OMB NO: 0412-0004 EXPIRATION DATE: 09/30/2005
RESPS:850 HOURS:425 COSTS(000):$5
Application for Approval of Commodity Eligibility
FORMS: AID-11
OMB NO: 0412-0011 EXPIRATION DATE: 12/31/2003
RESPS:85 HOURS:1,020 COSTS(000):$0
Application for Assistance - American Schools and Hospitals
FORMS: AID-1010-2
OMB NO: 0412-0012 EXPIRATION DATE: 05/31/2004
RESPS:2,400 HOURS:1,200 COSTS(000):$0
Supplier's Certificate Agreement With the U.S. Agency for
International Development-In voice and contract abstract.
FORMS: AID-282
OMB NO: 0412-0017 EXPIRATION DATE: 06/30/2003
RESPS:216 HOURS:126 COSTS(000):$0
Contractor's Certificate with the Agency for International
Development--Contractor's Invoice--Contract Abstract
FORMS: FORM-AID-1440-3
OMB NO: 0412-0020 EXPIRATION DATE: 06/30/2003
RESPS:300 HOURS:196 COSTS(000):$0
Supplier's Certificate and Agreement with the Agency for
International Development for Project Commodities/Invoice--and--
Contract
FORMS: FORM-AID-1450-4
OMB NO: 0412-0035 EXPIRATION DATE: 07/31/2003
RESPS:442 HOURS:1,320 COSTS(000):$0
USAID FOrm 1550-2 Private and Voluntary Organization Annual
Return
FORMS: 1550-2
OMB NO: 0412-0506 EXPIRATION DATE: 10/31/2003
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Vendor Database (formerly known as ACRIS)
FORMS: AID-1420-50 (03/31/2002)
OMB NO: 0412-0510 EXPIRATION DATE: 04/30/2005
RESPS:1,100 HOURS:37,400 COSTS(000):$0
Administration of Assistance Awards to U.S. Non-Governmental
Organizations - 22 CFR 226 and USAID ADS Chapter 303
FORMS: NONE
OMB NO: 0412-0514 EXPIRATION DATE: 09/30/2003
RESPS:1,991 HOURS:869 COSTS(000):$0
AID Regulation 1-Rules and Procedures Applicable to Commodity
Transactions
FORMS: NONE
OMB NO: 0412-0520 EXPIRATION DATE: 09/30/2004
RESPS:53,270 HOURS:74,620 COSTS(000):$0
Information collection elements in the USAID Acquisition
Regulation (AIDAR), 48 CFR Chapter 7
FORMS: FORM-1420-17
OMB NO: 0412-0542 EXPIRATION DATE: 09/30/2004
RESPS:1,140 HOURS:2,280 COSTS(000):$0
Request for Advance or Reimbursement
FORMS: AID-1558-2
OMB NO: 0412-0543 EXPIRATION DATE: 09/30/2004
RESPS:760 HOURS:5,320 COSTS(000):$0
Exception to the Financial Status Report (SF-269) and Supplement
to the Financial Status Report (worksheet)
FORMS: 1558-1 1558-1A
OMB NO: 0412-0552 EXPIRATION DATE: 07/31/2005
RESPS:320 HOURS:800 COSTS(000):$133
Financial Status Report by Country
FORMS: NONE
OMB NO: 0412-0554 EXPIRATION DATE: 09/30/2004
RESPS:15,720 HOURS:2,630 COSTS(000):$0
Training Results and Information Network (TraiNet)
FORMS: NONE
OMB NO: 0412-0565 EXPIRATION DATE: 12/31/2005
RESPS:4,000 HOURS:1,500 COSTS(000):$93
Applicant's Certification that it Does not Support Terrorist
Organizations or Individuals
FORMS: NONE
OMB NO: 3045-0045 EXPIRATION DATE: 04/30/2003
RESPS:1 HOURS:2,250 COSTS(000):$0
The 2000 Application Guidelines for Learn and Serve America
School- and Community-Based Programs
FORMS: NONE
OMB NO: 3045-0047 EXPIRATION DATE: 03/31/2005
RESPS:2,000 HOURS:20,000 COSTS(000):$0
AmeriCorps National, State and Indian Tribes and U.S.
Territories 2003 Application Instructions
FORMS: NONE
OMB NO: 3045-0048 EXPIRATION DATE: 03/31/2004
RESPS:290,000 HOURS:11,667 COSTS(000):$0
AmeriCorps*VISTA Alumni Locator Card Part A, B, and C
FORMS: NONE
OMB NO: 3045-0053 EXPIRATION DATE: 05/31/2005
RESPS:13,000 HOURS:1,083 COSTS(000):$0
Interest Accrual Form (Interest Accrued During National SVC)
FORMS: NONE
OMB NO: 3045-0067 EXPIRATION DATE: 05/31/2003
RESPS:1,304 HOURS:978 COSTS(000):$0
National Senior Service Corps (NSSC) Government Performance and
Results Act (GPRA) Project Data Report
FORMS: NONE
OMB NO: 3045-0068 EXPIRATION DATE: 06/30/2003
RESPS:319 HOURS:156 COSTS(000):$0
Evaluation of the Accomplishments and Outcomes of
AmeriCorps*NCCC Projects
FORMS: NONE
OMB NO: 3045-0070 EXPIRATION DATE: 08/31/2004
RESPS:3,337 HOURS:3,227 COSTS(000):$0
The Longitudinal Research on Member Outcomes
FORMS: NONE
OMB NO: 3045-0071 EXPIRATION DATE: 09/30/2003
RESPS:100 HOURS:1,000 COSTS(000):$2
Outreach to Individuals with a Disability to Increase their
Participation in National Service Application Guidelines
FORMS: NONE
OMB NO: 3045-0072 EXPIRATION DATE: 05/31/2004
RESPS:470 HOURS:470 COSTS(000):$0
Evaluation of the Effectiveness of Learn and Serve America
Grants in Promoting Institutuionalization of Service-Learning
FORMS: NONE
OMB NO: 3045-0078 EXPIRATION DATE: 11/30/2005
RESPS:11,700,000 HOURS:413,400 COSTS(000):$0
"Join Senior Service Now" Senior Service Web-based Recruitment
System
FORMS: NONE
OMB NO: 3045-0080 EXPIRATION DATE: 07/31/2005
RESPS:400 HOURS:200 COSTS(000):$0
Cross-sectional Study of AmeriCorps*VISTA Member and Supervisor
Training - Supervisor Survey
FORMS: NONE
OMB NO: 3045-0083 EXPIRATION DATE: 03/31/2005
RESPS:400 HOURS:4,000 COSTS(000):$0
Innovative and Demonstration Program 2003 Application
Instructions
FORMS: NONE
OMB NO: 3045-0084 EXPIRATION DATE: 07/31/2003
RESPS:187 HOURS:154 COSTS(000):$0
Study of Community, Higher Education, and School Partnership
(CHESP)
FORMS: NONE
OMB NO: 3046-0040 EXPIRATION DATE: 08/31/2003
RESPS:627,000 HOURS:16,677 COSTS(000):$0
Recordkeeping and Reporting under Title VII and the ADA
FORMS: NONE
OMB NO: 3046-0043 EXPIRATION DATE: 07/31/2003
RESPS:1 HOURS:41,000 COSTS(000):$0
Waiver of Rights and Claims Under the Age Discrimination in
Employment Act (ADEA)
FORMS: NONE
OMB NO: 3048-0003 EXPIRATION DATE: 02/29/2004
RESPS:600 HOURS:1,200 COSTS(000):$0
U.S. Small Business Administration Export-Import Bank of the
United States Joint Application for Working Capital Guarantee
FORMS: EIB-SBAFORM84-1
OMB NO: 3048-0004 EXPIRATION DATE: 02/28/2005
RESPS:50 HOURS:50 COSTS(000):$0
Annual Competitiveness Report Survey of Exporters and Bankers
FORMS: 00-02
OMB NO: 3048-0005 EXPIRATION DATE: 10/31/2004
RESPS:960 HOURS:310 COSTS(000):$0
Ex-Im Bank Letter of Interest Application
FORMS: EIB-95-9
OMB NO: 3048-0009 EXPIRATION DATE: 10/31/2003
RESPS:2,219 HOURS:2,219 COSTS(000):$0
Application forms for export credit insurance program
FORMS: EIB-92-34 EIB-92-37 EIB-92-41 EIB-92-45 EIB-92-48 EIB-92-50
EIB-92-64 EIB-92-72 EIB-92-79
OMB NO: 3048-0013 EXPIRATION DATE: 11/30/2004
RESPS:225 HOURS:337 COSTS(000):$0
Export-Import Bank of the United States Preliminary Commitment
and Final Commitment
FORMS: 95-10
OMB NO: 3139-0005 EXPIRATION DATE: 03/31/2006
RESPS:2 HOURS:120 COSTS(000):$0
Rules of Practice for Proceedings; 12 CFR Part 1102, subpart B
FORMS: NONE
OMB NO: 3090-0007 EXPIRATION DATE: 01/31/2005
RESPS:2,767 HOURS:6,917 COSTS(000):$0
Contractor's Qualifications and Financial Information
FORMS: GSA-527
OMB NO: 3090-0014 EXPIRATION DATE: 03/31/2005
RESPS:63,000 HOURS:18,900 COSTS(000):$0
Transfer Order - Surplus Personal Property and Continuation Sheet
FORMS: SF-123/123-A
OMB NO: 3090-0021 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:250 COSTS(000):$0
Profit and Loss Statement - Operating Statement
FORMS: GSA-2817
OMB NO: 3090-0023 EXPIRATION DATE: 05/31/2005
RESPS:12,000 HOURS:996 COSTS(000):$0
Surplus Personal Property Mailing List Application
FORMS: GSA-2170
OMB NO: 3090-0040 EXPIRATION DATE: 06/30/2004
RESPS:3,000 HOURS:1,000 COSTS(000):$0
Application for Shipping Instructions and Notice of Availability
FORMS: GSA-1611
OMB NO: 3090-0043 EXPIRATION DATE: 01/31/2005
RESPS:1,300 HOURS:2,080 COSTS(000):$0
Appraisal of Fair Annual parking Rate Per Space for Standard
Level User Charge
FORMS: GSA-3357
OMB NO: 3090-0044 EXPIRATION DATE: 11/30/2005
RESPS:8,000 HOURS:400 COSTS(000):$0
Application/Permit for Use of Space in Public Buildings and
Grounds
FORMS: GSA-3453
OMB NO: 3090-0057 EXPIRATION DATE: 01/31/2005
RESPS:500 HOURS:125 COSTS(000):$0
Deposit Bond Individual - Sale of Government Personal Property
FORMS: SF-150
OMB NO: 3090-0058 EXPIRATION DATE: 01/31/2005
RESPS:1,000 HOURS:250 COSTS(000):$6,600
Deposit Bond - Annual Sale of Government Personal Property
FORMS: SF-151
OMB NO: 3090-0271 EXPIRATION DATE: 04/30/2003
RESPS:23,400 HOURS:3,900 COSTS(000):$0
American Customer Satisfaction Index (ACSI)
FORMS: NONE
OMB NO: 3090-0273 EXPIRATION DATE: 04/30/2003
RESPS:1,000 HOURS:50 COSTS(000):$0
Questionnaire: CD-ROM of the Ctalog of Federal Domestic
Assistance and Federal Assistance Award Data System
FORMS: NONE
OMB NO: 3090-0274 EXPIRATION DATE: 05/31/2003
RESPS:360 HOURS:90 COSTS(000):$2
Art-in-Architecture Program National Artist Registry
FORMS: GSA-7437
OMB NO: 3090-0275 EXPIRATION DATE: 10/31/2003
RESPS:50 HOURS:1,250 COSTS(000):$0
Child Care Subsidy Application - Main Provider
FORMS: GSA-3674A
OMB NO: 3090-0277 EXPIRATION DATE: 04/30/2003
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: 06/30/2003
RESPS:2,250 HOURS:112 COSTS(000):$0
National Contact Center Customer Evaluation Survey
FORMS: NONE
OMB NO: 3117-0190 EXPIRATION DATE: 04/30/2003
RESPS:2,000 HOURS:66 COSTS(000):$0
ITC DataWeb: User Registration Forms
FORMS: NONE
OMB NO: 3117-0204 EXPIRATION DATE: 04/30/2003
RESPS:449 HOURS:3,592 COSTS(000):$0
Conditions of Competition in the US Mkt for Wood Structural
Building Components
FORMS: NONE
OMB NO: 3320-0001 EXPIRATION DATE: 06/30/2004
RESPS:80 HOURS:187 COSTS(000):$0
Application for National Roster of Environmental Dispute
Resolution and Consensus Building Professionals. Sub-Roster of
Transportation Mediators and Facilitors.
FORMS: NONE
OMB NO: 3320-0002 EXPIRATION DATE: 03/31/2005
RESPS:15 HOURS:160 COSTS(000):$0
Application for support from the US Institute for Environmental
Conflict Resolution for Environmental Conflict Resolution (ECR)
Participation Program
FORMS: NONE
OMB NO: 3320-0008 EXPIRATION DATE: 10/31/2005
RESPS:155 HOURS:106 COSTS(000):$0
Application for National Roster of Environmental Dispute
Resolution and Consensus Building Professionals
FORMS: NONE
OMB NO: 2700-0052 EXPIRATION DATE: 11/30/2004
RESPS:2,386 HOURS:7,276 COSTS(000):$0
NASA FAR Supplement, Part 1827, Patents, Data and Copyrights
FORMS: NONE
OMB NO: 2700-0054 EXPIRATION DATE: 08/31/2005
RESPS:176 HOURS:7,920 COSTS(000):$0
Contract Modifications, NASA FAR Supplement Part 18-43
FORMS: NONE
OMB NO: 2700-0057 EXPIRATION DATE: 05/31/2005
RESPS:30 HOURS:20 COSTS(000):$0
Application for Volunteer Program
FORMS: NONE
OMB NO: 2700-0063 EXPIRATION DATE: 05/31/2003
RESPS:75 HOURS:19 COSTS(000):$0
NASA Safety Reporting System
FORMS: NONE
OMB NO: 2700-0064 EXPIRATION DATE: 10/31/2003
RESPS:8,456 HOURS:702 COSTS(000):$0
Locator and Information Services Tracking System (LISTS) Form
FORMS: GSFC-24-27
OMB NO: 2700-0073 EXPIRATION DATE: 08/31/2005
RESPS:450 HOURS:5,400 COSTS(000):$0
Small Business and small disadvantaged business concerns and
related contract provisions, NASSA FAR Supplement Part 18-19, SF
295
FORMS: NONE
OMB NO: 2700-0078 EXPIRATION DATE: 09/30/2003
RESPS:96 HOURS:140 COSTS(000):$0
Small Business and Small Disadvantaged Business Concerns
FORMS: NONE
OMB NO: 2700-0085 EXPIRATION DATE: 11/30/2003
RESPS:1,496 HOURS:663,816 COSTS(000):$0
NASA Acquisition Process, bids and proposals for contracts with
an estimated value mor than $500,000.
FORMS: NONE
OMB NO: 2700-0086 EXPIRATION DATE: 11/30/2003
RESPS:250,865 HOURS:73,380 COSTS(000):$0
NASA Acquisition Process, Purchase orders for goods and services
with an estimated value of $100,000 or less
FORMS: NONE
OMB NO: 2700-0087 EXPIRATION DATE: 11/30/2003
RESPS:11,000 HOURS:2,790,000 COSTS(000):$0
NASA Acquisition Process, bids and proposals for contracts with
an estimated value less than $500,000.
FORMS: NONE
OMB NO: 2700-0088 EXPIRATION DATE: 05/31/2005
RESPS:38,460 HOURS:1,065,600 COSTS(000):$0
NASA Acquisition Process - Reports Required on Contracts Valued
at less than $500 K
FORMS: NONE
OMB NO: 2700-0089 EXPIRATION DATE: 11/30/2003
RESPS:76,160 HOURS:609,280 COSTS(000):$0
NASA Acquisiiton Process, reports required for contracts with an
estimated value more than $500,000.
FORMS: NONE
OMB NO: 2700-0093 EXPIRATION DATE: 08/31/2005
RESPS:95 HOURS:485 COSTS(000):$0
Grants and Cooperative Agreements with State and Local
Governments
FORMS: NONE
OMB NO: 2700-0094 EXPIRATION DATE: 08/31/2005
RESPS:11 HOURS:506 COSTS(000):$0
Cost Reduction Proposals under the NASA FAR Supplement Shared
Savings Clause
FORMS: NONE
OMB NO: 2700-0095 EXPIRATION DATE: 06/30/2003
RESPS:200 HOURS:200 COSTS(000):$0
NASA Small Business Innovative Research Commercial Metrics
FORMS: NONE
OMB NO: 2700-0102 EXPIRATION DATE: 01/31/2006
RESPS:10,000 HOURS:6,820 COSTS(000):$0
National Aviation Operations Monitoring Service - General
Aviation Pilots
FORMS: NONE
OMB NO: 2700-0103 EXPIRATION DATE: 11/30/2005
RESPS:40,000 HOURS:3,334 COSTS(000):$0
NASA Voluntary On-Line Job Applicant Racial and Ethnic Data
Collection
FORMS: NONE
OMB NO: 3095-0002 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:7 COSTS(000):$0
Statistical Research in Archival Records Containing Personal
Information
FORMS: NONE
OMB NO: 3095-0012 EXPIRATION DATE: 11/30/2005
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: 11/30/2005
RESPS:134 HOURS:7,636 COSTS(000):$0
National Historical Publications and Records Commission Grant
Program
FORMS: NONE
OMB NO: 3095-0014 EXPIRATION DATE: 11/30/2005
RESPS:9 HOURS:72 COSTS(000):$0
Applicatin for Archival Administration or Historical Documentary
Editing Fellowships
FORMS: NONE
OMB NO: 3095-0015 EXPIRATION DATE: 11/30/2005
RESPS:9 HOURS:153 COSTS(000):$0
Application for Host Institutions of Archival Administration or
Historical Documentary Editing Fellowships
FORMS: NONE
OMB NO: 3095-0017 EXPIRATION DATE: 05/31/2003
RESPS:1 HOURS:50 COSTS(000):$0
Request to Microfilm Records
FORMS: NONE
OMB NO: 3095-0021 EXPIRATION DATE: 02/29/2004
RESPS:36 HOURS:216 COSTS(000):$0
National Historical Publications and Records Commission (NHPRC)
Subvention Grant Guidelines and Aplications
FORMS: NONE
OMB NO: 3095-0022 EXPIRATION DATE: 12/31/2003
RESPS:36 HOURS:36 COSTS(000):$0
National Historical Publications & Records Commission (NHPRC)
Annual Sales Report for Subvention Grants
FORMS: NONE
OMB NO: 3095-0023 EXPIRATION DATE: 06/30/2003
RESPS:6,400 HOURS:533 COSTS(000):$0
NARA Class Evaluation Form
FORMS: NA-2019
OMB NO: 3095-0024 EXPIRATION DATE: 08/31/2004
RESPS:1,000 HOURS:333 COSTS(000):$0
Application and Permit for Use of Space in Presidential
FORMS: NA-16011
OMB NO: 3095-0026 EXPIRATION DATE: 08/31/2004
RESPS:1,266 HOURS:63 COSTS(000):$0
Request for and Record of Pass
FORMS: NA-6006
OMB NO: 3095-0027 EXPIRATION DATE: 03/31/2005
RESPS:97,600 HOURS:16,267 COSTS(000):$0
Order Forms for Genealogical Reserach in the National Archives
FORMS: NATF-81 NATF-82 NATF-83 NATF-84 NATF-85 NATF-86
OMB NO: 3095-0029 EXPIRATION DATE: 09/30/2005
RESPS:552,500 HOURS:46,042 COSTS(000):$0
Request Pertaining to Military Records
FORMS: SF-180
OMB NO: 3095-0033 EXPIRATION DATE: 04/30/2003
RESPS:10,000 HOURS:1,667 COSTS(000):$0
National Archives Order for Land Entry Files
FORMS: NATF-84
OMB NO: 3095-0035 EXPIRATION DATE: 11/30/2004
RESPS:1 HOURS:15 COSTS(000):$0
Request to use Paper-to-Paper Copiers at the National Archives
at the College Park Facility
FORMS: NONE
OMB NO: 3095-0039 EXPIRATION DATE: 12/31/2005
RESPS:79,800 HOURS:6,650 COSTS(000):$0
Forms Relating to Military Service Records
FORMS: NA-13036 NA-13042 NA-13075 NA-13055
OMB NO: 3095-0040 EXPIRATION DATE: 05/31/2003
RESPS:660 HOURS:110 COSTS(000):$0
Request to film, photograph, or videotape at a NARA facility for
news purposes
FORMS: NONE
OMB NO: 3095-0046 EXPIRATION DATE: 02/29/2004
RESPS:5,200 HOURS:867 COSTS(000):$0
Microfilm Order Form
FORMS: NATF-36
OMB NO: 3095-0047 EXPIRATION DATE: 04/30/2005
RESPS:130,000 HOURS:10,833 COSTS(000):$0
Customer Request for Information and Order Forms
FORMS: NA-14116
OMB NO: 3095-0052 EXPIRATION DATE: 10/31/2005
RESPS:5 HOURS:1 COSTS(000):$0
Use of NARA Official Seals
FORMS: NONE
OMB NO: 3137-0029 EXPIRATION DATE: 12/31/2003
RESPS:2,664 HOURS:36,432 COSTS(000):$0
Generic Clearance Grant Application Guidelines, Instructions and
Reporting Forms
FORMS: NONE
OMB NO: 3137-0040 EXPIRATION DATE: 01/31/2004
RESPS:1 HOURS:1,605 COSTS(000):$50,686
Technology Survey for Libraries and Museums
FORMS: NONE
OMB NO: 3137-0042 EXPIRATION DATE: 05/31/2004
RESPS:400 HOURS:78 COSTS(000):$0
Evaluation Professional Services Program
FORMS: NONE
OMB NO: 3137-0043 EXPIRATION DATE: 06/30/2004
RESPS:1 HOURS:2,250 COSTS(000):$33,533
Museum/School Program Research
FORMS: NONE
OMB NO: 3137-0044 EXPIRATION DATE: 08/31/2004
RESPS:1 HOURS:135 COSTS(000):$0
Survey on the Partnerships in Museums in the Community Grant
Program
FORMS: NONE
OMB NO: 3137-0046 EXPIRATION DATE: 03/31/2004
RESPS:1 HOURS:116 COSTS(000):$0
Survey on User Need Assessments in Digitization Projects
FORMS: NONE
OMB NO: 3137-0047 EXPIRATION DATE: 03/31/2005
RESPS:1,500 HOURS:750 COSTS(000):$73,585
Evaluation of IMLS General Operating Support Grant Program for
Museums
FORMS: NONE
OMB NO: 3137-0048 EXPIRATION DATE: 08/31/2005
RESPS:900 HOURS:36,000 COSTS(000):$0
Learning Opportunity Grant Application and Guidelines
FORMS: NONE
OMB NO: 3137-0049 EXPIRATION DATE: 01/31/2005
RESPS:1 HOURS:4,800 COSTS(000):$0
Recuriting and Educating Librarians for the 21st Century
FORMS: NONE
OMB NO: 3136-0134 EXPIRATION DATE: 06/30/2003
RESPS:20,569 HOURS:91,301 COSTS(000):$3,378
Generic Clearance Authority for the National Endowment for the
Humanities
FORMS: NONE
OMB NO: 3136-0137 EXPIRATION DATE: 11/30/2004
RESPS:1,224 HOURS:612 COSTS(000):$0
General Clearance Authority to Develop Evaluation Instruments
for the National Endowment for the Humanities
FORMS: NONE
OMB NO: 3145-0001 EXPIRATION DATE: 02/28/2005
RESPS:150 HOURS:262 COSTS(000):$0
Application for NATO Advanced Study Institutes Travel Award and
NATO Advanced Study Institutes Travel Award Report Form
FORMS: 192 250
OMB NO: 3145-0023 EXPIRATION DATE: 07/31/2005
RESPS:13,000 HOURS:156,000 COSTS(000):$0
Fellowship Applications and Award Forms
FORMS: NONE
OMB NO: 3145-0027 EXPIRATION DATE: 01/31/2005
RESPS:31,200 HOURS:59,400 COSTS(000):$0
Survey of Industrial Research and Development, 2001-2004
FORMS: RD-1 RD-1A
OMB NO: 3145-0034 EXPIRATION DATE: 07/31/2004
RESPS:25 HOURS:12 COSTS(000):$0
Antarctic Conservation Act Application and Permit Form
FORMS: NONE
OMB NO: 3145-0035 EXPIRATION DATE: 07/31/2005
RESPS:137 HOURS:1,467 COSTS(000):$0
National Science Foundation Science Honor Awards
FORMS: NSF-1122 NSF-1123 NSF-1124
OMB NO: 3145-0058 EXPIRATION DATE: 08/31/2004
RESPS:30,000 HOURS:3,600,000 COSTS(000):$0
National Science Foundation Proposal/Award Information - Grant
Proposal Guide
FORMS: NONE
OMB NO: 3145-0060 EXPIRATION DATE: 03/31/2005
RESPS:96,000 HOURS:480,000 COSTS(000):$0
National Science Foundation Proposal Evaluation Process
FORMS: NSF-FORM-1 NSF-FORM-428
OMB NO: 3145-0062 EXPIRATION DATE: 05/31/2005
RESPS:11,793 HOURS:28,796 COSTS(000):$0
Survey of Graduate Students and Postdoctorates in Science and
Engineering
FORMS: NSF-811 NSF-812
OMB NO: 3145-0077 EXPIRATION DATE: 05/31/2004
RESPS:11,475 HOURS:5,737 COSTS(000):$0
2001 National Survey of Recent College Graduates
FORMS: NONE
OMB NO: 3145-0100 EXPIRATION DATE: 07/31/2003
RESPS:646 HOURS:13,795 COSTS(000):$0
Survey of Research and Development Expenditures at Universities
and Colleges, FY 2002
FORMS: NSF-411
OMB NO: 3145-0153 EXPIRATION DATE: 04/30/2005
RESPS:364 HOURS:146 COSTS(000):$0
Impact on Industry of Interaction with Engineering Research
Centers
FORMS: NONE
OMB NO: 3145-0157 EXPIRATION DATE: 08/31/2005
RESPS:30,000 HOURS:5,000 COSTS(000):$0
National Science Foundation Surveys to Measure Customer
Satisfaction
FORMS: NONE
OMB NO: 3145-0161 EXPIRATION DATE: 07/31/2005
RESPS:14,040 HOURS:4,950 COSTS(000):$0
Cross-Project Evaluation of the National Science Foundation's
Local Systemic Change Through Teacher Enhancement Program (LSC)
FORMS: NONE
OMB NO: 3145-0174 EXPIRATION DATE: 12/31/2003
RESPS:1,620 HOURS:6,240 COSTS(000):$0
Generic Survey Clearance of the Science Resources Studies Survey
Improvement Projects and Quick Response Studies
FORMS: NONE
OMB NO: 3145-0175 EXPIRATION DATE: 11/30/2003
RESPS:1,040 HOURS:780 COSTS(000):$0
Evaluation of the NSF Summer Programs in Japan; NSF postdoctoral
Fellowships in Japan; and the NSF-CGP Fellowship Program.
FORMS: NONE
OMB NO: 3145-0177 EXPIRATION DATE: 05/31/2004
RESPS:3,120 HOURS:29,617 COSTS(000):$0
Medical Clearance Process for Deployment to the Polar Regions
FORMS: 1421 1422 1423 1424 1425 1426 1427 1428 1429 1451
OMB NO: 3145-0180 EXPIRATION DATE: 08/31/2004
RESPS:12 HOURS:480 COSTS(000):$0
Response plan and educational materials for non-governmental
Antarctic expeditions.
FORMS: NONE
OMB NO: 3145-0182 EXPIRATION DATE: 07/31/2005
RESPS:880 HOURS:690 COSTS(000):$0
Cross-Site Analysis of the NSF Integrative Graduate Education
and Research Traineeships Program
FORMS: NONE
OMB NO: 3145-0183 EXPIRATION DATE: 07/31/2004
RESPS:150 HOURS:734 COSTS(000):$0
Evaluation of the Preparing Future Faculty (PFF) Program
FORMS: NONE
OMB NO: 3145-0188 EXPIRATION DATE: 04/30/2005
RESPS:150 HOURS:37 COSTS(000):$0
Survey of Colleges, Universities and Professional Development
Providers Regarding Evaluation Training Programs
FORMS: NONE
OMB NO: 3145-0189 EXPIRATION DATE: 05/31/2005
RESPS:1 HOURS:68 COSTS(000):$0
Outcomes and Impact of the NSF Minority Postdoctoral Research
Fellowships (MPRF) Program
FORMS: NONE
OMB NO: 3145-0190 EXPIRATION DATE: 05/31/2005
RESPS:795 HOURS:318 COSTS(000):$0
Evaluation of NSF's Louis Stokes Alliances for Minority
Participation (LSAMP) Program
FORMS: NONE
OMB NO: 3145-0191 EXPIRATION DATE: 08/31/2004
RESPS:560 HOURS:560 COSTS(000):$0
NSF Graduate Research Traineeships Program Followup Study
FORMS: NONE
OMB NO: 3145-0192 EXPIRATION DATE: 09/30/2004
RESPS:6,132 HOURS:6,952 COSTS(000):$0
Evaluation of the Adoption and use of the National Institutes of
Health Curriculum Supplements on Students' Scientific Knowledge
FORMS: NONE
OMB NO: 3209-0002 EXPIRATION DATE: 12/31/2005
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: 3209-0007 EXPIRATION DATE: 03/31/2005
RESPS:294 HOURS:3,785 COSTS(000):$0
Executive Branch Qualified Trust Documents (see item #'s 1.-2.
of the Supporting Statement for precise title of all documents)
FORMS: NONE
OMB NO: 3209-0009 EXPIRATION DATE: 03/31/2005
RESPS:50 HOURS:3 COSTS(000):$0
Public Financial Disclosure Access Customer Service Survey
FORMS: NONE
OMB NO: 0348-0057 EXPIRATION DATE: 12/31/2003
RESPS:60,000 HOURS:1,036,800 COSTS(000):$0
Data Collection Form for Reporting on Audits of States, Local
Governments, and Non-Profit Organizations
FORMS: SF-SAC
OMB NO: 3206-0001 EXPIRATION DATE: 12/31/2003
RESPS:4,500 HOURS:750 COSTS(000):$0
Application for 10 point Veteran Preference
FORMS: SF-15
OMB NO: 3206-0005 EXPIRATION DATE: 12/31/2004
RESPS:252,310 HOURS:314,555 COSTS(000):$0
SF 85, Questionnaire for Non-Sensitive Positions; SF 85P,
Questionnaire for Public Trust Positions; SF 85PS, Supplemental
Questionnaire for Selected Positions, SF 86, Questionnaire for...
FORMS: SF-85 SF-85P SF-85PS SF-86 SF-86A SF-86C
OMB NO: 3206-0006 EXPIRATION DATE: 05/31/2003
RESPS:1,560 HOURS:3,120 COSTS(000):$2
Monthly Report of Federal Civilian Employment
FORMS: 113-A
OMB NO: 3206-0017 EXPIRATION DATE: 07/31/2005
RESPS:100 HOURS:17 COSTS(000):$0
Medicare Part B Certification
FORMS: RI-78-11
OMB NO: 3206-0032 EXPIRATION DATE: 11/30/2004
RESPS:14,000 HOURS:2,800 COSTS(000):$0
Self-Certification of Full-Time School Attendance
FORMS: RI-25-14
OMB NO: 3206-0034 EXPIRATION DATE: 09/30/2003
RESPS:21,000 HOURS:12,250 COSTS(000):$0
Annuitant's Report of Earned Income
FORMS: 30-2
OMB NO: 3206-0036 EXPIRATION DATE: 10/31/2005
RESPS:21,200 HOURS:75,800 COSTS(000):$0
Federal Wage System Data Collection forms
FORMS: DD-1918 DD-1919 DD-1919C
OMB NO: 3206-0076 EXPIRATION DATE: 02/29/2004
RESPS:10 HOURS:4 COSTS(000):$0
Application to be Listed Under the Voting Rights of 1965
FORMS: OPMFORM805 SERIES
OMB NO: 3206-0095 EXPIRATION DATE: 10/31/2005
RESPS:100,000 HOURS:8,333 COSTS(000):$0
Applicnt Race and National Origin Questionnaire
FORMS: OPM-1386B
OMB NO: 3206-0099 EXPIRATION DATE: 08/31/2003
RESPS:1,200 HOURS:1,800 COSTS(000):$0
Initial Certification of Full-time School Attendance
FORMS: RI-25-41
OMB NO: 3206-0106 EXPIRATION DATE: 07/31/2004
RESPS:5,700 HOURS:570 COSTS(000):$0
Mail Reinterview Form
FORMS: IS-10
OMB NO: 3206-0121 EXPIRATION DATE: 09/30/2004
RESPS:3,000 HOURS:3,000 COSTS(000):$0
Application for Deferred Retirement (Separations before October
1, 1956) -- Application for Deferred Retirement (Separations on
or after October 1, 1956)
FORMS: OPM-1496 OPM-1496A
OMB NO: 3206-0128 EXPIRATION DATE: 07/31/2004
RESPS:60,990 HOURS:31,298 COSTS(000):$0
Application for Refund of Retirement Deductions (CSRS)
FORMS: SF-2802 SF-2802B
OMB NO: 3206-0134 EXPIRATION DATE: 05/31/2003
RESPS:150 HOURS:75 COSTS(000):$0
Application to Make Deposit or Redeposit (CSRS) Application to
Make Service Credit Payment for Civilian Service (FERS)
FORMS: SF-2803 SF-3108
OMB NO: 3206-0136 EXPIRATION DATE: 12/31/2003
RESPS:41,000 HOURS:10,250 COSTS(000):$0
Designation of Beneficiary: Federal Employees' Group Life
Insurance Program
FORMS: SF-2823
OMB NO: 3206-0138 EXPIRATION DATE: 09/30/2003
RESPS:200 HOURS:200 COSTS(000):$0
Reinstatement of Disability Annuity Previously Terminated
Because of Restoration to Earning Capacity
FORMS: RI-30-9
OMB NO: 3206-0140 EXPIRATION DATE: 03/31/2004
RESPS:12,730 HOURS:6,490 COSTS(000):$0
RI 20-7 - Representative Payee Application RI 30-3 - Information
Necessary for a Competency Determination
FORMS: RI-20-7 RI-30-3
OMB NO: 3206-0141 EXPIRATION DATE: 06/30/2005
RESPS:30,000 HOURS:16,667 COSTS(000):$0
Health Benefits Registration Form
FORMS: OPM-2809
OMB NO: 3206-0143 EXPIRATION DATE: 05/31/2004
RESPS:8,000 HOURS:8,000 COSTS(000):$0
Request to Disability Annuitant for Information on Physical
Condition and Employment
FORMS: RI-30-1
OMB NO: 3206-0144 EXPIRATION DATE: 06/30/2005
RESPS:3,000 HOURS:250 COSTS(000):$0
We Need the Social Security Number of the Person Named Below
FORMS: RI-38-45
OMB NO: 3206-0156 EXPIRATION DATE: 05/31/2005
RESPS:74,800 HOURS:56,100 COSTS(000):$0
Application for Death Benefits Under the Civil Service
Retirement System Documentation and Elections in Support of
Application for Death Benefits When the Deceased Was an Employee
at the Time of..
FORMS: SF-2800 SF-2800A
OMB NO: 3206-0160 EXPIRATION DATE: 09/30/2004
RESPS:9,000 HOURS:4,500 COSTS(000):$0
Employee Health Benefits Election Form
FORMS: SF-2809
OMB NO: 3206-0162 EXPIRATION DATE: 10/31/2004
RESPS:500 HOURS:750 COSTS(000):$0
Report of Medical Examination of Person Electing Survivor
Benefits Under the Civil Service Retirement System
FORMS: OPM-1530
OMB NO: 3206-0165 EXPIRATION DATE: 03/31/2005
RESPS:1,962,947 HOURS:162,924 COSTS(000):$0
Investigative Request for Employment Data & Supervisory
Information; Investigation Request for Personal Information;
Investigative Request for Educational Registrar and Dean of.....
FORMS: INV-41 INV-42 INV-43 INV-44
OMB NO: 3206-0167 EXPIRATION DATE: 08/31/2005
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: 3206-0170 EXPIRATION DATE: 05/31/2005
RESPS:30,600 HOURS:9,633 COSTS(000):$0
Application for Refund of REtirement Deductions/Federal
Employees Retirement System (SF 3106) Current/Former Spouse's
Notification of Application for Refund of Retirement Deductions
Under the....
FORMS: SF-3106 SF-3106A
OMB NO: 3206-0172 EXPIRATION DATE: 12/31/2003
RESPS:8,061 HOURS:8,061 COSTS(000):$0
Application for Death Benefits/Federal Employees' Retirement
System Documentation and Elections in Support of Application for
Death Benefits when Deceased was an Employee at the Time of Death
FORMS: SF-3104 SF-3104B
OMB NO: 3206-0174 EXPIRATION DATE: 06/30/2003
RESPS:2,400 HOURS:1,834 COSTS(000):$0
Survivor Annuity Election for a Spouse/Cover Letter for RI 20-63
Giving Information About the Cost to elect Less Than the Maximum
Survivor Annuity/Cover Letter for RI 20-63 Giving Information....
FORMS: RI-20-63 RI-20-116 RI-20-117
OMB NO: 3206-0182 EXPIRATION DATE: 09/30/2003
RESPS:435,000 HOURS:108,750 COSTS(000):$0
Declaration for Federal Employment, Optional Form 306
FORMS: NONE
OMB NO: 3206-0187 EXPIRATION DATE: 02/28/2005
RESPS:8,000 HOURS:1,333 COSTS(000):$0
We Need More Information About Your Missing Payment
FORMS: RI-38-31
OMB NO: 3206-0190 EXPIRATION DATE: 08/31/2003
RESPS:1,272 HOURS:1,272 COSTS(000):$0
Application for Deferred or Postponed Retirement (FERS)
FORMS: RI-92-19 RI-92-19A
OMB NO: 3206-0197 EXPIRATION DATE: 05/31/2003
RESPS:25,400 HOURS:4,234 COSTS(000):$0
Verification of Who Is Getting Payments
FORMS: 38-107
OMB NO: 3206-0199 EXPIRATION DATE: 05/31/2005
RESPS:2,230 HOURS:262 COSTS(000):$0
Nonforeign Area COLA Price and Background Surveys
FORMS: NONE
OMB NO: 3206-0201 EXPIRATION DATE: 01/31/2004
RESPS:112,000 HOURS:18,666 COSTS(000):$0
Federal Employees Health Benefits (FEHB) Open Season Express
Interactive Voice Response (IVR) System
FORMS: NONE
OMB NO: 3206-0202 EXPIRATION DATE: 08/31/2004
RESPS:27,000 HOURS:20,250 COSTS(000):$0
Request to Change FEHB Enrollment or to receive Plan brochures
for Spouse Equity and Temporary Continuation of Coverage
Enrollees
FORMS: DPRS-2809
OMB NO: 3206-0213 EXPIRATION DATE: 07/31/2004
RESPS:2,600 HOURS:1,300 COSTS(000):$0
Marital Information Required of Refund Applicants
FORMS: RI-95-4
OMB NO: 3206-0215 EXPIRATION DATE: 12/31/2005
RESPS:10,000 HOURS:10,000 COSTS(000):$0
Verification of Full-Time School Attendance
FORMS: RS-25-49
OMB NO: 3206-0216 EXPIRATION DATE: 08/31/2004
RESPS:3,000 HOURS:250 COSTS(000):$0
We Need Important Information About Your Eligibility for Social
Security Disability Benefits, Our Records Show That You Have Not
Received a Decision From the Social Security Administration (SSA)
FORMS: RI-98-7
OMB NO: 3206-0218 EXPIRATION DATE: 10/31/2004
RESPS:1,850 HOURS:1,850 COSTS(000):$0
Death Benefit Payment Rollover Election Form
FORMS: RI-94-7
OMB NO: 3206-0219 EXPIRATION DATE: 08/31/2004
RESPS:431,600 HOURS:237,900 COSTS(000):$0
Applying for a Federal Job (OF 510) and Optional Application for
Federal Employment (OF 612)
FORMS: OF-510 OF-612
OMB NO: 3206-0226 EXPIRATION DATE: 12/31/2003
RESPS:45,500 HOURS:22,750 COSTS(000):$0
It's Time to Sign Up for Direct Deposit
FORMS: RI-38-128
OMB NO: 3206-0228 EXPIRATION DATE: 12/31/2003
RESPS:12,775 HOURS:12,775 COSTS(000):$0
CSRS/FERS Documentation in Support of Disability Retirement
Application
FORMS: SF-3112
OMB NO: 3206-0229 EXPIRATION DATE: 05/31/2005
RESPS:100 HOURS:17 COSTS(000):$0
Application for Federal Employee Commercial Garnishment
FORMS: OF-311
OMB NO: 3206-0237 EXPIRATION DATE: 03/31/2005
RESPS:3,100 HOURS:2,325 COSTS(000):$0
Information and Instructions on Your Reconsideration Rights
FORMS: RI-38-47
OMB NO: 3206-0239 EXPIRATION DATE: 09/30/2004
RESPS:9,000 HOURS:4,500 COSTS(000):$0
Annuitant/OWCP Health Benefits Election Form
FORMS: SF-2809-1
OMB NO: 3206-0240 EXPIRATION DATE: 08/31/2004
RESPS:5,000 HOURS:833 COSTS(000):$0
Child Care Tuition Assistance Program-Provider Information
FORMS: OPM-1644
OMB NO: 3206-0245 EXPIRATION DATE: 04/30/2006
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: 08/31/2003
RESPS:200 HOURS:200 COSTS(000):$0
Scholarship For Service (SFP) Program Internet Website
FORMS: NONE
OMB NO: 3255-0002 EXPIRATION DATE: 08/31/2003
RESPS:2,246 HOURS:2,689 COSTS(000):$0
(a) Complaint of Possible Prohibited Personnel Practice or Other
Prohibited Activity; (b) Disclosure of Information
FORMS: OSC-11 OSC-12
OMB NO: 3420-0018 EXPIRATION DATE: 06/30/2003
RESPS:123 HOURS:735 COSTS(000):$0
Sponsor Disclosure Report in Support of an Application for
Financing
FORMS: OPIC-129
OMB NO: 3420-0019 EXPIRATION DATE: 07/31/2003
RESPS:200 HOURS:600 COSTS(000):$0
Self-Monitoring Questionnaire for Insurance and Finance Projects
FORMS: OPIC162
OMB NO: 3420-0022 EXPIRATION DATE: 08/31/2003
RESPS:50 HOURS:200 COSTS(000):$0
Small Business Application for Political Risk Investment
Insurance
FORMS: OPIC-223
OMB NO: 0420-0001 EXPIRATION DATE: 08/31/2003
RESPS:1 HOURS:2,500 COSTS(000):$27,062
National Agency Check Questionnaire for Peace Corps Volunteer
Background Investigation
FORMS: PC-5
OMB NO: 0420-0005 EXPIRATION DATE: 04/30/2005
RESPS:30,000 HOURS:240,000 COSTS(000):$104,954
Peace Corps Volunteer Application Form
FORMS: PC-1502
OMB NO: 0420-0006 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:13,692 COSTS(000):$151
Peace Corps Reference Form
FORMS: PC-1532
OMB NO: 0420-0007 EXPIRATION DATE: 04/30/2005
RESPS:35,000 HOURS:1,021 COSTS(000):$0
Request for Information Card
FORMS: PC-1741
OMB NO: 0420-0510 EXPIRATION DATE: 02/29/2004
RESPS:12,500 HOURS:4,625 COSTS(000):$16
Health Status Review/Report of Medical Exam
FORMS: PC-1789 PC-1790
OMB NO: 0420-0525 EXPIRATION DATE: 07/31/2005
RESPS:1 HOURS:250 COSTS(000):$1,984
Peace Corps Fellows/ USA Program Alumni Questionnaire
FORMS: NONE
OMB NO: 0420-0529 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:8,100 COSTS(000):$55
Peace Corps Day Brochure
FORMS: NONE
OMB NO: 0420-0531 EXPIRATION DATE: 04/30/2005
RESPS:5,000 HOURS:150 COSTS(000):$8,900
Peace Corps Career Information Consultants (CIC) Waiver Form
FORMS: CIC-11/00-RVS15
OMB NO: 0420-0533 EXPIRATION DATE: 08/31/2003
RESPS:1,000 HOURS:83 COSTS(000):$0
Peace Corps - Crisis Corps Application
FORMS: NONE
OMB NO: 1212-0017 EXPIRATION DATE: 10/31/2004
RESPS:6 HOURS:72 COSTS(000):$72
Liability for Termination of Single-Employer Plans
FORMS: NONE
OMB NO: 1212-0020 EXPIRATION DATE: 11/30/2004
RESPS:1,411 HOURS:23 COSTS(000):$9
Termination of Multiemployer Plans (29 CFR Part 4041A)
FORMS: NONE
OMB NO: 1212-0021 EXPIRATION DATE: 11/30/2004
RESPS:24 HOURS:1 COSTS(000):$3
Variances for Sale of Assets (29 CFR Part 4204)
FORMS: NONE
OMB NO: 1212-0022 EXPIRATION DATE: 11/30/2004
RESPS:35 HOURS:8 COSTS(000):$5
Mergers and Transfers Between Multiemployer Plans (29 CFR Part
4231)
FORMS: NONE
OMB NO: 1212-0023 EXPIRATION DATE: 11/30/2004
RESPS:1 HOURS:1 COSTS(000):$3
Extension of Special Withdrawal Liability Rules (29 CFR Part
4203)
FORMS: NONE
OMB NO: 1212-0030 EXPIRATION DATE: 01/31/2006
RESPS:44 HOURS:41 COSTS(000):$0
Survey of Nonparticipating Single-Premium Group Annuity Rates
FORMS: NONE
OMB NO: 1212-0031 EXPIRATION DATE: 11/30/2004
RESPS:3 HOURS:1 COSTS(000):$0
Procedures for PBGC Approval of Plan Amendments (29 CFR Part
4220)
FORMS: NONE
OMB NO: 1212-0032 EXPIRATION DATE: 11/30/2004
RESPS:23,357 HOURS:1 COSTS(000):$115
Duties of Plan Sponsor Following Mass Withdrawal (29 CFR Part
4281)
FORMS: NONE
OMB NO: 1212-0033 EXPIRATION DATE: 11/30/2004
RESPS:838 HOURS:1 COSTS(000):$1
Notice of Insolvency (29 CFR Part 4245)
FORMS: NONE
OMB NO: 1212-0034 EXPIRATION DATE: 11/30/2004
RESPS:179 HOURS:4 COSTS(000):$5
Notice, Collection, and Redetermination of Withdrawal Liability
(29 CFR Part 4219)
FORMS: NONE
OMB NO: 3220-0099 EXPIRATION DATE: 06/30/2005
RESPS:100 HOURS:259 COSTS(000):$0
Statement Regarding contributions and Support
FORMS: G-134
OMB NO: 3220-0100 EXPIRATION DATE: 01/31/2006
RESPS:4,100 HOURS:1,025 COSTS(000):$0
Request for Review of Part B Medicare Claim
FORMS: G-790 G-791
OMB NO: 3220-0107 EXPIRATION DATE: 02/28/2006
RESPS:300 HOURS:150 COSTS(000):$0
Request to Non-Railroad Employer for Information About
Annuitant's Work and Earnings
FORMS: RL-231-F
OMB NO: 3220-0185 EXPIRATION DATE: 11/30/2004
RESPS:600 HOURS:100 COSTS(000):$0
Report of Medicaid State Office on Beneficiary's Buy-In Status
FORMS: RL-380-F
OMB NO: 3240-0017 EXPIRATION DATE: 08/31/2005
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: 3245-0071 EXPIRATION DATE: 04/30/2005
RESPS:5,200 HOURS:11,700 COSTS(000):$0
U.S. Small Business Administration Application for Section 504
Loan
FORMS: FORM-1244
OMB NO: 3245-0096 EXPIRATION DATE: 12/31/2005
RESPS:469 HOURS:1,876 COSTS(000):$0
Nomination for the Small Business Prime Contractor & Nomination
of the Small Business Subcontractor of the Year Award
FORMS: 1375 883
OMB NO: 3245-0124 EXPIRATION DATE: 03/31/2004
RESPS:500 HOURS:83 COSTS(000):$0
U.S. Small Business Administration Advisory Committee
Membership- Nominee Information
FORMS: SBAFORM898
OMB NO: 3245-0140 EXPIRATION DATE: 08/31/2004
RESPS:477 HOURS:34,191 COSTS(000):$0
SBA Form 1222-Notice of Award SBA Form 1224 Grant/Cooperative
Agreement Cost Sharing Proposal
FORMS: FORM-1222 FORM-1224
OMB NO: 3245-0141 EXPIRATION DATE: 10/31/2003
RESPS:63 HOURS:1,020 COSTS(000):$0
Prime Contracts Program Quarterly Report Part A and Part B
FORMS: 843A 843B
OMB NO: 3245-0212 EXPIRATION DATE: 12/31/2005
RESPS:5,000 HOURS:7,500 COSTS(000):$0
Secondary Market Assignment and Disclosure Form
FORMS: 1088
OMB NO: 3245-0213 EXPIRATION DATE: 08/31/2004
RESPS:475 HOURS:1,425 COSTS(000):$63
Application For Pool of Guaranteed Interest Certificates
FORMS: FORM-1454
OMB NO: 3245-0225 EXPIRATION DATE: 12/31/2003
RESPS:300 HOURS:2,400 COSTS(000):$0
Small Business Administration Application for Certificate of
Competency
FORMS: 1531
OMB NO: 3245-0270 EXPIRATION DATE: 12/31/2005
RESPS:13,884 HOURS:13,884 COSTS(000):$0
Representatives Used and Compensation Paid for Services in
Connection with Obtaining Federal Contracts
FORMS: 1790
OMB NO: 3245-0298 EXPIRATION DATE: 08/31/2003
RESPS:1,806 HOURS:68 COSTS(000):$0
Business Information Center Customer Satisfaction Survey
FORMS: FORM-1916(9-94)
OMB NO: 3245-0334 EXPIRATION DATE: 08/31/2004
RESPS:58 HOURS:29 COSTS(000):$0
Other Funding Under the SBDC Umbrella
FORMS: FORM-2186
OMB NO: 3245-0336 EXPIRATION DATE: 10/31/2004
RESPS:130 HOURS:120 COSTS(000):$0
Evaluation of State Efforts to Review and Alleviate State
Regulatory Burdens on Small Businesses
FORMS: NONE
OMB NO: 3245-0338 EXPIRATION DATE: 07/31/2005
RESPS:38 HOURS:91 COSTS(000):$37
NMVC Program Applicant Interview Questions: SSBIC Applicant
Tech, Proposal: Request for Approval of Management Services Fees
FORMS: 2215 2216 2217
OMB NO: 0960-0001 EXPIRATION DATE: 04/30/2004
RESPS:18,000 HOURS:4,500 COSTS(000):$0
Certification of Support
FORMS: SSA-760-F4
OMB NO: 0960-0002 EXPIRATION DATE: 06/30/2005
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
OMB NO: 0960-0003 EXPIRATION DATE: 11/30/2005
RESPS:5,000 HOURS:12,500 COSTS(000):$0
Application for Mother's or Father's Insurance Benefits - 20 CFR
404 Subparts D and G
FORMS: SSA-5-F6
OMB NO: 0960-0019 EXPIRATION DATE: 04/30/2004
RESPS:14,000 HOURS:2,333 COSTS(000):$0
Certificate of Responsibility for Welfare and Care of Child Not
in Applicant's Custody
FORMS: SSA-781
OMB NO: 0960-0034 EXPIRATION DATE: 03/31/2006
RESPS:150,000 HOURS:100,000 COSTS(000):$0
Letter to Employer Requesting Information About Wages Earned by
Beneficiary, 20 CFR 404703 and .801
FORMS: SSA-L725
OMB NO: 0960-0036 EXPIRATION DATE: 10/31/2004
RESPS:125,000 HOURS:37,500 COSTS(000):$0
Statement of Agricultural Employer (Year Prior to 1988);
Statement of Agricultural Employer (1988 & Later)
FORMS: SSA-1002 SSA-1003
OMB NO: 0960-0037 EXPIRATION DATE: 05/31/2004
RESPS:500,000 HOURS:1,000,000 COSTS(000):$0
Request for Waiver of Overpayment Recovery or Change in
Repayment Notice
FORMS: SSA-632-BK
OMB NO: 0960-0038 EXPIRATION DATE: 02/28/2006
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
OMB NO: 0960-0041 EXPIRATION DATE: 01/31/2006
RESPS:10 HOURS:1 COSTS(000):$0
Wage and Contributions Paid Prior to 1987 - 20 CFR, Subpart M,
404.1237 and .1249
FORMS: NONE
OMB NO: 0960-0045 EXPIRATION DATE: 08/31/2003
RESPS:305,500 HOURS:76,375 COSTS(000):$0
Statement of Claimant or Other Person
FORMS: SSA-795
OMB NO: 0960-0046 EXPIRATION DATE: 11/30/2003
RESPS:5,000 HOURS:417 COSTS(000):$0
Statement of Self-Employment Income
FORMS: SSA-766
OMB NO: 0960-0049 EXPIRATION DATE: 04/30/2003
RESPS:230,000 HOURS:24,167 COSTS(000):$0
Report to U.S. SSA by Person Receiving Benefits for a Child or
Adult Unable to Handle Funds; & Report to U.S. SSA
FORMS: SSA-7161-OCR-SM SSA-7162-OCR-SM
OMB NO: 0960-0050 EXPIRATION DATE: 02/29/2004
RESPS:20,000 HOURS:4,000 COSTS(000):$0
Questionnaire About Employment of Self-Employment Outside the
United States
FORMS: SSA-7163
OMB NO: 0960-0051 EXPIRATION DATE: 09/30/2003
RESPS:35,000 HOURS:2,917 COSTS(000):$0
Supplement to claim of Person Outside the United States
FORMS: SSA-221
OMB NO: 0960-0066 EXPIRATION DATE: 03/31/2004
RESPS:18,026,800 HOURS:1,991,667 COSTS(000):$7,376,339
Application for a Social Security Card/Enumeration At Birth
FORMS: SS-5
OMB NO: 0960-0086 EXPIRATION DATE: 08/31/2004
RESPS:20 HOURS:5 COSTS(000):$0
Chinese Custom Marriage Statement; Statement Regarding Chinese
Custom Marriage
FORMS: SSA-1344 SSA-1345
OMB NO: 0960-0088 EXPIRATION DATE: 02/28/2006
RESPS:75,000 HOURS:7,500 COSTS(000):$0
Student Reporting Form - 20 CFR, 404, Subparts D & E and 20 CFR,
422, Subpart B
FORMS: SSA-1383
OMB NO: 0960-0090 EXPIRATION DATE: 02/28/2005
RESPS:5,000 HOURS:833 COSTS(000):$0
SSA-1371, Statement by School Official About Student's
Attendance, and SSA-1371-FC, Statement to U.S. Social Security
Administration (SSA) By School Outside the United States......
FORMS: SSA-1371-BK SSA-1731-FC
OMB NO: 0960-0093 EXPIRATION DATE: 09/30/2003
RESPS:180 HOURS:45 COSTS(000):$0
Certification by Religious Group
FORMS: SSA-1458
OMB NO: 0960-0096 EXPIRATION DATE: 11/30/2003
RESPS:10 HOURS:3 COSTS(000):$0
Application for Special Age-72-or-Over
FORMS: SSA-19-F6
OMB NO: 0960-0097 EXPIRATION DATE: 11/30/2003
RESPS:18,000 HOURS:3,600 COSTS(000):$0
Application for Search of Census Record for Proof of Age
FORMS: SSA-1535
OMB NO: 0960-0098 EXPIRATION DATE: 07/31/2003
RESPS:140,000 HOURS:35,000 COSTS(000):$0
Request for Workers' Compensation/Public Disability Information
FORMS: SSA-1709
OMB NO: 0960-0101 EXPIRATION DATE: 06/30/2003
RESPS:300,000 HOURS:50,000 COSTS(000):$0
Claim for Amounts Due in the Case of a Deceased Beneficiary
FORMS: SSA-1724
OMB NO: 0960-0102 EXPIRATION DATE: 01/31/2005
RESPS:12,000 HOURS:6,000 COSTS(000):$0
Medical Report (Individual with Childhood Impairment)
FORMS: SSA-3827
OMB NO: 0960-0103 EXPIRATION DATE: 07/31/2004
RESPS:1,000 HOURS:1,000 COSTS(000):$0
Supplemental Statement Regarding Farming Activities of Persons
Living Outside the U.S.A.
FORMS: SSA-7163A-F4
OMB NO: 0960-0104 EXPIRATION DATE: 09/30/2003
RESPS:34,624 HOURS:17,312 COSTS(000):$0
Petition to Obtain Approval of a Fee for Representing a Claimant
Before the Social Security Administration
FORMS: SSA-1560-U4
OMB NO: 0960-0105 EXPIRATION DATE: 01/31/2004
RESPS:200,000 HOURS:33,333 COSTS(000):$0
Advance Notice of Termination of Child's Benefits, and Student's
Statement Regarding School Attendance
FORMS: SSA-1372
OMB NO: 0960-0109 EXPIRATION DATE: 09/30/2003
RESPS:130,000 HOURS:21,667 COSTS(000):$0
Statement of Care and Responsibility for Beneficiary
FORMS: SSA-788
OMB NO: 0960-0110 EXPIRATION DATE: 07/31/2003
RESPS:125 HOURS:125 COSTS(000):$0
State Mental Institution Policy Review--20 CFR 404 Subpart U and
416 Subpart F, Representative Payment
FORMS: SSA-9584-BK
OMB NO: 0960-0112 EXPIRATION DATE: 04/30/2004
RESPS:8,000 HOURS:2,000 COSTS(000):$0
Report by Former Representative Payee
FORMS: SSA-625
OMB NO: 0960-0118 EXPIRATION DATE: 04/30/2004
RESPS:300 HOURS:165 COSTS(000):$0
Application for Benefits Under The Federal Mine Safety and and
Dependent's Claim
FORMS: SSA-47-F4 SSA-48-F4 SSA-49-F3
OMB NO: 0960-0120 EXPIRATION DATE: 04/30/2004
RESPS:12,000 HOURS:2,000 COSTS(000):$0
Pre-1957 Military Service Federal Benefit Questionnaire
FORMS: SSA-2512
OMB NO: 0960-0124 EXPIRATION DATE: 04/30/2003
RESPS:355,000 HOURS:147,917 COSTS(000):$0
Statement of Income and Resources
FORMS: SSA-8010-BK
OMB NO: 0960-0174 EXPIRATION DATE: 04/30/2003
RESPS:438,400 HOURS:51,147 COSTS(000):$0
Statement of Living Arrangement, In-Kind Support and Maintenance
FORMS: SSA-8006-F4
OMB NO: 0960-0184 EXPIRATION DATE: 05/31/2003
RESPS:189 HOURS:2,646 COSTS(000):$0
Instructions for Completion of Federal Assistance Application
FORMS: SSA-96
OMB NO: 0960-0189 EXPIRATION DATE: 10/31/2004
RESPS:5,475 HOURS:2,521 COSTS(000):$0
RSI/DI Quality Review Case Analysis-Sampled Number Holder,
Auxiliaries/Survivors, Parent, Stewardship AET Workbook
FORMS: SSA-2930 2931 2932 4659
OMB NO: 0960-0229 EXPIRATION DATE: 03/31/2004
RESPS:1,249,933 HOURS:732,252 COSTS(000):$0
Application for Supplemental Security Income
FORMS: 8000-BK-20CFR SUBPARTC 416.305-.335
OMB NO: 0960-0269 EXPIRATION DATE: 11/30/2004
RESPS:556,000 HOURS:92,666 COSTS(000):$0
Request for Hearing by Administrative Law Judge
FORMS: HA-501
OMB NO: 0960-0274 EXPIRATION DATE: 10/31/2004
RESPS:50,000 HOURS:4,167 COSTS(000):$0
Report of Student Beneficiary About to Attain Age 19
FORMS: SSA-1390
OMB NO: 0960-0277 EXPIRATION DATE: 02/28/2005
RESPS:80,000 HOURS:13,333 COSTS(000):$0
Request for Review of Hearing Decision/Order
FORMS: HA-520
OMB NO: 0960-0282 EXPIRATION DATE: 03/31/2006
RESPS:8,000 HOURS:2,000 COSTS(000):$0
Vocational Rehabilitation "301" Program Development - 20 CFR,
Subpart D, Subpart P, Subpart M, and Subpart N
FORMS: SSA-4290
OMB NO: 0960-0284 EXPIRATION DATE: 08/31/2004
RESPS:12,000 HOURS:400 COSTS(000):$0
Waiver of Your Right to Personal Appearance before an
Administrative Law Judge
FORMS: HA-4608
OMB NO: 0960-0288 EXPIRATION DATE: 04/30/2004
RESPS:10,548 HOURS:879 COSTS(000):$0
Notice Regarding Substitution of Party Upon Death of Claimant
FORMS: HA-539
OMB NO: 0960-0293 EXPIRATION DATE: 10/31/2004
RESPS:500,000 HOURS:50,000 COSTS(000):$0
Authorization for SSA to Obtain Account Records from a Financial
Institution and Request for Records
FORMS: SSA-4641-U2
OMB NO: 0960-0300 EXPIRATION DATE: 11/30/2005
RESPS:120,000 HOURS:30,000 COSTS(000):$0
Claimnet's Work Background - 20 CFR 404 Subpart O and 20 CFR 416
Subpart I
FORMS: HA-4633
OMB NO: 0960-0316 EXPIRATION DATE: 03/31/2004
RESPS:442,720 HOURS:110,680 COSTS(000):$0
Claimant's Statement When Request for Hearing is Filed and the
Issue is Disability
FORMS: HA-4486
OMB NO: 0960-0323 EXPIRATION DATE: 06/30/2003
RESPS:90,500 HOURS:7,542 COSTS(000):$0
Third Party Liability Information Statement
FORMS: SSA-8019-U2
OMB NO: 0960-0341 EXPIRATION DATE: 03/31/2005
RESPS:2,400 HOURS:80 COSTS(000):$0
Request for Address Information from Motor Vehicles Records;
Request for Address Information from Employment Commissions
Records
FORMS: SSA-L711 SSA-L712
OMB NO: 0960-0347 EXPIRATION DATE: 07/31/2004
RESPS:1,925 HOURS:963 COSTS(000):$0
Response to Notice of Revised Determination
FORMS: SSSA-765
OMB NO: 0960-0348 EXPIRATION DATE: 10/31/2004
RESPS:7,483 HOURS:998 COSTS(000):$0
Request for Change in Time/Place of Disability Hearing
FORMS: SSA-769
OMB NO: 0960-0351 EXPIRATION DATE: 08/31/2004
RESPS:1,200 HOURS:100 COSTS(000):$0
Notice Regarding Substitution of Party Upon Death of Claimant
Reconsideration of Disability Cessation
FORMS: SSA-770
OMB NO: 0960-0371 EXPIRATION DATE: 03/31/2005
RESPS:1,000 HOURS:250 COSTS(000):$0
Application for U.S. Benefits Under the Canada-U.S.
International Social Security Agreement
FORMS: SSA-1294
OMB NO: 0960-0384 EXPIRATION DATE: 09/30/2003
RESPS:208 HOURS:1,248 COSTS(000):$0
SSA/DDS Cost-Effectiveness Measurement System (CEMS) Data
Reporting form
FORMS: SSA-1461
OMB NO: 0960-0416 EXPIRATION DATE: 10/31/2003
RESPS:920,000 HOURS:291,333 COSTS(000):$0
Statement for Determining Continuing Eligibiity for Supplemental
Security Income Payments
FORMS: SSA-8203-BK
OMB NO: 0960-0421 EXPIRATION DATE: 06/30/2004
RESPS:648 HOURS:756 COSTS(000):$0
State Agency Report of Obligations for SSA Disability Programs
and Addendum; Time Report of Personnel Services for Disability
Determination Services & State Agency Schedule of Equipment.....
FORMS: SSA-4514 SSA-871 SSA-4513
OMB NO: 0960-0425 EXPIRATION DATE: 12/31/2005
RESPS:484 HOURS:434 COSTS(000):$0
Coverage of Employees of State and Local Governments - 20 CFR,
Subpart M
FORMS: NONE
OMB NO: 0960-0445 EXPIRATION DATE: 09/30/2004
RESPS:200 HOURS:67 COSTS(000):$0
Application for Benefits under the Italy-US International Social
Security Agreement
FORMS: SSA-2528
OMB NO: 0960-0448 EXPIRATION DATE: 07/31/2005
RESPS:22,000 HOURS:11,000 COSTS(000):$0
Application for Benefits Under a U.S. International Social
Security Agreement
FORMS: SSA-2490
OMB NO: 0960-0451 EXPIRATION DATE: 03/31/2006
RESPS:9,000 HOURS:750 COSTS(000):$0
Permanent Residence Under Color of Law - 20 CFR, Subpart P,
416.1615 and .1618
FORMS: NONE
OMB NO: 0960-0454 EXPIRATION DATE: 10/31/2005
RESPS:49,000 HOURS:8,167 COSTS(000):$0
Letter to Landlord Requesting Rental Information
FORMS: SSA-L5061
OMB NO: 0960-0456 EXPIRATION DATE: 02/29/2004
RESPS:400,000 HOURS:100,000 COSTS(000):$0
Statement of Household Expenses and Contributions
FORMS: SSA-8011-F3
OMB NO: 0960-0481 EXPIRATION DATE: 04/30/2003
RESPS:40,000 HOURS:6,667 COSTS(000):$0
Statement of Funds You Provided to Another, Statement of Funds
You Received
FORMS: 2854 2855
OMB NO: 0960-0492 EXPIRATION DATE: 06/30/2004
RESPS:50,000 HOURS:4,167 COSTS(000):$0
Request for Supplemental Security Income Benefit Estimate
FORMS: SSA-3716
OMB NO: 0960-0499 EXPIRATION DATE: 04/30/2004
RESPS:272,000 HOURS:136,000 COSTS(000):$0
Questionnaire for Children Claiming SSI Benefits
FORMS: SSA-3881
OMB NO: 0960-0500 EXPIRATION DATE: 01/31/2006
RESPS:59,100 HOURS:9,850 COSTS(000):$0
Medical Report on Adult with Allegation of HIV Infection;
Medical Report on Child with Allegation of HIV Infection
FORMS: SSA-4814-F5 SSA-4815-F6
OMB NO: 0960-0516 EXPIRATION DATE: 10/31/2003
RESPS:60,000 HOURS:5,000 COSTS(000):$0
Continuation of Full Benefit Standard for Persons
Institutionalized - 20 CFR Subpart B 416.212
FORMS: NONE
OMB NO: 0960-0525 EXPIRATION DATE: 11/30/2004
RESPS:61,494 HOURS:11,274 COSTS(000):$0
Request for Social Security Earnings Information
FORMS: SSA-7050-F4
OMB NO: 0960-0526 EXPIRATION DATE: 04/30/2003
RESPS:31,514 HOURS:113,775 COSTS(000):$0
Voluntary Customer Surveys in Accordance with E.O. 12862
FORMS: NONE
OMB NO: 0960-0529 EXPIRATION DATE: 11/30/2003
RESPS:131,080 HOURS:21,847 COSTS(000):$0
Claimant's Statement About Loan of Food or Shelter & Statement
About Food or Shelter Provided to Another
FORMS: SSA-5062 SSA-L5063
OMB NO: 0960-0534 EXPIRATION DATE: 12/31/2003
RESPS:194 HOURS:49 COSTS(000):$0
Waiver of Right to Appear, Disability Hearing
FORMS: SSA-773-U4
OMB NO: 0960-0542 EXPIRATION DATE: 08/31/2004
RESPS:750,000 HOURS:250,000 COSTS(000):$0
Function Report, Child (Birth to 1st, Age 1 to 3rd, Age 3 to
6th, Age 6 to 12th, Age 12 to 18th Birthday)
FORMS: SSA-3375 3376 3377 3378 3379
OMB NO: 0960-0544 EXPIRATION DATE: 10/31/2005
RESPS:24,000 HOURS:400 COSTS(000):$0
Public Information Campaign Collection
FORMS: NONE
OMB NO: 0960-0546 EXPIRATION DATE: 11/30/2005
RESPS:100,000 HOURS:16,666 COSTS(000):$0
Supplemental Security Income Notice of Interim Assistance
Reimbursement
FORMS: SSA-8125 SSA-L8125-F4
OMB NO: 0960-0547 EXPIRATION DATE: 08/31/2004
RESPS:600 HOURS:300 COSTS(000):$0
Wage Reports and Pension Information (20 CFR 422.122(b))
FORMS: NONE
OMB NO: 0960-0555 EXPIRATION DATE: 08/31/2003
RESPS:13,156,166 HOURS:3,289,293 COSTS(000):$0
Generic Clearance of Information Collections Conducted by State
Disability Determinations Services on Behalf of SSA
FORMS: NONE
OMB NO: 0960-0565 EXPIRATION DATE: 02/28/2005
RESPS:30,000 HOURS:10,010 COSTS(000):$0
Employer Report of Special Wage Payments
FORMS: SSA-131
OMB NO: 0960-0566 EXPIRATION DATE: 08/31/2003
RESPS:2,228,500 HOURS:119,133 COSTS(000):$0
Privacy and Disclosure of Official Records and Information;
Availability of Information and Records to the Public; 20-CFR
401 & 402
FORMS: SSA-3288
OMB NO: 0960-0575 EXPIRATION DATE: 03/31/2004
RESPS:550,000 HOURS:18,334 COSTS(000):$0
Request to Resolve Questionable Quarters of Coverage (QC);
Request for QC History Based on Relationship
FORMS: SSA-512 SSA-513
OMB NO: 0960-0576 EXPIRATION DATE: 03/31/2004
RESPS:30,000 HOURS:10,000 COSTS(000):$0
Representative Payee Report of Benefits and Dedicated Account
FORMS: SSA-6233
OMB NO: 0960-0602 EXPIRATION DATE: 06/30/2005
RESPS:60,000 HOURS:2,000 COSTS(000):$0
Authorization To Obtain Earnings Data for The Social Security
Administration
FORMS: SSA-581
OMB NO: 0960-0615 EXPIRATION DATE: 06/30/2003
RESPS:12,000 HOURS:4,000 COSTS(000):$0
Application for Special Benefits for World War II Veterans
FORMS: SSA-2000
OMB NO: 0960-0616 EXPIRATION DATE: 08/31/2003
RESPS:189 HOURS:1,137 COSTS(000):$0
Notice of Proposed Rulemaking, 20 CFR Part 435, Uniform
FORMS: NONE
OMB NO: 0960-0617 EXPIRATION DATE: 06/30/2003
RESPS:1,000 HOURS:17 COSTS(000):$0
Denial of Supplemental Security Income Benefits for Fugitive
Felons and Probation and Parole Violators
FORMS: NONE
OMB NO: 0960-0623 EXPIRATION DATE: 02/29/2004
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: 0960-0626 EXPIRATION DATE: 11/30/2003
RESPS:250,040 HOURS:8,335 COSTS(000):$0
Integrated Registration for Employers and Submitters (IRES)
FORMS: NONE
OMB NO: 0960-0627 EXPIRATION DATE: 09/30/2003
RESPS:2,226 HOURS:446 COSTS(000):$0
Employment Support Representative Position (ESR): Survey of
Beneficiaries and Community Organizations
FORMS: NONE
OMB NO: 0960-0628 EXPIRATION DATE: 01/31/2004
RESPS:9,857 HOURS:9,519 COSTS(000):$0
Survey of Low-Income and Disabled Kids (SOLID KIDS)
FORMS: NONE
OMB NO: 0960-0639 EXPIRATION DATE: 10/31/2004
RESPS:200 HOURS:50 COSTS(000):$0
Contact with Rep Payee, Contact with Beneficiary
FORMS: SSA-L4945U2 SSA-L4947U2
OMB NO: 0960-0641 EXPIRATION DATE: 06/30/2005
RESPS:31,492 HOURS:5,915 COSTS(000):$0
1. State Agency Ticket Assignment Form. 2. State Vocational
Rehabilitation Ticket to Work Information Sheet and 3.
Individual Work Plans (IWP) Information Sheet
FORMS: SSA-1365 SSA-1366 SSA-1367
OMB NO: 0960-0642 EXPIRATION DATE: 12/31/2004
RESPS:1 HOURS:1 COSTS(000):$0
Listing of Impairments, Part 404, Subpart P, Appendix 1
FORMS: NONE
OMB NO: 0960-0643 EXPIRATION DATE: 10/31/2004
RESPS:55,000 HOURS:18,333 COSTS(000):$0
Statement for Determining Continuing Eligibility for
Supplemental Security Income (SSI) Payments-Adult Statement for
Determining Continuing Eligiblity for SSI payments - Child
FORMS: SSA-3988(TEST) SSA-3989(TEST)
OMB NO: 0960-0644 EXPIRATION DATE: 12/31/2004
RESPS:172,202 HOURS:201,680 COSTS(000):$0
The Ticket to Work and Self-Sufficiency Program
FORMS: NONE
OMB NO: 0960-0646 EXPIRATION DATE: 02/28/2005
RESPS:952,000 HOURS:277,416 COSTS(000):$0
National Teacher Questionnaire; Request for Administrative
Information
FORMS: SSA-5665-BK SSA-5666
OMB NO: 0960-0653 EXPIRATION DATE: 09/30/2003
RESPS:1 HOURS:1 COSTS(000):$0
20 CFR 416.570 and 416.572, Collection of SSI Overpayments from
Special Benefits for Certain WWII Vets
FORMS: NONE
OMB NO: 0960-0656 EXPIRATION DATE: 08/31/2003
RESPS:2,100 HOURS:1,575 COSTS(000):$0
Survey of Income and Program Participation (SIPP) for SSA
Beneficiaries
FORMS: NONE
OMB NO: 0960-0658 EXPIRATION DATE: 11/30/2005
RESPS:1,487 HOURS:478 COSTS(000):$0
Benefits for Certain World War II Veterans, 20 CFR 408 Subparts
B, C an D
FORMS: NONE
OMB NO: 0960-0660 EXPIRATION DATE: 12/31/2004
RESPS:1,000 HOURS:83 COSTS(000):$0
Social Security Number Verification Service (SSNVS)
FORMS: NONE
OMB NO: 9000-0001 EXPIRATION DATE: 10/31/2004
RESPS:715 HOURS:286 COSTS(000):$0
Standard Form 28, Affidavit of Individual Surety-FAR Sections
Affected: 28.106(e); 28.203(b); 53.228(e)
FORMS: 28
OMB NO: 9000-0004 EXPIRATION DATE: 10/31/2003
RESPS:35,000 HOURS:35,000 COSTS(000):$2,450,000
Architect-Engineer and Related Services Questionnaire, SF 254 -
FAR Sections Affected: Subpart 36.6 and 36.7; 53.236-2
FORMS: NONE
OMB NO: 9000-0005 EXPIRATION DATE: 10/31/2003
RESPS:20,000 HOURS:24,000 COSTS(000):$1,680,000
Architect-Engineer and Related Services Questionnaire for
Specific Project, SF 255 - 36.702(b)(2) and 53.236-2
FORMS: SF-255
OMB NO: 9000-0031 EXPIRATION DATE: 05/31/2005
RESPS:2,100 HOURS:525 COSTS(000):$22,050
Contractor Use of Government Supply Sources - FAR Sections
Affected: (Subpart 51.1 and 52.251-1)
FORMS: NONE
OMB NO: 9000-0032 EXPIRATION DATE: 05/31/2005
RESPS:140 HOURS:70 COSTS(000):$2,940
Contractor Use of Interagency Motor Pool Vehicles - FAR Sections
Affected: (Subpart 51.2 and 52.251-2)
FORMS: NONE
OMB NO: 9000-0034 EXPIRATION DATE: 11/30/2003
RESPS:382,840 HOURS:63,934 COSTS(000):$0
Examination of Records by Comptroller General and Contract
Audit; 52.215-2; 52.212-5; 52.214-26
FORMS: NONE
OMB NO: 9000-0035 EXPIRATION DATE: 04/30/2005
RESPS:13,500 HOURS:13,500 COSTS(000):$567,000
Claims and Appeals - FAR Sections Affected: Parts 32 and 33 and
52.233-1
FORMS: NONE
OMB NO: 9000-0037 EXPIRATION DATE: 10/31/2004
RESPS:42,480 HOURS:7,094 COSTS(000):$0
Presolicitation Notice and Response, Standard form 1417: FAR
Sections Affected: 14.205-4(c); 15.201-c; 36.301; 36.701(a); and
53.236-1(a)
FORMS: NONE
OMB NO: 9000-0038 EXPIRATION DATE: 04/30/2005
RESPS:4,673 HOURS:2,337 COSTS(000):$98,154
Mistakes in Bids - FAR Section Affected: 14.407 through 14.407-4
FORMS: NONE
OMB NO: 9000-0039 EXPIRATION DATE: 04/30/2005
RESPS:7,509 HOURS:1,254 COSTS(000):$56,028
Description Literature - FAR Section Affected: 14.202-5
FORMS: NONE
OMB NO: 9000-0043 EXPIRATION DATE: 03/31/2005
RESPS:17,200 HOURS:2,872 COSTS(000):$120,624
Delivery Schedules - FAR Sections Affected: 52.211-8 and 52.211-9
FORMS: NONE
OMB NO: 9000-0054 EXPIRATION DATE: 08/31/2005
RESPS:300 HOURS:75 COSTS(000):$3
U.S. Flag Air Carriers Certification - FAR Sections Affected:
47.405 and 52.247-63
FORMS: NONE
OMB NO: 9000-0114 EXPIRATION DATE: 09/30/2003
RESPS:130 HOURS:440 COSTS(000):$30
Right of First Refusal of Employment FAR Sections Affected:
FORMS: NONE
OMB NO: 9000-0115 EXPIRATION DATE: 11/30/2003
RESPS:100 HOURS:125 COSTS(000):$0
Notification of Ownership Changes FAR Section Affected:
15.408(k); 52.215-19
FORMS: NONE
OMB NO: 9000-0122 EXPIRATION DATE: 05/31/2004
RESPS:5,140 HOURS:2,285 COSTS(000):$0
Scope and Duration of Contract -- FAR Sections Affected: 52.241-3
FORMS: NONE
OMB NO: 9000-0123 EXPIRATION DATE: 06/30/2004
RESPS:5,140 HOURS:2,285 COSTS(000):$0
Change in Rates or Terms and Condiitons of Service for Regulated
Services -- FAR Sections Affected: 52.241-7
FORMS: NONE
OMB NO: 9000-0124 EXPIRATION DATE: 06/30/2004
RESPS:450 HOURS:900 COSTS(000):$0
Capital Credits - FAR Clause 52.241-13 FAR Sections Affected:
52.241-13
FORMS: NONE
OMB NO: 9000-0125 EXPIRATION DATE: 06/30/2004
RESPS:50 HOURS:25 COSTS(000):$0
Written Refusal of a Utility Supplier to Execute a Utility
Contract FAR Sections Affected: 41.202(c)
FORMS: NONE
OMB NO: 9000-0126 EXPIRATION DATE: 06/30/2004
RESPS:500 HOURS:225 COSTS(000):$0
Electric Service Territory Compliance Representation -- FAR
Sections affected: 52.241
FORMS: NONE
OMB NO: 9000-0144 EXPIRATION DATE: 09/30/2005
RESPS:140,000 HOURS:70,000 COSTS(000):$0
Payment by Electronic Fund Transfer
FORMS: NONE
OMB NO: 9000-0145 EXPIRATION DATE: 04/30/2003
RESPS:201,600 HOURS:4,147 COSTS(000):$106,494
use of data universal numbering system (DuNS) as Primary
52.204-6, 52.212-1)j)
FORMS: SF-294 SF-295
OMB NO: 9000-0147 EXPIRATION DATE: 07/31/2003
RESPS:19,500 HOURS:14,500 COSTS(000):$0
Pollution Prevention and Right-to-Know Information FAR Sections
Affected: Subpart 23.10 and 52.223-5
FORMS: NONE
OMB NO: 9000-0155 EXPIRATION DATE: 10/31/2004
RESPS:1 HOURS:250 COSTS(000):$6,750
Prohibition on Acquisition of Products Produced by Forced or
Indentured Child Labor (FAR 22.15)
FORMS: NONE
OMB NO: 9000-0156 EXPIRATION DATE: 10/31/2004
RESPS:75 HOURS:18 COSTS(000):$0
Trademarks for Government Products and Services - FAR Sections
Affected: Subpart 27.X; 52.227-XX
FORMS: NONE
OMB NO: 9000-0157 EXPIRATION DATE: 10/31/2003
RESPS:20,000 HOURS:580,000 COSTS(000):$0
Consolidated Form for Selection of Architect-Engineer Contracts
FORMS: SF-330