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OMB NO: 4040-0001 EXPIRATION DATE: 03/31/2005 RESPS:312,500 HOURS:12,500,000 COSTS(000):$0 SF-424 Research and Related (R&R;) FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
1 312,500 12,500,000 $0
(RETURN TO AGENCY LIST)
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: 10/31/2006 RESPS:85 HOURS:1,220 COSTS(000):$0 Application for Assistance - American Schools and Hospitals FORMS: 1010-2(11/91)
OMB NO: 0412-0012 EXPIRATION DATE: 08/31/2005 RESPS:2,400 HOURS:1,200 COSTS(000):$0 Supplier's Certificate and Agreement with U.S. Agency for International Development/Invoice and Contract Abstact FORMS: 282
OMB NO: 0412-0014 EXPIRATION DATE: 04/30/2006 RESPS:200 HOURS:3,200 COSTS(000):$0 Voluntary Agency Quarterly Report of Shipping Activity FORMS: 1550-6
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: 0412-0510 EXPIRATION DATE: 04/30/2005 RESPS:1,100 HOURS:37,437 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: 0412-0552 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: 10/31/2004 RESPS:15,720 HOURS:2,630 COSTS(000):$0 Training Results and Information Network (TraiNet) FORMS: NONE
OMB NO: 0412-0555 EXPIRATION DATE: 05/31/2006 RESPS:240 HOURS:24 COSTS(000):$0 Monthly Commodity Status Report/Monthly Recipient Status Report FORMS: NONE
OMB NO: 0412-0556 EXPIRATION DATE: 05/31/2006 RESPS:20 HOURS:240 COSTS(000):$0 Monetization Report FORMS: NONE
OMB NO: 0412-0557 EXPIRATION DATE: 05/31/2006 RESPS:20 HOURS:480 COSTS(000):$0 Annual Results Report FORMS: NONE
OMB NO: 0412-0562 EXPIRATION DATE: 06/30/2007 RESPS:380 HOURS:30,600 COSTS(000):$0 Narrative/Time-Line (NTL) Report FORMS: 1570-13
OMB NO: 0412-0563 EXPIRATION DATE: 06/30/2007 RESPS:1,120 HOURS:30,600 COSTS(000):$0 Report on Commodities FORMS: 1570-14
OMB NO: 0412-0565 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: 0412-0566 EXPIRATION DATE: 04/30/2006 RESPS:450 HOURS:150 COSTS(000):$0 PVO Classification Form FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
15 29,105 111,056 $341
(RETURN TO AGENCY LIST)
OMB NO: 3112-0001 EXPIRATION DATE: 12/31/2006 RESPS:748 HOURS:542 COSTS(000):$0 Surveys and other audiences research for Radio and TV Marti FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
1 748 542 $0
(RETURN TO AGENCY LIST)
OMB NO: 3037-0001 EXPIRATION DATE: 03/31/2006 RESPS:77 HOURS:231 COSTS(000):$0 Annual Certification - Qualified Nonprofit Agency Serving People Who are Blind FORMS: 403
OMB NO: 3037-0002 EXPIRATION DATE: 03/31/2006 RESPS:565 HOURS:1,695 COSTS(000):$0 Annual Certification - Qualified Nonprofit Agency Serving People who are Severly Disabled. FORMS: 404
OMB NO: 3037-0003 EXPIRATION DATE: 03/31/2005 RESPS:50 HOURS:50 COSTS(000):$0 Committee Form 402 -- Initial Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled FORMS: 402
OMB NO: 3037-0004 EXPIRATION DATE: 03/31/2005 RESPS:5 HOURS:5 COSTS(000):$0 Committee form 401 -- Initial Certification - Qualified Nonprofit Agency Serving Peiple Who Are Blind FORMS: 401
OMB NO: 3037-0005 EXPIRATION DATE: 01/31/2005 RESPS:650 HOURS:3,250 COSTS(000):$0 Nonprofit Agency Responsibilities FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
5 1,347 5,231 $0
(RETURN TO AGENCY LIST)
OMB NO: 3045-0005 EXPIRATION DATE: 10/31/2004 RESPS:500 HOURS:1,000 COSTS(000):$0 AmericCorps*NCCC Team Leader Application FORMS: NONE
OMB NO: 3045-0006 EXPIRATION DATE: 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:9,000 COSTS(000):$135,000 AmeriCorps*National Civilian Community Corps Service Project Application FORMS: NONE
OMB NO: 3045-0014 EXPIRATION DATE: 10/31/2004 RESPS:55,000 HOURS:4,585 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: 05/31/2005 RESPS:1,300 HOURS:2,166 COSTS(000):$0 Forbearance Request for National Service Form FORMS: NONE
OMB NO: 3045-0033 EXPIRATION DATE: 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: 03/31/2005 RESPS:1,513 HOURS:2,279 COSTS(000):$0 National Senior Service Corps Grant Application FORMS: 424-NSSC
OMB NO: 3045-0038 EXPIRATION DATE: 03/31/2005 RESPS:1,200 HOURS:7,400 COSTS(000):$10 AmeriCorps*VISTA 2003 Application Instructions FORMS: NONE
OMB NO: 3045-0043 EXPIRATION DATE: 05/31/2005 RESPS:4,800 HOURS:9,600 COSTS(000):$0 AmeriCorps*VISTA Project Progress Report FORMS: CNCS-1433
OMB NO: 3045-0045 EXPIRATION DATE: 04/30/2005 RESPS:225 HOURS:2,288 COSTS(000):$0 Learn and Serve America School- and Communty-Based Application 2003 Instructions FORMS: NONE
OMB NO: 3045-0046 EXPIRATION DATE: 04/30/2005 RESPS:400 HOURS:2,467 COSTS(000):$0 Learn and Serve America Higher Education Application 2003 Instructions FORMS: NONE
OMB NO: 3045-0047 EXPIRATION DATE: 03/31/2005 RESPS:2,000 HOURS:20,334 COSTS(000):$0 AmeriCorps National, State and Indian Tribes and U.S. Territories 2003 Application Instructions FORMS: NONE
OMB NO: 3045-0049 EXPIRATION DATE: 04/30/2007 RESPS:2,500 HOURS:1,875 COSTS(000):$48,825 Accomplishment Surveys for Senior Corps Programs FORMS: NONE
OMB NO: 3045-0053 EXPIRATION DATE: 05/31/2005 RESPS:13,000 HOURS:1,083 COSTS(000):$0 Interest Accrual Form (Interest Accrued During National SVC) FORMS: NONE
OMB NO: 3045-0054 EXPIRATION DATE: 10/31/2005 RESPS:60,000 HOURS:45,117 COSTS(000):$0 AmeriCorps Member Application FORMS: NONE
OMB NO: 3045-0065 EXPIRATION DATE: 03/31/2005 RESPS:300 HOURS:2,450 COSTS(000):$0 AmeriCorps Education Awards Program 2003 Application Instructions FORMS: NONE
OMB NO: 3045-0073 EXPIRATION DATE: 03/31/2005 RESPS:41 HOURS:1,032 COSTS(000):$0 AmeriCorps Promise Fellows Program 2003 Continuation Request Instructions FORMS: NONE
OMB NO: 3045-0077 EXPIRATION DATE: 10/31/2005 RESPS:10,000 HOURS:500 COSTS(000):$0 Volunteer Service Hour Tracking Tool 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:4,067 COSTS(000):$0 Innovative and Demonstration Program 2003 Application Instructions 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: 01/31/2005 RESPS:400 HOURS:4,000 COSTS(000):$0 Next Generation Grant 2003 Concept Paper and Application Instructions FORMS: NONE
OMB NO: 3045-0088 EXPIRATION DATE: 03/31/2007 RESPS:6,000 HOURS:2,000 COSTS(000):$0 Presidential Freedom Scholarships FORMS: NONE
OMB NO: 3045-0089 EXPIRATION DATE: 03/31/2007 RESPS:266 HOURS:532 COSTS(000):$15,960 Learn and Serve America Grantee Performance Report FORMS: NONE
OMB NO: 3045-0090 EXPIRATION DATE: 11/30/2004 RESPS:1 HOURS:7,500 COSTS(000):$0 Peer Reviewer Application FORMS: NONE
OMB NO: 3045-0091 EXPIRATION DATE: 10/31/2004 RESPS:200 HOURS:600 COSTS(000):$9,900 Spirit Service Awards Nomination Guidelines and Application - Senior Corps FORMS: NONE
OMB NO: 3045-0092 EXPIRATION DATE: 10/31/2004 RESPS:200 HOURS:600 COSTS(000):$9,900 Spirit of Service Awards Nomination Guidelines and Application - AmeriCorps FORMS: NONE
OMB NO: 3045-0093 EXPIRATION DATE: 10/31/2004 RESPS:200 HOURS:600 COSTS(000):$9,900 Spirit of Service Awards Nomination Guidelines and Application - Learn and Serve America FORMS: NONE
OMB NO: 3045-0094 EXPIRATION DATE: 09/30/2007 RESPS:3,747 HOURS:630 COSTS(000):$9,900 Performance Measurement in AmeriCorps: Surveys of Members, Organizations and End Beneficiaries FORMS: NONE
OMB NO: 3045-0095 EXPIRATION DATE: 09/30/2007 RESPS:2,668 HOURS:2,542 COSTS(000):$0 Learn and Serve America Program and Performance Reporting System FORMS: NONE
OMB NO: 3045-0096 EXPIRATION DATE: 07/31/2007 RESPS:3,290 HOURS:827 COSTS(000):$0 Parent Corps Evaluation FORMS: NONE
OMB NO: 3045-0097 EXPIRATION DATE: 08/31/2007 RESPS:2,603 HOURS:1,470 COSTS(000):$39 Project Director and Station Supervisor Survey Components of the Senior Corps Performance Surveys FORMS: NONE
OMB NO: 3045-0098 EXPIRATION DATE: 08/31/2007 RESPS:3,100 HOURS:1,168 COSTS(000):$5,208 Volunteer and Service Recipient Survey Components of the Senior Corps Performance Surveys FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
35 12,078,804 677,023 $1,900,642
(RETURN TO AGENCY LIST)
OMB NO: 3046-0003 EXPIRATION DATE: 12/31/2004 RESPS:5,000 HOURS:10,000 COSTS(000):$0 Elementary-Secondary Staff Information (EEO-5) FORMS: EEOC-168A
OMB NO: 3046-0006 EXPIRATION DATE: 12/31/2004 RESPS:3,000 HOURS:4,500 COSTS(000):$0 Local Union Report (EEO-3) FORMS: 274
OMB NO: 3046-0007 EXPIRATION DATE: 12/31/2004 RESPS:170,000 HOURS:402,700 COSTS(000):$0 Employer Information Report (EEO-1) FORMS: SF-100
OMB NO: 3046-0008 EXPIRATION DATE: 12/31/2004 RESPS:10,000 HOURS:40,000 COSTS(000):$0 State and Local Government Information (EEO-4) FORMS: EEOC-164
OMB NO: 3046-0017 EXPIRATION DATE: 12/31/2004 RESPS:666,000 HOURS:1,450,000 COSTS(000):$0 Uniform Guidelines on Employee Selection Procedures FORMS: NONE
OMB NO: 3046-0040 EXPIRATION DATE: 11/30/2006 RESPS:627,000 HOURS:16,667 COSTS(000):$0 Recordkeeping Under Title VII and the ADA FORMS: NONE
OMB NO: 3046-0042 EXPIRATION DATE: 10/31/2006 RESPS:13,700 HOURS:41,000 COSTS(000):$0 Waivers of Rights and Claims Under the ADEA; Informational Requirements FORMS: NONE
OMB NO: 3046-0044 EXPIRATION DATE: 09/30/2007 RESPS:100 HOURS:1,000 COSTS(000):$0 Nomination for the EEOC's "Freedom to Compete" Award FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
8 1,494,800 1,965,867 $0
(RETURN TO AGENCY LIST)
OMB NO: 0300-0012 EXPIRATION DATE: 08/31/2007 RESPS:300 HOURS:300 COSTS(000):$0 State/local budget information data collection for ONDCP's 25 cities project FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
1 300 300 $0
(RETURN TO AGENCY LIST)
OMB NO: 3048-0003 EXPIRATION DATE: 10/31/2004 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: 3048-0005 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: 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: 10/31/2004 RESPS:2 HOURS:1,200 COSTS(000):$0 Foreign Content Aggregate/Cause Report FORMS: EIB-FORM-01-02 EIB-FORM-01-02A
OMB NO: 3048-0013 EXPIRATION DATE: 11/30/2004 RESPS:100 HOURS:175 COSTS(000):$0 Export-Import Bank of the United States Preliminary Commitment and Final Commitment 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
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
6 4,413 5,636 $0
(RETURN TO AGENCY LIST)
OMB NO: 3139-0003 EXPIRATION DATE: 10/31/2004 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: 10/31/2004 RESPS:4 HOURS:17 COSTS(000):$0 12 CFR part 1102, subpart C. Rules pertaining to the privacy of individuals and systems of records maintained by the Appraisal Subcommittee. FORMS: NONE
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: 3139-0006 EXPIRATION DATE: 10/31/2004 RESPS:1 HOURS:5 COSTS(000):$0 12 CFR Part 1102, Subpart D. Implements the Freedom of Information Act, descrition of office, rule petitions, and confidential treatment requests FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
4 8 152 $0
(RETURN TO AGENCY LIST)
OMB NO: 3076-0001 EXPIRATION DATE: 01/31/2006 RESPS:250 HOURS:250 COSTS(000):$0 Arbitrator's Personal Data Questionnaire FORMS: R-22
OMB NO: 3076-0002 EXPIRATION DATE: 02/28/2006 RESPS:18,000 HOURS:3,000 COSTS(000):$0 Request for Arbitration FORMS: R-43
OMB NO: 3076-0003 EXPIRATION DATE: 01/31/2006 RESPS:2,500 HOURS:416 COSTS(000):$0 Arbitrator's Report and Fee Statement FORMS: R-19
OMB NO: 3076-0004 EXPIRATION DATE: 01/31/2006 RESPS:21,000 HOURS:1,750 COSTS(000):$0 Notice to Mediation Agency FORMS: F-7
OMB NO: 3076-0006 EXPIRATION DATE: 05/31/2006 RESPS:336 HOURS:672 COSTS(000):$0 FMCS Grant Program and Grant Evaluation Package FORMS: SF-424 SF-269A LM-6 LM-8 SF-270A LM-7 LM-9 LM-3
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
5 42,086 6,088 $0
(RETURN TO AGENCY LIST)
OMB NO: 3090-0006 EXPIRATION DATE: 05/31/2005 RESPS:15,496 HOURS:15,496 COSTS(000):$0 Qualifications of Employees, GSAR Reference 537.110(b) FORMS: GSA-176
OMB NO: 3090-0007 EXPIRATION DATE: 01/31/2005 RESPS:2,767 HOURS:6,917 COSTS(000):$0 Contractor's Qualifications and Financial Information FORMS: GSA-527
OMB NO: 3090-0014 EXPIRATION DATE: 03/31/2005 RESPS:63,000 HOURS:18,900 COSTS(000):$0 Transfer Order - Surplus Personal Property and Continuation Sheet FORMS: SF-123/123-A
OMB NO: 3090-0023 EXPIRATION DATE: 05/31/2005 RESPS:12,000 HOURS:996 COSTS(000):$0 Surplus Personal Property Mailing List Application FORMS: GSA-2170
OMB NO: 3090-0027 EXPIRATION DATE: 01/31/2005 RESPS:116,869 HOURS:7,830 COSTS(000):$0 GSAM, Part 542, Contract Administration - Part 546, Quality Assurance FORMS: GSA-1678 GSA-250 GSA-308
OMB NO: 3090-0043 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: 3090-0080 EXPIRATION DATE: 01/31/2005 RESPS:2,000 HOURS:200 COSTS(000):$0 General Services Administration Acquisition Manual (GSAM) Part 532, Contract Financing FORMS: GSA-1142
OMB NO: 3090-0086 EXPIRATION DATE: 03/31/2005 RESPS:5,016 HOURS:25,183 COSTS(000):$0 GSA Form 1364, Proposal to Lease Space FORMS: GSA-1364
OMB NO: 3090-0093 EXPIRATION DATE: 11/30/2004 RESPS:1,434 HOURS:1,434 COSTS(000):$0 Transportation Discrepancy Report, SF 361 FORMS: SF-361
OMB NO: 3090-0112 EXPIRATION DATE: 05/31/2005 RESPS:220 HOURS:330 COSTS(000):$0 State Agency Monthly Donation Report of Surplus Personal Property FORMS: GSA-3040
OMB NO: 3090-0118 EXPIRATION DATE: 01/31/2005 RESPS:874 HOURS:291 COSTS(000):$0 Statement of Witness, Standard Form 94 FORMS: SF-94
OMB NO: 3090-0121 EXPIRATION DATE: 01/31/2005 RESPS:184,280 HOURS:1,530 COSTS(000):$0 GSAM, Part 538.2 Establishing and Administering Schedules FORMS: GSA-72A
OMB NO: 3090-0163 EXPIRATION DATE: 11/30/2004 RESPS:172,500 HOURS:68,900 COSTS(000):$0 Information Specific to a Contract FORMS: NONE
OMB NO: 3090-0197 EXPIRATION DATE: 01/31/2005 RESPS:6,722 HOURS:6,722 COSTS(000):$0 GSAR 537.110(a) (Insert 552.237-70, Qualification of Offerors) FORMS: NONE
OMB NO: 3090-0200 EXPIRATION DATE: 01/31/2005 RESPS:10 HOURS:5 COSTS(000):$0 General Services Administration Acquisition Manual Part 514, Sealed Bidding FORMS: NONE
OMB NO: 3090-0204 EXPIRATION DATE: 02/28/2005 RESPS:10,305 HOURS:2,669 COSTS(000):$0 GSAR Part 552.211.-82 Notice of Shipment & Part 552.211-78 Commercial Delivery Schedule (Multiple Award Schedule) FORMS: NONE
OMB NO: 3090-0221 EXPIRATION DATE: 01/31/2007 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: 06/30/2006 RESPS:500 HOURS:1,000 COSTS(000):$0 Nondiscrimination in Federal Financial Assistance Programs FORMS: NONE
OMB NO: 3090-0235 EXPIRATION DATE: 04/30/2005 RESPS:19,094 HOURS:143,205 COSTS(000):$0 Price Reductions Clause FORMS: NONE
OMB NO: 3090-0246 EXPIRATION DATE: 01/31/2005 RESPS:931,219 HOURS:7,760 COSTS(000):$0 General Services Administration Acquisition Regulation (GSAR) Packing List Clause FORMS: NONE
OMB NO: 3090-0248 EXPIRATION DATE: 09/30/2005 RESPS:5,380 HOURS:1,345 COSTS(000):$0 GSAR 516.506 Solicitation Provisions and Contracts, 552.216-72 Placement of orders, 552.216-73 Ordering Information FORMS: NONE
OMB NO: 3090-0250 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Zero Burden Information Collection Reports FORMS: NONE
OMB NO: 3090-0252 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:12,240 COSTS(000):$0 Preparation, Submission, and Neogtiation of Subcontracting Plans FORMS: NONE
OMB NO: 3090-0259 EXPIRATION DATE: 08/31/2005 RESPS:25 HOURS:12 COSTS(000):$0 Market Research Questionnaire FORMS: NONE
OMB NO: 3090-0262 EXPIRATION DATE: 03/31/2005 RESPS:9,200 HOURS:46,000 COSTS(000):$0 Idenfitication of Products with Environmental Attributes FORMS: NONE
OMB NO: 3090-0270 EXPIRATION DATE: 07/31/2006 RESPS:1,000,000 HOURS:250,000 COSTS(000):$0 Access Certificates for Electronic Services (ACES) FORMS: NONE
OMB NO: 3090-0274 EXPIRATION DATE: 07/31/2006 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: 04/30/2006 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: 06/30/2006 RESPS:2,250 HOURS:112 COSTS(000):$0 National Contract Center Customer Evaluation Survey FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
32 2,572,568 622,259 $6,600
(RETURN TO AGENCY LIST)
OMB NO: 3117-0016 EXPIRATION DATE: 06/30/2005 RESPS:5,216 HOURS:210,129 COSTS(000):$13,551 Information collections for import injury investigations (producers, importers, purchasers, and foreign producer questionnaires and institution notices for 5-year reviews) FORMS: NONE
OMB NO: 3117-0188 EXPIRATION DATE: 12/31/2005 RESPS:600 HOURS:100 COSTS(000):$0 USITC Reader Satisfaction Survey FORMS: NONE
OMB NO: 3117-0190 EXPIRATION DATE: 05/31/2006 RESPS:10,000 HOURS:333 COSTS(000):$0 USITC DataWeb: User Registration Form FORMS: NONE
OMB NO: 3117-0207 EXPIRATION DATE: 12/31/2004 RESPS:400 HOURS:16,000 COSTS(000):$0 Foundry Products: Competitive Conditions in the U.S. Market- Producer Questionnaire FORMS: 332-460
OMB NO: 3117-0208 EXPIRATION DATE: 12/31/2004 RESPS:500 HOURS:7,500 COSTS(000):$0 Foundry Products: Competitive Conditions in the U.S. Market- Purchaser Questionnaire FORMS: 332-460
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
5 16,716 234,062 $13,551
(RETURN TO AGENCY LIST)
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: 3320-0003 EXPIRATION DATE: 06/30/2005 RESPS:530 HOURS:103 COSTS(000):$0 Program Evaluation Instruments-Environmental Conflict Assessment Services (Three Questionnaries) FORMS: NONE
OMB NO: 3320-0004 EXPIRATION DATE: 06/30/2005 RESPS:5,445 HOURS:775 COSTS(000):$0 Program Evaluation Instruments--Environmental Conflict Resolution Services (Six Questionaries) FORMS: NONE
OMB NO: 3320-0005 EXPIRATION DATE: 06/30/2005 RESPS:492 HOURS:137 COSTS(000):$0 Program Evaluation Instruments-National Roster of Environmental Dispute Resolution and Consensus Building Professionals (Five Questionnaries) FORMS: NONE
OMB NO: 3320-0006 EXPIRATION DATE: 06/30/2005 RESPS:24,450 HOURS:476 COSTS(000):$0 Program Evaluation Instruments-Environmental Conflict Resolution Training (Five Questionnaires) FORMS: NONE
OMB NO: 3320-0007 EXPIRATION DATE: 06/30/2005 RESPS:2,500 HOURS:382 COSTS(000):$0 Program Evaluation Instruments - Meeting Facilitation Services (One Questionnaire) 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
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
7 33,587 2,139 $0
(RETURN TO AGENCY LIST)
OMB NO: 3124-0009 EXPIRATION DATE: 01/31/2007 RESPS:6,300 HOURS:6,300 COSTS(000):$0 E-Appeal/US Merit Systems Protection Board Appeal Form FORMS: MSPB-185
OMB NO: 3124-0012 EXPIRATION DATE: 10/31/2004 RESPS:1,500 HOURS:375 COSTS(000):$0 Customer Surveys FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
2 7,800 6,675 $0
(RETURN TO AGENCY LIST)
OMB NO: 2700-0003 EXPIRATION DATE: 01/31/2006 RESPS:10,200 HOURS:91,500 COSTS(000):$0 NASA Contractor Financial Management Reports FORMS: NASA-533M NASA-533Q
OMB NO: 2700-0007 EXPIRATION DATE: 08/31/2005 RESPS:30 HOURS:29 COSTS(000):$0 Radioactive Material Transfer Receipt FORMS: JSC-1625
OMB NO: 2700-0009 EXPIRATION DATE: 10/31/2004 RESPS:930 HOURS:895 COSTS(000):$0 AST-Technology Utilization FORMS: NONE
OMB NO: 2700-0010 EXPIRATION DATE: 10/31/2006 RESPS:90 HOURS:45 COSTS(000):$0 Patient License Report FORMS: NONE
OMB NO: 2700-0017 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:7,000 COSTS(000):$0 NASA Property in the Custody of Contractors FORMS: NASA-1018
OMB NO: 2700-0039 EXPIRATION DATE: 10/31/2006 RESPS:85 HOURS:680 COSTS(000):$0 Application for a Patent License FORMS: NONE
OMB NO: 2700-0047 EXPIRATION DATE: 08/31/2005 RESPS:28,596 HOURS:114,384 COSTS(000):$0 Property Management and Control, Grants FORMS: NONE
OMB NO: 2700-0048 EXPIRATION DATE: 02/28/2005 RESPS:9,082 HOURS:16,150 COSTS(000):$0 Patents - Grants and Coopeative Agreements FORMS: NONE
OMB NO: 2700-0049 EXPIRATION DATE: 03/31/2006 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: 02/28/2005 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: 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: 08/31/2005 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: 10/31/2006 RESPS:52 HOURS:78 COSTS(000):$0 Mentor Protege Program Small Business and Small Disadvantaged Business Concerns FORMS: NONE
OMB NO: 2700-0080 EXPIRATION DATE: 10/31/2006 RESPS:300 HOURS:975 COSTS(000):$0 Uncompensated Overtime FORMS: NONE
OMB NO: 2700-0085 EXPIRATION DATE: 04/30/2007 RESPS:1,313 HOURS:750,800 COSTS(000):$0 NASA acquisition process, bids and proposals for contracts with an estimated value more than $500,000 FORMS: NONE
OMB NO: 2700-0086 EXPIRATION DATE: 04/30/2007 RESPS:242,955 HOURS:73,152 COSTS(000):$0 NASA acquisition process, Purchase orders for goods and services with an estimated value of $100,000 or less FORMS: NONE
OMB NO: 2700-0087 EXPIRATION DATE: 04/30/2007 RESPS:7,900 HOURS:2,560,000 COSTS(000):$0 NASA acquisition process, bids and propsals for contracts with an estimated value less than $500,000 FORMS: NONE
OMB NO: 2700-0088 EXPIRATION DATE: 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: 04/30/2007 RESPS:85,904 HOURS:601,328 COSTS(000):$0 NASA acquisition process, reports required for contracts with an estimated value more than $500,000 FORMS: NONE
OMB NO: 2700-0092 EXPIRATION DATE: 05/31/2005 RESPS:658 HOURS:4,592 COSTS(000):$0 Cooperative Agreements with Commercial Firms 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: 08/31/2006 RESPS:200 HOURS:200 COSTS(000):$11 NASA Small Business Innovation Research Commercial Metrics FORMS: NONE
OMB NO: 2700-0097 EXPIRATION DATE: 03/31/2006 RESPS:1,200 HOURS:3,130 COSTS(000):$0 Required Central Contractor Registration FORMS: NONE
OMB NO: 2700-0099 EXPIRATION DATE: 07/31/2005 RESPS:8,000 HOURS:5,455 COSTS(000):$0 National Aviation Operations Monitoring Service FORMS: NONE
OMB NO: 2700-0101 EXPIRATION DATE: 02/28/2005 RESPS:720 HOURS:180 COSTS(000):$0 NASA Procurement Customer Survey FORMS: NONE
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: 2700-0106 EXPIRATION DATE: 05/31/2006 RESPS:93 HOURS:425 COSTS(000):$0 Federal Automotive Statistical Tool (FAST) Collection FORMS: NONE
OMB NO: 2700-0107 EXPIRATION DATE: 08/31/2006 RESPS:50 HOURS:25 COSTS(000):$0 BOREAS Data User Satisfaction Survey FORMS: NONE
OMB NO: 2700-0109 EXPIRATION DATE: 10/31/2006 RESPS:917 HOURS:459 COSTS(000):$0 Title IX Recipient Request FORMS: NONE
OMB NO: 2700-0112 EXPIRATION DATE: 02/28/2007 RESPS:250 HOURS:62 COSTS(000):$0 Evaluating the Effectiveness of the 2003-2004 NASA Science Files / Connect Program Series FORMS: NONE
OMB NO: 2700-0113 EXPIRATION DATE: 02/28/2007 RESPS:2,300 HOURS:900 COSTS(000):$0 Effective Messaging Research FORMS: NONE
OMB NO: 2700-0114 EXPIRATION DATE: 04/30/2007 RESPS:499 HOURS:373 COSTS(000):$0 GLOBE Program Evaluation FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
37 550,173 5,622,225 $11
(RETURN TO AGENCY LIST)
OMB NO: 3095-0002 EXPIRATION DATE: 11/30/2004 RESPS:1 HOURS:7 COSTS(000):$0 Statistical Research in Archival Records Containing Personal Information FORMS: NONE
OMB NO: 3095-0007 EXPIRATION DATE: 04/30/2007 RESPS:9,600 HOURS:800 COSTS(000):$0 Customer Comment Form FORMS: NA-14045
OMB NO: 3095-0012 EXPIRATION DATE: 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: 3095-0016 EXPIRATION DATE: 06/30/2005 RESPS:27,273 HOURS:3,636 COSTS(000):$0 Researcher Application FORMS: NA-14003
OMB NO: 3095-0017 EXPIRATION DATE: 07/31/2006 RESPS:5 HOURS:50 COSTS(000):$0 Request to Microfilm Records FORMS: NONE
OMB NO: 3095-0023 EXPIRATION DATE: 07/31/2006 RESPS:4,340 HOURS:362 COSTS(000):$0 Class Evaluation FORMS: NA-2019
OMB NO: 3095-0024 EXPIRATION DATE: 11/30/2004 RESPS:1,000 HOURS:333 COSTS(000):$0 Application and Permit for Use of Space in Presidential FORMS: NA-16011
OMB NO: 3095-0025 EXPIRATION DATE: 08/31/2007 RESPS:2,816 HOURS:704 COSTS(000):$0 Item Approval Request List FORMS: 14110 14110A
OMB NO: 3095-0026 EXPIRATION DATE: 10/31/2004 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: 3095-0035 EXPIRATION DATE: 11/30/2004 RESPS:1 HOURS:15 COSTS(000):$0 Request to use Paper-to-Paper Copiers at the National Archives at the College Park Facility FORMS: NONE
OMB NO: 3095-0036 EXPIRATION DATE: 04/30/2005 RESPS:1 HOURS:31 COSTS(000):$1 Presidential Library Facilities FORMS: NONE
OMB NO: 3095-0037 EXPIRATION DATE: 02/28/2006 RESPS:4,500 HOURS:375 COSTS(000):$0 Forms Relating to Civilian Service Records FORMS: 13022 13064 13068
OMB NO: 3095-0038 EXPIRATION DATE: 12/31/2005 RESPS:5,000 HOURS:1,250 COSTS(000):$0 Court Order Requirements FORMS: NA-13027
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: 07/31/2006 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: 01/31/2006 RESPS:4,960 HOURS:827 COSTS(000):$0 Miitary Personnel Records (MPR) Customer Satisfaction Survey FORMS: NONE
OMB NO: 3095-0043 EXPIRATION DATE: 07/31/2006 RESPS:52 HOURS:52 COSTS(000):$0 Requests to Use NARA Facilities for Events FORMS: NA-16008
OMB NO: 3095-0045 EXPIRATION DATE: 02/28/2007 RESPS:2,593 HOURS:216 COSTS(000):$0 Applicant Background Survey FORMS: NA-3035
OMB NO: 3095-0046 EXPIRATION DATE: 04/30/2007 RESPS:5,200 HOURS:867 COSTS(000):$0 Microfilm Publication Order Form FORMS: NATF-36
OMB NO: 3095-0047 EXPIRATION DATE: 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:10 HOURS:3 COSTS(000):$0 Use of NARA Official Seals FORMS: NONE
OMB NO: 3095-0053 EXPIRATION DATE: 05/31/2006 RESPS:400 HOURS:33 COSTS(000):$0 Records Management Conference Electronic Registration Form and Records Management Training Class Registration Form FORMS: NA-14123 NA-14124
OMB NO: 3095-0054 EXPIRATION DATE: 07/31/2006 RESPS:100 HOURS:15 COSTS(000):$0 Independent Researcher Listing Application Form FORMS: NA-14115
OMB NO: 3095-0057 EXPIRATION DATE: 02/28/2007 RESPS:600 HOURS:30 COSTS(000):$0 Contractor / Agency Reviewer Identification Badge Authorization FORMS: NA-6000B
OMB NO: 3095-0058 EXPIRATION DATE: 03/31/2005 RESPS:25,897 HOURS:51,794 COSTS(000):$0 Financial Disclosure Form FORMS: NONE
OMB NO: 3095-0059 EXPIRATION DATE: 08/31/2007 RESPS:5,200 HOURS:867 COSTS(000):$0 Microfilm Rental Order Form FORMS: NA-14127
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
31 961,552 150,130 $1
(RETURN TO AGENCY LIST)
OMB NO: 3130-0005 EXPIRATION DATE: 04/30/2005 RESPS:325 HOURS:2 COSTS(000):$0 Assessment of NCLIS Sister Libraries Millennium project FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
1 325 2 $0
(RETURN TO AGENCY LIST)
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: 3137-0047 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: 3137-0050 EXPIRATION DATE: 04/30/2006 RESPS:300 HOURS:300 COSTS(000):$7,812 IMLS Survey of Education Opportunities Available for Library Support/Paraprofessional Staff in the U.S. 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: 3137-0054 EXPIRATION DATE: 12/31/2004 RESPS:6,366 HOURS:6,366 COSTS(000):$0 Survey of the status of technology and digitization in museums, libraries, archives, and state library agencies FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
7 12,283 86,694 $82,086
(RETURN TO AGENCY LIST)
OMB NO: 3135-0094 EXPIRATION DATE: 03/31/2005 RESPS:40 HOURS:1,800 COSTS(000):$0 Application for Indemnification FORMS: NONE
OMB NO: 3135-0098 EXPIRATION DATE: 08/31/2006 RESPS:250 HOURS:25 COSTS(000):$0 National Endowment for the Arts Panelist Profile Form FORMS: NONE
OMB NO: 3135-0112 EXPIRATION DATE: 02/28/2005 RESPS:5,380 HOURS:129,152 COSTS(000):$0 FY 2004 - 2007 Blanket Justification for NEA Funding Application Guidelines and Reporting Requirements FORMS: NONE
OMB NO: 3135-0114 EXPIRATION DATE: 04/30/2005 RESPS:40 HOURS:550 COSTS(000):$0 Customer Service Information Collection FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
4 5,710 131,527 $0
(RETURN TO AGENCY LIST)
OMB NO: 3136-0134 EXPIRATION DATE: 06/30/2006 RESPS:10,670 HOURS:91,412 COSTS(000):$0 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
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
2 11,894 92,024 $0
(RETURN TO AGENCY LIST)
OMB NO: 3140-0001 EXPIRATION DATE: 10/31/2005 RESPS:68 HOURS:17 COSTS(000):$0 Application for Investigation of Representation Dispute FORMS: NONE
OMB NO: 3140-0002 EXPIRATION DATE: 09/30/2005 RESPS:70 HOURS:17 COSTS(000):$0 Application for Mediation Services FORMS: NONE
OMB NO: 3140-0003 EXPIRATION DATE: 05/31/2006 RESPS:80 HOURS:20 COSTS(000):$0 Request for Arbitration Panel for Airline System Boards of Adjustment FORMS: NMB-3
OMB NO: 3140-0004 EXPIRATION DATE: 05/31/2006 RESPS:25 HOURS:25 COSTS(000):$0 Arbitration Services - Personal Data Sheet FORMS: NMB-4
OMB NO: 3140-0005 EXPIRATION DATE: 05/31/2006 RESPS:15 HOURS:3 COSTS(000):$0 Request for PL Board Member FORMS: NMB-5
OMB NO: 3140-0006 EXPIRATION DATE: 05/31/2006 RESPS:624 HOURS:156 COSTS(000):$0 Arbitration Services - Official Travel/Referee Compensation Authorization FORMS: NMB-6
OMB NO: 3140-0007 EXPIRATION DATE: 05/31/2006 RESPS:624 HOURS:156 COSTS(000):$0 Arbitration Services - Pay Voucher for Personal Servies FORMS: NMB-7
OMB NO: 3140-0008 EXPIRATION DATE: 05/31/2006 RESPS:624 HOURS:156 COSTS(000):$0 Neutral's Report of Activity FORMS: NMB-8
OMB NO: 3140-0009 EXPIRATION DATE: 07/31/2007 RESPS:45 HOURS:9 COSTS(000):$0 Application for Alternative Dispute Resolutin (ADR) Services FORMS: NMB-9
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
9 2,175 559 $0
(RETURN TO AGENCY LIST)
OMB NO: 3145-0001 EXPIRATION DATE: 02/28/2005 RESPS:150 HOURS:262 COSTS(000):$0 Application for NATO Advanced Study Institutes Travel Award and NATO Advanced Study Institutes Travel Award Report Form FORMS: 192 250
OMB NO: 3145-0019 EXPIRATION DATE: 04/30/2006 RESPS:37,485 HOURS:11,870 COSTS(000):$0 Survey of Earned Doctorates FORMS: NONE
OMB NO: 3145-0020 EXPIRATION DATE: 11/30/2004 RESPS:34,000 HOURS:14,167 COSTS(000):$0 2003 Survey of Doctorate Recipients (SDR) FORMS: NONE
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:59,900 COSTS(000):$0 Survey of Industrial Research and Development, 2001-2004 FORMS: RD-1 RD-1A
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: 07/31/2005 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: 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: 03/31/2005 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: 09/30/2005 RESPS:14,400 HOURS:6,000 COSTS(000):$0 2003 National Survey of Recent College Graduates (2003 NSRCG) FORMS: NONE
OMB NO: 3145-0080 EXPIRATION DATE: 05/31/2006 RESPS:75 HOURS:41,850 COSTS(000):$0 Request for Proposals FORMS: NONE
OMB NO: 3145-0096 EXPIRATION DATE: 08/31/2005 RESPS:5,000 HOURS:250 COSTS(000):$0 Applicant Survey FORMS: NSF-1232
OMB NO: 3145-0100 EXPIRATION DATE: 08/31/2006 RESPS:672 HOURS:14,950 COSTS(000):$0 Survey of Research and Development Expenditures at Universities and Colleges, FY 2003 through FY 2005 FORMS: NSF-411
OMB NO: 3145-0101 EXPIRATION DATE: 04/30/2006 RESPS:671 HOURS:21,983 COSTS(000):$0 Survey of Science and Engineering Research Facilities FORMS: NONE
OMB NO: 3145-0121 EXPIRATION DATE: 04/30/2006 RESPS:9,333 HOURS:4,328 COSTS(000):$0 Evaluation of NSF Support for Undergraduate Research Opportunities (URO) FORMS: NONE
OMB NO: 3145-0136 EXPIRATION DATE: 11/30/2004 RESPS:16,517 HOURS:49,733 COSTS(000):$50,000 EHR Generic Clearance FORMS: NONE
OMB NO: 3145-0141 EXPIRATION DATE: 04/30/2006 RESPS:218,000 HOURS:74,877 COSTS(000):$0 2003 National Survey of College Graduates (NSCG) FORMS: NONE
OMB NO: 3145-0153 EXPIRATION DATE: 04/30/2005 RESPS:364 HOURS:146 COSTS(000):$0 Impact on Industry of Interaction with Engineering Research Centers FORMS: NONE
OMB NO: 3145-0157 EXPIRATION DATE: 08/31/2005 RESPS:30,000 HOURS:5,250 COSTS(000):$43,993 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: 12/31/2006 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: 10/31/2004 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:2,555 HOURS:1,180 COSTS(000):$0 Evaluation of the Initial Impacts of NSF's Integrative Graduate Education and Research Traineeships (IGERT) Program FORMS: NONE
OMB NO: 3145-0184 EXPIRATION DATE: 02/28/2005 RESPS:6,500 HOURS:4,875 COSTS(000):$0 eRecruitment System FORMS: NONE
OMB NO: 3145-0186 EXPIRATION DATE: 09/30/2005 RESPS:243 HOURS:121 COSTS(000):$0 Cross-Site Evaluation of USP Program FORMS: NONE
OMB NO: 3145-0187 EXPIRATION DATE: 03/31/2005 RESPS:1 HOURS:1,253 COSTS(000):$0 Evaluation of NSF's Graduate teaching Fellows in K-12 Education (GK-12) FORMS: NONE
OMB NO: 3145-0188 EXPIRATION DATE: 04/30/2005 RESPS:150 HOURS:37 COSTS(000):$0 Survey of Colleges, Universities and Professional Development Providers Regarding Evaluation Training Programs FORMS: NONE
OMB NO: 3145-0189 EXPIRATION DATE: 05/31/2005 RESPS:1 HOURS:68 COSTS(000):$0 Outcomes and Impact of the NSF Minority Postdoctoral Research Fellowships (MPRF) Program FORMS: NONE
OMB NO: 3145-0190 EXPIRATION DATE: 05/31/2005 RESPS:795 HOURS:318 COSTS(000):$0 Evaluation of NSF's Louis Stokes Alliances for Minority Participation (LSAMP) Program FORMS: NONE
OMB NO: 3145-0191 EXPIRATION DATE: 12/31/2004 RESPS:560 HOURS:560 COSTS(000):$0 NSF Graduate Research Traineeships Program Followup Study FORMS: NONE
OMB NO: 3145-0194 EXPIRATION DATE: 01/31/2006 RESPS:6 HOURS:600 COSTS(000):$0 Grantee Reporting Requirements for Science and Technology Centers (STC): Integrative Partnerships FORMS: NONE
OMB NO: 3145-0195 EXPIRATION DATE: 04/30/2006 RESPS:360 HOURS:322 COSTS(000):$6 Request for Clearance of a Program Evaluation Study of the National Science Foundation's Centers for Learning and Teaching Program FORMS: NONE
OMB NO: 3145-0196 EXPIRATION DATE: 08/31/2006 RESPS:100 HOURS:100 COSTS(000):$0 Survey of IGERT Recipients FORMS: NONE
OMB NO: 3145-0197 EXPIRATION DATE: 03/31/2007 RESPS:2,050 HOURS:512 COSTS(000):$0 Data Collection on Public Understanding of Science and Technology FORMS: NONE
OMB NO: 3145-0198 EXPIRATION DATE: 07/31/2007 RESPS:596 HOURS:360 COSTS(000):$0 Evaluation of the Research Experiences for Teachers (RET) Program FORMS: NONE
OMB NO: 3145-0199 EXPIRATION DATE: 09/30/2005 RESPS:2,552 HOURS:45,344 COSTS(000):$0 NSF Math and Science Partnership Monitoring System FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
38 616,283 5,877,488 $93,999
(RETURN TO AGENCY LIST)
OMB NO: 3147-0022 EXPIRATION DATE: 06/30/2006 RESPS:185 HOURS:124 COSTS(000):$0 SCADA Questionnaire FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
1 185 124 $0
(RETURN TO AGENCY LIST)
OMB NO: 3209-0001 EXPIRATION DATE: 08/31/2006 RESPS:449 HOURS:1,347 COSTS(000):$2 Executive Branch Personnel Public Financial Disclosure Report FORMS: 278
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: 3209-0006 EXPIRATION DATE: 09/30/2005 RESPS:10 HOURS:15 COSTS(000):$0 Executive Branch Confidential Financial Disclosure Report FORMS: 450
OMB NO: 3209-0007 EXPIRATION DATE: 03/31/2005 RESPS:294 HOURS:3,785 COSTS(000):$0 Executive Branch Qualified Trust Documents (see item #'s 1.-2. of the Supporting Statement for precise title of all documents) FORMS: NONE
OMB NO: 3209-0009 EXPIRATION DATE: 03/31/2005 RESPS:50 HOURS:3 COSTS(000):$0 Public Financial Disclosure Access Customer Service Survey FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
5 1,025 5,187 $2
(RETURN TO AGENCY LIST)
OMB NO: 0348-0002 EXPIRATION DATE: 07/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 SF-271: Outlay Report and Request for Reimbursement for Construction Programs FORMS: SF-271
OMB NO: 0348-0003 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-272 and SF-272A: Federal Cash Transactions Report FORMS: SF-272 SF-272A
OMB NO: 0348-0004 EXPIRATION DATE: 07/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 SF-270: Request for Advance or Reimbursement FORMS: 270
OMB NO: 0348-0038 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF 269A: Financial Status Report (Short Form) FORMS: SF-269A
OMB NO: 0348-0039 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-269: Financial Status Report (Long Form) FORMS: SF-269
OMB NO: 0348-0040 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-424B: Assurances - Nonconstruction Programs FORMS: SF-424B
OMB NO: 0348-0041 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-424C: Budget Informatin - Construction Programs FORMS: SF-424C
OMB NO: 0348-0042 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-424D: Assurances - Construction Programs FORMS: SF-424D
OMB NO: 0348-0043 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-424: Application for Federal Assistance FORMS: SF-424
OMB NO: 0348-0044 EXPIRATION DATE: 01/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 SF-424A: Budget Information - Nonconstruction Programs FORMS: SF-424A
OMB NO: 0348-0046 EXPIRATION DATE: 07/31/2006 RESPS:300 HOURS:50 COSTS(000):$0 Disclosure of Lobbying Activities FORMS: SF-LLL
OMB NO: 0348-0057 EXPIRATION DATE: 04/30/2007 RESPS:60,000 HOURS:1,036,800 COSTS(000):$0 Data Collection Form for Reporting on Audits of States, Local Governments, and Non-Profit Organizations FORMS: SF-SAC
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
12 60,310 1,036,860 $0
(RETURN TO AGENCY LIST)
OMB NO: 3201-0007 EXPIRATION DATE: 12/31/2004 RESPS:1,000 HOURS:250 COSTS(000):$0 Community Drug Prevention Campaign Tracking Study FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
1 1,000 250 $0
(RETURN TO AGENCY LIST)
OMB NO: 3206-0001 EXPIRATION DATE: 05/31/2007 RESPS:4,500 HOURS:750 COSTS(000):$0 Application for 10-Point Veteran Preference FORMS: SF-15
OMB NO: 3206-0005 EXPIRATION DATE: 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: 3206-0017 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: 3206-0033 EXPIRATION DATE: 05/31/2006 RESPS:2,500 HOURS:625 COSTS(000):$0 Marital Status Certification Survey FORMS: RI-25-7
OMB NO: 3206-0034 EXPIRATION DATE: 11/30/2006 RESPS:21,000 HOURS:12,250 COSTS(000):$0 Annuitant's Report of Earned Income FORMS: RI-30-2
OMB NO: 3206-0036 EXPIRATION DATE: 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: 3206-0040 EXPIRATION DATE: 08/31/2005 RESPS:500,000 HOURS:195,000 COSTS(000):$0 Occupational Questionnaire FORMS: 1203-AW 1203-FX 1203-EZ
OMB NO: 3206-0042 EXPIRATION DATE: 08/31/2006 RESPS:2,500 HOURS:835 COSTS(000):$0 Notice of Change in Student's Status FORMS: RI-25-15
OMB NO: 3206-0061 EXPIRATION DATE: 11/30/2004 RESPS:50 HOURS:13 COSTS(000):$0 Application for Minimum Annuity FORMS: RI-20-1
OMB NO: 3206-0082 EXPIRATION DATE: 11/30/2004 RESPS:5,000 HOURS:12,500 COSTS(000):$0 Presidential Management Fellows (PMF) Program Online Application and Resume Builder FORMS: OPM-1300
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: 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: 10/31/2004 RESPS:5,700 HOURS:570 COSTS(000):$0 Mail Reinterview Form FORMS: IS-10
OMB NO: 3206-0121 EXPIRATION DATE: 10/31/2004 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: 09/30/2007 RESPS:7,130 HOURS:4,588 COSTS(000):$0 Application for Refund of Retirement Deductions (CSRS) Current/Former Spouse's Notification of Application for Refund FORMS: SF-2802 SF-2802A
OMB NO: 3206-0131 EXPIRATION DATE: 04/30/2006 RESPS:1,400 HOURS:4,200 COSTS(000):$0 Combined Federal Campaign FORMS: OPM-1647
OMB NO: 3206-0134 EXPIRATION DATE: 09/30/2006 RESPS:150 HOURS:75 COSTS(000):$0 Application to Make Deposit or Redeposit (CSRS) Application to Make Service Credit Payment fo Civilian Service (FERS) FORMS: SF-2803 SF-3108
OMB NO: 3206-0136 EXPIRATION DATE: 06/30/2007 RESPS:48,000 HOURS:12,000 COSTS(000):$0 Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI) FORMS: SF-2823
OMB NO: 3206-0138 EXPIRATION DATE: 11/30/2006 RESPS:200 HOURS:200 COSTS(000):$0 Reinstatement of Disability Annuity Previously Terminated Because of Restoration to Earning Capacity FORMS: RI-30-9
OMB NO: 3206-0140 EXPIRATION DATE: 08/31/2007 RESPS:12,480 HOURS:6,490 COSTS(000):$0 RI 20-7 - Representative Payee Application RI 30-3 - Information Necessary for a Competency Determination FORMS: RI-20-7 RI-30-3
OMB NO: 3206-0141 EXPIRATION DATE: 06/30/2005 RESPS:30,000 HOURS:16,667 COSTS(000):$0 Health Benefits Registration Form FORMS: OPM-2809
OMB NO: 3206-0142 EXPIRATION DATE: 11/30/2004 RESPS:2,000 HOURS:500 COSTS(000):$0 Designation of Beneficiary (CSRS) FORMS: SF-2808
OMB NO: 3206-0143 EXPIRATION DATE: 08/31/2007 RESPS:8,000 HOURS:8,000 COSTS(000):$0 Request to Disability Annuitant for Information on Physical Condition and Employment FORMS: RI-30-1
OMB NO: 3206-0144 EXPIRATION DATE: 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: 3206-0150 EXPIRATION DATE: 12/31/2004 RESPS:225,000 HOURS:18,750 COSTS(000):$0 Fingerprint Charts FORMS: SF-87 SF-87A
OMB NO: 3206-0156 EXPIRATION DATE: 05/31/2005 RESPS:74,800 HOURS:56,100 COSTS(000):$0 Application for Death Benefits Under the Civil Service Retirement System Documentation and Elections in Support of Application for Death Benefits When the Deceased Was an Employee at the Time of.. FORMS: SF-2800 SF-2800A
OMB NO: 3206-0160 EXPIRATION DATE: 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: 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: 3206-0168 EXPIRATION DATE: 06/30/2005 RESPS:200 HOURS:67 COSTS(000):$0 Alternative Annuity Election FORMS: RI-20-80
OMB NO: 3206-0170 EXPIRATION DATE: 09/30/2006 RESPS:30,600 HOURS:9,633 COSTS(000):$0 Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the.... FORMS: SF-3106 SF-3106A
OMB NO: 3206-0172 EXPIRATION DATE: 05/31/2007 RESPS:10,847 HOURS:10,847 COSTS(000):$0 Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death FORMS: 3104 3104A 3104B
OMB NO: 3206-0173 EXPIRATION DATE: 08/31/2005 RESPS:2,037 HOURS:509 COSTS(000):$0 Designation of Beneficiary (FERS) FORMS: 3102
OMB NO: 3206-0174 EXPIRATION DATE: 12/31/2006 RESPS:2,400 HOURS:1,834 COSTS(000):$0 Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the.... FORMS: RI-20-63 RI-20-116 RI-20-117
OMB NO: 3206-0179 EXPIRATION DATE: 09/30/2007 RESPS:2,500 HOURS:2,500 COSTS(000):$0 Disabled Dependent Questionnaire FORMS: RI-30-10
OMB NO: 3206-0182 EXPIRATION DATE: 10/31/2005 RESPS:474,000 HOURS:118,500 COSTS(000):$0 Declaration for Federal Employment FORMS: 306
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: 08/31/2007 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: 02/28/2005 RESPS:360 HOURS:180 COSTS(000):$0 Campaign Results Report FORMS: OPM-ONLINE-1417
OMB NO: 3206-0194 EXPIRATION DATE: 02/28/2007 RESPS:700 HOURS:175 COSTS(000):$0 Annuity Supplement Earnings Report FORMS: RI-92-22
OMB NO: 3206-0197 EXPIRATION DATE: 05/31/2006 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: 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: 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: 11/30/2004 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: 3206-0204 EXPIRATION DATE: 03/31/2005 RESPS:19,000 HOURS:9,500 COSTS(000):$0 Court Orders Affecting Retirement Benefits - 5 CFR Sections 838.221, 838.421, and 838.721 FORMS: NONE
OMB NO: 3206-0206 EXPIRATION DATE: 06/30/2005 RESPS:250 HOURS:250 COSTS(000):$0 Evidence to Prove Dependency of a Child FORMS: RI-25-37
OMB NO: 3206-0208 EXPIRATION DATE: 06/30/2007 RESPS:11,000 HOURS:3,667 COSTS(000):$0 Representative Payee Survey FORMS: RI-38-115
OMB NO: 3206-0211 EXPIRATION DATE: 05/31/2007 RESPS:3,000 HOURS:250 COSTS(000):$0 Reemployment of Annuitants - 5 CFR Section 837.103 FORMS: NONE
OMB NO: 3206-0212 EXPIRATION DATE: 05/31/2006 RESPS:1,500 HOURS:750 COSTS(000):$0 Rollover Election FORMS: RI-38-117 RI-38-118 RI-37-22
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: 11/30/2004 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: 11/30/2004 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: 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: 3206-0229 EXPIRATION DATE: 05/31/2005 RESPS:100 HOURS:17 COSTS(000):$0 Application for Federal Employee Commercial Garnishment FORMS: OF-311
OMB NO: 3206-0230 EXPIRATION DATE: 12/31/2004 RESPS:100 HOURS:25 COSTS(000):$0 Life Insurance Election FORMS: SF-2817
OMB NO: 3206-0232 EXPIRATION DATE: 12/31/2004 RESPS:100 HOURS:100 COSTS(000):$0 Procedures for Submitting Compensation and Leave Claims FORMS: NONE
OMB NO: 3206-0233 EXPIRATION DATE: 10/31/2004 RESPS:34,800 HOURS:17,400 COSTS(000):$0 Civil Service Retirement System Survivor Annuitant Express Pay Apkication for Death Benefits FORMS: RI-25-51
OMB NO: 3206-0234 EXPIRATION DATE: 12/31/2004 RESPS:3,000 HOURS:750 COSTS(000):$0 Claim for Unpaid Compensation of Decreased Civilian Employee FORMS: SF-1153
OMB NO: 3206-0235 EXPIRATION DATE: 03/31/2005 RESPS:30 HOURS:23 COSTS(000):$0 Survivor Annuity Election for a Former Spouse FORMS: RI-20-64
OMB NO: 3206-0236 EXPIRATION DATE: 01/31/2006 RESPS:4,800,900 HOURS:705,074 COSTS(000):$0 Agency Generic Survey Plan FORMS: NONE
OMB NO: 3206-0237 EXPIRATION DATE: 03/31/2005 RESPS:3,100 HOURS:2,325 COSTS(000):$0 Information and Instructions on Your Reconsideration Rights FORMS: RI-38-47
OMB NO: 3206-0240 EXPIRATION DATE: 11/30/2004 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: 12/31/2006 RESPS:200 HOURS:200 COSTS(000):$0 Scholarship For Service (SFS) Program Internet Site FORMS: NONE
OMB NO: 3206-0247 EXPIRATION DATE: 05/31/2007 RESPS:8,300 HOURS:1,066 COSTS(000):$0 General Population Rental Equivalence Survey (GPRES) FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
69 9,506,841 2,156,624 $0
(RETURN TO AGENCY LIST)
OMB NO: 3255-0002 EXPIRATION DATE: 08/31/2006 RESPS:2,246 HOURS:2,689 COSTS(000):$0 (a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information FORMS: OSC-11 OSC-12
OMB NO: 3255-0003 EXPIRATION DATE: 07/31/2005 RESPS:840 HOURS:323 COSTS(000):$0 3 OSC Surveys: 48a - Prohibited Personnel Practice or other Prohibited activity; 48b - Hatch Act Advisory Opinion; 48c - Whistleblower Disclosure FORMS: 48A 48B 48C
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
2 3,086 3,012 $0
(RETURN TO AGENCY LIST)
OMB NO: 0350-0009 EXPIRATION DATE: 11/30/2006 RESPS:70 HOURS:140 COSTS(000):$0 Application for inclusion on NAFTA Chapter 19 roster FORMS: NONE
OMB NO: 0350-0011 EXPIRATION DATE: 11/30/2005 RESPS:500 HOURS:4,100 COSTS(000):$57,505 Questionnaire for Exclusion Requesters (Anniversary) under Section 203 of the Trade Act FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
2 570 4,240 $57,505
(RETURN TO AGENCY LIST)
OMB NO: 3420-0001 EXPIRATION DATE: 08/31/2007 RESPS:343 HOURS:171 COSTS(000):$0 Request for Registration for Political Risk Investment Insurance FORMS: OPIC-50
OMB NO: 3420-0004 EXPIRATION DATE: 10/31/2004 RESPS:25 HOURS:175 COSTS(000):$0 Project Information Report FORMS: OPIC-71
OMB NO: 3420-0011 EXPIRATION DATE: 10/31/2004 RESPS:150 HOURS:1,050 COSTS(000):$3 Application for Political Risk Investment Insurance FORMS: OPIC-52
OMB NO: 3420-0015 EXPIRATION DATE: 12/31/2004 RESPS:300 HOURS:1,050 COSTS(000):$0 Finance Application FORMS: 115
OMB NO: 3420-0018 EXPIRATION DATE: 06/30/2006 RESPS:150 HOURS:900 COSTS(000):$0 Sponsor Disclosure Report FORMS: OPIC-129
OMB NO: 3420-0019 EXPIRATION DATE: 07/31/2007 RESPS:230 HOURS:1,955 COSTS(000):$0 Self-Monitoring Questionnaire for Insurance and Finance Projects FORMS: OPIC-162
OMB NO: 3420-0020 EXPIRATION DATE: 07/31/2006 RESPS:90 HOURS:90 COSTS(000):$0 Expedited Screening Questionnaire for Downstream Investments FORMS: OPIC-168
OMB NO: 3420-0023 EXPIRATION DATE: 07/31/2007 RESPS:189 HOURS:1,606 COSTS(000):$0 Self-Monitoring Questionnaire for Investment Funds' Sub-Projects FORMS: OPIC-217
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
8 1,477 6,997 $3
(RETURN TO AGENCY LIST)
OMB NO: 0420-0001 EXPIRATION DATE: 08/31/2007 RESPS:10,000 HOURS:2,500 COSTS(000):$0 Peace Corps National Agency Check (NAC) Questionnaire Form for Peace Corps Volunteer Background Investigations FORMS: 5
OMB NO: 0420-0005 EXPIRATION DATE: 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: 03/31/2007 RESPS:21,700 HOURS:13,275 COSTS(000):$564 Health Status Review; Report of Medical Exam; Report of Dental Exam FORMS: PC-1789 PC-1790S PC-1790
OMB NO: 0420-0513 EXPIRATION DATE: 07/31/2005 RESPS:16,000 HOURS:1,833 COSTS(000):$9,000 Teacher Enrollment Form; Volunteer Enrollment Form; Teacher Survey FORMS: WWS-PCV-2000 WWS/ED-2000 WWS-TEACHER
OMB NO: 0420-0525 EXPIRATION DATE: 07/31/2005 RESPS:700 HOURS:270 COSTS(000):$2,384 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: 09/30/2006 RESPS:650 HOURS:54 COSTS(000):$0 Peace Corps Crisis Corps Volunteer Application Form FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
10 119,052 280,895 $126,008
(RETURN TO AGENCY LIST)
OMB NO: 1212-0009 EXPIRATION DATE: 11/30/2006 RESPS:32,246 HOURS:3,055 COSTS(000):$15,965 Payment of Premiums (29 CFR Part 4007), Disclosure to Participants (29 CFR Part 4011) FORMS: FORM-1 FORM-1-EZ FORM-1-ES
OMB NO: 1212-0013 EXPIRATION DATE: 01/31/2006 RESPS:537 HOURS:2,260 COSTS(000):$452 Reportable Events FORMS: 10 10-ADVANCE
OMB NO: 1212-0017 EXPIRATION DATE: 01/31/2005 RESPS:6 HOURS:72 COSTS(000):$72 Liability for Termination of Single-Employer Plans FORMS: NONE
OMB NO: 1212-0020 EXPIRATION DATE: 02/28/2005 RESPS:1,411 HOURS:23 COSTS(000):$9 Termination of Multiemployer Plans (29 CFR Part 4041A) FORMS: NONE
OMB NO: 1212-0021 EXPIRATION DATE: 02/28/2005 RESPS:24 HOURS:1 COSTS(000):$3 Variances for Sale of Assets (29 CFR Part 4204) FORMS: NONE
OMB NO: 1212-0022 EXPIRATION DATE: 02/28/2005 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: 02/28/2005 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: 02/28/2005 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: 02/28/2005 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: 02/28/2005 RESPS:838 HOURS:1 COSTS(000):$1 Notice of Insolvency (29 CFR Part 4245) FORMS: NONE
OMB NO: 1212-0034 EXPIRATION DATE: 02/28/2005 RESPS:179 HOURS:4 COSTS(000):$5 Notice, Collection, and Redetermination of Withdrawal Liability (29 CFR Part 4219) FORMS: NONE
OMB NO: 1212-0035 EXPIRATION DATE: 02/28/2005 RESPS:5 HOURS:10 COSTS(000):$0 Allocating Unfunded Vested Benefits (29 CFR Part 4211) FORMS: NONE
OMB NO: 1212-0036 EXPIRATION DATE: 09/30/2007 RESPS:1,175 HOURS:1,743 COSTS(000):$1,973 Terminationof Single Employer Plans FORMS: 500 501 600 601 602 SCHED.-EA-S REP-S EA-D MP
OMB NO: 1212-0039 EXPIRATION DATE: 02/28/2005 RESPS:2,001 HOURS:250 COSTS(000):$200 Reduction or Waiver of Partial Withdrawal Liability (29 CFR Part 4208) FORMS: NONE
OMB NO: 1212-0041 EXPIRATION DATE: 01/31/2006 RESPS:30 HOURS:64 COSTS(000):$12 Notice of Failure to Make Required Contributions FORMS: 200
OMB NO: 1212-0044 EXPIRATION DATE: 02/28/2005 RESPS:201 HOURS:25 COSTS(000):$20 Reduction or Waiver of Complete Withdrawal Liability (29 CFR Part 4207) FORMS: NONE
OMB NO: 1212-0049 EXPIRATION DATE: 03/31/2005 RESPS:70 HOURS:552 COSTS(000):$700 Annual Financial and Actuarial Information Reporting (29 CFR Part 4010) FORMS: NONE
OMB NO: 1212-0050 EXPIRATION DATE: 11/30/2004 RESPS:3,331 HOURS:8,878 COSTS(000):$355 Disclosure to Participants FORMS: NONE
OMB NO: 1212-0053 EXPIRATION DATE: 10/31/2006 RESPS:9,500 HOURS:2,500 COSTS(000):$0 Customer Service Focus Groups and Surveys FORMS: NONE
OMB NO: 1212-0054 EXPIRATION DATE: 12/31/2006 RESPS:664 HOURS:234 COSTS(000):$483 Qualified Domestic Relations Orders Submitted to the PBGC FORMS: NONE
OMB NO: 1212-0055 EXPIRATION DATE: 04/30/2006 RESPS:140,450 HOURS:77,700 COSTS(000):$51 Locating and Paying Participants FORMS: 700-701 702-703 705-706 707-709 710-713 714-715 718-719 720 721 722
OMB NO: 1212-0057 EXPIRATION DATE: 12/31/2004 RESPS:37,700 HOURS:3,859 COSTS(000):$2,553 Annual Information Return/Report FORMS: 5500-SERIES
OMB NO: 1212-0059 EXPIRATION DATE: 10/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 Filing, Issuance, Computation of Time, and Record Retention FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
24 253,809 101,284 $22,977
(RETURN TO AGENCY LIST)
OMB NO: 3220-0002 EXPIRATION DATE: 10/31/2006 RESPS:19,100 HOURS:10,083 COSTS(000):$0 Approval for Employee Annuity Under the Railroad Retirement Act FORMS: AA-1 AA-1-CERT AA-1D G-204
OMB NO: 3220-0005 EXPIRATION DATE: 09/30/2006 RESPS:3,418 HOURS:570 COSTS(000):$0 Employer Reporting FORMS: AA-12 G-88A.1 G.88A.2 BA-6A BA-6A(INTERNET)
OMB NO: 3220-0007 EXPIRATION DATE: 07/31/2007 RESPS:860 HOURS:285 COSTS(000):$0 Appeal Under the Railraod Retirement and Railraod Unemployment Insurance Act FORMS: HA-1
OMB NO: 3220-0008 EXPIRATION DATE: 02/28/2005 RESPS:1,028 HOURS:37,927 COSTS(000):$0 Railroad Service and Compensation Reports FORMS: BA-3A BA-4 BA-4(INTERNET)
OMB NO: 3220-0012 EXPIRATION DATE: 03/31/2006 RESPS:2,200 HOURS:917 COSTS(000):$0 Employer's Quarterly Report of Contributions Under the RUIA FORMS: DC-1
OMB NO: 3220-0014 EXPIRATION DATE: 07/31/2006 RESPS:65 HOURS:33 COSTS(000):$0 Employee Representatives' Status and Compensation Reports FORMS: DC-2A DC-2
OMB NO: 3220-0016 EXPIRATION DATE: 05/31/2005 RESPS:3,600 HOURS:360 COSTS(000):$0 Certification of Relinquishment of Rights FORMS: G-88
OMB NO: 3220-0021 EXPIRATION DATE: 01/31/2006 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: 09/30/2006 RESPS:78,700 HOURS:8,617 COSTS(000):$0 Application and Claim for Unemployment Benefits and Employment Service FORMS: UI-1 UI-1(INTERNET) UI-3
OMB NO: 3220-0025 EXPIRATION DATE: 02/28/2007 RESPS:7,905 HOURS:1,622 COSTS(000):$0 RUIA Investigations and Continuing Entitlement FORMS: UI-9-UI-23 UI-44-ID-4F ID-4U-ID-4X ID-4Y-ID-20-1 ID-20-2-ID-20-4 ID-51- ID-5R(SUP) ID-49R UI-48
OMB NO: 3220-0030 EXPIRATION DATE: 04/30/2007 RESPS:4,137 HOURS:1,718 COSTS(000):$0 Application for Survivor Insurance Annuities FORMS: AA-17 AA-17B AA-17CERT AA-18 AA-19 AA-19A AA-20
OMB NO: 3220-0031 EXPIRATION DATE: 03/31/2006 RESPS:20,600 HOURS:5,150 COSTS(000):$0 Application for Survivor Death Benefits FORMS: AA-21 AA-21-CERT G-273A AA-11A G-131
OMB NO: 3220-0032 EXPIRATION DATE: 05/31/2006 RESPS:8,000 HOURS:1,391 COSTS(000):$0 Survivor Questionnaire FORMS: RL-94-F
OMB NO: 3220-0034 EXPIRATION DATE: 08/31/2005 RESPS:400 HOURS:40 COSTS(000):$0 Statement of Authority to Act for Employee FORMS: SI-10
OMB NO: 3220-0036 EXPIRATION DATE: 02/28/2005 RESPS:28,500 HOURS:1,691 COSTS(000):$0 Supplemental Information on Accident and Insurance FORMS: SI-1C SI-5 ID-3S ID-3S-1 ID-3U ID-30K ID-30K-1
OMB NO: 3220-0038 EXPIRATION DATE: 11/30/2005 RESPS:29,950 HOURS:12,417 COSTS(000):$0 Medical Reports FORMS: G-3EMP G-250 G-250A G-260 RL-11B RL-11D
OMB NO: 3220-0039 EXPIRATION DATE: 03/31/2007 RESPS:260,900 HOURS:26,321 COSTS(000):$0 Railroad Unemployment Insurance Act Applications FORMS: SI-1A SI-1B SI-3 SI-7 SI-8 ID-7H ID-11A ID-11B
OMB NO: 3220-0042 EXPIRATION DATE: 09/30/2006 RESPS:8,500 HOURS:4,297 COSTS(000):$0 Application for Spouse Annuity Under the Railroad Retirement Act FORMS: AA-3 AA-3CERT
OMB NO: 3220-0052 EXPIRATION DATE: 04/30/2007 RESPS:20,300 HOURS:16,350 COSTS(000):$0 Railroad Retirement Act Continuing Entitlement FORMS: AA-5 G-478 RB-5
OMB NO: 3220-0055 EXPIRATION DATE: 12/31/2005 RESPS:200 HOURS:23 COSTS(000):$0 Application and Claim for RUIA Benefits Due at Death FORMS: UI-63
OMB NO: 3220-0057 EXPIRATION DATE: 08/31/2007 RESPS:23,000 HOURS:1,452 COSTS(000):$0 Placement Service FORMS: ES-2 ES-21 ES-21C UI-35
OMB NO: 3220-0070 EXPIRATION DATE: 07/31/2007 RESPS:3,000 HOURS:400 COSTS(000):$0 Employer_Service and Compensation Reports FORMS: UI-41 UI-41A
OMB NO: 3220-0079 EXPIRATION DATE: 08/31/2007 RESPS:2,900 HOURS:487 COSTS(000):$0 Certification Regarding Rights to Unemployment Benefits FORMS: UI-45
OMB NO: 3220-0082 EXPIRATION DATE: 12/31/2005 RESPS:1,040 HOURS:165 COSTS(000):$0 Medicare FORMS: AA-6 AA-7 AA-8 RL-311-F
OMB NO: 3220-0083 EXPIRATION DATE: 01/31/2007 RESPS:290 HOURS:121 COSTS(000):$0 Evidence for Application of Overall Minimum FORMS: G-319 G-320
OMB NO: 3220-0086 EXPIRATION DATE: 07/31/2005 RESPS:50 HOURS:8 COSTS(000):$0 Application for Reimbursement for Hospital Services in Canada FORMS: AA-104
OMB NO: 3220-0089 EXPIRATION DATE: 02/28/2006 RESPS:1,515 HOURS:203 COSTS(000):$0 Pension Plan Reports FORMS: G-88P G-88R G-88R.1
OMB NO: 3220-0097 EXPIRATION DATE: 08/31/2007 RESPS:350 HOURS:29 COSTS(000):$0 Pay Rate Report FORMS: UI-1E
OMB NO: 3220-0099 EXPIRATION DATE: 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: 3220-0123 EXPIRATION DATE: 01/31/2007 RESPS:1,230 HOURS:121 COSTS(000):$0 Student Beneficiary Monitoring FORMS: G-315 G-315A G-315A.1
OMB NO: 3220-0127 EXPIRATION DATE: 05/31/2005 RESPS:1,200 HOURS:1,700 COSTS(000):$0 Financial Disclosure Statement FORMS: G-423
OMB NO: 3220-0131 EXPIRATION DATE: 10/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 Request for Medicare Payment FORMS: G-740S CMS-1500
OMB NO: 3220-0132 EXPIRATION DATE: 04/30/2006 RESPS:516 HOURS:237 COSTS(000):$0 Gross Earnings Report FORMS: BA-11
OMB NO: 3220-0136 EXPIRATION DATE: 07/31/2007 RESPS:1,170 HOURS:294 COSTS(000):$0 Public Service Pension Questionnaires FORMS: G-208 G-212
OMB NO: 3220-0138 EXPIRATION DATE: 07/31/2007 RESPS:600 HOURS:415 COSTS(000):$0 Self-Employment Questionnaire FORMS: AA-4
OMB NO: 3220-0140 EXPIRATION DATE: 11/30/2005 RESPS:5,400 HOURS:450 COSTS(000):$0 Employee's Certification FORMS: G-346
OMB NO: 3220-0141 EXPIRATION DATE: 11/30/2006 RESPS:6,000 HOURS:3,045 COSTS(000):$0 Vocational Report FORMS: G-251
OMB NO: 3220-0145 EXPIRATION DATE: 07/31/2006 RESPS:1,300 HOURS:650 COSTS(000):$0 Nonresident Questionnaire FORMS: RRB-1001
OMB NO: 3220-0149 EXPIRATION DATE: 05/31/2007 RESPS:20,000 HOURS:1 COSTS(000):$0 Withholding Certificate for Railroad Retirement Monthly Annuity Payments FORMS: RRB-W-4P
OMB NO: 3220-0151 EXPIRATION DATE: 10/31/2004 RESPS:6,535 HOURS:2,032 COSTS(000):$0 Representative Payee Monitoring FORMS: G-99A G-99C
OMB NO: 3220-0154 EXPIRATION DATE: 07/31/2005 RESPS:500 HOURS:55 COSTS(000):$0 Employee Noncovered Service Pension Questionnaire FORMS: G-209
OMB NO: 3220-0155 EXPIRATION DATE: 06/30/2007 RESPS:100 HOURS:17 COSTS(000):$0 Supplement to Claim of Person Outside the United States FORMS: G-45
OMB NO: 3220-0156 EXPIRATION DATE: 08/31/2006 RESPS:4,000 HOURS:133 COSTS(000):$0 Employer's Deemed Service Month Questionnaire FORMS: GL-99
OMB NO: 3220-0164 EXPIRATION DATE: 06/30/2005 RESPS:7,600 HOURS:1,085 COSTS(000):$0 Availability for Work FORMS: UI-38 UI-38S ID-8K
OMB NO: 3220-0169 EXPIRATION DATE: 08/31/2006 RESPS:300 HOURS:25 COSTS(000):$0 Repayment of Debt FORMS: G-421F
OMB NO: 3220-0171 EXPIRATION DATE: 06/30/2005 RESPS:18,600 HOURS:460 COSTS(000):$0 RUIA Claims Notification System FORMS: ID-4K
OMB NO: 3220-0173 EXPIRATION DATE: 05/31/2005 RESPS:1,009 HOURS:1,262 COSTS(000):$0 Railroad Separation Allowance or Severance Pay Report FORMS: BA-9
OMB NO: 3220-0175 EXPIRATION DATE: 02/28/2005 RESPS:239 HOURS:219 COSTS(000):$0 Sick Pay and Miscellaneous Payments Report FORMS: BA-10
OMB NO: 3220-0176 EXPIRATION DATE: 05/31/2005 RESPS:1,850 HOURS:154 COSTS(000):$0 Representative Payee Parental Custody Monitoring FORMS: G-99D
OMB NO: 3220-0179 EXPIRATION DATE: 11/30/2005 RESPS:1,000 HOURS:250 COSTS(000):$0 Annual Earnings Questionnaire for Annuitants in Last Pre-Retire- ment Non-Railroad Employment FORMS: G-19L
OMB NO: 3220-0183 EXPIRATION DATE: 09/30/2006 RESPS:900 HOURS:225 COSTS(000):$0 Statement of Claimant or Other Person FORMS: G-93
OMB NO: 3220-0184 EXPIRATION DATE: 07/31/2007 RESPS:1,000 HOURS:133 COSTS(000):$0 Earnings Information Request FORMS: G-19-F
OMB NO: 3220-0185 EXPIRATION DATE: 11/30/2004 RESPS:600 HOURS:100 COSTS(000):$0 Report of Medicaid State Office on Beneficiary's Buy-In Status FORMS: RL-380-F
OMB NO: 3220-0187 EXPIRATION DATE: 10/31/2005 RESPS:3,000 HOURS:748 COSTS(000):$0 Continuing Disability Report FORMS: G-254 G-254A
OMB NO: 3220-0192 EXPIRATION DATE: 12/31/2006 RESPS:2,050 HOURS:742 COSTS(000):$0 Voluntary Customer Surveys in Accordance with E.O. 12862 FORMS: G-201
OMB NO: 3220-0193 EXPIRATION DATE: 11/30/2006 RESPS:430 HOURS:144 COSTS(000):$0 Job Information Report FORMS: G-251A G-251B
OMB NO: 3220-0195 EXPIRATION DATE: 05/31/2005 RESPS:500 HOURS:500 COSTS(000):$0 Statement Regarding Contributions and Support of Children FORMS: G-139
OMB NO: 3220-0196 EXPIRATION DATE: 07/31/2007 RESPS:80 HOURS:13 COSTS(000):$0 Invetigation of Claim for Possible Days of Employment FORMS: ID-5S(SUP)
OMB NO: 3220-0197 EXPIRATION DATE: 11/30/2004 RESPS:90 HOURS:180 COSTS(000):$0 Verification of Supplement Annuity FORMS: G-88P.1 G-88P.2
OMB NO: 3220-0198 EXPIRATION DATE: 04/30/2007 RESPS:23,520 HOURS:1,274 COSTS(000):$0 Request for Internet Services FORMS: NONE
OMB NO: 3220-0199 EXPIRATION DATE: 02/28/2005 RESPS:900 HOURS:283 COSTS(000):$0 System Access Application FORMS: BA-12
OMB NO: 3220-0200 EXPIRATION DATE: 07/31/2007 RESPS:100 HOURS:25 COSTS(000):$0 Designation of Contact Officials FORMS: G-117A
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
64 648,428 151,280 $0
(RETURN TO AGENCY LIST)
OMB NO: 3240-0002 EXPIRATION DATE: 07/31/2005 RESPS:601,418 HOURS:20,047 COSTS(000):$0 Selective Service Registration Form FORMS: SSS-1 SSS-1M
OMB NO: 3240-0003 EXPIRATION DATE: 08/31/2005 RESPS:729,878 HOURS:24,305 COSTS(000):$0 SSS Change of Information, SSS Registration Status Form, SSS Acknowledgement and Correction/Change Form FORMS: SSS-2 SSS-3A SSS-3B SSS-3C
OMB NO: 3240-0005 EXPIRATION DATE: 11/30/2004 RESPS:900 HOURS:225 COSTS(000):$0 Potential Board Member Information FORMS: SSS-404
OMB NO: 3240-0006 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Registrant Claim Form FORMS: SSS-9
OMB NO: 3240-0010 EXPIRATION DATE: 08/31/2005 RESPS:2,705 HOURS:89 COSTS(000):$0 Uncompensated Registrar Appointment FORMS: SSS-402
OMB NO: 3240-0014 EXPIRATION DATE: 05/31/2007 RESPS:1 HOURS:1 COSTS(000):$0 Registrant Travel Reimbursement Request FORMS: SSS-350
OMB NO: 3240-0015 EXPIRATION DATE: 05/31/2007 RESPS:1 HOURS:1 COSTS(000):$0 Application for Voluntary Induction FORMS: SSS-254
OMB NO: 3240-0017 EXPIRATION DATE: 08/31/2005 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: 3240-0018 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Student Certificate FORMS: SSS-109
OMB NO: 3240-0022 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form Alien or Dual National FORMS: SSS=26
OMB NO: 3240-0023 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form Minister of Religion FORMS: SSS-25
OMB NO: 3240-0024 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form Hardship to Dependents FORMS: SSS-24
OMB NO: 3240-0025 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form Administrative FORMS: SSS-21
OMB NO: 3240-0026 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form - Divinity Student FORMS: SSS-23
OMB NO: 3240-0027 EXPIRATION DATE: 08/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form Postponement of Induction FORMS: SSS-27
OMB NO: 3240-0028 EXPIRATION DATE: 05/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 Claim Documentation Form - Conscientious Objector FORMS: SSS-22
OMB NO: 3240-0029 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Alternative Service Worker Travel Reimubursement Request FORMS: SSS-164
OMB NO: 3240-0030 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Claim for Reimbursement for Emergency Medical Care FORMS: SSS-166
OMB NO: 3240-0031 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 employer data sheet FORMS: SSS-153
OMB NO: 3240-0032 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Skills Questionnaire FORMS: SSS-156
OMB NO: 3240-0033 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Alternative Service Job Data Form FORMS: SSS-157
OMB NO: 3240-0034 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 Request for Overseas Job Assignment FORMS: SSS-160
OMB NO: 3240-0035 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 employment verification form FORMS: SSS-163
OMB NO: 3240-0036 EXPIRATION DATE: 07/31/2005 RESPS:1 HOURS:1 COSTS(000):$0 alternative service employement agreement FORMS: SSS-152
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
24 1,334,921 44,686 $0
(RETURN TO AGENCY LIST)
OMB NO: 3245-0007 EXPIRATION DATE: 03/31/2007 RESPS:31,113 HOURS:1,164 COSTS(000):$0 Surety Bond Guarantee Assistance FORMS: 990 991 994 994B 994C 994F 994H
OMB NO: 3245-0009 EXPIRATION DATE: 08/31/2007 RESPS:4,200 HOURS:700 COSTS(000):$0 Size Status Declaration FORMS: 480
OMB NO: 3245-0012 EXPIRATION DATE: 05/31/2005 RESPS:5,000 HOURS:5,000 COSTS(000):$0 Requests from borrowers (Financial Statements) FORMS: 770
OMB NO: 3245-0016 EXPIRATION DATE: 11/30/2004 RESPS:60,000 HOURS:1,200,000 COSTS(000):$0 Applications for Business Loans FORMS: FORM-4 SCH.-A FORM-4-1 FORM-4-L
OMB NO: 3245-0017 EXPIRATION DATE: 07/31/2007 RESPS:12,742 HOURS:29,754 COSTS(000):$0 Disaster Business Loan Application FORMS: 5 1368
OMB NO: 3245-0018 EXPIRATION DATE: 09/30/2006 RESPS:47,962 HOURS:71,943 COSTS(000):$0 Disaster Home Loan Application FORMS: 5C 739
OMB NO: 3245-0024 EXPIRATION DATE: 02/28/2007 RESPS:10,000 HOURS:2,500 COSTS(000):$0 Pro-Net FORMS: NONE
OMB NO: 3245-0062 EXPIRATION DATE: 04/30/2007 RESPS:680 HOURS:10,880 COSTS(000):$4,280 SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire FORMS: 2181 2182 2183
OMB NO: 3245-0063 EXPIRATION DATE: 10/31/2004 RESPS:1,040 HOURS:16,480 COSTS(000):$0 SBIC Financial Reports FORMS: FORM-468
OMB NO: 3245-0071 EXPIRATION DATE: 04/30/2005 RESPS:5,200 HOURS:11,700 COSTS(000):$0 U.S. Small Business Administration Application for Section 504 Loan FORMS: FORM-1244
OMB NO: 3245-0074 EXPIRATION DATE: 08/31/2007 RESPS:1 HOURS:7,560 COSTS(000):$151 CDC Annual Report Guide FORMS: 1253
OMB NO: 3245-0075 EXPIRATION DATE: 03/31/2007 RESPS:200,000 HOURS:40,000 COSTS(000):$0 Training Program Evaluation FORMS: 20
OMB NO: 3245-0076 EXPIRATION DATE: 05/31/2005 RESPS:486,000 HOURS:487,600 COSTS(000):$0 Notice to New SBA Borrowers FORMS: 793
OMB NO: 3245-0077 EXPIRATION DATE: 09/30/2006 RESPS:14 HOURS:1,120 COSTS(000):$120 Reports to SBA; Provisions of 13 CFR 120.472 FORMS: NONE
OMB NO: 3245-0078 EXPIRATION DATE: 09/30/2007 RESPS:4,000 HOURS:800 COSTS(000):$0 Portfolio Financing Report FORMS: SBA-1031
OMB NO: 3245-0080 EXPIRATION DATE: 12/31/2006 RESPS:200 HOURS:100 COSTS(000):$0 Statement of Personal History FORMS: 1081
OMB NO: 3245-0081 EXPIRATION DATE: 07/31/2005 RESPS:125 HOURS:110 COSTS(000):$0 25-Model Corp. Resol. or GP Certif., 33-Model Letter to Selling Agent 34-Bank ID, 1065 Appl. Lic. Assure. of Compliance FORMS: 25 33 34 1065
OMB NO: 3245-0084 EXPIRATION DATE: 09/30/2006 RESPS:42,196 HOURS:10,549 COSTS(000):$0 Disaster Home/Business Loan Inquiry Record FORMS: 700
OMB NO: 3245-0096 EXPIRATION DATE: 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: 3245-0101 EXPIRATION DATE: 07/31/2006 RESPS:10,500 HOURS:42,000 COSTS(000):$0 Application for Small Business Size Determination FORMS: 355
OMB NO: 3245-0109 EXPIRATION DATE: 08/31/2006 RESPS:2,160 HOURS:2,160 COSTS(000):$0 Request for Information Concerning Portfolio Financing FORMS: 857
OMB NO: 3245-0110 EXPIRATION DATE: 09/30/2006 RESPS:24,156 HOURS:12,078 COSTS(000):$0 Borrower's Progress Certification FORMS: 1366
OMB NO: 3245-0116 EXPIRATION DATE: 08/31/2006 RESPS:1,500 HOURS:750 COSTS(000):$0 Financial Institution Confirmation Form FORMS: 860
OMB NO: 3245-0118 EXPIRATION DATE: 11/30/2005 RESPS:400 HOURS:187 COSTS(000):$0 Disclosure Statement, Leveraged Licenses and Disclosure Statement Non-Leveaged Licensees FORMS: SBA-856 SBA-856A
OMB NO: 3245-0121 EXPIRATION DATE: 06/30/2006 RESPS:47 HOURS:940 COSTS(000):$0 Governor's Request for Disaster Declaration FORMS: NONE
OMB NO: 3245-0131 EXPIRATION DATE: 05/31/2006 RESPS:18,637 HOURS:3,089 COSTS(000):$0 Transaction Report on Loans Serviced by Lenders FORMS: SBA-172
OMB NO: 3245-0132 EXPIRATION DATE: 03/31/2005 RESPS:5,000 HOURS:5,000 COSTS(000):$0 Lender Transcript of Account FORMS: FORM-1149
OMB NO: 3245-0136 EXPIRATION DATE: 03/31/2007 RESPS:3,000 HOURS:249 COSTS(000):$0 Disaster Survey Worksheet FORMS: 987
OMB NO: 3245-0169 EXPIRATION DATE: 03/31/2007 RESPS:126 HOURS:8,568 COSTS(000):$0 Federal Cash Transaction Report, Financial Status Report, Program Income Report, Narrative Program Report FORMS: SF-269 SF-272 SBA-2113
OMB NO: 3245-0172 EXPIRATION DATE: 08/31/2007 RESPS:600 HOURS:600 COSTS(000):$0 Stockholders' Confirmation (Corporation); Ownership Confirmation (Partnership) FORMS: 1405 1405A
OMB NO: 3245-0178 EXPIRATION DATE: 09/30/2006 RESPS:55,000 HOURS:13,750 COSTS(000):$0 Statement of Personal History FORMS: 912
OMB NO: 3245-0183 EXPIRATION DATE: 09/30/2006 RESPS:15,000 HOURS:3,000 COSTS(000):$0 SBA Counseling Evaluation FORMS: 1419
OMB NO: 3245-0188 EXPIRATION DATE: 11/30/2004 RESPS:187,027 HOURS:280,608 COSTS(000):$0 Personal Financial Statement FORMS: SBA-FORM-413
OMB NO: 3245-0193 EXPIRATION DATE: 05/31/2005 RESPS:4,200 HOURS:4,200 COSTS(000):$0 Servicing Agent Agreement FORMS: 1506
OMB NO: 3245-0200 EXPIRATION DATE: 03/31/2005 RESPS:39,988 HOURS:29,991 COSTS(000):$0 Settlement Sheet FORMS: FORM-1050
OMB NO: 3245-0201 EXPIRATION DATE: 05/31/2005 RESPS:115,000 HOURS:9,584 COSTS(000):$0 7(a) Loan Closing Forms FORMS: 159 160 160A
OMB NO: 3245-0205 EXPIRATION DATE: 10/31/2004 RESPS:6,942 HOURS:13,884 COSTS(000):$0 8(a) Annual Update FORMS: 1450
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: 3245-0225 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: 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: 3245-0301 EXPIRATION DATE: 09/30/2007 RESPS:190 HOURS:380 COSTS(000):$0 Financing Eligibility Statement - Social Disadvantage/Economic Disadvantage FORMS: SBA-1941A SBA-1941B SBA-1941C
OMB NO: 3245-0313 EXPIRATION DATE: 08/31/2007 RESPS:8,400 HOURS:36,210 COSTS(000):$0 8(a)/SDB Paper and Electronic Application FORMS: 1010 1010E 1010B 2065 1010C
OMB NO: 3245-0314 EXPIRATION DATE: 06/30/2005 RESPS:11,038 HOURS:2,760 COSTS(000):$0 Voluntary Customer Surveys in accordance with E.O. 12862 FORMS: NONE
OMB NO: 3245-0320 EXPIRATION DATE: 02/28/2006 RESPS:10,000 HOURS:10,000 COSTS(000):$0 HUBZone Internet Application Form FORMS: 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: 3245-0330 EXPIRATION DATE: 12/31/2006 RESPS:98 HOURS:196 COSTS(000):$0 Military Reservist Economist Injury Disaster Loan Application FORMS: SBA-FORM-5R
OMB NO: 3245-0332 EXPIRATION DATE: 09/30/2005 RESPS:1,131 HOURS:13,925 COSTS(000):$2,699 New Markets Venture Capital (NMVC) Program Application, Funding and Reporting FORMS: SFS-269/270 272/424 SBA-34/159/468 480/1031/2184 2185/2207-2211 2219
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: 3245-0340 EXPIRATION DATE: 04/30/2006 RESPS:1 HOURS:400 COSTS(000):$0 Veterans Business Ownership Survey FORMS: NONE
OMB NO: 3245-0345 EXPIRATION DATE: 08/31/2006 RESPS:100 HOURS:50 COSTS(000):$0 Costs of litigation to small business; Executive Interview Questionnaire FORMS: NONE
OMB NO: 3245-0346 EXPIRATION DATE: 02/28/2007 RESPS:886 HOURS:832 COSTS(000):$0 PCLP Quarterly Loan Loss Reserve Report and PCLP Guarantee Request FORMS: 2233 2234A/B/C
OMB NO: 3245-0347 EXPIRATION DATE: 08/31/2006 RESPS:750 HOURS:63 COSTS(000):$0 Small Business Questionnaire (Use of Telecommunication) FORMS: NONE
OMB NO: 3245-0348 EXPIRATION DATE: 02/28/2007 RESPS:20,000 HOURS:17,500 COSTS(000):$0 SBA Express Information Collection FORMS: 1919 1920SX 2236 2237 2238
OMB NO: 3245-0350 EXPIRATION DATE: 02/28/2007 RESPS:6,000 HOURS:3,000 COSTS(000):$0 HUBZone Application Data Update FORMS: NONE
OMB NO: 3245-0351 EXPIRATION DATE: 12/31/2005 RESPS:14,000 HOURS:2,333 COSTS(000):$0 Entrepreneurial Development Impact Survey FORMS: FORM-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
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
57 1,497,042 2,515,123 $7,287
(RETURN TO AGENCY LIST)
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: 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:50,000 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: 0960-0004 EXPIRATION DATE: 12/31/2006 RESPS:288,580 HOURS:72,145 COSTS(000):$0 Application for Widow's or Widower's Insurance Benefits 20 CFR 404.335-.338, 20 CFR 404.603 FORMS: SSA-10
OMB NO: 0960-0009 EXPIRATION DATE: 11/30/2005 RESPS:180,000 HOURS:15,000 COSTS(000):$0 Marriage Certification - 20 CFR 404 Subpart H FORMS: SSA-3-F6
OMB NO: 0960-0010 EXPIRATION DATE: 05/31/2007 RESPS:1,740,000 HOURS:372,417 COSTS(000):$0 Application for Child's Insurance Benefits 20 CFR 404.350-404.368, 404.603, 416.350 FORMS: SSA-4-BK
OMB NO: 0960-0012 EXPIRATION DATE: 02/28/2006 RESPS:1,400 HOURS:350 COSTS(000):$0 Application for Parent's Insurance Benefits,, 20 CFR 404.370 - .374, .601 - .603 FORMS: SSA-7-F6
OMB NO: 0960-0013 EXPIRATION DATE: 03/31/2007 RESPS:877,000 HOURS:146,167 COSTS(000):$0 Application for Lump-Sum Death Payment; 404.390 - .392 FORMS: SSA-8-F4
OMB NO: 0960-0014 EXPIRATION DATE: 08/31/2006 RESPS:2,121,686 HOURS:371,295 COSTS(000):$0 Request to be Selected as Payee, 20 CFR 404.2010 - .2025, 410.582 - .583 and 416.601 - .665 FORMS: SSA-11-BK
OMB NO: 0960-0015 EXPIRATION DATE: 10/31/2006 RESPS:100,000 HOURS:8,333 COSTS(000):$0 Request for Withdrawal of Application 20 CFR 404.640 FORMS: SSA-521
OMB NO: 0960-0016 EXPIRATION DATE: 08/31/2005 RESPS:1,200 HOURS:200 COSTS(000):$0 Statement Regarding Date of Birth and Citizenship FORMS: SSA-702
OMB NO: 0960-0017 EXPIRATION DATE: 05/31/2005 RESPS:40,000 HOURS:6,000 COSTS(000):$0 Statement Regarding Marriage FORMS: SSA-753
OMB NO: 0960-0019 EXPIRATION DATE: 07/31/2007 RESPS:14,000 HOURS:2,333 COSTS(000):$0 Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody FORMS: SSA-781
OMB NO: 0960-0020 EXPIRATION DATE: 06/30/2005 RESPS:30,000 HOURS:8,500 COSTS(000):$0 Statement Regarding Contributions FORMS: SSA-783
OMB NO: 0960-0024 EXPIRATION DATE: 05/31/2007 RESPS:120,000 HOURS:20,000 COSTS(000):$0 Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits FORMS: SSA-787 20-CFR-404.2015 416.615
OMB NO: 0960-0025 EXPIRATION DATE: 03/31/2006 RESPS:12,350 HOURS:6,175 COSTS(000):$0 Partnership Questionnaire - 20 CFR, Subpart K, 404.1080-.1082 FORMS: SSA-7104
OMB NO: 0960-0029 EXPIRATION DATE: 10/31/2004 RESPS:375,000 HOURS:62,500 COSTS(000):$0 Request for Correction of Earnings Record FORMS: SSA-7008
OMB NO: 0960-0030 EXPIRATION DATE: 07/31/2006 RESPS:925,000 HOURS:308,333 COSTS(000):$0 Statement of Employer, 20 CFR 404.801 - .803 FORMS: SSA-7011-BK
OMB NO: 0960-0034 EXPIRATION DATE: 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: 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: 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: 0960-0040 EXPIRATION DATE: 02/28/2007 RESPS:47,500 HOURS:19,792 COSTS(000):$0 Employment Relationship Questionnaire FORMS: SSA-7160
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: 10/31/2006 RESPS:305,500 HOURS:76,375 COSTS(000):$0 Statement of Claimant or Other Person FORMS: SSA-795
OMB NO: 0960-0046 EXPIRATION DATE: 11/30/2006 RESPS:5,000 HOURS:417 COSTS(000):$0 Statement of Self-Employment Income, 20 CFR 404.101, 404-110, 404.1096(a)-(d) FORMS: SSA-766
OMB NO: 0960-0049 EXPIRATION DATE: 04/30/2006 RESPS:235,000 HOURS:24,583 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: 08/31/2006 RESPS:35,000 HOURS:2,917 COSTS(000):$0 Supplement to Claim of Person Outside the United States 20 CFR 404.460-463, 20 CFR 422.505, 42 CFR 407.27 FORMS: SSA-21
OMB NO: 0960-0052 EXPIRATION DATE: 10/31/2004 RESPS:750,000 HOURS:375,000 COSTS(000):$0 Medical Report (General) FORMS: SSA-3826-F4
OMB NO: 0960-0058 EXPIRATION DATE: 12/31/2005 RESPS:50,000 HOURS:30,000 COSTS(000):$0 Report on Individual with Mental Impairment - 20 CFR, Subparts O & I FORMS: SSA-824
OMB NO: 0960-0059 EXPIRATION DATE: 04/30/2006 RESPS:300,000 HOURS:225,000 COSTS(000):$0 Work Activity Report--Employee FORMS: SSA-821-BK
OMB NO: 0960-0061 EXPIRATION DATE: 06/30/2007 RESPS:47,500 HOURS:7,917 COSTS(000):$0 Farm Self-Employment Questionnaire FORMS: SSA-7156
OMB NO: 0960-0062 EXPIRATION DATE: 05/31/2005 RESPS:3,200 HOURS:800 COSTS(000):$0 Application for Survivors Benefits FORMS: SSA-24
OMB NO: 0960-0064 EXPIRATION DATE: 08/31/2005 RESPS:38,000 HOURS:19,000 COSTS(000):$0 Farm Arrangement Questionnaire--20 CFR 404.1082(c) FORMS: SSA-7157-F4
OMB NO: 0960-0066 EXPIRATION DATE: 10/31/2006 RESPS:18,096,000 HOURS:1,987,533 COSTS(000):$7,951 Application for a Social Security Card; Enumeration at Birth; 20 CFR 422.103 - .110 FORMS: SS-5 SS-5-FS
OMB NO: 0960-0068 EXPIRATION DATE: 02/28/2005 RESPS:5,527,755 HOURS:1,381,939 COSTS(000):$0 Representative Payee Report FORMS: SSA-623 SSA-6230
OMB NO: 0960-0069 EXPIRATION DATE: 09/30/2007 RESPS:252,000 HOURS:126,000 COSTS(000):$0 Representative Payee Evaluation Report 20 CFR 404.2065, 416.665 FORMS: SSA-624
OMB NO: 0960-0071 EXPIRATION DATE: 04/30/2006 RESPS:27,000 HOURS:2,250 COSTS(000):$0 Report of New Information in Disability Cases, 20 CFR 404.408, 404.460, 404.468, and 404.1588 FORMS: SSA-612
OMB NO: 0960-0072 EXPIRATION DATE: 03/31/2005 RESPS:852,000 HOURS:426,000 COSTS(000):$0 Report of Continuing Disability Interview FORMS: SSA-454-BK
OMB NO: 0960-0073 EXPIRATION DATE: 03/31/2006 RESPS:70,000 HOURS:5,833 COSTS(000):$0 Reporting Changes That Affect Your Social Security Benefit, 20 CFR 404 Subpart D FORMS: SSA-1425
OMB NO: 0960-0078 EXPIRATION DATE: 06/30/2005 RESPS:125,000 HOURS:10,417 COSTS(000):$0 Railroad Employment Questionnaire FORMS: SSA-671
OMB NO: 0960-0088 EXPIRATION DATE: 12/31/2006 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: 10/31/2006 RESPS:180 HOURS:45 COSTS(000):$0 Certification by Religious Group - 20 CFR, Subpart K, 404.1075 FORMS: SSA-1458
OMB NO: 0960-0096 EXPIRATION DATE: 11/30/2006 RESPS:10 HOURS:3 COSTS(000):$0 Application for Special Age 72-or-Over Monthly Payments, 20 CFR 404.380-384 FORMS: SSA-19-F6
OMB NO: 0960-0097 EXPIRATION DATE: 10/31/2006 RESPS:18,030 HOURS:3,606 COSTS(000):$0 Application for Search of Census Record for Proof of Age, 20 CFR 404.716 FORMS: SSA-1535
OMB NO: 0960-0098 EXPIRATION DATE: 10/31/2006 RESPS:140,000 HOURS:35,000 COSTS(000):$0 Request for Workers' Compensation/Public Disability Information - 20 CFR, Subpart E, 404.408 FORMS: SSA-1709
OMB NO: 0960-0101 EXPIRATION DATE: 08/31/2006 RESPS:300,000 HOURS:50,000 COSTS(000):$0 Claim for Amounts Due in the Case of a Deceased Beneficiary, 20 CFR 404.503(b) FORMS: SSA-1724
OMB NO: 0960-0102 EXPIRATION DATE: 01/31/2005 RESPS:12,000 HOURS:6,000 COSTS(000):$0 Medical Report (Individual with Childhood Impairment) FORMS: SSA-3827
OMB NO: 0960-0103 EXPIRATION DATE: 07/31/2007 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: 01/31/2007 RESPS:269,000 HOURS:134,500 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: 02/28/2007 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
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: 01/31/2005 RESPS:125 HOURS:125 COSTS(000):$0 State Mental Institution Policy Review FORMS: SSA-9584-BK
OMB NO: 0960-0112 EXPIRATION DATE: 10/31/2004 RESPS:8,000 HOURS:2,000 COSTS(000):$0 Report by Former Representative Payee FORMS: SSA-625
OMB NO: 0960-0113 EXPIRATION DATE: 03/31/2005 RESPS:50 HOURS:8 COSTS(000):$0 Statement Regarding Students' School Attendance FORMS: SSA-2434
OMB NO: 0960-0116 EXPIRATION DATE: 03/31/2007 RESPS:50,000 HOURS:12,500 COSTS(000):$0 Child Relationship Statement FORMS: SSA-2519
OMB NO: 0960-0120 EXPIRATION DATE: 03/31/2007 RESPS:10,000 HOURS:1,667 COSTS(000):$0 Pre-1957 Military Service Federal Questionnaire; 20 CFR 404.1301-1371 FORMS: SSA-2512
OMB NO: 0960-0124 EXPIRATION DATE: 05/31/2006 RESPS:341,000 HOURS:142,083 COSTS(000):$0 Statement of Income and Resources - 20 CFR, Subpart C, 416.301-310, and 20 CFR, Subpat G, 416.704, and .708 FORMS: SSA-8010-BK
OMB NO: 0960-0127 EXPIRATION DATE: 02/28/2005 RESPS:20,000 HOURS:3,333 COSTS(000):$0 Agreement to Sell Property FORMS: SSA-8060-U3
OMB NO: 0960-0128 EXPIRATION DATE: 03/31/2005 RESPS:33,200 HOURS:2,767 COSTS(000):$0 Reporting Events - SSI FORMS: SSA-8150-EV
OMB NO: 0960-0130 EXPIRATION DATE: 05/31/2005 RESPS:120 HOURS:120 COSTS(000):$0 Quarterly Statistical Report on Recipients and Payments Under State-Administered Assistance Programs for Aged, Blind, and Disabled (Individuals and Couples) Recipient FORMS: SSA-9741
OMB NO: 0960-0133 EXPIRATION DATE: 04/30/2006 RESPS:12,000 HOURS:15,000 COSTS(000):$0 SSI Quality Review Case Analysis FORMS: SSA-8508-BK
OMB NO: 0960-0138 EXPIRATION DATE: 07/31/2006 RESPS:133,000 HOURS:66,500 COSTS(000):$0 Letter to Employer Requesting Wage Information FORMS: SSA-L4201
OMB NO: 0960-0140 EXPIRATION DATE: 09/30/2005 RESPS:2,134,100 HOURS:177,842 COSTS(000):$0 Record of Supplemental Security Income Inquiry - 20 CFR 416.345 FORMS: SSA-3462
OMB NO: 0960-0142 EXPIRATION DATE: 05/31/2005 RESPS:1,059,400 HOURS:61,798 COSTS(000):$0 Statement of Death by Funeral Director FORMS: SSA-721
OMB NO: 0960-0144 EXPIRATION DATE: 08/31/2006 RESPS:1,112,818 HOURS:564,754 COSTS(000):$0 Disability Report--Appeal 20 CFR 404.1512 & 416.912 and 20 CFR, 404.916(c) & 416.1416(c) FORMS: SSA-3441
OMB NO: 0960-0145 EXPIRATION DATE: 11/30/2006 RESPS:1,310,000 HOURS:313,000 COSTS(000):$0 Statement for determining continuing eligibility for Supplemental security income payments, 20 CFR 416.204 FORMS: SSA-8202-BK SSA-8202-OCR-SM
OMB NO: 0960-0160 EXPIRATION DATE: 07/31/2005 RESPS:30,000 HOURS:15,833 COSTS(000):$0 Government Pension Questionnaire FORMS: SSA-3885
OMB NO: 0960-0174 EXPIRATION DATE: 04/30/2006 RESPS:173,380 HOURS:45,603 COSTS(000):$0 Statement of Living Arrangements, In-Kind Support and Maintenance 20 CFR 416.1130-.1148 FORMS: SSA-8006-F4
OMB NO: 0960-0184 EXPIRATION DATE: 08/31/2006 RESPS:200 HOURS:2,800 COSTS(000):$0 Instructions for Completion of Federal Assistance Application for SSA Research and Demonstration Grant Programs FORMS: SSA-96
OMB NO: 0960-0189 EXPIRATION DATE: 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: 04/30/2007 RESPS:1,128,374 HOURS:661,039 COSTS(000):$0 SSA-8000-BK - 20 CFR, Subpart C, 416.305-.335 FORMS: NONE
OMB NO: 0960-0240 EXPIRATION DATE: 12/31/2006 RESPS:26 HOURS:71 COSTS(000):$0 Subpart T-State Supplementation Provisions; Payment 20 CFR 416.2099 FORMS: NONE
OMB NO: 0960-0247 EXPIRATION DATE: 01/31/2006 RESPS:100,000 HOURS:25,000 COSTS(000):$0 Worker's Compensation/Public Disability Benefit Questionnaire - 20 CFR 404.408, Subpart E FORMS: SSA-546
OMB NO: 0960-0267 EXPIRATION DATE: 03/31/2006 RESPS:60,000 HOURS:3,000 COSTS(000):$0 Medicaid Use Report, 20 CFR 216.628 FORMS: NONE
OMB NO: 0960-0269 EXPIRATION DATE: 11/30/2004 RESPS:556,000 HOURS:92,666 COSTS(000):$0 Request for Hearing by Administrative Law Judge FORMS: HA-501
OMB NO: 0960-0277 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: 09/30/2007 RESPS:12,000 HOURS:400 COSTS(000):$0 Waiver of Your Right to Personal Appearance Before an Administrative Law Judge FORMS: HA-4608
OMB NO: 0960-0288 EXPIRATION DATE: 04/30/2007 RESPS:10,548 HOURS:879 COSTS(000):$0 Notice Regarding Substitution of Party Upon Death of Claimant; 20 CFR 404.957(c)(4); 20 CFR 416.1457(c)(4) FORMS: HA-539
OMB NO: 0960-0289 EXPIRATION DATE: 07/31/2006 RESPS:171,939 HOURS:42,985 COSTS(000):$0 Claimant's Medications - 20 CFR, Subpart P, 404.1512 and Subpart 1, 416.912 FORMS: HA-4632
OMB NO: 0960-0292 EXPIRATION DATE: 05/31/2006 RESPS:320,000 HOURS:53,333 COSTS(000):$0 Claimant's Recent Medical Treatment, 20 CFR 404.1512 and 416.92 FORMS: HA-4631
OMB NO: 0960-0293 EXPIRATION DATE: 10/31/2004 RESPS:500,000 HOURS:50,000 COSTS(000):$0 Authorization for SSA to Obtain Account Records from a Financial Institution and Request for Records FORMS: SSA-4641-U2
OMB NO: 0960-0300 EXPIRATION DATE: 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: 0960-0310 EXPIRATION DATE: 01/31/2007 RESPS:16,300 HOURS:9,048 COSTS(000):$0 Vocational Rehabilitation Provider Claim, 20 CFR 404 Subpart V FORMS: SSA-199
OMB NO: 0960-0323 EXPIRATION DATE: 08/31/2006 RESPS:95,000 HOURS:7,917 COSTS(000):$0 Third Party Liability Information Statement - 42 CFR 433.136-.139 FORMS: SSA-8019-U2
OMB NO: 0960-0324 EXPIRATION DATE: 03/31/2006 RESPS:7,500 HOURS:1,250 COSTS(000):$0 Supplemental Security Income Claim Information Notice - 20 CFR, Subpart B, 416.210 FORMS: L8050
OMB NO: 0960-0341 EXPIRATION DATE: 03/31/2005 RESPS:2,400 HOURS:80 COSTS(000):$0 Request for Address Information from Motor Vehicles Records; Request for Address Information from Employment Commissions Records FORMS: SSA-L711 SSA-L712
OMB NO: 0960-0347 EXPIRATION DATE: 06/30/2007 RESPS:1,925 HOURS:963 COSTS(000):$0 Response to Notice of Revised Determination 20 CFR 404.913-.914, 404.992(b), 416.1413, 416.1492(d) FORMS: SSA-765
OMB NO: 0960-0348 EXPIRATION DATE: 09/30/2007 RESPS:7,483 HOURS:998 COSTS(000):$0 Request for Change in Time/Place of Disability Hearing, 20 CFR 404.914(c)(2) and 416.1414(c)(2) FORMS: SSA-769
OMB NO: 0960-0349 EXPIRATION DATE: 10/31/2006 RESPS:49,000 HOURS:10,045 COSTS(000):$0 Request for Reconsideration--Disability Cessation--20 CFR, Subpart J. 404.409 & Sunpart N, 416.1409 FORMS: SSA-789
OMB NO: 0960-0351 EXPIRATION DATE: 06/30/2007 RESPS:1,200 HOURS:100 COSTS(000):$0 Notice Regarding Substitution of Party Upon Death of Claimant Reconsiderationof Disability Cessation FORMS: SSA-770
OMB NO: 0960-0369 EXPIRATION DATE: 01/31/2007 RESPS:225,000 HOURS:37,500 COSTS(000):$0 Annual Earnings Test-Direct Mail Follow-up Program Notices; 20 CFR 404.452-.455 FORMS: SSA-L9778 SSA-L9779 SSA-L9781 SSA-L9784 SSA-L9785
OMB NO: 0960-0371 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: 0960-0395 EXPIRATION DATE: 01/31/2005 RESPS:90,000 HOURS:12,000 COSTS(000):$0 Modified Benefit Formula Questionnaire FORMS: SSA-150
OMB NO: 0960-0398 EXPIRATION DATE: 05/31/2006 RESPS:30,000 HOURS:1,000 COSTS(000):$0 Certificate of Elections for Reduced Spouse's Benefits FORMS: SSA-25
OMB NO: 0960-0413 EXPIRATION DATE: 10/31/2006 RESPS:1,253,703 HOURS:313,426 COSTS(000):$0 Psychiatric Review Technique - 20 CFR, Subpart P, 404.1520(a) Subpart 1, 416.920(a) FORMS: SSA-2506-BK
OMB NO: 0960-0416 EXPIRATION DATE: 11/30/2006 RESPS:900,000 HOURS:285,000 COSTS(000):$0 Statement for determining continuing eligibility for Supplemental Security Income Payments, 20 CFR 416.204 FORMS: SSA-8203-BK
OMB NO: 0960-0421 EXPIRATION DATE: 06/30/2007 RESPS:208 HOURS:728 COSTS(000):$0 State Agency Report of obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services; Schedule of Equipment Purchased for SSA.. FORMS: SSA-4513 SSA-4514 SSA-871
OMB NO: 0960-0425 EXPIRATION DATE: 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: 0960-0428 EXPIRATION DATE: 06/30/2007 RESPS:36 HOURS:18 COSTS(000):$0 Subpoena-Disability Hearing FORMS: SSA-1272-U4
OMB NO: 0960-0430 EXPIRATION DATE: 06/30/2007 RESPS:49,000 HOURS:12,250 COSTS(000):$0 Summary of Evidence, 20 CFR 404.913(b), 404.914(a), 416.1407, 416.1413(b), and 416.1414(a) FORMS: SSA-887
OMB NO: 0960-0431 EXPIRATION DATE: 05/31/2007 RESPS:2,421,865 HOURS:807,288 COSTS(000):$0 Physical Residual Functional Capacity Assessment and Mental Residual Capacity Assessment FORMS: SSA-4734-BK SSA-4734-F4-SUP 20-CFR-404.1545 20-CFR-404.1546 416.945-46
OMB NO: 0960-0432 EXPIRATION DATE: 12/31/2005 RESPS:472,292 HOURS:236,146 COSTS(000):$0 Missing and Discrepant Wage Reports Letter and Questionnaire FORMS: SSA-L93 SSA-95 SSA-97
OMB NO: 0960-0434 EXPIRATION DATE: 10/31/2004 RESPS:50,000 HOURS:8,333 COSTS(000):$0 Travel Expense Reimbursement FORMS: NONE
OMB NO: 0960-0437 EXPIRATION DATE: 01/31/2005 RESPS:3,146,600 HOURS:786,650 COSTS(000):$0 Disability Determination and Transmittal FORMS: SSA-831-C3-U3
OMB NO: 0960-0440 EXPIRATION DATE: 10/31/2004 RESPS:100,000 HOURS:100,000 COSTS(000):$0 Disability Hearing Officer's Report of Disability Hearing FORMS: SSA-1205-BK
OMB NO: 0960-0441 EXPIRATION DATE: 06/30/2007 RESPS:65,000 HOURS:48,750 COSTS(000):$0 Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417 FORMS: SSA-1207 SSA-1207-SUP1 SSA-1207-SUP3
OMB NO: 0960-0442 EXPIRATION DATE: 04/30/2005 RESPS:354,450 HOURS:177,225 COSTS(000):$0 Cessation or Continuance of Disability or Blindness Determination and Transmittal FORMS: SSA-833-C3/U3
OMB NO: 0960-0443 EXPIRATION DATE: 01/31/2005 RESPS:402,250 HOURS:201,113 COSTS(000):$0 Cessation or Continuance of Disability or Blindness Determination and Transmittal FORMS: SSA-832-C3-U3
OMB NO: 0960-0444 EXPIRATION DATE: 02/28/2006 RESPS:872,956 HOURS:219,547 COSTS(000):$0 Application for Supplemental Security Income - 20 CFR, Subpart D, 416.305-.335 FORMS: SSA-8001
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: 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: 03/31/2007 RESPS:400,000 HOURS:100,000 COSTS(000):$0 Statement of Household Expenses and Contributions; 20 CFR 416.1130-.1148 FORMS: SSA-8011-F3
OMB NO: 0960-0460 EXPIRATION DATE: 02/28/2006 RESPS:5,100 HOURS:425 COSTS(000):$0 Marital Relationship Questionnaire, 20 CFR 416.1826 FORMS: SSA-4178
OMB NO: 0960-0461 EXPIRATION DATE: 06/30/2007 RESPS:200,000 HOURS:23,333 COSTS(000):$0 Information about Joint Checking/Savings Account 20 CFR 416.1201(b) and 416.1208 FORMS: SSA-2574
OMB NO: 0960-0462 EXPIRATION DATE: 11/30/2006 RESPS:19,000 HOURS:1,583 COSTS(000):$0 You Can Make Your Payment by Credit Card FORMS: SSA-4588 SSA-4589
OMB NO: 0960-0466 EXPIRATION DATE: 07/31/2007 RESPS:800,000 HOURS:66,667 COSTS(000):$0 Request for Social Security Statement FORMS: SSA-7004
OMB NO: 0960-0470 EXPIRATION DATE: 09/30/2007 RESPS:1,000 HOURS:50 COSTS(000):$0 Agency/Employer Government Pension Offset Questionnaire, 20 CFR 404.408(a) FORMS: SSA-4163
OMB NO: 0960-0471 EXPIRATION DATE: 07/31/2007 RESPS:5,438 HOURS:1,813 COSTS(000):$0 Real Property Current Market Value Estimate FORMS: SSA-L2794
OMB NO: 0960-0472 EXPIRATION DATE: 07/31/2007 RESPS:50,000 HOURS:8,333 COSTS(000):$0 Employer Verification of Earnings After Death FORMS: SSA-L4112
OMB NO: 0960-0473 EXPIRATION DATE: 10/31/2004 RESPS:4,750 HOURS:792 COSTS(000):$1 Employee Identification Statement FORMS: SSA-4156
OMB NO: 0960-0474 EXPIRATION DATE: 08/31/2007 RESPS:2,000 HOURS:167 COSTS(000):$0 Child-Care Dropout Questionnaire 20 CFR 404.211(e)(4) FORMS: SSA-4162
OMB NO: 0960-0477 EXPIRATION DATE: 01/31/2005 RESPS:30,000 HOURS:10,000 COSTS(000):$0 Modified Benefits Formula Questionnaire, Employer FORMS: SSA-58
OMB NO: 0960-0481 EXPIRATION DATE: 05/31/2006 RESPS:40,000 HOURS:6,667 COSTS(000):$0 Statement of Funds You Provided to Another and Statement of Funds You Received, 20 CFR 416.1103 FORMS: SSA-2854 SSA-2855
OMB NO: 0960-0483 EXPIRATION DATE: 09/30/2006 RESPS:15,000 HOURS:3,750 COSTS(000):$0 Employee Work Activity Questionnaire FORMS: SSA-3033
OMB NO: 0960-0487 EXPIRATION DATE: 09/30/2006 RESPS:50,000 HOURS:16,667 COSTS(000):$0 Self-Employment/Corporate Officer Questionnaire FORMS: SSA-4184
OMB NO: 0960-0499 EXPIRATION DATE: 05/31/2007 RESPS:253,000 HOURS:126,500 COSTS(000):$0 Questionnaire for Children Claiming SSI Benefits FORMS: SSA-3881-BK
OMB NO: 0960-0500 EXPIRATION DATE: 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: 0960-0501 EXPIRATION DATE: 02/28/2007 RESPS:50 HOURS:13 COSTS(000):$0 Blood Donor Locator Service (BDLS), 20 CFR 401.200 FORMS: NONE
OMB NO: 0960-0502 EXPIRATION DATE: 06/30/2007 RESPS:133,400 HOURS:11,117 COSTS(000):$0 Beneficiary Recontact Report, 20 CFR 404.703 and 404.705 FORMS: SSA-1588-OCR-SM
OMB NO: 0960-0505 EXPIRATION DATE: 06/30/2007 RESPS:20,000 HOURS:3,333 COSTS(000):$0 Employer Verification of Records for Children Under Age Seven, 20 CFR 404.801-.803, 404.821-.822 FORMS: SSA-L3231-C1
OMB NO: 0960-0507 EXPIRATION DATE: 01/31/2005 RESPS:100,000 HOURS:100,000 COSTS(000):$0 Disability Hearing Officer's Report of Disability Hearing (DC) FORMS: SSA-1204-BK
OMB NO: 0960-0508 EXPIRATION DATE: 07/31/2007 RESPS:3,000,000 HOURS:500,000 COSTS(000):$0 SSA-L2765, Request for Self-Employment Information, SSA-L3365, Request for Employee Information, SSA-L4002, Request for Employer Information FORMS: SSA-L2765 SSA-L3365 SSA-L4002
OMB NO: 0960-0511 EXPIRATION DATE: 09/30/2005 RESPS:981,000 HOURS:245,250 COSTS(000):$0 Disability Report Update--20 CFR 404.1589-.1595 and 416.988-.996 FORMS: SSA-455 SSA-455-OCR-SM
OMB NO: 0960-0516 EXPIRATION DATE: 03/31/2007 RESPS:60,000 HOURS:5,000 COSTS(000):$0 Continuation of Full Benefit Standard for Persons Institutionalized - 20 CFR Subpart B 416.212(b)(1) FORMS: NONE
OMB NO: 0960-0525 EXPIRATION DATE: 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: 04/30/2006 RESPS:1,526,892 HOURS:136,013 COSTS(000):$0 Voluntary Customer Surveys in Accordance with E.O. 12862 FORMS: NONE
OMB NO: 0960-0527 EXPIRATION DATE: 08/31/2007 RESPS:551,520 HOURS:91,920 COSTS(000):$0 Appointment of Representative - 20 CFR 404 Subpart R, 410 Subpart F and 416 Subpart O FORMS: SSA-1696-U4
OMB NO: 0960-0529 EXPIRATION DATE: 10/31/2006 RESPS:131,080 HOURS:21,846 COSTS(000):$0 Claimant's Statement About Loan of Food and/or Shelter & Statement About Food or Shelter Provided by Another 20 CFR 416.1130-1148 FORMS: SSA-5062 SSA-L5063
OMB NO: 0960-0534 EXPIRATION DATE: 12/31/2006 RESPS:200 HOURS:10 COSTS(000):$0 Waiver of Right to Appear, Disability Hearing; 20 CFR 404.916(b)(5) and 416.1416(b)(5) FORMS: SSA-773-U4
OMB NO: 0960-0536 EXPIRATION DATE: 10/31/2004 RESPS:982,357 HOURS:49,118 COSTS(000):$0 Beneficiary Recontact Report FORMS: SSA-1587-OCR-SM
OMB NO: 0960-0540 EXPIRATION DATE: 04/30/2007 RESPS:250,000 HOURS:62,500 COSTS(000):$0 Pain Report - Child, 20 CFR 416.912 & 404.512 FORMS: SSA-3371-BK
OMB NO: 0960-0542 EXPIRATION DATE: 09/30/2007 RESPS:650,000 HOURS:216,667 COSTS(000):$0 Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2) FORMS: SSA-3375 SSA-3376 SSA-3377 SSA-3378 SSA-3379
OMB NO: 0960-0544 EXPIRATION DATE: 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: 06/30/2007 RESPS:600 HOURS:300 COSTS(000):$0 Wage Reports and Pension Information, 20 CFR 422.122(b) FORMS: NONE
OMB NO: 0960-0554 EXPIRATION DATE: 10/31/2004 RESPS:40,000 HOURS:20,000 COSTS(000):$0 Certificate of Coverage Request FORMS: NONE
OMB NO: 0960-0555 EXPIRATION DATE: 03/31/2007 RESPS:12,011,787 HOURS:3,300,197 COSTS(000):$0 Clearance of Information Collections Conducted by State Disability Determination Services on Behalf of SSA FORMS: NONE
OMB NO: 0960-0557 EXPIRATION DATE: 12/31/2005 RESPS:2,100 HOURS:105 COSTS(000):$0 Inquiry to File an SSI Child's Application; 20 CFR 416.345 FORMS: SSRO-3-293
OMB NO: 0960-0559 EXPIRATION DATE: 10/31/2004 RESPS:7,000 HOURS:14,000 COSTS(000):$0 Plan for Achieving Self-Support FORMS: SSA-545
OMB NO: 0960-0561 EXPIRATION DATE: 05/31/2007 RESPS:50,000 HOURS:8,333 COSTS(000):$0 Modified Benefit Formula Questionnaire-Foreign Pension FORMS: SSA-308
OMB NO: 0960-0564 EXPIRATION DATE: 07/31/2006 RESPS:395,000 HOURS:197,500 COSTS(000):$0 QuickStart Enrollment Process -- 31 CFR 210 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: 11/30/2006 RESPS:2,228,500 HOURS:119,133 COSTS(000):$0 Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public; 20 CFR 401 & 402 FORMS: SSA-3288
OMB NO: 0960-0568 EXPIRATION DATE: 12/31/2006 RESPS:750,000 HOURS:312,500 COSTS(000):$0 Childhood Disability Evaluation Form 20 CFR 416.924(g) FORMS: SSA-538
OMB NO: 0960-0575 EXPIRATION DATE: 04/30/2007 RESPS:550,000 HOURS:18,334 COSTS(000):$0 Request to Resolve Questionnaire Quarters of Coverage (QC); Request for QC History Based on Relationship FORMS: SSA-512 SSA-513
OMB NO: 0960-0576 EXPIRATION DATE: 02/28/2007 RESPS:30,000 HOURS:10,000 COSTS(000):$0 Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665 FORMS: SSA-6233
OMB NO: 0960-0577 EXPIRATION DATE: 07/31/2007 RESPS:525,500 HOURS:528,000 COSTS(000):$0 Disability Report - Child FORMS: SSA-3820 I3820 EDCS
OMB NO: 0960-0578 EXPIRATION DATE: 07/31/2007 RESPS:871,000 HOURS:871,000 COSTS(000):$0 Work History Report FORMS: SSA-3369-BK
OMB NO: 0960-0579 EXPIRATION DATE: 11/30/2006 RESPS:2,116,667 HOURS:2,215,667 COSTS(000):$0 Social Security Disability Report FORMS: SSA-3368-BK
OMB NO: 0960-0581 EXPIRATION DATE: 01/31/2007 RESPS:100,000 HOURS:28,333 COSTS(000):$0 Application of Circuit Court Law FORMS: 404.985(B) 416.1485(B)
OMB NO: 0960-0583 EXPIRATION DATE: 01/31/2007 RESPS:21,000 HOURS:525 COSTS(000):$0 Internet Request for Replacement SSA-1099/1042S FORMS: NONE
OMB NO: 0960-0585 EXPIRATION DATE: 03/31/2007 RESPS:98 HOURS:98 COSTS(000):$0 Discrimination Complaint Form FORMS: SSA-437
OMB NO: 0960-0595 EXPIRATION DATE: 04/30/2005 RESPS:133,920 HOURS:1,116 COSTS(000):$0 Electronic Benefit Verification Information (BEVE) FORMS: NONE
OMB NO: 0960-0596 EXPIRATION DATE: 08/31/2006 RESPS:210,000 HOURS:13,333 COSTS(000):$0 Request for Internet Services - Authetication, 20 CFR 401.45 FORMS: NONE
OMB NO: 0960-0598 EXPIRATION DATE: 03/31/2005 RESPS:100,000 HOURS:50,000 COSTS(000):$0 Work Activity Report (Self-Employed) FORMS: SSA-820-F4
OMB NO: 0960-0602 EXPIRATION DATE: 06/30/2005 RESPS:60,000 HOURS:2,000 COSTS(000):$0 Authorization To Obtain Earnings Data for The Social Security Administration FORMS: SSA-581
OMB NO: 0960-0606 EXPIRATION DATE: 10/31/2004 RESPS:88,000 HOURS:220,000 COSTS(000):$12,194 Annual Registration Statement Identifying Participants with Vested Benefits FORMS: NONE
OMB NO: 0960-0610 EXPIRATION DATE: 09/30/2005 RESPS:12,024 HOURS:2,211 COSTS(000):$0 State Partnership Initiative Demonstration Project FORMS: NONE
OMB NO: 0960-0615 EXPIRATION DATE: 08/31/2006 RESPS:400 HOURS:133 COSTS(000):$0 Application for Special Benefits for World War II Veterans--20 CFR, Subpart C, 408 FORMS: SSA-2000-F6
OMB NO: 0960-0616 EXPIRATION DATE: 12/31/2006 RESPS:413 HOURS:8,955 COSTS(000):$0 Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher Learning, Hospitals and Others FORMS: NONE
OMB NO: 0960-0617 EXPIRATION DATE: 08/31/2006 RESPS:1,000 HOURS:17 COSTS(000):$0 SSI Ineligibility for Fugitives and Probation/Parole Violators; 20 CFR 416.708(o) FORMS: NONE
OMB NO: 0960-0618 EXPIRATION DATE: 05/31/2007 RESPS:3,843,369 HOURS:995,457 COSTS(000):$0 Social Security Benefits Application (Internet, Retirement Survivor & Disability) - Part 404 Subpart D, G & P FORMS: SSA-1 SSA-2 SSA-16
OMB NO: 0960-0619 EXPIRATION DATE: 10/31/2006 RESPS:40 HOURS:40 COSTS(000):$0 Individuals or Agents Seeking Information or Testimony in Non-SSA Cases 20 CFR 403.100-155 FORMS: NONE
OMB NO: 0960-0621 EXPIRATION DATE: 10/31/2006 RESPS:100 HOURS:17 COSTS(000):$0 Representative Payee Report-Special Veterans Benefits FORMS: SSA-2001
OMB NO: 0960-0622 EXPIRATION DATE: 10/31/2006 RESPS:1,455,000 HOURS:194,000 COSTS(000):$0 Request for Reconsideration - 20 CFR, Subpart J. 404.907-.921 & Subpart N, 416.1407-.1421 FORMS: SSA-561
OMB NO: 0960-0623 EXPIRATION DATE: 05/31/2007 RESPS:15,415,712 HOURS:2,569,285 COSTS(000):$0 Authorization to Source to Release Information to the Social Security Administration FORMS: SSA-827
OMB NO: 0960-0624 EXPIRATION DATE: 04/30/2007 RESPS:144 HOURS:144 COSTS(000):$0 Medical Parking Application, 42 CFR 101.20-104.2 FORMS: SSA-3192
OMB NO: 0960-0625 EXPIRATION DATE: 02/28/2005 RESPS:55 HOURS:28 COSTS(000):$0 Electronic Death Registration Survey FORMS: NONE
OMB NO: 0960-0626 EXPIRATION DATE: 01/31/2007 RESPS:250,120 HOURS:8,337 COSTS(000):$0 Integrated Registration for Employers and Submitters (IRES) FORMS: NONE
OMB NO: 0960-0629 EXPIRATION DATE: 04/30/2007 RESPS:60,569 HOURS:5,317 COSTS(000):$0 Benefits Planning, Assistance and Outreach (BPAO) Program, Cooperative Agreement Announcement No. SSA-OESP-03-1 FORMS: NONE
OMB NO: 0960-0630 EXPIRATION DATE: 06/30/2007 RESPS:200 HOURS:50 COSTS(000):$0 Beneficiary Interview and Auditor's Observations FORMS: SSA-322
OMB NO: 0960-0632 EXPIRATION DATE: 02/28/2007 RESPS:475,604 HOURS:76,096 COSTS(000):$0 Request for Internet Services - Password FORMS: NONE
OMB NO: 0960-0633 EXPIRATION DATE: 04/30/2007 RESPS:2,720 HOURS:1,020 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: 01/31/2005 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: 0960-0644 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:1,112,000 HOURS:324,417 COSTS(000):$0 National Teacher Questionnaire; Request for Administrative Information FORMS: SSA-5665-BK SSA-5666
OMB NO: 0960-0648 EXPIRATION DATE: 06/30/2005 RESPS:150 HOURS:13 COSTS(000):$0 Credit Card Payment Form FORMS: SSA-1414
OMB NO: 0960-0649 EXPIRATION DATE: 11/30/2006 RESPS:1 HOURS:1 COSTS(000):$0 Access to Information Held by Financial Institutions 20 CFR Part 416 FORMS: NONE
OMB NO: 0960-0653 EXPIRATION DATE: 10/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 Collection of SSI Overpayments from Special Benefits for Certain WWII Veterans, 20 CFR 416.572 FORMS: NONE
OMB NO: 0960-0654 EXPIRATION DATE: 10/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 20 CFR Parts 404 Subpart P & 416 Subpart 1 404.1512, 404.1545, 404.1560, 416.912, 416.945 & 416.960 FORMS: NONE
OMB NO: 0960-0657 EXPIRATION DATE: 10/31/2006 RESPS:35,000 HOURS:43,750 COSTS(000):$0 Disability Hearing Officer's Decision-Title XVI Disabled Child Continuing Disability Review 20 CFR 404.913-914 FORMS: SSA-1209
OMB NO: 0960-0658 EXPIRATION DATE: 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: 0960-0662 EXPIRATION DATE: 12/31/2005 RESPS:10,000 HOURS:50,000 COSTS(000):$0 Medical Source Statement of Ability To Do Work-Related Activities (Physical & Mental) FORMS: HA-1151 HA-1152
OMB NO: 0960-0663 EXPIRATION DATE: 12/31/2005 RESPS:4 HOURS:1 COSTS(000):$0 Private Printing and Modification of Prescribed Applications and Other Forms; 20 CFR 422.527 FORMS: NONE
OMB NO: 0960-0664 EXPIRATION DATE: 05/31/2006 RESPS:67,176 HOURS:3,172 COSTS(000):$0 20 CFR Parts 404.617 and 416.327 - Claimant Identification Pilot Project FORMS: NONE
OMB NO: 0960-0665 EXPIRATION DATE: 12/31/2006 RESPS:320,000 HOURS:37,333 COSTS(000):$0 Form SSA-711, Request for a Deceased Individual's Social Security Record FORMS: SSA-711
OMB NO: 0960-0666 EXPIRATION DATE: 02/28/2006 RESPS:5,538 HOURS:4,735 COSTS(000):$0 National Employment Activity and Disability Survey FORMS: NONE
OMB NO: 0960-0667 EXPIRATION DATE: 02/28/2006 RESPS:68 HOURS:7 COSTS(000):$0 20 CFR 429 Subpart 100, Filing Claims Under the Federal Tort Claims Act FORMS: NONE
OMB NO: 0960-0669 EXPIRATION DATE: 03/31/2006 RESPS:500,000 HOURS:83,333 COSTS(000):$0 Employee Verification Service FORMS: NONE
OMB NO: 0960-0671 EXPIRATION DATE: 11/30/2004 RESPS:1,099,002 HOURS:228,001 COSTS(000):$0 404 Subpart J & 416 Subpart N -- Video Teleconferencing Appearances before Administrative Law Judges FORMS: HA-504
OMB NO: 0960-0673 EXPIRATION DATE: 03/31/2005 RESPS:85,200 HOURS:170,400 COSTS(000):$0 Internet Report of Continuing Disability Interview (i454) FORMS: NONE
OMB NO: 0960-0675 EXPIRATION DATE: 10/31/2006 RESPS:17,000 HOURS:3,400 COSTS(000):$0 Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form, 20 CFR 416.1040 ff. FORMS: SSA-536
OMB NO: 0960-0676 EXPIRATION DATE: 10/31/2006 RESPS:1 HOURS:1 COSTS(000):$0 Annual Earnings Test, 20 CFR 404.428(b), .429(d), .435(d)(e) and .452(a)-(e) FORMS: NONE
OMB NO: 0960-0677 EXPIRATION DATE: 10/31/2006 RESPS:68,000 HOURS:13,600 COSTS(000):$0 Medical Consultant's Review of Psychiatric Review Technique Form, 20 CFR 404.1520a, 1640, 1645 FORMS: SSA-3023
OMB NO: 0960-0678 EXPIRATION DATE: 11/30/2006 RESPS:45,000 HOURS:9,000 COSTS(000):$0 Mental Residual Functional Capacity Assessment 20 CFR 404.1520(a), 1640, 1643, 416.920(a) FORMS: SSA-392-SUP
OMB NO: 0960-0679 EXPIRATION DATE: 11/30/2006 RESPS:3,318 HOURS:389 COSTS(000):$0 Representative Payment Rgulation -- Part 404, Subpart U, Part 408 Subpart F & Part 416, Subpart F FORMS: NONE
OMB NO: 0960-0680 EXPIRATION DATE: 12/31/2006 RESPS:91,904 HOURS:18,380 COSTS(000):$0 Medical Consultant's Review of Physical Residual Functional Capacity Assessment FORMS: SSA-392
OMB NO: 0960-0681 EXPIRATION DATE: 12/31/2006 RESPS:4,005,367 HOURS:2,002,684 COSTS(000):$0 Function Report - Adult FORMS: SSA-3373
OMB NO: 0960-0683 EXPIRATION DATE: 01/31/2007 RESPS:60 HOURS:22 COSTS(000):$0 Special Benefits for Certain World War II Veterans, 20 CFR 408 Subparts G, H, I, J & L FORMS: NONE
OMB NO: 0960-0684 EXPIRATION DATE: 01/31/2007 RESPS:125,000 HOURS:2,083 COSTS(000):$0 Evidence Requirements for Assignment of SSNs/Assignment of SSNs to Foreign Academic Students FORMS: NONE
OMB NO: 0960-0685 EXPIRATION DATE: 02/28/2007 RESPS:1 HOURS:1 COSTS(000):$0 Filing of Applications and Related Forms; 404.610, .611; 422.505 FORMS: NONE
OMB NO: 0960-0686 EXPIRATION DATE: 03/31/2007 RESPS:5,000 HOURS:417 COSTS(000):$0 International Direct Deposit / 31 CFR 210 FORMS: SSA-1199
OMB NO: 0960-0687 EXPIRATION DATE: 06/30/2007 RESPS:25,000 HOURS:10,000 COSTS(000):$0 Youth Transition Process Demonstration Evaluation Collection FORMS: NONE
OMB NO: 0960-0688 EXPIRATION DATE: 04/30/2007 RESPS:200,000 HOURS:10,000 COSTS(000):$0 Certification of Prison Records by Prison Officials 20 CFR 422.107 FORMS: NONE
OMB NO: 0960-0689 EXPIRATION DATE: 07/31/2007 RESPS:4,800 HOURS:800 COSTS(000):$0 Certification of Contents of Document(s) or Record(s) FORMS: SSA-704
OMB NO: 0960-0690 EXPIRATION DATE: 08/31/2007 RESPS:2 HOURS:2 COSTS(000):$0 Reinstatement of Entitlement to Disability Benefits, 20 CFR 404.1592c & .1592d and 416.999a & .99b FORMS: SSA-790P
OMB NO: 0960-0691 EXPIRATION DATE: 08/31/2007 RESPS:750,000 HOURS:187,500 COSTS(000):$0 Representative Payee Report - 20 CFR 404.2965 and 416.665 FORMS: SSA-6234
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
228 117,969,507 30,730,478 $20,146
(RETURN TO AGENCY LIST)
OMB NO: 3316-0002 EXPIRATION DATE: 11/30/2004 RESPS:2,054 HOURS:3,792 COSTS(000):$0 Power Distributors Monthly and Annual Reports to TVA FORMS: 3957 4171
OMB NO: 3316-0008 EXPIRATION DATE: 12/31/2006 RESPS:100 HOURS:1,000 COSTS(000):$0 Foreign Line Crossing Data FORMS: TVA-6573 TVA-6593
OMB NO: 3316-0009 EXPIRATION DATE: 09/30/2007 RESPS:33.3 HOURS:467 COSTS(000):$0 Salary Surveys for Salary Policy Bargining Unit Employees FORMS: NONE
OMB NO: 3316-0016 EXPIRATION DATE: 09/30/2006 RESPS:150 HOURS:40 COSTS(000):$0 Farmer Questionnaire - Vicinity of Nuclear Power Plants FORMS: TVA-9476
OMB NO: 3316-0019 EXPIRATION DATE: 03/31/2007 RESPS:31,000 HOURS:9,300 COSTS(000):$0 Energy Right Program FORMS: 17650 17651 17652 17653 17654 17655 17656 17657 17658/17659 17676
OMB NO: 3316-0060 EXPIRATION DATE: 08/31/2006 RESPS:2,500 HOURS:3,750 COSTS(000):$0 Application for Section 26a Permit, Tennessee Valley Authority FORMS: TVA-17423
OMB NO: 3316-0062 EXPIRATION DATE: 05/31/2007 RESPS:24,252 HOURS:49,019 COSTS(000):$0 TVA Procurement Documents (Request for Offer; Solicitation, Offer & Acceptance; other related procurement/sale documents. FORMS: 916 9650-1 9903 9903A 9903C 9903D 9910 17300 17432 17527
OMB NO: 3316-0063 EXPIRATION DATE: 12/31/2006 RESPS:17,543 HOURS:17,543 COSTS(000):$0 Employment Application FORMS: 1 3595 9871 17353 13045A
OMB NO: 3316-0096 EXPIRATION DATE: 11/30/2004 RESPS:1,700 HOURS:85 COSTS(000):$0 Customer Input Card for TVA Recreation Areas FORMS: 17429
OMB NO: 3316-0099 EXPIRATION DATE: 04/30/2005 RESPS:800 HOURS:160 COSTS(000):$0 TVA Aquatic Plant Management FORMS: NONE
OMB NO: 3316-0104 EXPIRATION DATE: 10/31/2005 RESPS:567 HOURS:567 COSTS(000):$0 Economic Assessment of Waterway Docks and Terminals FORMS: NONE
OMB NO: 3316-0105 EXPIRATION DATE: 10/31/2004 RESPS:2,000 HOURS:167 COSTS(000):$0 TVA Police Customer Satisfaction Survey FORMS: NONE
OMB NO: 3316-0106 EXPIRATION DATE: 06/30/2006 RESPS:2,000 HOURS:200 COSTS(000):$0 TVA Accounts Payable Customer Satisfaction Survey FORMS: 17713
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
13 84,699 86,090 $0
(RETURN TO AGENCY LIST)
OMB NO: 9000-0001 EXPIRATION DATE: 12/31/2004 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: 9000-0006 EXPIRATION DATE: 08/31/2007 RESPS:14,622 HOURS:739,225 COSTS(000):$0 Subcontracting Plans/Subcontracting Report for Individual Contact (SF 294) Sections Affected: Subpart 19.7; 52.219-9 FORMS: SF-294
OMB NO: 9000-0007 EXPIRATION DATE: 10/31/2006 RESPS:7,098 HOURS:112,864 COSTS(000):$0 Summary Subcontract Report FAR Sections Affected: Subpart 19.7; 53.219; SF 295 FORMS: SF-295 OF-312
OMB NO: 9000-0010 EXPIRATION DATE: 09/30/2005 RESPS:864,000 HOURS:475,000 COSTS(000):$0 Progress Payments, SF 1443 FAR Sections Affected: Subpart 32.5; 52.232-13 thru 52.232-16 FORMS: NONE
OMB NO: 9000-0011 EXPIRATION DATE: 10/31/2006 RESPS:5,478 HOURS:113,942 COSTS(000):$0 Preaward Survey Forms (SFs 1403, 1404, 1405, 1406, 1407, and 1408) FAR Sections Affected 9.106-2 thru -4 FORMS: SF-1403 SF-1404 SF-1405 SF-1407 SF-1408 SF-1406
OMB NO: 9000-0012 EXPIRATION DATE: 08/31/2007 RESPS:2,092 HOURS:5,023 COSTS(000):$0 Termination Settlement Proposal Forms (SFs 1435 through 1440) FAR Section Affected: Subpart 49.6 FORMS: SF-1435-TO-1440
OMB NO: 9000-0013 EXPIRATION DATE: 12/31/2004 RESPS:199,992 HOURS:10,101,684 COSTS(000):$0 Cost or Pricing Data Exemption--FAR: Subparts 15.4; 42.7; 52.214-28; 52.215-12; 52.215-13; 52.215-20; 52.215-21 FORMS: NONE
OMB NO: 9000-0014 EXPIRATION DATE: 12/31/2004 RESPS:63,000 HOURS:3,150 COSTS(000):$0 Statement and Acknowledgment (SF 1413); FAR sections affected; 22.406-5, 22.407(a), 52.222-11(b), 53.222(e), 53.301-SF 1413 FORMS: NONE
OMB NO: 9000-0018 EXPIRATION DATE: 11/30/2004 RESPS:1,285,000 HOURS:8,352 COSTS(000):$0 Certification of Independent Price Determination and Parent Company and Identifying Data - Sections Affected 3.103; 3.302 FORMS: NONE
OMB NO: 9000-0022 EXPIRATION DATE: 12/31/2004 RESPS:13,300 HOURS:6,650 COSTS(000):$0 Customs and Duties - FAR Sections Affected: 52.225-8 FORMS: NONE
OMB NO: 9000-0024 EXPIRATION DATE: 12/31/2004 RESPS:58,590 HOURS:6,361 COSTS(000):$0 Buy American Act-Balance of Payment Program Certificate -- FAR Sections Affected: 52.225-2 FORMS: NONE
OMB NO: 9000-0025 EXPIRATION DATE: 12/31/2004 RESPS:11,400 HOURS:1,238 COSTS(000):$0 Buy American Act, Trade Agreements Act, Balance of Payments Program - - FAR Sections Affected: 52.225-6 FORMS: NONE
OMB NO: 9000-0026 EXPIRATION DATE: 04/30/2006 RESPS:157,500 HOURS:26,355 COSTS(000):$0 Change Order Accounting - 43.205(f); 52.243-6 FORMS: NONE
OMB NO: 9000-0027 EXPIRATION DATE: 12/31/2004 RESPS:1,600 HOURS:48,000 COSTS(000):$0 Value Engineering Requirements FAR Sections Affected: Subparts 48.1 and 48.2; 2.248-1; 52.248-2; 52.248-3 FORMS: NONE
OMB NO: 9000-0029 EXPIRATION DATE: 12/31/2004 RESPS:100 HOURS:1,600 COSTS(000):$0 Extraordinary Contractual Action Requests - FAR Sections Affected: 50.403-3; 52.250-1 FORMS: NONE
OMB NO: 9000-0031 EXPIRATION DATE: 05/31/2005 RESPS:2,100 HOURS:525 COSTS(000):$22,050 Contractor Use of Government Supply Sources - FAR Sections Affected: (Subpart 51.1 and 52.251-1) FORMS: NONE
OMB NO: 9000-0032 EXPIRATION DATE: 05/31/2005 RESPS:140 HOURS:70 COSTS(000):$2,940 Contractor Use of Interagency Motor Pool Vehicles - FAR Sections Affected: (Subpart 51.2 and 52.251-2) FORMS: NONE
OMB NO: 9000-0033 EXPIRATION DATE: 12/31/2004 RESPS:1 HOURS:82 COSTS(000):$0 Contractor's Signature Authority--FAR Sections Affected: 4.102 FORMS: NONE
OMB NO: 9000-0034 EXPIRATION DATE: 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: 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: 12/31/2004 RESPS:42,480 HOURS:3,398 COSTS(000):$0 Presolicitation Notice and Response, Standard form 1417: FAR Sections Affected: 14.205-4(c); 15.201-c; 36.301; 36.701(a); and 53.236-1(a) FORMS: NONE
OMB NO: 9000-0038 EXPIRATION DATE: 04/30/2005 RESPS:4,673 HOURS:2,337 COSTS(000):$98,154 Mistakes in Bids - FAR Section Affected: 14.407 through 14.407-4 FORMS: NONE
OMB NO: 9000-0039 EXPIRATION DATE: 04/30/2005 RESPS:7,509 HOURS:1,254 COSTS(000):$56,028 Description Literature - FAR Section Affected: 14.202-5 FORMS: NONE
OMB NO: 9000-0043 EXPIRATION DATE: 03/31/2005 RESPS:17,200 HOURS:2,872 COSTS(000):$120,624 Delivery Schedules - FAR Sections Affected: 52.211-8 and 52.211-9 FORMS: NONE
OMB NO: 9000-0044 EXPIRATION DATE: 05/31/2005 RESPS:12,320 HOURS:209 COSTS(000):$8,778 Bid/Offer Acceptance Period - Sections Affected: 52.214-15; 52.214-16; 52.215-1 FORMS: NONE
OMB NO: 9000-0045 EXPIRATION DATE: 12/31/2004 RESPS:56,520 HOURS:23,738 COSTS(000):$0 Bid, Performance, and Payments Bonds - FAR Sections Affected; Subparts 28.1 and 28.2; 52-228-1; 53.228 FORMS: SF-24 SF-25 SF-25-A SF-25-B SF-34 SF-35 SF-273 SF-274/SF-275 SF-1416 SF-1418
OMB NO: 9000-0047 EXPIRATION DATE: 10/31/2006 RESPS:1,111,558 HOURS:50,577 COSTS(000):$0 Place of Performance--FAR Sections Affected: (14.201-6(b), 15.209(f), 52.214-14, and 52.215-6) FORMS: NONE
OMB NO: 9000-0048 EXPIRATION DATE: 10/31/2006 RESPS:525,280 HOURS:8,930 COSTS(000):$0 Authorized Negotiators--FAR Sections Affected: 52.215-1(c)(2)(iv) FORMS: NONE
OMB NO: 9000-0053 EXPIRATION DATE: 07/31/2005 RESPS:3,318 HOURS:312 COSTS(000):$13,104 Permits, Authorities, or Franchises Certification--FAR Sections Affected: 47.207-1(a) and 52.247-2 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: 9000-0055 EXPIRATION DATE: 07/31/2005 RESPS:7,920 HOURS:1,323 COSTS(000):$55,566 Freight Classification Description--FAR Sections Affected: 47.305-9(b) and 52.247-53 FORMS: NONE
OMB NO: 9000-0056 EXPIRATION DATE: 05/31/2005 RESPS:1,000 HOURS:167 COSTS(000):$7,014 Report of Shipment - FAR Sections Affected: (42.1406-1, 42-1406-2, and 52.242-12) FORMS: NONE
OMB NO: 9000-0057 EXPIRATION DATE: 08/31/2005 RESPS:400 HOURS:100 COSTS(000):$4 Evaluation of Export Offers - FAR Sections Affected: 47.305-6(e) and 52.247-51 FORMS: NONE
OMB NO: 9000-0058 EXPIRATION DATE: 05/31/2005 RESPS:5,200 HOURS:5,200 COSTS(000):$218,400 Schedules for Construction Contracts - FAR Section Affected: 52.236-15 FORMS: NONE
OMB NO: 9000-0059 EXPIRATION DATE: 05/31/2005 RESPS:424 HOURS:72 COSTS(000):$3,024 North Carolina Sales Tax Certification - FAR Sections Affected 29.304(d); 29.401-2; and 52.229-2 FORMS: NONE
OMB NO: 9000-0060 EXPIRATION DATE: 05/31/2005 RESPS:4,212 HOURS:8,424 COSTS(000):$410,670 Accident Prevention Plans and Recordkeeping - FAR Section Affected: 52.236-13 FORMS: NONE
OMB NO: 9000-0061 EXPIRATION DATE: 07/31/2005 RESPS:1,385,990 HOURS:65,870 COSTS(000):$2,737,644 Transportation Requirements - FAR Sections Affected: 47.207-1; 47.303-1 thru 47.303-16; 47.305-2, -3, -6, and 13; 47-507(e) FORMS: NONE
OMB NO: 9000-0062 EXPIRATION DATE: 05/31/2005 RESPS:4,740 HOURS:1,185 COSTS(000):$41,475 Material and Workmanship - FAR Section Affected: 53.236-5 FORMS: NONE
OMB NO: 9000-0064 EXPIRATION DATE: 05/31/2005 RESPS:50 HOURS:38 COSTS(000):$1,330 Organization and Direction of Work - - Sections Affected: 36.519, 52.236.19 FORMS: NONE
OMB NO: 9000-0065 EXPIRATION DATE: 04/30/2005 RESPS:1,270 HOURS:318 COSTS(000):$13,356 Overtime - FAR Sections Affected: (22.103 and 52.222-2 FORMS: NONE
OMB NO: 9000-0066 EXPIRATION DATE: 07/31/2007 RESPS:8,670 HOURS:4,335 COSTS(000):$0 Professional Employee Compensation Plan; Subpart 22.11; 52.222-46 FORMS: NONE
OMB NO: 9000-0067 EXPIRATION DATE: 06/30/2005 RESPS:3,000 HOURS:3,000 COSTS(000):$131,250 Incentive Contracts - FAR Sections Affected: Subpart 16.4; 52.216-16; 52.216-17 FORMS: NONE
OMB NO: 9000-0068 EXPIRATION DATE: 08/31/2005 RESPS:5,346 HOURS:1,337 COSTS(000):$0 Economic Price Adjustment - FAR Sections Affected: 16.203; 15.216-2; 52.216-3; and 52.216-4 FORMS: NONE
OMB NO: 9000-0069 EXPIRATION DATE: 12/31/2005 RESPS:3,000 HOURS:6,564,000 COSTS(000):$0 Indirect Cost Rates - FAR Secions Affected: Subpart 42.7; 52.216-7; 52.216-13; and 52.216-15 FORMS: NONE
OMB NO: 9000-0070 EXPIRATION DATE: 07/31/2005 RESPS:9,600,000 HOURS:240,000 COSTS(000):$8,400,000 Payments - FAR Sections Affected: 52.232-1 thru 52.232-11 FORMS: NONE
OMB NO: 9000-0071 EXPIRATION DATE: 09/30/2005 RESPS:7,000 HOURS:7,000 COSTS(000):$0 Price redetermination - FAR Sections Affected: 16.205, 16.206; 52.216-5; and 52.216-6 FORMS: NONE
OMB NO: 9000-0073 EXPIRATION DATE: 07/31/2005 RESPS:500 HOURS:500 COSTS(000):$17,500 Advance Payments - FAR Sections Affected: Subpart 32.4 and 52.232-12 FORMS: NONE
OMB NO: 9000-0074 EXPIRATION DATE: 08/31/2005 RESPS:53,456 HOURS:26,728 COSTS(000):$0 Contract Funding - Limitation of Costs/Funds -- FAR Sections Affected: Subpart 32.7 and 52.232-20 thru 52.232-22 FORMS: NONE
OMB NO: 9000-0075 EXPIRATION DATE: 10/31/2006 RESPS:13,624,122 HOURS:6,575,805 COSTS(000):$0 Government Property - Part 45; Clauses 52.245-2; -4; -5; thru -11; -17 thru 19 FORMS: 1426/1427 1428/1429 1430/1431 1432/1433 1434
OMB NO: 9000-0076 EXPIRATION DATE: 06/30/2006 RESPS:1,000 HOURS:458 COSTS(000):$0 Novation/Change of Name Requirements - FAR Sections Affected: Subpart 42.12 FORMS: NONE
OMB NO: 9000-0077 EXPIRATION DATE: 10/31/2004 RESPS:950 HOURS:39,719 COSTS(000):$0 Quality Assurance Requirements --FAR Sections Affected: Supbarts 46.1 thru 46.3; 52.246-2 thru 52.246-8; 52.246-10; 52.246-12; 52.246-15 FORMS: NONE
OMB NO: 9000-0078 EXPIRATION DATE: 12/31/2004 RESPS:450 HOURS:3,600 COSTS(000):$0 Make-or-Buy Program - FAR Sections Affected: 15-407-2; 52.215-9 FORMS: NONE
OMB NO: 9000-0079 EXPIRATION DATE: 06/30/2006 RESPS:3,000 HOURS:18,000 COSTS(000):$0 Corporate Aircraft Costs FAR Sections Affected: 31-205-46 FORMS: NONE
OMB NO: 9000-0080 EXPIRATION DATE: 09/30/2005 RESPS:10,000 HOURS:10,000 COSTS(000):$0 Integrity of Unit Prices - Sections Affected: 15.408(f) and 52.215-14 FORMS: NONE
OMB NO: 9000-0082 EXPIRATION DATE: 09/30/2005 RESPS:38,100 HOURS:31,623 COSTS(000):$0 Economic Purchase Quantities - Supplies FAR Sections Affected: 7.203 and 52.207-4 FORMS: NONE
OMB NO: 9000-0083 EXPIRATION DATE: 09/30/2005 RESPS:220,700 HOURS:55,175 COSTS(000):$0 Qualification Requirements - FAR Sections Affected: Subpart 9.2 and 52.209-1 FORMS: NONE
OMB NO: 9000-0090 EXPIRATION DATE: 06/30/2007 RESPS:1,100 HOURS:19,040 COSTS(000):$0 Rights in Data and Copyrights; Subpart 27.4; 52.227-14 thru 52.227-21 FORMS: NONE
OMB NO: 9000-0091 EXPIRATION DATE: 06/30/2005 RESPS:100 HOURS:100 COSTS(000):$4,200 Abti-Kickback Procedures - FAR Sections Affected: 3.502; 52.203-7 FORMS: NONE
OMB NO: 9000-0094 EXPIRATION DATE: 03/31/2007 RESPS:1,100,000 HOURS:91,667 COSTS(000):$0 Debarment and Suspension. FAR Sections Affected: 9.103; 9.104; 9.404; 52.212-209-6; 52.212-3(h) FORMS: NONE
OMB NO: 9000-0095 EXPIRATION DATE: 12/31/2004 RESPS:11,700 HOURS:45,630 COSTS(000):$0 Commerce Patent Regulations - FAR Sections Affected: 27.3; 52.227-11 thru -13; Pub. L. 98-620 FORMS: NONE
OMB NO: 9000-0096 EXPIRATION DATE: 10/31/2006 RESPS:30 HOURS:15 COSTS(000):$0 Patents FAR Sections Affected: 27.2; 52.227-2; 52.227-6; 52.227-9 FORMS: NONE
OMB NO: 9000-0097 EXPIRATION DATE: 12/31/2004 RESPS:3,000,000 HOURS:195,000 COSTS(000):$0 Information Reporting to the Internal Revenue Service (Taxpayer Identification Number)-Secs. Affected: Subpart 4.9;52.204-3 FORMS: NONE
OMB NO: 9000-0101 EXPIRATION DATE: 05/31/2005 RESPS:600 HOURS:102 COSTS(000):$8,400 Drug-Free Workplace - FAR Section Affected: 52.223-6(b)(5) FORMS: NONE
OMB NO: 9000-0102 EXPIRATION DATE: 10/31/2004 RESPS:420,134 HOURS:671,211 COSTS(000):$0 Prompt Payment--FAR Sections Affected: Subparts 32.9; 52.232-5; 52.232-26; 52.232-27; 52.212-4 FORMS: NONE
OMB NO: 9000-0107 EXPIRATION DATE: 09/30/2005 RESPS:2,500 HOURS:2,500 COSTS(000):$0 Notice of Radioactive Materials - FAR Section Affected: 23.602 and 52.223-7 FORMS: NONE
OMB NO: 9000-0108 EXPIRATION DATE: 06/30/2005 RESPS:1,000 HOURS:1,250 COSTS(000):$52,500 Bankruptcy--FAR Section Affected: 52.242-13 FORMS: NONE
OMB NO: 9000-0113 EXPIRATION DATE: 12/31/2004 RESPS:20 HOURS:20 COSTS(000):$0 Acquisition of Helium --FAR Section Affected 8.5 FORMS: NONE
OMB NO: 9000-0114 EXPIRATION DATE: 10/31/2006 RESPS:200 HOURS:685 COSTS(000):$0 Right of First Refusal of Employment FAR Sections Afected: 52:207-3 FORMS: NONE
OMB NO: 9000-0115 EXPIRATION DATE: 01/31/2007 RESPS:100 HOURS:125 COSTS(000):$0 Notification of Ownership Changes -- FAR Sections Affected: 15.408(k); 52.215-19 FORMS: NONE
OMB NO: 9000-0129 EXPIRATION DATE: 10/31/2006 RESPS:1,462 HOURS:293,650 COSTS(000):$0 Cost Accounting Standards Administration FAR Sections Affected" Subpart 30.6; 52.230-5 FORMS: NONE
OMB NO: 9000-0130 EXPIRATION DATE: 04/30/2006 RESPS:5,700 HOURS:666 COSTS(000):$0 Buy American Act-North American Free Trade Agreement-Israeli Trade Act Certificate FAR Section Affected: 52.225-4 FORMS: NONE
OMB NO: 9000-0132 EXPIRATION DATE: 10/31/2006 RESPS:1,580 HOURS:26,860 COSTS(000):$0 Contractors' Purchasing Systems Reviews FAR Sections Affected 44-305-2(c); 44.305-3; 52.244-2(j) FORMS: NONE
OMB NO: 9000-0133 EXPIRATION DATE: 10/31/2006 RESPS:18 HOURS:1,800 COSTS(000):$0 Defense Production Act Amendments - FAR Sections Affected: 34.1 and 52.234-1 FORMS: NONE
OMB NO: 9000-0134 EXPIRATION DATE: 12/31/2004 RESPS:64,350 HOURS:20,914 COSTS(000):$0 Environmentally Sound Products - FAR Sections Affected: 23.405; 52.223-4 FORMS: NONE
OMB NO: 9000-0135 EXPIRATION DATE: 07/31/2007 RESPS:63,490 HOURS:15,872.50 COSTS(000):$0 Prospective Subcontractor Requests for Bonds; FAR 28.106-4(b); 52.228-12 FORMS: NONE
OMB NO: 9000-0136 EXPIRATION DATE: 10/31/2006 RESPS:1,275,000 HOURS:397,800 COSTS(000):$0 Commercial Item Acquisitions - FAR Sections Affected: Part 12; 52.212-1 and 52.212-3 FORMS: NONE
OMB NO: 9000-0138 EXPIRATION DATE: 10/31/2004 RESPS:11,000 HOURS:22,000 COSTS(000):$0 Contract Financing--FAR Sections Affected Subparts 32.0; 32.1, 32.2; 32.5, 32.10; 52.232-29 thru 32 FORMS: NONE
OMB NO: 9000-0139 EXPIRATION DATE: 12/31/2005 RESPS:167,487 HOURS:58,621 COSTS(000):$0 Federal Acquisition and Commuinity Right-to-Know-FAR Sections Affected Subpart 23.9; 52.223-13; and 52.223-14 FORMS: NONE
OMB NO: 9000-0141 EXPIRATION DATE: 06/30/2005 RESPS:1,000 HOURS:2,500 COSTS(000):$69,125 Buy American Act - Construction - FAR Sections Affected: Subpart 25.2; 52.225-9; and 52.25-11 FORMS: NONE
OMB NO: 9000-0142 EXPIRATION DATE: 11/30/2005 RESPS:600,000 HOURS:1,200,000 COSTS(000):$0 Past Performance Information (FAR Sections 9.104-1; 9.105-1; 15.406; 15.604; 15.608; 42.302; Subpart 42.15 FORMS: NONE
OMB NO: 9000-0144 EXPIRATION DATE: 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: 04/30/2006 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: 06/30/2006 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: 06/30/2006 RESPS:15,349 HOURS:13,353 COSTS(000):$0 Subcontract Consent - FAR Sections Affected: 44.201; 52.244-2 FORMS: NONE
OMB NO: 9000-0150 EXPIRATION DATE: 06/30/2006 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: 06/30/2006 RESPS:19,906 HOURS:9,953 COSTS(000):$0 Service Contracting--FAR Sections Affected: 52.237-10; 37.115-3 FORMS: NONE
OMB NO: 9000-0153 EXPIRATION DATE: 03/31/2005 RESPS:100 HOURS:100 COSTS(000):$0 OMB Circular A-119 FAR Parts Affected: Subparts 11.1; 11.2; 52.211-7 FORMS: NONE
OMB NO: 9000-0154 EXPIRATION DATE: 03/31/2006 RESPS:1 HOURS:81,000 COSTS(000):$0 Davis-Bacon Act--Price Adjustment (Actual Method) FAR Section Affected: 52.222-32 FORMS: NONE
OMB NO: 9000-0155 EXPIRATION DATE: 12/31/2004 RESPS:1 HOURS:162 COSTS(000):$6,750 Prohibition on Acquisition of Products Produced by Forced or Indentured Child Labor (FAR 22.15) FORMS: NONE
OMB NO: 9000-0157 EXPIRATION DATE: 12/31/2006 RESPS:20,000 HOURS:580,000 COSTS(000):$0 Consolidated Form for Selection of Archietect-Engineer Contracts FORMS: SF-330
OMB NO: 9000-0159 EXPIRATION DATE: 06/30/2006 RESPS:54,199 HOURS:54,199 COSTS(000):$0 Central Contractor Registration - Sections Affected: 2.101; Subpart 4.11; 13.102; 32.805; 32.1103; 32.1110; 52.204-6; 52.204xxx; 52.212-1; 52.212-4; and 52.232-33 FORMS: NONE
AGENCY TOTALS:
ACTIVE ANNUAL ANNUAL ANNUAL REPORTS RESPONSES HOURS COSTS($000)
91 37,172,236 29,643,772 $13,066,889
(RETURN TO AGENCY LIST)
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