PAPERWORK
REDUCTION
ACT
SUBMISSION
Please
read
the
instructions
before
completing
this
form.
For
additional
forms
or
assistance
in
completing
this
form,
contact
your
agency's
Paperwork
Clearance
Officer.
Send
two
copies
of
this
form,
the
collection
instrument
to
be
reviewed,
the
Supporting
Statement,
and
any
additional
documentation
to:
Office
of
Information
and
Regulatory
Affairs,
Office
of
Management
and
Budget.
Docket
Library,
Room
10102,
725
17th
Street
NW
Washington,
DC
20503.

1.
Agency/
Subagency
originating
request
U.
S.
Environmental
Protection
Agency
Office
of
Air
and
Radiation/
Office
of
Air
Quality
and
Planning
Standards
2.
OMB
control
number
b.
G
None
a.
_
2_
_
0_
_
6_
_
0_
­­
_
0_
_
2_
_
6_
_
4_
___
___
___
___

3.
Type
of
information
collection
(
check
one)
a.
G
New
collection
b.
x
Revision
of
a
currently
approved
collection
c.
G
Extension
of
a
currently
approved
collection
d.
G
Reinstatement,
without
change,
of
a
previously
approved
collection
for
which
approval
has
expired
e.
G
Reinstatement,
with
change,
of
a
previously
approved
collection
for
which
approval
has
expired
f.
G
Existing
collection
in
use
without
an
OMB
control
number
For
b­­
f,
note
item
A2
of
Supporting
Statement
instructions
4.
Type
of
review
requested
(
check
one)
a.
X
Regular
b.
G
Emergency
­
Approval
requested
by:
______/______/______
c.
G
Delegated
5.
Small
entities
Will
this
information
collection
have
a
significant
economic
impact
on
a
substantial
number
of
small
entities?
G
Yes
X
No
6.
Requested
expiration
date
a.
x
Three
years
from
approval
date
b.
G
Other
Specify:
____/____

7.
Title
Application
Requirements
for
the
Approval
and
Delegation
of
Federal
Air
Toxics
Programs
to
State,
Territorial,
Local,
and
Tribal
Agencies
8.
Agency
form
number(
s)
(
if
applicable)
EPA
ICR
1643.04
9.
Keywords
Air
Toxics,
Delegation,
State
Agencies,
Local
Agencies,
Tribal
Governments
10.
Abstract
The
40
CFR
part
63,
subpart
E
amended
regulations
offer
five
options
for
State,
territorial,
local,
and
tribal
agencies
(
S/
L/
Ts)
to
accept
delegation
of
the
section
112
standards.
The
S/
LT
must
demonstrate
to
the
EPA
that
it
has
the
ability
to
implement
the
Federal
standards
in
an
effective
manner.

11.
Affected
public
(
Mark
primary
with
"
P"
and
all
others
that
apply
with
"
X")
a.
___
Individuals
or
households
d.___
Farms
b.
___
Business
or
other
for­
profit
e.___
Federal
Government
c.
___
Not­
for­
profit
institutions
f.
_
P
State,
Local,
or
Tribal
Governments
12.
Obligation
to
respond
(
Mark
primary
with
"
P"
and
all
others
that
apply
with
"
X")
a.
P
Voluntary
b.
G
Required
to
obtain
or
retain
benefits
c.
X
Mandatory
13.
Annual
reporting
and
recordkeeping
hour
burden
a.
Number
of
respondents
_____________
127_________________
b.
Total
annual
responses
____________
4,555_________________
1.
Percentage
of
these
responses
collected
electronically
___
0________________________________%
c.
Total
annual
hours
requested
_________
130,198___________________
d.
Current
OMB
inventory
_________
79,885__________________
e.
Difference
______________
50,313____________
f.
Explanation
of
difference
1.
Program
change
_______________
0_________________
2.
Adjustment
______________
50,313____________
14.
Annual
reporting
and
recordkeeping
cost
burden
(
in
thousands
of
dollars)
a.
Total
annualized
capital/
startup
costs
________
0_________________
b.
Total
annual
costs
(
O&
M)
____________
0_________________
c.
Total
annualized
cost
requested
____________
0_________________
d.
Current
OMB
inventory
____________
0_________________
e.
Difference
____________
0__________________
f.
Explanation
of
difference
1.
Program
change
__________________________________
2.
Adjustment
__________________________________

15.
Purpose
of
information
collection
(
Mark
primary
with
"
P"
and
all
others
that
apply
with
"
X")
a.
____
Application
for
benefits
e.
____
Program
planning
or
management
b.
____
Program
evaluation
f.
____
Research
c.
____
General
purpose
statistics
g.
_
P_
Regulatory
or
compliance
d.
____
Audit
16.
Frequency
of
recordkeeping
or
reporting
(
check
all
that
apply)
a.
G
Recordkeeping
b.
G
Third
party
disclosure
c.
X
Reporting
1.
G
On
occasion
2.
G
Weekly
3.
G
Monthly
4.
G
Quarterly
5.
G
Semi­
annually
6.
G
Annually
7.
G
Biennially
8.
X
Other
(
describe)
One
Time/
Voluntary
17.
Statistical
methods
Does
this
information
collection
employ
statistical
methods?

G
Yes
X
No
18.
Agency
contact
(
person
who
can
best
answer
question
regarding
the
content
of
this
submission)

Name:
Pam
Smith,
USEPA/
OAQPS_____________________________

Phone:
_
541­
0635______________________________________________

OMB
83­
I
10/
95
19.
Certification
for
paperwork
Reduction
Act
Submissions
On
behalf
of
this
Federal
agency,
I
certify
that
the
collection
of
information
encompassed
by
this
request
complies
with
5
CFR
1320.9.

NOTE:
The
text
of
5
CFR
1320.9,
and
related
provisions
of
5
CFR
1320.8
(
b)(
3),
appear
at
the
end
of
the
instructions.
The
certification
is
to
be
made
with
reference
to
those
regulatory
provisions
as
set
forth
in
the
instructions.

The
following
is
a
summary
of
the
topics,
regarding
the
proposed
collection
of
information,
that
the
certification
covers:

(
a)
It
is
necessary
for
the
proper
performance
of
agency
functions;

(
b)
It
avoids
unnecessary
duplication;

(
c)
It
reduces
burden
on
small
entities;

(
d)
It
uses
plain,
coherent,
and
unambiguous
terminology
that
is
understandable
to
respondents;

(
e)
Its
implementation
will
be
consistent
and
compatible
with
current
reporting
and
recordkeeping
practices;

(
f)
It
indicates
the
retention
periods
for
recordkeeping
requirements;

(
g)
It
informs
respondents
of
the
information
called
for
under
5
CFR
1320.8
(
b)(
3):

(
I)
Why
the
information
is
being
collected;

(
ii)
Use
of
information;

(
iii)
Burden
estimate;

(
iv)
Nature
of
response
(
voluntary,
required
for
a
benefit,
or
mandatory);

(
v)
Nature
and
extent
of
confidentiality;
and
(
vi)
Need
to
display
currently
valid
OMB
control
number;

(
h)
It
was
developed
by
an
office
that
has
planned
and
allocated
resources
for
the
efficient
and
effective
manage­
ment
and
use
of
the
information
to
be
collected
(
see
note
in
Item
19
of
the
instructions);

(
I)
It
uses
effective
and
efficient
statistical
survey
methodology;
and
(
j)
It
makes
appropriate
use
of
information
technology.

If
you
are
unable
to
certify
compliance
with
any
of
these
provisions,
identify
the
item
below
and
explain
the
reason
in
Item
18
of
the
Supporting
Statement.

Signature
of
Program
Office
Official
Date
Signature
of
Senior
Official
or
designee
Director,
Regulatory
Information
Division
Date
OMB
83­
I
10/
95
