PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET

Part II: Information Collection Detail

IMPORTANT:  A separate Part II must be completed for each Information
Collection (IC) activity associated with the ICR.  If more than one Part
II is required, create a separate Part II document for each IC.  For
more information see OEI’s ICR website at   HYPERLINK
"http://intranet.epa.gov/icrintra/"  http://intranet.epa.gov/icrintra/ .
 There you will find information on completing this form (see OEI’s
ICRAS instructions under the Prepare an ICR tab) and information on how
break your ICR into ICs (see OMB’s ROCIS IC Q&A under the Download
Guidance tab).

1. Title of Information Collection:    FORMTEXT  NESHAP for Flexible
Polyurethane Foam Production and Fabrication 

2. Is this a common form? 

  FORMCHECKBOX    Yes

  FORMCHECKBOX    No

(Select Yes to identify forms that EPA is willing to host for potential
use by other Federal Agencies.)

	3. Obligation to respond (check one):

       FORMCHECKBOX    Voluntary

       FORMCHECKBOX    Required to obtain or retain benefits

       FORMCHECKBOX     Mandatory

Note: Only one selection may be made.  If multiple categories apply, you
must create additional ICs to account for the burden associated with
each category.	4. Frequency of reporting (only to be completed if there
are reporting requirements, check all that apply): 



  FORMCHECKBOX    Hourly

  FORMCHECKBOX    Daily

  FORMCHECKBOX    Weekly

  FORMCHECKBOX    Monthly

  FORMCHECKBOX    Yearly	    FORMCHECKBOX    Every Decade

    FORMCHECKBOX    Quarterly

    FORMCHECKBOX    Semi-Annually

  FORMCHECKBOX    Biennially

  FORMCHECKBOX    Once

  FORMCHECKBOX    Occasionally

5.  CFR Citation(s) for the information collection under review (if
applicable):

Title    FORMTEXT  40   Part    FORMTEXT  63   Section    FORMTEXT 
11418                        

        Part    FORMTEXT          Section   
FORMTEXT        

Title    FORMTEXT          Part    FORMTEXT         
Section    FORMTEXT        

Title    FORMTEXT          Part    FORMTEXT         
Section    FORMTEXT                               

6. Information Collection Instruments/Forms (if applicable) :

Form Name:    FORMTEXT        		

Form Number:    FORMTEXT        

URL (required if electronic) :    FORMTEXT        

Is this form available electronically?        FORMCHECKBOX    Yes       
FORMCHECKBOX    No

If yes, can this form be submitted electronically?        FORMCHECKBOX  
 Yes        FORMCHECKBOX    No

Form Name:    FORMTEXT        		

Form Number:    FORMTEXT        

URL (required if electronic) :    FORMTEXT        

Is this form available electronically?        FORMCHECKBOX    Yes       
FORMCHECKBOX    No

If yes, can this form be submitted electronically?        FORMCHECKBOX  
 Yes        FORMCHECKBOX    No

Form Name:    FORMTEXT        		

Form Number:    FORMTEXT        

URL (required if electronic) :    FORMTEXT        

Is this form available electronically?        FORMCHECKBOX    Yes       
FORMCHECKBOX    No

If yes, can this form be submitted electronically?        FORMCHECKBOX  
 Yes        FORMCHECKBOX    No

Attach additional sheets if necessary.

Note: Instruments/Forms must be submitted/uploaded as a separate
attachment.





7.  Federal Enterprise Architecture Business Reference Model:

Line of Business (check one) :                                          
                              Subfunction (check one) :

  FORMCHECKBOX    Environmental Management

  FORMCHECKBOX    Environmental Monitoring and Forecasting

  FORMCHECKBOX    Environmental Remediation

  FORMCHECKBOX    Pollution Prevention and Control

  FORMCHECKBOX    Health

  FORMCHECKBOX    Illness Prevention

  FORMCHECKBOX    Immunization Management

  FORMCHECKBOX    Public Health Monitoring

  FORMCHECKBOX    Health Care Services

  FORMCHECKBOX    Consumer Health and Safety

  FORMCHECKBOX    Natural Resources

  FORMCHECKBOX    Water Resource Management

  FORMCHECKBOX    Conservation, Marine and Land Management

  FORMCHECKBOX    Recreational Resource Management and Tourism

  FORMCHECKBOX    Agricultural Innovation and Services

Note: Most EPA ICRs will be aligned with the Environmental Management
FEA Line of Business.  Other likely categories are also listed.  For a
full listing of the FEA Business Reference Model categories and
definitions, see:   HYPERLINK
"http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_Qui
ckGuide.pdf" 
http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_Quic
kGuide.pdf .

8. Privacy Act System of Records (if applicable) :

      

Federal Register Citation:    Volume    FORMTEXT           
Page Number    FORMTEXT            Publication Date   
FORMTEXT        

9. Respondents

Total Number:    FORMTEXT  49 

Small Entity Number:    FORMTEXT        

Percentage of responses collected electronically:    FORMTEXT 
      	

Affected Public (check one) :

  FORMCHECKBOX    Individuals or Households

  FORMCHECKBOX    Private Sector (if private sector, check all that
apply)

                  FORMCHECKBOX    Business or other for-profit

                  FORMCHECKBOX    Not-for-profit institutions

                  FORMCHECKBOX    Farms

  FORMCHECKBOX    State, Local, or Tribal Governments

  FORMCHECKBOX    Federal Government

Note:  Only one selection may be made.  If multiple categories apply,
you must create additional ICs to account for the burden associated with
each category.  Selecting multiple subcategories within “Private
Sector” will not affect then number of ICs required.

10. Frequency: How often on average will each respondent respond to the
Information Collection?	

Calculated Annual Frequency:    FORMTEXT  0.37  

   (responses per respondent per year)

Calculated Annual Number of Responses:    FORMTEXT  18 

  FORMCHECKBOX    Year

  FORMCHECKBOX    Hour 
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	Number of Respondents   FORMTEXT  two one-time notifications   per     
                                                       

                                                           

                                                           

                                                           

                                                           

                                                          

                                                           

	11. Hour and Cost Burden: Enter the hours and cost (per response)
broken out by reporting, record keeping, and third party disclosure:

Hours per Response

Total Annual Hour Burden

Cost per Response

Total Annual Cost Burden

Reporting

  FORMTEXT  51.4 

  FORMTEXT  925.00 

  FORMTEXT  $0.00 

  FORMTEXT  $0.00 

Recordkeeping

      

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

Third Party Disclosure

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

Total

  FORMTEXT  51.4 

  FORMTEXT  925.00 

  FORMTEXT  $0.00 

  FORMTEXT  $0.00 

IMPORTANT: “Cost per Response” and “Total Annual Cost Burden”
should include Capital/Startup and O&M costs only.





12. Annual Responses and Burden Change

Total Requested

Program Change due to New Statute

Program Change due to Agency Discretion

Change due to Adjustment in Agency Estimate

Change due to Violation of the PRA

Currently Approved

Annual Responses

  FORMTEXT  18.00 

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  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

  FORMTEXT  0.00 

Annual Hour Burden

  FORMTEXT  925.00 

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

  FORMTEXT  0.00 

Annual Cost Burden

  FORMTEXT  $0.00 

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

  FORMTEXT        

  FORMTEXT  $0.00 





 PAGE   

 PAGE   1 

Revised 9/1/2006

