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: 0412-0571 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
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
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: 3045-0045 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: 3045-0078 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: 3045-0091 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: 3045-0097 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: 3045-0110 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: 3045-0115 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
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
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: 3048-0019 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
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
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: 3090-0204 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: 3090-0274 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: 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
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: 2700-0085 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: 2700-0093 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: 2700-0107 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: 2700-0119 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
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: 3095-0012 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: 3095-0024 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: 3095-0027 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: 3095-0037 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: 3095-0039 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: 3095-0062 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
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: 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
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: 3145-0023 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: 3145-0100 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: 3145-0141 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: 3145-0197 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
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: 3209-0007 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
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
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
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: 3206-0042 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: 3206-0134 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: 3206-0143 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: 3206-0156 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: 3206-0170 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: 3206-0174 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: 3206-0187 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: 3206-0197 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: 3206-0215 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: 3206-0232 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: 3206-0237 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
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: 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: 0420-0510 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: 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: 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: 3220-0099 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: 3220-0185 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: 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: 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: 3245-0096 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: 3245-0124 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: 3245-0212 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: 3245-0313 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: 3245-0351 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
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: 0960-0019 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: 0960-0034 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: 0960-0049 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: 0960-0071 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: 0960-0093 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: 0960-0103 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: 0960-0174 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: 0960-0282 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: 0960-0293 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: 0960-0341 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: 0960-0348 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: 0960-0416 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: 0960-0442 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: 0960-0481 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: 0960-0499 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: 0960-0505 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: 0960-0516 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: 0960-0542 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: 0960-0555 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: 0960-0565 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: 0960-0575 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: 0960-0602 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: 0960-0612 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: 0960-0622 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: 0960-0632 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: 0960-0656 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: 0960-0658 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: 0960-0679 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: 0960-0683 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: 0960-0692 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: 0960-0702 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: 0960-0709 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: 0960-0716 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: 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: 9000-0053 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: 9000-0113 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: 9000-0139 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: 9000-0144 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