Office of Information Resources Management (OIRM)
Paperwork Reduction Act
Required Disclosure Statements
The following statement is suggested burden statement language for OPDIV use on all newly printed collections of information (surveys, questionnaires, etc). The Paperwork Reduction Act of 1995 and Office of Management and Budget (OMB) regulations at 5 CFR 1320.8 (b)(3) establish the requirement for this statement.
Paperwork Reduction Act (PRA) Public Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990- . The time required to complete this information collection is estimated to average ( hours)(minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:
U.S. Department of Health & Human Services
OS/OIRM/PRA
200 Independence Ave., S.W., Suite 531-H
Washington D.C. 20201
Attention: PRA Reports Clearance Officer.
Last revised: April 22, 2003
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