249 COSTS(000):$0
Disaster Survey Worksheet
FORMS: 987
OMB NO: 3245-0140 EXPIRATION DATE: 06/30/2009
RESPS:2,592 HOURS:202,261 COSTS(000):$0
Notice of Award and Grant/Cooperative Agreement Cost Sharing
Proposal
FORMS: 1222 1224
OMB NO: 3245-0169 EXPIRATION DATE: 03/31/2007
RESPS:126 HOURS:8,568 COSTS(000):$0
Federal Cash Transaction Report, Financial Status Report,
Program Income Report, Narrative Program Report
FORMS: SF-269 SF-272 SBA-2113
OMB NO: 3245-0172 EXPIRATION DATE: 08/31/2007
RESPS:600 HOURS:600 COSTS(000):$0
Stockholders' Confirmation (Corporation); Ownership Confirmation
(Partnership)
FORMS: 1405 1405A
OMB NO: 3245-0178 EXPIRATION DATE: 09/30/2006
RESPS:55,000 HOURS:13,750 COSTS(000):$0
Statement of Personal History
FORMS: 912
OMB NO: 3245-0183 EXPIRATION DATE: 09/30/2006
RESPS:15,000 HOURS:3,000 COSTS(000):$0
SBA Counseling Evaluation
FORMS: 1419
OMB NO: 3245-0185 EXPIRATION DATE: 03/31/2008
RESPS:14,000 HOURS:42,000 COSTS(000):$0
Secondary Participation Guaranty Agreement
FORMS: 1086 1502
OMB NO: 3245-0188 EXPIRATION DATE: 03/31/2008
RESPS:148,788 HOURS:223,182 COSTS(000):$0
Personal Financial Statement
FORMS: 413
OMB NO: 3245-0193 EXPIRATION DATE: 09/30/2008
RESPS:15,516 HOURS:15,516 COSTS(000):$0
Servicing Agent Agreement
FORMS: 1506
OMB NO: 3245-0200 EXPIRATION DATE: 06/30/2008
RESPS:36,000 HOURS:27,000 COSTS(000):$0
Settlement Sheet
FORMS: 1050
OMB NO: 3245-0201 EXPIRATION DATE: 09/30/2008
RESPS:27,753 HOURS:2,558 COSTS(000):$0
Compensation Agreement; Resolution of Board of Directors, and
Certificate as to Partners
FORMS: 159(7A) 159(504) 159D 160 160A
OMB NO: 3245-0205 EXPIRATION DATE: 01/31/2009
RESPS:7,258 HOURS:14,516 COSTS(000):$0
8(a) Annual Update
FORMS: 1450
OMB NO: 3245-0212 EXPIRATION DATE: 03/31/2007
RESPS:6,500 HOURS:9,750 COSTS(000):$0
Form of Detached Assignment for U.S. Small Business
Administration Loan Pool or Guaranteed Interest Certificate
FORMS: 1088
OMB NO: 3245-0225 EXPIRATION DATE: 09/30/2007
RESPS:300 HOURS:2,400 COSTS(000):$0
Small Business Administration: Application for Certificate of
Competency
FORMS: 1531
OMB NO: 3245-0270 EXPIRATION DATE: 03/31/2009
RESPS:18,084 HOURS:18,084 COSTS(000):$0
Representatives Used and Compensation Paid for Services in
Connection with Obtaining Federal Contracts
FORMS: SBA-1790
OMB NO: 3245-0301 EXPIRATION DATE: 09/30/2007
RESPS:190 HOURS:380 COSTS(000):$0
Financing Eligibility Statement - Social Disadvantage/Economic
Disadvantage
FORMS: SBA-1941A SBA-1941B SBA-1941C
OMB NO: 3245-0313 EXPIRATION DATE: 03/31/2007
RESPS:400 HOURS:300 COSTS(000):$0
Federal Agency Comment Form
FORMS: 1993
OMB NO: 3245-0320 EXPIRATION DATE: 05/31/2009
RESPS:6,375 HOURS:10,725 COSTS(000):$0
HUBZone Program Electronic Application, Recertificaiton and
Program Examination
FORMS: SBA-2103
OMB NO: 3245-0324 EXPIRATION DATE: 09/30/2006
RESPS:1 HOURS:67,500 COSTS(000):$0
Entrepreneurial Development Management Information System
(EDMIS) Counseling Information Form & Management Training Report
FORMS: 641 888
OMB NO: 3245-0326 EXPIRATION DATE: 09/30/2006
RESPS:2,500 HOURS:5,000 COSTS(000):$0
Pre-Disaster Mitigation Small Business Loan Application
FORMS: 5M
OMB NO: 3245-0329 EXPIRATION DATE: 09/30/2008
RESPS:156 HOURS:312 COSTS(000):$0
PRIME (Program for Investment in Microentrepreneurs)
FORMS: NONE
OMB NO: 3245-0331 EXPIRATION DATE: 08/31/2007
RESPS:8,400 HOURS:36,210 COSTS(000):$0
8(A)/SBD Paper and Electronic Application
FORMS: 1010 1010E 1010B 2065 1010C
OMB NO: 3245-0332 EXPIRATION DATE: 10/31/2008
RESPS:1,151 HOURS:14,012 COSTS(000):$2,729
NMVC Program Application, Funding and Reporting
FORMS: SFS-269 270 272 424(A-B) SBA-2184 2185 2216 34 2211 2210
OMB NO: 3245-0346 EXPIRATION DATE: 02/28/2007
RESPS:886 HOURS:832 COSTS(000):$0
PCLP Quarterly Loan Loss Reserve Report and PCLP Guarantee
Request
FORMS: 2233 2234A/B/C
OMB NO: 3245-0348 EXPIRATION DATE: 02/28/2007
RESPS:20,000 HOURS:17,500 COSTS(000):$0
SBA Express Information Collection
FORMS: 1919 1920SX 2236 2237 2238
OMB NO: 3245-0350 EXPIRATION DATE: 02/28/2007
RESPS:6,000 HOURS:3,000 COSTS(000):$0
HUBZone Application Data Update
FORMS: NONE
OMB NO: 3245-0351 EXPIRATION DATE: 03/31/2009
RESPS:7,378 HOURS:1,230 COSTS(000):$0
Entrepreneurial Development Impact Study
FORMS: 2214
OMB NO: 3245-0352 EXPIRATION DATE: 07/31/2007
RESPS:2,500 HOURS:625 COSTS(000):$0
Microloan Program Electronic Reporting System (MPERS)
(MPERsystem)
FORMS: NONE
OMB NO: 3245-0353 EXPIRATION DATE: 05/31/2008
RESPS:52 HOURS:1,344 COSTS(000):$0
Quarterly Reports file by Grantees of the Drug Free Workplace
Program
FORMS: NONE
OMB NO: 3245-0354 EXPIRATION DATE: 08/31/2008
RESPS:1,200 HOURS:300 COSTS(000):$0
Survey of Small Business Lending Practices
FORMS: 2269
OMB NO: 3245-0355 EXPIRATION DATE: 12/31/2006
RESPS:500 HOURS:375 COSTS(000):$0
Gulf Coast Relief Financing Pilot Information Collection
FORMS: 2276/A/B/C 2281 2282
OMB NO: 3245-0356 EXPIRATION DATE: 03/31/2009
RESPS:37,000 HOURS:20,000 COSTS(000):$0
Small Business Innovation Research (SBIR) and Small Business
Technology Transfer (STTR) Tech-Net Database
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
59 928,308 1,582,660 $13,881
Social Security Administration
OMB NO: 0960-0001 EXPIRATION DATE: 03/31/2007
RESPS:18,000 HOURS:4,500 COSTS(000):$0
Certificate of Support, 20 CFR 404.408a, 404.370, and 404.750
FORMS: SSA-760-F4
OMB NO: 0960-0002 EXPIRATION DATE: 07/31/2008
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: 02/28/2009
RESPS:50,000 HOURS:12,500 COSTS(000):$0
Application for Mother's of Father's Insurance Benefits 20CFR
404.339-404.342; 20CFR404.601-404.603
FORMS: SSA-5-F6
OMB NO: 0960-0004 EXPIRATION DATE: 12/31/2006
RESPS:288,580 HOURS:72,145 COSTS(000):$0
Application for Widow's or Widower's Insurance Benefits 20 CFR
404.335-.338, 20 CFR 404.603
FORMS: SSA-10
OMB NO: 0960-0009 EXPIRATION DATE: 11/30/2008
RESPS:180,000 HOURS:15,000 COSTS(000):$0
Marriage Certification; 20 CFR 404.725
FORMS: SSA-3-F6
OMB NO: 0960-0010 EXPIRATION DATE: 05/31/2007
RESPS:1,740,000 HOURS:372,417 COSTS(000):$0
Application for Child's Insurance Benefits 20 CFR
404.350-404.368, 404.603, 416.350
FORMS: SSA-4-BK
OMB NO: 0960-0012 EXPIRATION DATE: 04/30/2009
RESPS:1,400 HOURS:350 COSTS(000):$0
Application for Parent's Insurance Benefits 20 CFR 404.370,
.371, .373, .374, .601-.603
FORMS: SSA-7-F6
OMB NO: 0960-0013 EXPIRATION DATE: 03/31/2007
RESPS:877,000 HOURS:146,167 COSTS(000):$0
Application for Lump-Sum Death Payment; 404.390 - .392
FORMS: SSA-8-F4
OMB NO: 0960-0014 EXPIRATION DATE: 01/31/2009
RESPS:2,121,686 HOURS:371,295 COSTS(000):$0
Request to be Selected as Payee 20 CFR 404.2010-.2025,
414.582-.583, 416.601-.665
FORMS: SSA-11-BK
OMB NO: 0960-0015 EXPIRATION DATE: 10/31/2006
RESPS:100,000 HOURS:8,333 COSTS(000):$0
Request for Withdrawal of Application 20 CFR 404.640
FORMS: SSA-521
OMB NO: 0960-0016 EXPIRATION DATE: 10/31/2008
RESPS:1,200 HOURS:200 COSTS(000):$0
Statement Regarding Date of Birth and Citizenship 20 CFR 404.716
FORMS: SSA-702
OMB NO: 0960-0017 EXPIRATION DATE: 07/31/2008
RESPS:40,000 HOURS:6,000 COSTS(000):$0
Statement Regarding Marriage, 20 CFR 404.726
FORMS: SSA-753
OMB NO: 0960-0019 EXPIRATION DATE: 07/31/2007
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: 08/31/2008
RESPS:30,000 HOURS:8,500 COSTS(000):$0
Statement Regarding Contributions 20 CFR 404.360-404.366 and
404.736
FORMS: SSA-783
OMB NO: 0960-0024 EXPIRATION DATE: 05/31/2007
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 20-CFR-404.2015 416.615
OMB NO: 0960-0025 EXPIRATION DATE: 05/31/2009
RESPS:12,350 HOURS:6,175 COSTS(000):$0
Partnership Questionnaire 20 CFR 404.1080-404.1082(e)
FORMS: SSA-7104
OMB NO: 0960-0029 EXPIRATION DATE: 10/31/2007
RESPS:375,000 HOURS:62,500 COSTS(000):$0
Request for Correction of Earnings Record, 20 CFR 404.820 and
422.125
FORMS: SSA-7008
OMB NO: 0960-0030 EXPIRATION DATE: 08/31/2006
RESPS:925,000 HOURS:308,333 COSTS(000):$0
Statement of Employer, 20 CFR 404.801 - .803
FORMS: SSA-7011-BK
OMB NO: 0960-0034 EXPIRATION DATE: 05/31/2009
RESPS:150,000 HOURS:100,000 COSTS(000):$0
Letter to Employer Requesting Information About Wages Earned by
Beneficiary 20 CFR 404.703, 404.801
FORMS: SSA-L725
OMB NO: 0960-0036 EXPIRATION DATE: 10/31/2007
RESPS:125,000 HOURS:62,500 COSTS(000):$0
Statement of Agricultural Employer (Year Prior to 1988; 1988 and
Later), 20 CFR 404.702, .802, & .1056
FORMS: SSA-1002 SSA-1003
OMB NO: 0960-0037 EXPIRATION DATE: 07/31/2007
RESPS:500,000 HOURS:875,000 COSTS(000):$0
Request for Waiver of Overpayment Recovery or Change in
Repayment Rate
FORMS: SSA-632-BK
OMB NO: 0960-0038 EXPIRATION DATE: 03/31/2009
RESPS:30,000 HOURS:15,000 COSTS(000):$0
Statement of Marital Relationship (By one of the parties) 20 CFR
404.726
FORMS: SSA-754-F4
OMB NO: 0960-0040 EXPIRATION DATE: 02/28/2007
RESPS:47,500 HOURS:19,792 COSTS(000):$0
Employment Relationship Questionnaire
FORMS: SSA-7160
OMB NO: 0960-0045 EXPIRATION DATE: 10/31/2006
RESPS:305,500 HOURS:76,375 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: SSA-795
OMB NO: 0960-0046 EXPIRATION DATE: 11/30/2006
RESPS:5,000 HOURS:417 COSTS(000):$0
Statement of Self-Employment Income, 20 CFR 404.101, 404-110,
404.1096(a)-(d)
FORMS: SSA-766
OMB NO: 0960-0049 EXPIRATION DATE: 06/30/2007
RESPS:257,000 HOURS:26,417 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: 03/31/2007
RESPS:20,000 HOURS:4,000 COSTS(000):$0
Questionnaire About Employment or Self-Employment Outside the
United States 20 CFR 404.401, .415-.417
FORMS: SSA-7163
OMB NO: 0960-0051 EXPIRATION DATE: 02/28/2009
RESPS:35,000 HOURS:5,833 COSTS(000):$0
Supplement To Claim of Person Outside the United States 20 CFR
406.460, 404.463, 422.505(b), 42 CFR 407.27(c)
FORMS: SSA-21
OMB NO: 0960-0052 EXPIRATION DATE: 10/31/2007
RESPS:750,000 HOURS:375,000 COSTS(000):$0
Medical Report (General), 20 CFR 404.1512-.1515 and 416.912-.915
FORMS: SSA-3826
OMB NO: 0960-0058 EXPIRATION DATE: 01/31/2009
RESPS:50,000 HOURS:30,000 COSTS(000):$0
Report on Individual With Mental Impairment 20 CFR 404.1513,
416.913
FORMS: SSA-824
OMB NO: 0960-0059 EXPIRATION DATE: 06/30/2009
RESPS:300,000 HOURS:225,000 COSTS(000):$0
Work Activity Report--Employee 20 CFR 404.1520(b),
404.1571-.1576, 404.1584-.1593 and 416.971-.976
FORMS: SSA-821-BK
OMB NO: 0960-0061 EXPIRATION DATE: 06/30/2007
RESPS:47,500 HOURS:7,917 COSTS(000):$0
Farm Self-Employment Questionnaire
FORMS: SSA-7156
OMB NO: 0960-0062 EXPIRATION DATE: 06/30/2008
RESPS:3,200 HOURS:800 COSTS(000):$0
Application for Survivor's Benefits, 20 CFR 404.611(a) and (c)
FORMS: SSA-24
OMB NO: 0960-0064 EXPIRATION DATE: 09/30/2008
RESPS:38,000 HOURS:19,000 COSTS(000):$0
Farm Arrangement Questionnaire 20 CFR 404.1082(c)
FORMS: SSA-7157-F4
OMB NO: 0960-0066 EXPIRATION DATE: 04/30/2009
RESPS:13,584,000 HOURS:1,933,000 COSTS(000):$8,367
Application for a Social Security Card, 20 CFR 422.103-.110
FORMS: SS-5 SS-5-FS
OMB NO: 0960-0068 EXPIRATION DATE: 03/31/2008
RESPS:5,250,000 HOURS:1,312,500 COSTS(000):$0
Representative Payee Report, 20 CFR 404.2035, 20 CFR 404.2065,
20 CFR 416.635, and 20 CFR 416.665
FORMS: SSA-623 SSA-6230
OMB NO: 0960-0069 EXPIRATION DATE: 09/30/2007
RESPS:252,000 HOURS:126,000 COSTS(000):$0
Representative Payee Evaluation Report 20 CFR 404.2065, 416.665
FORMS: SSA-624
OMB NO: 0960-0071 EXPIRATION DATE: 03/31/2009
RESPS:27,000 HOURS:2,250 COSTS(000):$0
Report of New Information in Disability Cases, 20 CFR 404.460,
404.468, 404.408, and 404.1588
FORMS: SSA-612
OMB NO: 0960-0072 EXPIRATION DATE: 05/31/2008
RESPS:792,020 HOURS:792,020 COSTS(000):$0
Continuing Disability Review Report, 20 CFR 404.1589, 20 CFR
416.989
FORMS: SSA-454-BK
OMB NO: 0960-0073 EXPIRATION DATE: 06/30/2007
RESPS:70,000 HOURS:5,833 COSTS(000):$0
Reporting Changes That Affect Your Social Security Payment 20
CFR 404, Subparts D & E
FORMS: SSA-1425
OMB NO: 0960-0078 EXPIRATION DATE: 07/31/2008
RESPS:125,000 HOURS:10,417 COSTS(000):$0
Railroad Employment Questionnaire; 20 CFR 404.1401, 404.1406 -
404.1408
FORMS: SSA-671
OMB NO: 0960-0088 EXPIRATION DATE: 03/31/2008
RESPS:75,000 HOURS:7,500 COSTS(000):$0
Student Reporting Form - 20 CFR 404.415, 404.434, 404.352(b)(2),
404.367, 404.368, 422.135
FORMS: SSA-1383
OMB NO: 0960-0093 EXPIRATION DATE: 10/31/2006
RESPS:180 HOURS:45 COSTS(000):$0
Certification by Religious Group - 20 CFR, Subpart K, 404.1075
FORMS: SSA-1458
OMB NO: 0960-0096 EXPIRATION DATE: 11/30/2006
RESPS:10 HOURS:3 COSTS(000):$0
Application for Special Age 72-or-Over Monthly Payments, 20 CFR
404.380-384
FORMS: SSA-19-F6
OMB NO: 0960-0097 EXPIRATION DATE: 10/31/2006
RESPS:18,030 HOURS:3,606 COSTS(000):$0
Application for Search of Census Record for Proof of Age, 20 CFR
404.716
FORMS: SSA-1535
OMB NO: 0960-0098 EXPIRATION DATE: 10/31/2006
RESPS:140,000 HOURS:35,000 COSTS(000):$0
Request for Workers' Compensation/Public Disability Information
- 20 CFR, Subpart E, 404.408
FORMS: SSA-1709
OMB NO: 0960-0101 EXPIRATION DATE: 08/31/2006
RESPS:300,000 HOURS:50,000 COSTS(000):$0
Claim for Amounts Due in the Case of a Deceased Beneficiary, 20
CFR 404.503(b)
FORMS: SSA-1724
OMB NO: 0960-0102 EXPIRATION DATE: 01/31/2008
RESPS:12,000 HOURS:6,000 COSTS(000):$0
Medical Report (Individual with Childhood Impairment), 20 CFR
404.1512-404.1515, 416.912-416.915
FORMS: SSA-3827
OMB NO: 0960-0103 EXPIRATION DATE: 07/31/2007
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: 06/30/2008
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: 11/30/2008
RESPS:200,000 HOURS:33,333 COSTS(000):$0
Advanced Notice of Termination of Child's Benefits, and
Student's Statement Regarding School Attendance
FORMS: SSA-1372-BK SSA-1372-BK-FC
OMB NO: 0960-0109 EXPIRATION DATE: 10/31/2006
RESPS:130,000 HOURS:21,667 COSTS(000):$0
Statement of Care and Responsibility for Beneficiary - 20 CFR,
404.2020, .2025, & 416.620, .625
FORMS: SSA-788
OMB NO: 0960-0110 EXPIRATION DATE: 02/29/2008
RESPS:100 HOURS:100 COSTS(000):$0
State Mental Institution Policy Review Booklet, 20 CFR 404
Subpart U and 20 CFR 416 Subpart F
FORMS: SSA-9584-BK
OMB NO: 0960-0116 EXPIRATION DATE: 03/31/2007
RESPS:50,000 HOURS:12,500 COSTS(000):$0
Child Relationship Statement
FORMS: SSA-2519
OMB NO: 0960-0120 EXPIRATION DATE: 03/31/2007
RESPS:10,000 HOURS:1,667 COSTS(000):$0
Pre-1957 Military Service Federal Questionnaire; 20 CFR
404.1301-1371
FORMS: SSA-2512
OMB NO: 0960-0124 EXPIRATION DATE: 08/31/2008
RESPS:341,000 HOURS:147,767 COSTS(000):$0
Statement of Income and Resources; 20 CFR 416.207, 416.301-.310,
416.704, 416.708
FORMS: SSA-8010-BK
OMB NO: 0960-0127 EXPIRATION DATE: 03/31/2008
RESPS:20,000 HOURS:3,333 COSTS(000):$0
Agreement to Sell Property, 20 CFR 416.1240, 20 CFR 416.1242, 20
CFR 416.1244, 20 CFR 416.1245
FORMS: SSA-8060-U3
OMB NO: 0960-0128 EXPIRATION DATE: 03/31/2008
RESPS:30,180 HOURS:2,515 COSTS(000):$0
Reporting Events SSI, 20 CFR 416.701-.732
FORMS: SSA-8150-EV
OMB NO: 0960-0130 EXPIRATION DATE: 06/30/2008
RESPS:124 HOURS:124 COSTS(000):$0
Quarterly Statistical Report on Recipients and Payments Under
State-Administered Assistance Programs for Aged, Blind, and
Disabled
FORMS: SSA-9741
OMB NO: 0960-0133 EXPIRATION DATE: 05/31/2009
RESPS:4,500 HOURS:4,500 COSTS(000):$0
Supplemental Security Income-Quality Review Case Analysis
FORMS: SSA-8508-BK
OMB NO: 0960-0138 EXPIRATION DATE: 07/31/2009
RESPS:133,000 HOURS:66,500 COSTS(000):$0
Letter to Employer Requesting Wage Information
FORMS: SSA-L4201
OMB NO: 0960-0140 EXPIRATION DATE: 11/30/2008
RESPS:2,134,100 HOURS:177,842 COSTS(000):$0
Record of SSI Inquiry 20 CFR 416.345
FORMS: SSA-3462
OMB NO: 0960-0142 EXPIRATION DATE: 07/31/2008
RESPS:729,761 HOURS:42,569 COSTS(000):$0
Report of Death by Funeral Director, 20 CFR 404.715 & 404.720
FORMS: SSA-721
OMB NO: 0960-0144 EXPIRATION DATE: 08/31/2006
RESPS:1,112,818 HOURS:564,754 COSTS(000):$0
Disability Report--Appeal 20 CFR 404.1512 & 416.912 and 20 CFR,
404.916(c) & 416.1416(c)
FORMS: SSA-3441
OMB NO: 0960-0145 EXPIRATION DATE: 11/30/2006
RESPS:1,310,000 HOURS:313,000 COSTS(000):$0
Statement for determining continuing eligibility for
Supplemental security income payments, 20 CFR 416.204
FORMS: SSA-8202-BK SSA-8202-OCR-SM
OMB NO: 0960-0160 EXPIRATION DATE: 07/31/2008
RESPS:76,000 HOURS:15,833 COSTS(000):$0
Government Pension Questionnaire; 20 CFR 404.408a
FORMS: SSA-3885
OMB NO: 0960-0174 EXPIRATION DATE: 06/30/2009
RESPS:173,380 HOURS:20,228 COSTS(000):$0
Statement of Living Arrangements, In-Kind Support and
Maintenance, 20 CFR 416.1130-416.1148
FORMS: SSA-8006-F4
OMB NO: 0960-0184 EXPIRATION DATE: 08/31/2006
RESPS:200 HOURS:2,800 COSTS(000):$0
Instructions for Completion of Federal Assistance Application
for SSA Research and Demonstration Grant Programs
FORMS: SSA-96
OMB NO: 0960-0189 EXPIRATION DATE: 02/29/2008
RESPS:5,475 HOURS:2,521 COSTS(000):$0
Sample Number Holder; Auxiliaries/Survivors; Parents;
Stewardship Annual Earnings Test Workbook
FORMS: SSA-2930 SSA-2931 SSA-2932 SSA-4659
OMB NO: 0960-0229 EXPIRATION DATE: 06/30/2008
RESPS:1,128,374 HOURS:679,846 COSTS(000):$0
SSA-8000-BK - 20 CFR, 416.207 & Subpart C, 416.305-.335
FORMS: NONE
OMB NO: 0960-0240 EXPIRATION DATE: 12/31/2006
RESPS:26 HOURS:71 COSTS(000):$0
Subpart T-State Supplementation Provisions; Payment 20 CFR
416.2099
FORMS: NONE
OMB NO: 0960-0247 EXPIRATION DATE: 05/31/2009
RESPS:100,000 HOURS:25,000 COSTS(000):$0
Workers' Compensation/Public Disability Benefit Questionnaire,
20 CFR 404.408
FORMS: SSA-546
OMB NO: 0960-0267 EXPIRATION DATE: 05/31/2009
RESPS:60,000 HOURS:3,000 COSTS(000):$0
Medicaid Use Report 20 CFR 416.268
FORMS: NONE
OMB NO: 0960-0269 EXPIRATION DATE: 01/31/2008
RESPS:667,236 HOURS:111,206 COSTS(000):$0
Request for Hearing By Administrative Law Judge, 20 CFR 404.933,
20 CFR 405.722
FORMS: HA-501-U5
OMB NO: 0960-0277 EXPIRATION DATE: 03/31/2008
RESPS:107,485 HOURS:17,914 COSTS(000):$0
Request for Review of Hearing Decision/Order, 20 CFR
404.967-.981, 20 CFR 416.1467-.1481
FORMS: HA-520
OMB NO: 0960-0282 EXPIRATION DATE: 02/29/2008
RESPS:17,000 HOURS:4,250 COSTS(000):$0
Development for Participation in an Appropriate Program of
Vocational Rehab, 20 CFR 404 and 416
FORMS: SSA-4290
OMB NO: 0960-0284 EXPIRATION DATE: 09/30/2007
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: 04/30/2007
RESPS:10,548 HOURS:879 COSTS(000):$0
Notice Regarding Substitution of Party Upon Death of Claimant;
20 CFR 404.957(c)(4); 20 CFR 416.1457(c)(4)
FORMS: HA-539
OMB NO: 0960-0289 EXPIRATION DATE: 08/31/2006
RESPS:171,939 HOURS:42,985 COSTS(000):$0
Claimant's Medications - 20 CFR, Subpart P, 404.1512 and Subpart
1, 416.912
FORMS: HA-4632
OMB NO: 0960-0292 EXPIRATION DATE: 06/30/2009
RESPS:320,000 HOURS:53,333 COSTS(000):$0
Claimant's Recent Medical Treatment 20 CFR, 404.1512 & 416.912
FORMS: HA-4631
OMB NO: 0960-0293 EXPIRATION DATE: 11/30/2007
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: 12/31/2008
RESPS:120,000 HOURS:30,000 COSTS(000):$0
Claimant's Work Background 20 CFR 404.1565(b) and 20 CFR
416.965(b)
FORMS: HA-4633
OMB NO: 0960-0310 EXPIRATION DATE: 01/31/2007
RESPS:16,300 HOURS:9,048 COSTS(000):$0
Vocational Rehabilitation Provider Claim, 20 CFR 404 Subpart V
FORMS: SSA-199
OMB NO: 0960-0323 EXPIRATION DATE: 07/31/2009
RESPS:73,540 HOURS:6,128 COSTS(000):$0
Third Party Liability Information Statement 42 CFR 433.136-.139
FORMS: SSA-8019-U2
OMB NO: 0960-0324 EXPIRATION DATE: 05/31/2009
RESPS:7,500 HOURS:1,250 COSTS(000):$0
Supplemental Security Income Claim Information Notice 20 CFR
Subpart B, 416.210
FORMS: SSA-L8050-U3
OMB NO: 0960-0341 EXPIRATION DATE: 06/30/2008
RESPS:2,400 HOURS:80 COSTS(000):$0
Request for Address Information: from Motor Vehicles Records;
from Employment Commissions Records
FORMS: SSA-L711 SSA-L712
OMB NO: 0960-0347 EXPIRATION DATE: 06/30/2007
RESPS:1,925 HOURS:963 COSTS(000):$0
Response to Notice of Revised Determination 20 CFR 404.913-.914,
404.992(b), 416.1413, 416.1492(d)
FORMS: SSA-765
OMB NO: 0960-0348 EXPIRATION DATE: 09/30/2007
RESPS:7,483 HOURS:998 COSTS(000):$0
Request for Change in Time/Place of Disability Hearing, 20 CFR
404.914(c)(2) and 416.1414(c)(2)
FORMS: SSA-769
OMB NO: 0960-0349 EXPIRATION DATE: 10/31/2006
RESPS:49,000 HOURS:10,045 COSTS(000):$0
Request for Reconsideration--Disability Cessation--20 CFR,
Subpart J. 404.409 & Sunpart N, 416.1409
FORMS: SSA-789
OMB NO: 0960-0351 EXPIRATION DATE: 06/30/2007
RESPS:1,200 HOURS:100 COSTS(000):$0
Notice Regarding Substitution of Party Upon Death of Claimant
Reconsiderationof Disability Cessation
FORMS: SSA-770
OMB NO: 0960-0369 EXPIRATION DATE: 01/31/2007
RESPS:225,000 HOURS:37,500 COSTS(000):$0
Annual Earnings Test-Direct Mail Follow-up Program Notices; 20
CFR 404.452-.455
FORMS: SSA-L9778 SSA-L9779 SSA-L9781 SSA-L9784 SSA-L9785
OMB NO: 0960-0395 EXPIRATION DATE: 02/29/2008
RESPS:90,000 HOURS:12,000 COSTS(000):$0
Modified Benefit Formula Questionnaire
FORMS: SSA-150
OMB NO: 0960-0398 EXPIRATION DATE: 06/30/2009
RESPS:30,000 HOURS:1,000 COSTS(000):$0
Certification of Elections for Reduced Spouse's Benefits 20 CFR
404.421
FORMS: SSA-25
OMB NO: 0960-0413 EXPIRATION DATE: 10/31/2006
RESPS:1,253,703 HOURS:313,426 COSTS(000):$0
Psychiatric Review Technique - 20 CFR, Subpart P, 404.1520(a)
Subpart 1, 416.920(a)
FORMS: SSA-2506-BK
OMB NO: 0960-0416 EXPIRATION DATE: 11/30/2006
RESPS:900,000 HOURS:285,000 COSTS(000):$0
Statement for determining continuing eligibility for
Supplemental Security Income Payments, 20 CFR 416.204
FORMS: SSA-8203-BK
OMB NO: 0960-0421 EXPIRATION DATE: 06/30/2007
RESPS:208 HOURS:728 COSTS(000):$0
State Agency Report of obligations for SSA Disability Programs
and Addendum; Time Report of Personnel Services for Disability
Determination Services; Schedule of Equipment Purchased for SSA..
FORMS: SSA-4513 SSA-4514 SSA-871
OMB NO: 0960-0425 EXPIRATION DATE: 02/28/2009
RESPS:482 HOURS:434 COSTS(000):$0
20 CFR 404, Subpart M Coverage of Employees of State and Local
Governments
FORMS: NONE
OMB NO: 0960-0428 EXPIRATION DATE: 06/30/2007
RESPS:36 HOURS:18 COSTS(000):$0
Subpoena-Disability Hearing
FORMS: SSA-1272-U4
OMB NO: 0960-0430 EXPIRATION DATE: 06/30/2007
RESPS:49,000 HOURS:12,250 COSTS(000):$0
Summary of Evidence, 20 CFR 404.913(b), 404.914(a), 416.1407,
416.1413(b), and 416.1414(a)
FORMS: SSA-887
OMB NO: 0960-0431 EXPIRATION DATE: 05/31/2007
RESPS:2,421,865 HOURS:807,288 COSTS(000):$0
Physical Residual Functional Capacity Assessment and Mental
Residual Capacity Assessment
FORMS: SSA-4734-BK SSA-4734-F4-SUP 20-CFR-404.1545 20-CFR-404.1546
416.945-46
OMB NO: 0960-0432 EXPIRATION DATE: 02/28/2009
RESPS:359,999 HOURS:180,000 COSTS(000):$0
Missing and Discrepant Wage Reports Letter and Questionnaire
FORMS: SSA-L93 SSA-L94 SSA-95 SSA-97
OMB NO: 0960-0434 EXPIRATION DATE: 11/30/2007
RESPS:50,000 HOURS:8,333 COSTS(000):$0
Travel Expense Reimbursement, 20 CFR 404.999(d) and 416.1499
FORMS: NONE
OMB NO: 0960-0437 EXPIRATION DATE: 02/29/2008
RESPS:3,200,000 HOURS:800,000 COSTS(000):$0
Disability Determination and Transmittal 20 CFR 404.1615(e) and
416.1015(f)
FORMS: SSA-831-C3/U3
OMB NO: 0960-0440 EXPIRATION DATE: 10/31/2007
RESPS:100,000 HOURS:100,000 COSTS(000):$0
Disability Hearing Officer's Report of Disability Hearing
FORMS: SSA-1205-BK 20-CFR-404.917 416.1407 416.1417
OMB NO: 0960-0441 EXPIRATION DATE: 06/30/2007
RESPS:65,000 HOURS:48,750 COSTS(000):$0
Disability Hearing Officer's Decision 20 CFR Sections 404.917
and 416.1417
FORMS: SSA-1207 SSA-1207-SUP1 SSA-1207-SUP3
OMB NO: 0960-0442 EXPIRATION DATE: 04/30/2008
RESPS:303,564 HOURS:151,782 COSTS(000):$0
Cessation or Continuance of Disability or Blindness
Determination and Transmital--Title II, 20 CFR 404.1615
FORMS: SSA-833-C3/U3
OMB NO: 0960-0443 EXPIRATION DATE: 02/29/2008
RESPS:402,250 HOURS:201,113 COSTS(000):$0
Cessation or Continuance of Disability or Blindness
Determination and Transmittal-Title XVI, 20 CFR
FORMS: SSA-832-C3-U3
OMB NO: 0960-0444 EXPIRATION DATE: 04/30/2009
RESPS:1,154,760 HOURS:285,755 COSTS(000):$0
Application for Supplemental Security Income 20 CFR
416.305-416.335
FORMS: SSA-8001-BK
OMB NO: 0960-0445 EXPIRATION DATE: 07/31/2007
RESPS:200 HOURS:67 COSTS(000):$0
Application for Benefits Under the Italy-U.S. International
Social Security Agreements, 20 CFR 404.1925
FORMS: SSA-2528
OMB NO: 0960-0448 EXPIRATION DATE: 09/30/2008
RESPS:23,200 HOURS:11,600 COSTS(000):$0
Application for Benefits Under a U.S. International Social
Security Agreement 20 CFR 404.1925
FORMS: SSA-2490-BK
OMB NO: 0960-0451 EXPIRATION DATE: 05/31/2009
RESPS:9,000 HOURS:750 COSTS(000):$0
Permanent Residence in the United States Under Color of Law
(PRUCOL) 20 CFR 416.1615 & 416.1618
FORMS: NONE
OMB NO: 0960-0454 EXPIRATION DATE: 11/30/2008
RESPS:49,000 HOURS:8,167 COSTS(000):$0
Letter to Landlord Requesting Rental Information 20 CFR
416.1130(b)
FORMS: SSA-L5061
OMB NO: 0960-0456 EXPIRATION DATE: 03/31/2007
RESPS:400,000 HOURS:100,000 COSTS(000):$0
Statement of Household Expenses and Contributions; 20 CFR
416.1130-.1148
FORMS: SSA-8011-F3
OMB NO: 0960-0460 EXPIRATION DATE: 02/28/2009
RESPS:5,100 HOURS:425 COSTS(000):$0
Marital Relationship Questionnaire 20 CFR 416.1826
FORMS: SSA-4178
OMB NO: 0960-0461 EXPIRATION DATE: 06/30/2007
RESPS:200,000 HOURS:23,333 COSTS(000):$0
Information about Joint Checking/Savings Account 20 CFR
416.1201(b) and 416.1208
FORMS: SSA-2574
OMB NO: 0960-0462 EXPIRATION DATE: 11/30/2006
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: 07/31/2007
RESPS:800,000 HOURS:66,667 COSTS(000):$0
Request for Social Security Statement
FORMS: SSA-7004
OMB NO: 0960-0470 EXPIRATION DATE: 09/30/2007
RESPS:1,000 HOURS:50 COSTS(000):$0
Agency/Employer Government Pension Offset Questionnaire, 20 CFR
404.408(a)
FORMS: SSA-4163
OMB NO: 0960-0471 EXPIRATION DATE: 07/31/2007
RESPS:5,438 HOURS:1,813 COSTS(000):$0
Real Property Current Market Value Estimate
FORMS: SSA-L2794
OMB NO: 0960-0472 EXPIRATION DATE: 07/31/2007
RESPS:50,000 HOURS:8,333 COSTS(000):$0
Employer Verification of Earnings After Death
FORMS: SSA-L4112
OMB NO: 0960-0473 EXPIRATION DATE: 02/29/2008
RESPS:4,750 HOURS:792 COSTS(000):$0
Employee Identification Statement, 20 CFR 404.702
FORMS: SSA-4156
OMB NO: 0960-0474 EXPIRATION DATE: 08/31/2007
RESPS:2,000 HOURS:167 COSTS(000):$0
Child-Care Dropout Questionnaire 20 CFR 404.211(e)(4)
FORMS: SSA-4162
OMB NO: 0960-0477 EXPIRATION DATE: 02/29/2008
RESPS:30,000 HOURS:10,000 COSTS(000):$0
Modified Benefit Formula Questionnaire-Employer
FORMS: SSA-58
OMB NO: 0960-0481 EXPIRATION DATE: 06/30/2009
RESPS:40,000 HOURS:6,667 COSTS(000):$0
Statement of Funds You Provided to Another, Statement of Funds
You Received 20 CFR 416.1103(f)
FORMS: SSA-2854 SSA-2855
OMB NO: 0960-0483 EXPIRATION DATE: 06/30/2008
RESPS:15,000 HOURS:3,750 COSTS(000):$0
Employee Work Activity Questionnaire, 20 CFR 404.1574
FORMS: SSA-3033
OMB NO: 0960-0487 EXPIRATION DATE: 09/30/2006
RESPS:50,000 HOURS:16,667 COSTS(000):$0
Self-Employment/Corporate Officer Questionnaire
FORMS: SSA-4184
OMB NO: 0960-0499 EXPIRATION DATE: 05/31/2007
RESPS:253,000 HOURS:126,500 COSTS(000):$0
Questionnaire for Children Claiming SSI Benefits
FORMS: SSA-3881-BK
OMB NO: 0960-0500 EXPIRATION DATE: 02/28/2009
RESPS:59,100 HOURS:9,850 COSTS(000):$0
Medical Report will Allegation of Human Immunodeficiency Virus
(HIV) Infection--Adult and Child 20 CFR 416.933-934
FORMS: SSA-4814-F5 SSA-4815-F6
OMB NO: 0960-0501 EXPIRATION DATE: 02/28/2007
RESPS:50 HOURS:13 COSTS(000):$0
Blood Donor Locator Service (BDLS), 20 CFR 401.200
FORMS: NONE
OMB NO: 0960-0502 EXPIRATION DATE: 06/30/2007
RESPS:133,400 HOURS:11,117 COSTS(000):$0
Beneficiary Recontact Report, 20 CFR 404.703 and 404.705
FORMS: SSA-1588-OCR-SM
OMB NO: 0960-0505 EXPIRATION DATE: 06/30/2007
RESPS:20,000 HOURS:3,333 COSTS(000):$0
Employer Verification of Records for Children Under Age Seven,
20 CFR 404.801-.803, 404.821-.822
FORMS: SSA-L3231-C1
OMB NO: 0960-0507 EXPIRATION DATE: 02/29/2008
RESPS:35,000 HOURS:35,000 COSTS(000):$0
Disability Hearing Officer's Report of Disability Hearing (DC),
20 CFR 416.1407
FORMS: SSA-1204-BK
OMB NO: 0960-0508 EXPIRATION DATE: 07/31/2007
RESPS:3,000,000 HOURS:500,000 COSTS(000):$0
SSA-L2765, Request for Self-Employment Information, SSA-L3365,
Request for Employee Information, SSA-L4002, Request for
Employer Information
FORMS: SSA-L2765 SSA-L3365 SSA-L4002
OMB NO: 0960-0511 EXPIRATION DATE: 10/31/2008
RESPS:981,000 HOURS:245,250 COSTS(000):$0
Disability Update Report 20 CFR 404.1589-404.1595; 20 CFR
416.988-416.996
FORMS: SSA-455 SSA-455-OCR-SM
OMB NO: 0960-0516 EXPIRATION DATE: 03/31/2007
RESPS:60,000 HOURS:5,000 COSTS(000):$0
Continuation of Full Benefit Standard for Persons
Institutionalized - 20 CFR Subpart B 416.212(b)(1)
FORMS: NONE
OMB NO: 0960-0525 EXPIRATION DATE: 01/31/2008
RESPS:87,000 HOURS:15,950 COSTS(000):$0
Request for Social Security Earnings Information, 20 CFR
404.810, 20 CFR 401.100
FORMS: SSA-7050-F4
OMB NO: 0960-0526 EXPIRATION DATE: 06/30/2009
RESPS:1,355,344 HOURS:120,610 COSTS(000):$0
Generic Clearance of Customer Satisfaction Surveys
FORMS: NONE
OMB NO: 0960-0527 EXPIRATION DATE: 07/31/2008
RESPS:551,520 HOURS:91,920 COSTS(000):$0
Appointment of Representative - 20 CFR 404 Subpart R, 410
Subpart F and 416 Subpart O
FORMS: SSA-1696-U4
OMB NO: 0960-0529 EXPIRATION DATE: 10/31/2006
RESPS:131,080 HOURS:21,846 COSTS(000):$0
Claimant's Statement About Loan of Food and/or Shelter &
Statement About Food or Shelter Provided by Another 20 CFR
416.1130-1148
FORMS: SSA-5062 SSA-L5063
OMB NO: 0960-0534 EXPIRATION DATE: 12/31/2006
RESPS:200 HOURS:10 COSTS(000):$0
Waiver of Right to Appear, Disability Hearing; 20 CFR
404.916(b)(5) and 416.1416(b)(5)
FORMS: SSA-773-U4
OMB NO: 0960-0536 EXPIRATION DATE: 10/31/2007
RESPS:982,357 HOURS:49,118 COSTS(000):$0
Beneficiary Recontact Report 20 CFR 404.703 and .705
FORMS: SSA-1587-OCR-SM
OMB NO: 0960-0540 EXPIRATION DATE: 04/30/2007
RESPS:250,000 HOURS:62,500 COSTS(000):$0
Pain Report - Child, 20 CFR 416.912 & 404.512
FORMS: SSA-3371-BK
OMB NO: 0960-0542 EXPIRATION DATE: 09/30/2007
RESPS:650,000 HOURS:216,667 COSTS(000):$0
Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd
Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12
to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2)
FORMS: SSA-3375 SSA-3376 SSA-3377 SSA-3378 SSA-3379
OMB NO: 0960-0544 EXPIRATION DATE: 03/31/2009
RESPS:16,000 HOURS:267 COSTS(000):$0
Public Information Campaign
FORMS: NONE
OMB NO: 0960-0546 EXPIRATION DATE: 12/31/2008
RESPS:100,000 HOURS:16,666 COSTS(000):$0
SSI Notice of Interim Assistance Reimbursement (IAR)
FORMS: SSA-8125 SSA-L8125-F6
OMB NO: 0960-0547 EXPIRATION DATE: 06/30/2007
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: 11/30/2007
RESPS:46,000 HOURS:23,000 COSTS(000):$0
Certificate of Coverage Request
FORMS: NONE
OMB NO: 0960-0555 EXPIRATION DATE: 03/31/2007
RESPS:12,011,787 HOURS:3,300,197 COSTS(000):$0
Clearance of Information Collections Conducted by State
Disability Determination Services on Behalf of SSA
FORMS: NONE
OMB NO: 0960-0559 EXPIRATION DATE: 10/31/2008
RESPS:7,000 HOURS:14,000 COSTS(000):$0
Plan to Achieve Self-Support 20 CFR 416.110(e),
416.1180-416.1182, 416.1225-416.1227
FORMS: SSA-545
OMB NO: 0960-0561 EXPIRATION DATE: 05/31/2007
RESPS:50,000 HOURS:8,333 COSTS(000):$0
Modified Benefit Formula Questionnaire-Foreign Pension
FORMS: SSA-308
OMB NO: 0960-0564 EXPIRATION DATE: 06/30/2009
RESPS:395,000 HOURS:19,750 COSTS(000):$0
Quickstart Automated Enrollment System 31 CFR 210
FORMS: NONE
OMB NO: 0960-0565 EXPIRATION DATE: 02/29/2008
RESPS:30,000 HOURS:10,010 COSTS(000):$0
Employer Report of Special Wage Payments, 20 CFR 404.428-404.429
FORMS: SSA-131
OMB NO: 0960-0566 EXPIRATION DATE: 11/30/2006
RESPS:2,223,500 HOURS:111,175 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: 12/31/2006
RESPS:750,000 HOURS:312,500 COSTS(000):$0
Childhood Disability Evaluation Form 20 CFR 416.924(g)
FORMS: SSA-538
OMB NO: 0960-0575 EXPIRATION DATE: 04/30/2007
RESPS:550,000 HOURS:18,334 COSTS(000):$0
Request to Resolve Questionnaire Quarters of Coverage (QC);
Request for QC History Based on Relationship
FORMS: SSA-512 SSA-513
OMB NO: 0960-0576 EXPIRATION DATE: 02/28/2007
RESPS:30,000 HOURS:10,000 COSTS(000):$0
Representative Payee Report of Benefits and Dedicated Account,
20 CFR 416.546 & 640, and 20 CFR 416.635 & 665
FORMS: SSA-6233
OMB NO: 0960-0577 EXPIRATION DATE: 07/31/2007
RESPS:525,500 HOURS:528,000 COSTS(000):$0
Disability Report - Child
FORMS: SSA-3820 I3820 EDCS
OMB NO: 0960-0578 EXPIRATION DATE: 07/31/2007
RESPS:871,000 HOURS:871,000 COSTS(000):$0
Work History Report
FORMS: SSA-3369-BK
OMB NO: 0960-0579 EXPIRATION DATE: 01/31/2008
RESPS:2,116,667 HOURS:2,257,667 COSTS(000):$0
Disability Report - Adult, 20 CFR 404.1512 and 416.912
FORMS: SSA-3368
OMB NO: 0960-0581 EXPIRATION DATE: 01/31/2007
RESPS:100,000 HOURS:28,333 COSTS(000):$0
Application of Circuit Court Law
FORMS: 404.985(B) 416.1485(B)
OMB NO: 0960-0583 EXPIRATION DATE: 01/31/2007
RESPS:21,000 HOURS:525 COSTS(000):$0
Internet Request for Replacement SSA-1099/1042S
FORMS: NONE
OMB NO: 0960-0585 EXPIRATION DATE: 03/31/2007
RESPS:98 HOURS:98 COSTS(000):$0
Discrimination Complaint Form
FORMS: SSA-437
OMB NO: 0960-0595 EXPIRATION DATE: 06/30/2008
RESPS:133,920 HOURS:11,160 COSTS(000):$0
Electronic Benefit Verification Informaiton (BEVE), 20 CFR 401.40
FORMS: NONE
OMB NO: 0960-0596 EXPIRATION DATE: 08/31/2006
RESPS:1,899,477 HOURS:47,487 COSTS(000):$0
Request for Internet Services - Authetication, 20 CFR 401.45
FORMS: NONE
OMB NO: 0960-0598 EXPIRATION DATE: 03/31/2008
RESPS:100,000 HOURS:50,000 COSTS(000):$0
Work Activity Report (Self-Employed Person), 20 CFR 404.1520(b),
404.1571-.1576, 404.1584-.1593, 416.971-.976
FORMS: SSA-820-F4
OMB NO: 0960-0602 EXPIRATION DATE: 08/31/2008
RESPS:60,000 HOURS:2,000 COSTS(000):$0
Authorization to Obtain Earnings Data from the Social Security
Administration, 26 USC 6103
FORMS: SSA-581
OMB NO: 0960-0606 EXPIRATION DATE: 05/31/2007
RESPS:88,000 HOURS:220,000 COSTS(000):$12,194
Annual Registration Statement Identifying Separated Participants
with Deferred Vested Benefits
FORMS: NONE
OMB NO: 0960-0612 EXPIRATION DATE: 07/31/2008
RESPS:1,400 HOURS:350 COSTS(000):$0
Public Understanding Measurement Systems (PUMS) Survey
FORMS: NONE
OMB NO: 0960-0615 EXPIRATION DATE: 08/31/2006
RESPS:400 HOURS:133 COSTS(000):$0
Application for Special Benefits for World War II Veterans--20
CFR, Subpart C, 408
FORMS: SSA-2000-F6
OMB NO: 0960-0616 EXPIRATION DATE: 12/31/2006
RESPS:413 HOURS:8,955 COSTS(000):$0
Uniform Administrative Requirements for Grants and Agreements
With Institutions of Higher Learning, Hospitals and Others
FORMS: NONE
OMB NO: 0960-0617 EXPIRATION DATE: 08/31/2006
RESPS:1,000 HOURS:17 COSTS(000):$0
SSI Ineligibility for Fugitives and Probation/Parole Violators;
20 CFR 416.708(o)
FORMS: NONE
OMB NO: 0960-0618 EXPIRATION DATE: 05/31/2007
RESPS:3,843,369 HOURS:995,457 COSTS(000):$0
Social Security Benefits Application (Internet, Retirement
Survivor & Disability) - Part 404 Subpart D, G & P
FORMS: SSA-1 SSA-2 SSA-16
OMB NO: 0960-0619 EXPIRATION DATE: 10/31/2006
RESPS:40 HOURS:40 COSTS(000):$0
Individuals or Agents Seeking Information or Testimony in
Non-SSA Cases 20 CFR 403.100-155
FORMS: NONE
OMB NO: 0960-0621 EXPIRATION DATE: 10/31/2006
RESPS:100 HOURS:17 COSTS(000):$0
Representative Payee Report-Special Veterans Benefits
FORMS: SSA-2001
OMB NO: 0960-0622 EXPIRATION DATE: 10/31/2006
RESPS:1,455,000 HOURS:194,000 COSTS(000):$0
Request for Reconsideration - 20 CFR, Subpart J. 404.907-.921 &
Subpart N, 416.1407-.1421
FORMS: SSA-561
OMB NO: 0960-0623 EXPIRATION DATE: 05/31/2007
RESPS:15,415,712 HOURS:2,569,285 COSTS(000):$0
Authorization to Source to Release Information to the Social
Security Administration
FORMS: SSA-827
OMB NO: 0960-0624 EXPIRATION DATE: 04/30/2007
RESPS:144 HOURS:144 COSTS(000):$0
Medical Parking Application, 42 CFR 101.20-104.2
FORMS: SSA-3192
OMB NO: 0960-0626 EXPIRATION DATE: 01/31/2007
RESPS:250,120 HOURS:8,337 COSTS(000):$0
Integrated Registration for Employers and Submitters (IRES)
FORMS: NONE
OMB NO: 0960-0629 EXPIRATION DATE: 04/30/2007
RESPS:60,569 HOURS:5,317 COSTS(000):$0
Benefits Planning, Assistance and Outreach (BPAO) Program,
Cooperative Agreement Announcement No. SSA-OESP-03-1
FORMS: NONE
OMB NO: 0960-0630 EXPIRATION DATE: 06/30/2007
RESPS:200 HOURS:50 COSTS(000):$0
Beneficiary Interview and Auditor's Observations
FORMS: SSA-322
OMB NO: 0960-0632 EXPIRATION DATE: 02/28/2007
RESPS:1,443,334 HOURS:240,556 COSTS(000):$0
Request for Internet Services - Password
FORMS: NONE
OMB NO: 0960-0633 EXPIRATION DATE: 04/30/2007
RESPS:7,860 HOURS:2,426 COSTS(000):$0
Site Review Questionnaires for Volume and Fee-for-Service Payees
and Beneficiary Interview Form
FORMS: SSA-637 SSA-638 SSA-639
OMB NO: 0960-0634 EXPIRATION DATE: 06/30/2007
RESPS:9,000 HOURS:1,500 COSTS(000):$0
Internet Direct Deposit Application, 31 CFR 210
FORMS: NONE
OMB NO: 0960-0635 EXPIRATION DATE: 08/31/2007
RESPS:1,000,000 HOURS:500,000 COSTS(000):$0
Function Report - Adult Third Party, 20 CFR 404.1512 and 416.912
FORMS: SSA-3380-BK
OMB NO: 0960-0639 EXPIRATION DATE: 02/29/2008
RESPS:200 HOURS:50 COSTS(000):$0
Contact with Rep Payee, Contact with Beneficiary
FORMS: SSA-L4945-U2 SSA-L4947-U2
OMB NO: 0960-0641 EXPIRATION DATE: 09/30/2008
RESPS:25,174 HOURS:1,259 COSTS(000):$0
State Agency Ticket Assignment Form Ticket to Work and Self
Sufficiency Program
FORMS: SSA-1365
OMB NO: 0960-0642 EXPIRATION DATE: 03/31/2008
RESPS:1 HOURS:1 COSTS(000):$0
Listing of Impairments; 404, Subpart P, Appendix 1 20 CFR
404.1512-404.1515 and 416.912-416.915
FORMS: NONE
OMB NO: 0960-0643 EXPIRATION DATE: 12/31/2008
RESPS:715,000 HOURS:309,834 COSTS(000):$0
Statement for Determining Continuing Eligibility for
Supplemental Security Income Payment--Adult/Statement for
Determining Continuing Eligibility for Supplemental Security
Income.....
FORMS: SSA-3988 SSA-3989
OMB NO: 0960-0644 EXPIRATION DATE: 07/31/2008
RESPS:248,664 HOURS:993,384 COSTS(000):$0
The Ticket to Work and Self-Sufficiency Program, 20 CFR
411.160-.730
FORMS: NONE
OMB NO: 0960-0646 EXPIRATION DATE: 07/31/2008
RESPS:1,112,000 HOURS:324,417 COSTS(000):$0
Teacher Questionnaire; Request for Administrative Information;
20 CFR 416.924a, 20 CFR 404.1520
FORMS: SSA-5665-BK SSA-5666
OMB NO: 0960-0648 EXPIRATION DATE: 01/31/2009
RESPS:100 HOURS:8 COSTS(000):$0
Credit Card Payment Acknowledgement Form
FORMS: SSA-1414
OMB NO: 0960-0656 EXPIRATION DATE: 12/31/2007
RESPS:4,200 HOURS:3,150 COSTS(000):$0
Survey of Income and Program Participation (SIPP) for SSA
Beneficiaries
FORMS: NONE
OMB NO: 0960-0657 EXPIRATION DATE: 10/31/2006
RESPS:35,000 HOURS:43,750 COSTS(000):$0
Disability Hearing Officer's Decision-Title XVI Disabled Child
Continuing Disability Review 20 CFR 404.913-914
FORMS: SSA-1209
OMB NO: 0960-0658 EXPIRATION DATE: 12/31/2006
RESPS:762 HOURS:252 COSTS(000):$0
20 CFR 408 Subparts B, C, and D
FORMS: NONE
OMB NO: 0960-0660 EXPIRATION DATE: 04/30/2008
RESPS:200,000 HOURS:2,000,000 COSTS(000):$0
Social Security Number Verification Service (SSNVS)
FORMS: NONE
OMB NO: 0960-0662 EXPIRATION DATE: 04/30/2009
RESPS:200,000 HOURS:50,000 COSTS(000):$0
Medical Source Statement of Ability To Do Work-Related
Activities: Physical and Mental
FORMS: HA-1151 HA-1152
OMB NO: 0960-0663 EXPIRATION DATE: 03/31/2009
RESPS:324 HOURS:43 COSTS(000):$0
Private Printing and Modification of Prescribed Application and
Other Forms, 20 CFR 422.527
FORMS: NONE
OMB NO: 0960-0665 EXPIRATION DATE: 12/31/2006
RESPS:320,000 HOURS:37,333 COSTS(000):$0
Form SSA-711, Request for a Deceased Individual's Social
Security Record
FORMS: SSA-711
OMB NO: 0960-0666 EXPIRATION DATE: 12/31/2007
RESPS:5,533 HOURS:4,519 COSTS(000):$0
National Beneficiary Survey
FORMS: NONE
OMB NO: 0960-0667 EXPIRATION DATE: 04/30/2009
RESPS:68 HOURS:7 COSTS(000):$0
Filing Claims Under the Federal Tort Claims Act 20 CFR
429.101-429.110
FORMS: NONE
OMB NO: 0960-0669 EXPIRATION DATE: 04/30/2009
RESPS:600,000 HOURS:100,000 COSTS(000):$0
Employee Verification Service 20 CFR, 401.45
FORMS: NONE
OMB NO: 0960-0671 EXPIRATION DATE: 02/29/2008
RESPS:1,099,000 HOURS:227,999 COSTS(000):$0
Acknowledgement of Receipt (Notice of Hearing), Part 404,
Subpart J, 404.936, .938, .950, Part 416, Subpart N
FORMS: HA-504
OMB NO: 0960-0675 EXPIRATION DATE: 10/31/2006
RESPS:17,000 HOURS:3,400 COSTS(000):$0
Medical or Psychological Consultant's Review of Childhood
Disability Evaluation Form, 20 CFR 416.1040 ff.
FORMS: SSA-536
OMB NO: 0960-0677 EXPIRATION DATE: 10/31/2006
RESPS:68,000 HOURS:13,600 COSTS(000):$0
Medical Consultant's Review of Psychiatric Review Technique
Form, 20 CFR 404.1520a, 1640, 1645
FORMS: SSA-3023
OMB NO: 0960-0678 EXPIRATION DATE: 11/30/2006
RESPS:45,000 HOURS:9,000 COSTS(000):$0
Mental Residual Functional Capacity Assessment 20 CFR
404.1520(a), 1640, 1643, 416.920(a)
FORMS: SSA-392-SUP
OMB NO: 0960-0679 EXPIRATION DATE: 11/30/2006
RESPS:3,318 HOURS:389 COSTS(000):$0
Representative Payment Rgulation -- Part 404, Subpart U, Part
408 Subpart F & Part 416, Subpart F
FORMS: NONE
OMB NO: 0960-0680 EXPIRATION DATE: 12/31/2006
RESPS:91,904 HOURS:18,380 COSTS(000):$0
Medical Consultant's Review of Physical Residual Functional
Capacity Assessment
FORMS: SSA-392
OMB NO: 0960-0681 EXPIRATION DATE: 12/31/2006
RESPS:4,005,367 HOURS:2,002,684 COSTS(000):$0
Function Report - Adult
FORMS: SSA-3373
OMB NO: 0960-0683 EXPIRATION DATE: 01/31/2007
RESPS:60 HOURS:22 COSTS(000):$0
Special Benefits for Certain World War II Veterans, 20 CFR 408
Subparts G, H, I, J & L
FORMS: NONE
OMB NO: 0960-0684 EXPIRATION DATE: 01/31/2007
RESPS:125,000 HOURS:2,083 COSTS(000):$0
Evidence Requirements for Assignment of SSNs/Assignment of SSNs
to Foreign Academic Students
FORMS: NONE
OMB NO: 0960-0685 EXPIRATION DATE: 02/28/2007
RESPS:1 HOURS:1 COSTS(000):$0
Filing of Applications and Related Forms; 404.610, .611; 422.505
FORMS: NONE
OMB NO: 0960-0686 EXPIRATION DATE: 03/31/2007
RESPS:5,000 HOURS:417 COSTS(000):$0
International Direct Deposit / 31 CFR 210
FORMS: SSA-1199
OMB NO: 0960-0687 EXPIRATION DATE: 06/30/2007
RESPS:25,000 HOURS:10,000 COSTS(000):$0
Youth Transition Process Demonstration Evaluation Collection
FORMS: NONE
OMB NO: 0960-0688 EXPIRATION DATE: 04/30/2007
RESPS:200,000 HOURS:10,000 COSTS(000):$0
Certification of Prison Records by Prison Officials 20 CFR
422.107
FORMS: NONE
OMB NO: 0960-0689 EXPIRATION DATE: 07/31/2007
RESPS:4,800 HOURS:800 COSTS(000):$0
Certification of Contents of Document(s) or Record(s)
FORMS: SSA-704
OMB NO: 0960-0690 EXPIRATION DATE: 08/31/2007
RESPS:2 HOURS:2 COSTS(000):$0
Reinstatement of Entitlement to Disability Benefits, 20 CFR
404.1592c & .1592d and 416.999a & .99b
FORMS: SSA-790P
OMB NO: 0960-0691 EXPIRATION DATE: 08/31/2007
RESPS:750,000 HOURS:187,500 COSTS(000):$0
Representative Payee Report - 20 CFR 404.2965 and 416.665
FORMS: SSA-6234
OMB NO: 0960-0692 EXPIRATION DATE: 11/30/2007
RESPS:1 HOURS:1 COSTS(000):$0
Expanded Cross-Program Recovery Regulations; 20 CFR Part 404
Subpart F & 20 CFR 416 Subpart E
FORMS: NONE
OMB NO: 0960-0693 EXPIRATION DATE: 11/30/2007
RESPS:7,200 HOURS:1,200 COSTS(000):$0
Letter to Custodian of Birth Records, 20 CFR 404.704, 404.716,
416.802, and 422.107
FORMS: SSA-L106 SSA-L706
OMB NO: 0960-0694 EXPIRATION DATE: 12/31/2007
RESPS:5,000 HOURS:417 COSTS(000):$0
Incorporation by Reference of Oral Findings of Fact and
Rationale in Wholly Favorable Written Decisions
FORMS: SSA-9641
OMB NO: 0960-0695 EXPIRATION DATE: 01/31/2008
RESPS:75,000 HOURS:12,500 COSTS(000):$0
Appeal of Determination for Help with Medicare Prescription Drug
Plan Costs
FORMS: SSA-1021
OMB NO: 0960-0696 EXPIRATION DATE: 12/31/2007
RESPS:7,000,000 HOURS:4,416,667 COSTS(000):$0
Application for Help with Medicare Prescription Drug Plan Costs
FORMS: SSA-1020
OMB NO: 0960-0698 EXPIRATION DATE: 02/29/2008
RESPS:450 HOURS:900 COSTS(000):$0
Request for Waiver of Special Veterans Benefits (SVB)
Overpayment Recovery or Change in Repayment Rate
FORMS: SSA-2032-BK
OMB NO: 0960-0699 EXPIRATION DATE: 02/29/2008
RESPS:500 HOURS:500 COSTS(000):$0
Non-Attorney Representative Demonstration Project Application
FORMS: NONE
OMB NO: 0960-0700 EXPIRATION DATE: 03/31/2008
RESPS:1 HOURS:1 COSTS(000):$17,114
State Death Match Collections -- 20 CFR 404.301; 404.310-311;
404.316; 404.330-341; 404.350-352; 404.371; 416.912
FORMS: NONE
OMB NO: 0960-0701 EXPIRATION DATE: 03/31/2008
RESPS:25 HOURS:50 COSTS(000):$0
Epidemiological Research Request -- 20 CFR 401.165
FORMS: NONE
OMB NO: 0960-0702 EXPIRATION DATE: 05/31/2008
RESPS:6,056 HOURS:518 COSTS(000):$0
Medicare Part D Subsidies, 20 CFR 418.3120 through 418.3670
FORMS: NONE
OMB NO: 0960-0703 EXPIRATION DATE: 12/31/2006
RESPS:76,000 HOURS:44,333 COSTS(000):$0
Application for Help with Medicare Prescription Drug Plan Costs
(Subsidy Change Redeterminations)
FORMS: SSA-1020-SC
OMB NO: 0960-0704 EXPIRATION DATE: 09/30/2007
RESPS:516 HOURS:557 COSTS(000):$0
Homeless Outreach Project and Evaluation (HOPE) Evaluation
FORMS: NONE
OMB NO: 0960-0706 EXPIRATION DATE: 10/31/2008
RESPS:1,000,000 HOURS:33,333 COSTS(000):$1,452
Help America Vote Act (HAVA)
FORMS: NONE
OMB NO: 0960-0707 EXPIRATION DATE: 04/30/2009
RESPS:69,000 HOURS:17,249 COSTS(000):$0
Medicare Subsidy Quality Review Case Analysis
FORMS: SSA-9301 9302 9303 9304 9308 9309 9310 8510
OMB NO: 0960-0709 EXPIRATION DATE: 10/31/2008
RESPS:9,200 HOURS:9,200 COSTS(000):$0
Evidentiary Requirements for Making Findings about Medical
Equivalence -- 20 CFR 404.918(d) and 416.1418(d)
FORMS: NONE
OMB NO: 0960-0710 EXPIRATION DATE: 03/31/2009
RESPS:12,118 HOURS:5,598 COSTS(000):$0
Administrative Review Process for Adjudicating Initial
Disability Claims Parts 404, 405, 416 and 422
FORMS: NONE
OMB NO: 0960-0711 EXPIRATION DATE: 10/31/2008
RESPS:110,000 HOURS:3,373 COSTS(000):$10,390
National Direct Deposit Initiative, 31 CFR 210
FORMS: NONE
OMB NO: 0960-0712 EXPIRATION DATE: 11/30/2008
RESPS:10,000 HOURS:1,333 COSTS(000):$0
Denial of Title II Benefits to Fugitive Felons
FORMS: NONE
OMB NO: 0960-0715 EXPIRATION DATE: 08/31/2006
RESPS:3,600 HOURS:300 COSTS(000):$0
Monthly SSI Wage Reporting Pilot--Phase II
FORMS: NONE
OMB NO: 0960-0716 EXPIRATION DATE: 01/31/2009
RESPS:5,000 HOURS:250 COSTS(000):$0
General Request for Social Security Records--eFOIA 20 CFR
402.130 5 USC 552(a)(3)
FORMS: NONE
OMB NO: 0960-0718 EXPIRATION DATE: 02/28/2009
RESPS:4,001 HOURS:4,001 COSTS(000):$0
Limiting Social Security Number Replacement Cards, 422.103(e),
422.110
FORMS: NONE
OMB NO: 0960-0719 EXPIRATION DATE: 02/28/2009
RESPS:100 HOURS:17 COSTS(000):$0
Application to Collect A Fee for Payee Services
FORMS: SSA-445
OMB NO: 0960-0720 EXPIRATION DATE: 05/31/2009
RESPS:24,000 HOURS:6,000 COSTS(000):$0
Certification of Low Birth Weight for SSI Eligibility 20 CFR,
416.931, 416.926a(m)(7) and (8) and 416.924
FORMS: SSA-3830
OMB NO: 0960-0721 EXPIRATION DATE: 06/30/2009
RESPS:60,000 HOURS:30,000 COSTS(000):$0
Request for School Records 20 CFR 416.906, 416.913, 416.946, 404
Dubpart P, Appendix 1
FORMS: HA-68
OMB NO: 0960-0722 EXPIRATION DATE: 05/31/2009
RESPS:400,000 HOURS:100,000 COSTS(000):$0
Request for Evidence from Doctor or Hospital 20 CFR 404 Subpart
I and 20 CFR 416 Subpart P
FORMS: 1J 2J
OMB NO: 0960-0723 EXPIRATION DATE: 05/31/2009
RESPS:1,876,000 HOURS:250,333 COSTS(000):$0
Redetermination of Eligibility for Help with Medicare
Prescription Drug Plan Costs, 20 CFR 418.3125
FORMS: SSA-L1026 SSA-1026-REDE SSA-1026-SCE
OMB NO: 0960-0725 EXPIRATION DATE: 05/31/2009
RESPS:7,695 HOURS:6,728 COSTS(000):$0
Section 107 Representative Payee Study
FORMS: NONE
OMB NO: 0960-0726 EXPIRATION DATE: 07/31/2009
RESPS:30,050 HOURS:8,828 COSTS(000):$0
Mental Health Treatment Study (MHTS)
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
245 127,247,181 38,761,583 $49,517
Tennessee Valley Authority
OMB NO: 3316-0002 EXPIRATION DATE: 11/30/2007
RESPS:2,054 HOURS:3,792 COSTS(000):$0
Power Distributors Monthly and Annual Reports to TVA
FORMS: TVA-3957 TVA-4171
OMB NO: 3316-0008 EXPIRATION DATE: 12/31/2006
RESPS:100 HOURS:1,000 COSTS(000):$0
Foreign Line Crossing Data
FORMS: TVA-6573 TVA-6593
OMB NO: 3316-0009 EXPIRATION DATE: 09/30/2007
RESPS:33.3 HOURS:467 COSTS(000):$0
Salary Surveys for Salary Policy Bargining Unit Employees
FORMS: NONE
OMB NO: 3316-0016 EXPIRATION DATE: 09/30/2006
RESPS:150 HOURS:40 COSTS(000):$0
Farmer Questionnaire - Vicinity of Nuclear Power Plants
FORMS: TVA-9476
OMB NO: 3316-0019 EXPIRATION DATE: 03/31/2007
RESPS:31,000 HOURS:9,300 COSTS(000):$0
Energy Right Program
FORMS: 17650 17651 17652 17653 17654 17655 17656 17657 17658/17659
17676
OMB NO: 3316-0060 EXPIRATION DATE: 08/31/2006
RESPS:2,500 HOURS:3,750 COSTS(000):$0
Application for Section 26a Permit, Tennessee Valley Authority
FORMS: TVA-17423
OMB NO: 3316-0062 EXPIRATION DATE: 05/31/2007
RESPS:24,252 HOURS:49,019 COSTS(000):$0
TVA Procurement Documents (Request for Offer; Solicitation,
Offer & Acceptance; other related procurement/sale documents.
FORMS: 916 9650-1 9903 9903A 9903C 9903D 9910 17300 17432 17527
OMB NO: 3316-0063 EXPIRATION DATE: 12/31/2006
RESPS:17,543 HOURS:17,543 COSTS(000):$0
Employment Application
FORMS: 1 3595 9871 17353 13045A
OMB NO: 3316-0101 EXPIRATION DATE: 09/30/2006
RESPS:200 HOURS:50 COSTS(000):$1
Customer Survey for TVA Recreation Boating Safety on Tributary
Lakes
FORMS: NONE
OMB NO: 3316-0105 EXPIRATION DATE: 10/31/2007
RESPS:50 HOURS:4 COSTS(000):$0
TVA Police Customer Satisfaction Survey
FORMS: 17592
OMB NO: 3316-0108 EXPIRATION DATE: 08/31/2008
RESPS:3,000 HOURS:990 COSTS(000):$0
Reservoir Operation Study - Recreation Questionnaire
FORMS: NONE
OMB NO: 3316-0109 EXPIRATION DATE: 10/31/2008
RESPS:629 HOURS:346 COSTS(000):$0
Confirmation of TVA-Owned Cash
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
12 81,511 86,301 $1
U.S. Trade and Development Agency
OMB NO: 3330-0005 EXPIRATION DATE: 12/31/2008
RESPS:2,600 HOURS:866 COSTS(000):$0
Evaluation of USTDA Performance
FORMS: 1000E-2005A
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
1 2,600 866 $0
FEDERAL ACQUISITION REGULATIONS
OMB NO: 9000-0001 EXPIRATION DATE: 02/29/2008
RESPS:715 HOURS:286 COSTS(000):$0
Standard Form 28, Affidavit of Individual Surety - FAR Sections
Affected: 28.106-1(e); 28.203(b); 53.228(e)
FORMS: SF-28
OMB NO: 9000-0006 EXPIRATION DATE: 08/31/2007
RESPS:14,622 HOURS:739,225 COSTS(000):$0
Subcontracting Plans/Subcontracting Report for Individual
Contact (SF 294) Sections Affected: Subpart 19.7; 52.219-9
FORMS: SF-294
OMB NO: 9000-0007 EXPIRATION DATE: 10/31/2006
RESPS:7,098 HOURS:112,864 COSTS(000):$0
Summary Subcontract Report FAR Sections Affected: Subpart 19.7;
53.219; SF 295
FORMS: SF-295 OF-312
OMB NO: 9000-0010 EXPIRATION DATE: 03/31/2009
RESPS:864,000 HOURS:475,000 COSTS(000):$0
Progress Payments, SF 1443, FAR Sections Affected: Subpart 32.5;
52.232-13 thru 52.232-16
FORMS: SF-1443
OMB NO: 9000-0011 EXPIRATION DATE: 10/31/2006
RESPS:5,478 HOURS:113,942 COSTS(000):$0
Preaward Survey Forms (SFs 1403, 1404, 1405, 1406, 1407, and
1408) FAR Sections Affected 9.106-2 thru -4
FORMS: SF-1403 SF-1404 SF-1405 SF-1407 SF-1408 SF-1406
OMB NO: 9000-0012 EXPIRATION DATE: 08/31/2007
RESPS:2,092 HOURS:5,023 COSTS(000):$0
Termination Settlement Proposal Forms (SFs 1435 through 1440)
FAR Section Affected: Subpart 49.6
FORMS: SF-1435-TO-1440
OMB NO: 9000-0013 EXPIRATION DATE: 05/31/2008
RESPS:199,992 HOURS:10,101,684 COSTS(000):$0
Cost or Pricing Data Exemption - FAR Sections Affected 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: 01/31/2008
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: SF-1413
OMB NO: 9000-0018 EXPIRATION DATE: 01/31/2008
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: 02/29/2008
RESPS:13,300 HOURS:6,650 COSTS(000):$0
Duty-Free Entry - FAR Sections Affected: 52.225-8
FORMS: NONE
OMB NO: 9000-0024 EXPIRATION DATE: 02/29/2008
RESPS:58,590 HOURS:6,361 COSTS(000):$0
Buy American Act Certificate - FAR Sections Affected: 52.225-2
FORMS: NONE
OMB NO: 9000-0025 EXPIRATION DATE: 02/29/2008
RESPS:11,400 HOURS:1,238 COSTS(000):$0
Buy American Act, Trade Agreements Act Certificate - - FAR
Sections Affected: 52.225-6
FORMS: NONE
OMB NO: 9000-0026 EXPIRATION DATE: 05/31/2009
RESPS:157,500 HOURS:26,355 COSTS(000):$0
Change Order Accounting - 43.205(f); 52.243-6
FORMS: NONE
OMB NO: 9000-0027 EXPIRATION DATE: 02/29/2008
RESPS:1,600 HOURS:48,000 COSTS(000):$0
Value Engineering Requirements FAR Sections Affected: Subparts
48.1 and 48.2; 52.248-1; 52.248-2; 52.248-3
FORMS: NONE
OMB NO: 9000-0029 EXPIRATION DATE: 01/31/2008
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: 05/31/2008
RESPS:2,100 HOURS:525 COSTS(000):$0
Contractor Use of Government Supply Sources-FAR Sections
Affected (Subpart 51-1 and 52.251-1)
FORMS: NONE
OMB NO: 9000-0032 EXPIRATION DATE: 05/31/2008
RESPS:140 HOURS:70 COSTS(000):$0
Contractor Use of Interagency Motor Pool Vehicles--FAR Section
Affected: (Subpart 51.2 and 52.251-2)
FORMS: NONE
OMB NO: 9000-0034 EXPIRATION DATE: 01/31/2007
RESPS:382,840 HOURS:63,934 COSTS(000):$0
Examination of Records by Comptroller General and Contract
Audit; Sections Affected: 52.215-2; 52.212-5; 52.214-26
FORMS: NONE
OMB NO: 9000-0035 EXPIRATION DATE: 05/31/2008
RESPS:13,500 HOURS:13,500 COSTS(000):$0
Claims and Appeals - FAR Sections Affected: Parts 32 and 33 and
52.233-1
FORMS: NONE
OMB NO: 9000-0037 EXPIRATION DATE: 01/31/2008
RESPS:42,480 HOURS:3,398 COSTS(000):$0
Presolicitation Notice and Response - FAR Sections Affected:
14.205; 15.201-c and 36.213-2
FORMS: NONE
OMB NO: 9000-0043 EXPIRATION DATE: 05/31/2008
RESPS:17,200 HOURS:2,872 COSTS(000):$0
Delivery Schedules - FAR Sections Affected: 52.211-8 and 52.211-9
FORMS: NONE
OMB NO: 9000-0045 EXPIRATION DATE: 02/29/2008
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; 52-228-2; 52-228-13;
52.228-15; 52-228-16
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: 10/31/2006
RESPS:1,111,558 HOURS:50,577 COSTS(000):$0
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: 10/31/2006
RESPS:525,280 HOURS:8,930 COSTS(000):$0
Authorized Negotiators--FAR Sections Affected: 52.215-1(c)(2)(iv)
FORMS: NONE
OMB NO: 9000-0053 EXPIRATION DATE: 08/31/2008
RESPS:3,318 HOURS:312 COSTS(000):$0
Permits, Authorities, or Franchises Certification -- FAR
Sections Affected: 47.207-1(a) and 52.247-2
FORMS: NONE
OMB NO: 9000-0054 EXPIRATION DATE: 09/30/2008
RESPS:300 HOURS:75 COSTS(000):$0
U.S. Flag Air Carriers Certification -- FAR Sections Affected:
47.405 and 52.247-63
FORMS: NONE
OMB NO: 9000-0055 EXPIRATION DATE: 09/30/2008
RESPS:7,920 HOURS:1,323 COSTS(000):$0
Freight Classification Description - - FAR Sections Affected:
47.305-9(b) and 52.247-53
FORMS: NONE
OMB NO: 9000-0056 EXPIRATION DATE: 05/31/2008
RESPS:1,000 HOURS:167 COSTS(000):$0
Report of Shipment - FAR Sections Affected: 42.1406-1;
42-1406-2; and 52-242-12
FORMS: NONE
OMB NO: 9000-0057 EXPIRATION DATE: 09/30/2008
RESPS:400 HOURS:100 COSTS(000):$0
Evaluation of Export Offers - - FAR Sections Affected:
47.305-6(e) and 52.247-51
FORMS: NONE
OMB NO: 9000-0058 EXPIRATION DATE: 05/31/2008
RESPS:5,200 HOURS:5,200 COSTS(000):$0
Schedules for Construction Contracts - FAR Section Affected:
52.236-15
FORMS: NONE
OMB NO: 9000-0059 EXPIRATION DATE: 05/31/2008
RESPS:424 HOURS:72 COSTS(000):$0
North Carolina Sales Tax Certification--FAR Sections Affected:
29.304(d); 29.401-2; and 562.229-2
FORMS: NONE
OMB NO: 9000-0060 EXPIRATION DATE: 05/31/2008
RESPS:4,212 HOURS:8,424 COSTS(000):$0
Accident Prevention Plans and Recordkeeping - FAR Section
Affected: 52.236-13
FORMS: NONE
OMB NO: 9000-0061 EXPIRATION DATE: 09/30/2008
RESPS:1,385,800 HOURS:66,518 COSTS(000):$0
Transportation Requirements - - FAR Sections Affected: 47.207-1;
47.303-1 thru 47.303-16; 47.305-2, -3, -6, and -13; 47.507(a)
FORMS: NONE
OMB NO: 9000-0062 EXPIRATION DATE: 05/31/2008
RESPS:4,740 HOURS:1,185 COSTS(000):$0
Material and Workmanship - FAR Section Affected: 52.236-5
FORMS: NONE
OMB NO: 9000-0064 EXPIRATION DATE: 05/31/2008
RESPS:50 HOURS:38 COSTS(000):$0
Organization and Direction of Work - Sections Affected: 36.519;
52.236.19
FORMS: NONE
OMB NO: 9000-0065 EXPIRATION DATE: 05/31/2008
RESPS:1,270 HOURS:318 COSTS(000):$0
Overtime - FAR Sections Affected: (22.103 and 52.222-2)
FORMS: NONE
OMB NO: 9000-0066 EXPIRATION DATE: 07/31/2007
RESPS:8,670 HOURS:4,335 COSTS(000):$0
Professional Employee Compensation Plan; Subpart 22.11; 52.222-46
FORMS: NONE
OMB NO: 9000-0067 EXPIRATION DATE: 09/30/2008
RESPS:3,000 HOURS:3,000 COSTS(000):$0
Incentive Contracts - FAR Sections Affected: Subpart 16.4;
52.216-10; 52.216-16; 52.216-17
FORMS: NONE
OMB NO: 9000-0068 EXPIRATION DATE: 07/31/2008
RESPS:5,346 HOURS:1,337 COSTS(000):$0
Economic Price Adjustment -- FAR Sections Affected: 16.203;
52.216-2; 52.216-3; and 52.216-4
FORMS: NONE
OMB NO: 9000-0069 EXPIRATION DATE: 08/31/2006
RESPS:3,000 HOURS:6,564,000 COSTS(000):$0
Indirect Cost Rates - FAR Secions Affected: Subpart 42.7;
52.216-7; 52.216-13; and 52.216-15
FORMS: NONE
OMB NO: 9000-0070 EXPIRATION DATE: 09/30/2008
RESPS:9,600,000 HOURS:240,000 COSTS(000):$0
Payments - FAR Sections Affected: 52.232-1 thru 52.232-11
FORMS: NONE
OMB NO: 9000-0071 EXPIRATION DATE: 10/31/2008
RESPS:7,000 HOURS:7,000 COSTS(000):$0
Price Redetermination--FAR Sections Affected: 16.205; 16.206;
52.216-5; and 52.216-6
FORMS: NONE
OMB NO: 9000-0073 EXPIRATION DATE: 09/30/2008
RESPS:500 HOURS:500 COSTS(000):$0
Advance Payments - FAR Sections Affected: Subpart 32.4 and
52.232-12
FORMS: NONE
OMB NO: 9000-0074 EXPIRATION DATE: 09/30/2008
RESPS:53,456 HOURS:26,728 COSTS(000):$0
Contract Funding - Limitation of Costs/Funds - FAR Sections
Affected: Subpart 32.7 and 52.232-20 thru 52.232-22
FORMS: NONE
OMB NO: 9000-0075 EXPIRATION DATE: 10/31/2006
RESPS:13,624,122 HOURS:6,575,805 COSTS(000):$0
Government Property - Part 45; Clauses 52.245-2; -4; -5; thru
-11; -17 thru 19
FORMS: 1426/1427 1428/1429 1430/1431 1432/1433 1434
OMB NO: 9000-0076 EXPIRATION DATE: 06/30/2009
RESPS:1,000 HOURS:458 COSTS(000):$0
Novation/Change of Name Requirements--FAR Sections Affected:
Subpart 42.12
FORMS: NONE
OMB NO: 9000-0077 EXPIRATION DATE: 10/31/2007
RESPS:850 HOURS:35,746 COSTS(000):$0
Quality Assurance Requirements - FAR Sections Affected: Subparts
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: 01/31/2008
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: 06/30/2009
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: 10/31/2008
RESPS:10,000 HOURS:10,000 COSTS(000):$0
Integrity of Unit Prices - Sections Affected: 15.408(f) and
52.215-14
FORMS: NONE
OMB NO: 9000-0082 EXPIRATION DATE: 10/31/2008
RESPS:38,100 HOURS:31,623 COSTS(000):$0
Economic Purchase Quantities--Supplies FAR Sections Affected:
7.203 and 52.207-4
FORMS: NONE
OMB NO: 9000-0083 EXPIRATION DATE: 10/31/2008
RESPS:220,700 HOURS:55,175 COSTS(000):$0
Qualification Requirements--FAR Sections Affected: Subpart 9.2
and 52.209-1
FORMS: NONE
OMB NO: 9000-0088 EXPIRATION DATE: 04/30/2008
RESPS:10 HOURS:14,500 COSTS(000):$0
Travel Costs - FAR Sections Affected: 31.205-46
FORMS: NONE
OMB NO: 9000-0090 EXPIRATION DATE: 06/30/2007
RESPS:1,100 HOURS:19,040 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: 09/30/2008
RESPS:100 HOURS:100 COSTS(000):$0
Anti-Kickback Procedures - - FAR Sections Affected: 3.502;
52.203-7
FORMS: NONE
OMB NO: 9000-0094 EXPIRATION DATE: 03/31/2007
RESPS:1,100,000 HOURS:91,667 COSTS(000):$0
Debarment and Suspension. FAR Sections Affected: 9.103; 9.104;
9.404; 52.212-209-6; 52.212-3(h)
FORMS: NONE
OMB NO: 9000-0095 EXPIRATION DATE: 01/31/2008
RESPS:11,700 HOURS:45,630 COSTS(000):$0
Commerce Patent Regulations--FAR Sections Affected: 27.3;
52.227-11 thru - 13
FORMS: NONE
OMB NO: 9000-0096 EXPIRATION DATE: 10/31/2006
RESPS:30 HOURS:15 COSTS(000):$0
Patents FAR Sections Affected: 27.2; 52.227-2; 52.227-6; 52.227-9
FORMS: NONE
OMB NO: 9000-0097 EXPIRATION DATE: 03/31/2008
RESPS:500,000 HOURS:195,000 COSTS(000):$0
Information Reporting to the Internal Revenue Service (Taxpayer
Identification Number) FAR Sections Affected: 4.905; 52.204-3;
52.212-3
FORMS: NONE
OMB NO: 9000-0101 EXPIRATION DATE: 05/31/2008
RESPS:600 HOURS:102 COSTS(000):$0
Drug-Free Workplace - FAR Section Affected: 52.223-6(b)(5)
FORMS: NONE
OMB NO: 9000-0102 EXPIRATION DATE: 10/31/2007
RESPS:403,326 HOURS:644,360 COSTS(000):$0
Prompt Payment - FAR Sections Affected: Subparts 32.9; 52.232-5;
52.232-26; 2.232-27; 52.212-4
FORMS: NONE
OMB NO: 9000-0107 EXPIRATION DATE: 10/31/2008
RESPS:2,500 HOURS:2,500 COSTS(000):$0
Notice of Radioactive Materials--FAR Sections Affected: 23.602
and 52.223-7
FORMS: NONE
OMB NO: 9000-0108 EXPIRATION DATE: 08/31/2008
RESPS:1,000 HOURS:1,250 COSTS(000):$0
Bankruptcy - FAR Section Affected: 52.242-13
FORMS: NONE
OMB NO: 9000-0113 EXPIRATION DATE: 02/29/2008
RESPS:26 HOURS:26 COSTS(000):$0
Acquisition of Helium - FAR Section Affected: 8.5
FORMS: NONE
OMB NO: 9000-0114 EXPIRATION DATE: 10/31/2006
RESPS:200 HOURS:685 COSTS(000):$0
Right of First Refusal of Employment FAR Sections Afected:
52:207-3
FORMS: NONE
OMB NO: 9000-0115 EXPIRATION DATE: 01/31/2007
RESPS:100 HOURS:125 COSTS(000):$0
Notification of Ownership Changes -- FAR Sections Affected:
15.408(k); 52.215-19
FORMS: NONE
OMB NO: 9000-0129 EXPIRATION DATE: 10/31/2006
RESPS:1,462 HOURS:255,829 COSTS(000):$0
Cost Accounting Standards Administration FAR Sections Affected"
Subpart 30.6; 52.230-5
FORMS: NONE
OMB NO: 9000-0130 EXPIRATION DATE: 05/31/2009
RESPS:5,700 HOURS:666 COSTS(000):$0
Buy American Act-Free Trade Agreements-Israeli Trade Act
Certificate; FAR Section Affected 52.225-4
FORMS: NONE
OMB NO: 9000-0132 EXPIRATION DATE: 10/31/2006
RESPS:1,580 HOURS:26,860 COSTS(000):$0
Contractors' Purchasing Systems Reviews FAR Sections Affected
44-305-2(c); 44.305-3; 52.244-2(j)
FORMS: NONE
OMB NO: 9000-0133 EXPIRATION DATE: 10/31/2006
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: 01/31/2008
RESPS:64,350 HOURS:20,914 COSTS(000):$0
Environmentally Sound Products - FAR Sections Affected: 23.406;
52.223-4
FORMS: NONE
OMB NO: 9000-0135 EXPIRATION DATE: 07/31/2007
RESPS:63,490 HOURS:15,872.50 COSTS(000):$0
Prospective Subcontractor Requests for Bonds; FAR 28.106-4(b);
52.228-12
FORMS: NONE
OMB NO: 9000-0136 EXPIRATION DATE: 10/31/2006
RESPS:1,275,000 HOURS:397,800 COSTS(000):$0
Commercial Item Acquisitions - FAR Sections Affected: Part 12;
52.212-1 and 52.212-3
FORMS: NONE
OMB NO: 9000-0138 EXPIRATION DATE: 10/31/2007
RESPS:11,000 HOURS:22,000 COSTS(000):$0
Contract Financing - FAR Sections Affected: Subparts 32.0 thru
32.1; 32.2; 32.5; 32,10; 52,232-29 thru 32
FORMS: NONE
OMB NO: 9000-0139 EXPIRATION DATE: 01/31/2009
RESPS:167,487 HOURS:58,621 COSTS(000):$0
Federal Acquisition and Community Right-to-know (Sections
affected - FAR Subpart 23.9, 52.223-13, and 52.223-14)
FORMS: NONE
OMB NO: 9000-0141 EXPIRATION DATE: 09/30/2008
RESPS:1,000 HOURS:2,500 COSTS(000):$0
Buy American Act --Construction --FAR Sections Affected: Subpart
25.2; 52.225-9; and 52.225-11
FORMS: NONE
OMB NO: 9000-0142 EXPIRATION DATE: 11/30/2008
RESPS:600,000 HOURS:1,200,000 COSTS(000):$0
Past Performance Information (FAR Sections 9.104-1; 9.105-1;
15.406; 15.604; 15.608; 42.302; Subpart 42.15)
FORMS: NONE
OMB NO: 9000-0144 EXPIRATION DATE: 10/31/2008
RESPS:140,000 HOURS:70,000 COSTS(000):$0
Payment by Electronic Fund Transfer
FORMS: NONE
OMB NO: 9000-0145 EXPIRATION DATE: 10/31/2006
RESPS:142,776 HOURS:2,852 COSTS(000):$0
Use of Data Universal Numbering System (DUNS) as Primary
Contractor Identification FAR Sections Affected: 4.602; 4-603;
52.204-6; 52.212-1(j)
FORMS: NONE
OMB NO: 9000-0147 EXPIRATION DATE: 09/30/2006
RESPS:13,350 HOURS:10,500 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: 07/31/2009
RESPS:15,349 HOURS:13,353 COSTS(000):$0
Subcontract Consent FAR Sections Affected: 44.201 and 52.244-2
FORMS: NONE
OMB NO: 9000-0150 EXPIRATION DATE: 08/31/2006
RESPS:183,257 HOURS:268,105 COSTS(000):$0
Small Disadvantaged Business Procurement Credit Programs FAR
Secs. Affected: Subparts 19.11; 19.12; 52.219-22 through
52.219-26
FORMS: NONE
OMB NO: 9000-0152 EXPIRATION DATE: 07/31/2009
RESPS:19,906 HOURS:9,953 COSTS(000):$0
Service Contractng FAR Sections Affected: 52.237-10 and 37.115-3
FORMS: NONE
OMB NO: 9000-0153 EXPIRATION DATE: 05/31/2008
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: 03/31/2009
RESPS:1 HOURS:81,000 COSTS(000):$0
Davis-Bacon Act -- Price Adjustment (Actual Method); FAR Section
Affected: 52.222-32
FORMS: NONE
OMB NO: 9000-0155 EXPIRATION DATE: 01/31/2008
RESPS:500 HOURS:162 COSTS(000):$0
Prohibition on Acquisition of Products Produced by Forced or
Indentured Child Labor - FAR Sections Affected: 12.301; 22.1505;
52.212-3; 52.222-18; 52.222-19
FORMS: NONE
OMB NO: 9000-0157 EXPIRATION DATE: 12/31/2006
RESPS:20,000 HOURS:580,000 COSTS(000):$0
Consolidated Form for Selection of Archietect-Engineer Contracts
FORMS: SF-330
OMB NO: 9000-0159 EXPIRATION DATE: 07/31/2009
RESPS:87,677 HOURS:87,677 COSTS(000):$0
Central Contractor Registration - Sections Affected 2.101;
4.603; Subpart 4.11; 13.102; 32.805; 32.1103; 32.1110; 52.204-6;
52.204-7; 52.212-1; 52.212-4; and 52.232-33.
FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
88 34,664,628 29,624,375 $0
