CHECKLIST

OMB 83-1 FORM (Complete blocks 1 - 17.)

Indicate whether or not the information collection applies to any proposed or final rulemaking in block 5.

List several Federal Register Thesaurus of Indexing Terms "key words" at the beginning of the description of the information collection in item 9.

Compare burden data in block 13 with items 11 and 12 of Justification to assure that data is consistent.

Prepare for signatures of: (1) Departmental Reports Clearance Officer; and (2) Director of Administration, ITA at the bottom of the form.

JUSTIFICATION

Provide a full and detailed explanation of why the information is needed in items 1 and 2. Be Specific AS POSSIBLE. Identify any legal or administrative requirements that mandate the data collection. Be sure to discuss the consequences that would follow if this information was not collected.

Ensure that renewal packages are updated to reflect current circumstance (i.e. the original package indicates that it is a "new " collection or program). This would not apply for the renewal of a collection.

Give the name and phone number of non-DOC persons who were consulted on any aspect of the collection activity and indicate their organization/affiliation in item 8. In addition, describe other public contacts or opportunities provided for public comment and include a summary of the comments received.

Explain how the burden hours were determined in block 13 of the OMB 83-1 form. Briefly list sources of information and basic assumptions. Show your calculations.

Describe the statistical methodology used in developing the collection in item 14 and indicate the collection of information does not employ statistical methods.