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Z  PleasemailthisformtoyourEPAGrantSpecialistwithin90daysofprojectcompletion.DONOTsendthisinformationto   theOfficeofManagement&Budget.  z  AssistanceAgreementNumber(s): * ____________________________________ B ____________________________________  ____________________________________ : *lZ dd%dd %Zhp&hp&l,dd ,kdd ,dd +  BB    Iherebycertifythatnoneofthesefundshavebeenusedtoengageinthelobbyingofthe  FederalGovernmentorinlitigationagainsttheUnitedStatesunlessauthorizedunderexisting ~ law. V ______________________________________________________________________ n SignatureoftheChiefExecutiveOfficerDate F __________________________________________   PrintName  f!  " *Zdddd kdd kdd Z hp&hp&,%dd +  n"n Y%&BurdenStatementTheannualpublicreportingandrecordkeepingburdenforthiscollectionofinformationisestimatedtoaverage5minutesper :# respondent.Burdenmeansthetotaltime,effort,orfinancialresourcesexpendedbypersonstogenerate,maintain,retain,ordiscloseorprovide $ informationtoorforaFederalagency.Thisincludesthetimeneededtoreviewinstructions;develop,acquire,install,andutilizetechnologyandsystems 2% forthepurposesofcollecting,validatingandverifyinginformation,processingandmaintaininginformation,anddisclosingandprovidinginformation; J & adjusttheexistingwaystocomplywithanypreviouslyapplicableinstructionsandrequirements;trainpersonneltobeabletorespondtoacollectionof  ' information;searchdatasources;completeandreviewthecollectionofinformation;andtransmitorotherwisedisclosetheinformation.Anagencymay !B ( notconductorsponsor,andapersonisnotrequiredtorespondto,acollectionofinformationunlessitdisplaysacurrentlyvalidOMBcontrolnumber. Z" ) TheOMBcontrolnumbersforEPAsregulationsarelistedin40_CFR_ԀPart9and48_CFR_ԀChapter15.  #!* SendcommentsontheAgencysneedforthisinformation,theaccuracyoftheprovidedburdenestimates,andanysuggestedmethodsforminimizing j$#, respondentburden,includingthroughtheuseofautomatedcollectiontechniquestotheDirector,RegulatoryInformationDivision,U.S.Environmental %#- ProtectionAgency,ArielRiosBuilding,1200PennsylvaniaAvenue,_N.W._,MailCode3213A,Washington,DC20460;andtotheOfficeofInformation %b$. andRegulatoryAffairs,OfficeofManagementandBudget,72517thStreet,_N.W._,Washington,DC20503,Attention:DeskOfficerforEPA.Includethe z&%/ EPAICRnumberandOMBcontrolnumberinanycorrespondence. *'%0 EPAForm570053(Rev.7_Ԅ2009)_  .,:  YP  #  PW##Y 8# .0.=