83­
I
IMPORTANT
NOTE
TO
USER:

This
OMB
form
has
been
recreated
in
WP6.0
by
OPPTS
staff.
The
margins
and
lines
are
NOT
block
protected,
so
you
must
fill
the
form
with
caution,
paying
attention
to
any
shifting
of
the
existing
text.
The
following
tips
should
make
this
a
simple
task:

­
Fill
in
the
spaces
by
using
the
type
over
command.
Otherwise
you'll
have
to
delete
a
space
for
each
letter
you
add.

­
Use
the
same
font
(
Times
New
Roman
8pt).

­
Do
not
change
table
lines
(
although
you
can
delete
an
extra
space
line
to
provide
more
space
elsewhere.

­
It
is
not
recommended
that
you
convert
this
form
to
WP5.1,
some
of
these
features
are
not
available
in
WP5.1,
so
the
text
will
scramble.

If
you
have
any
problems
or
questions,
please
call
your
RID
Desk
Officer
@
260­
2706.

ADDITIONAL
INFORMATION
FOR
OC
STAFF:

The
83
­
I
is
signed
by
the
Division
Director
in
the
box
labeled
"
program
official"
These
are
the
usual
answers
for
OC's
ICRs.
They
have
already
been
marked
on
the
form.

Block
3
c
Block
4
a
Block
6
a
Block
11
b
Block
12
c
Block
15
g
Block
17
no
BLOCK
13
­
Numbers
are
drawn
directly
from
your
tables
and
supporting
statement.

Example:
10
existing
sources,
3
new
a
year
(
9
new
over
the
life
of
the
ICR),
semiannual
reports
13.
Annual
reporting
and
recordkeeping
hour
burden
a.
Number
of
respondents
478
b.
Total
annual
responses
1912
(
3
new
X
6
#
of
initial
reports
(
this
example
assumes
6.
Count
them
for
your
particular
ICR))
+
(
10
existing
x
2
for
semiannual
reports)

1.
Percentage
of
these
responses
collected
electronically
0
%
c.
Total
annual
hours
requested
Total
hours
from
industry
burden
table
d.
Current
OMB
inventory
Total
requested
&
approved
from
previously
approved
ICR
e.
Difference
d
minus
c
(
can
be
+
or
­)
This
is
a
number
f.
Explanation
of
difference
1.
Program
Change
Do
not
use
this
line
unless
there
has
been
a
change
to
the
recordkeeping
and/
or
reporting
in
the
regulation!

2.
Adjustment
#
in
e
BLOCK
14
­
This
is
a
relatively
new
one
Does
this
standard
require
continuous
monitoring?
If
no
then
zero
out
block
14
and
explain
in
burden
section
of
the
supporting
statement.
This
is
probably
only
the
case
in
a
few
old
NSPS
regulations
and
in
LDAR
regulations.
If
yes
then
what
type
of
monitoring?
PM,
VOC
and
what
is
the
cost
of
the
monitoring
device
alone,
not
the
control
equipment!
How
much
is
yearly
maintenance
on
the
monitor?

14.
Annual
reporting
and
recordkeeping
cost
burden
(
in
thousands
of
dollars)

a.
Total
annualized
capital/
startup
costs
3
(
3
new
per
year
X
$
1,000
(
example
#
only)

initial
capital
cost
per
monitor)
Remember
it
is
in
thousands
b.
Total
annual
costs
(
O&
M)
5
(
10
existing
X
$
500
(
example
#
only)
operation
&

maintenance
cost
per
monitor)
Remember
it
is
in
thousands
c.
Total
annualized
cost
requested
8,000
(
a
+
b)

d.
Current
OMB
inventory
From
previously
approved
ICR.
If
the
OMB
cover
form
had
no
block
14
use
0.

e.
Difference
d
minus
c
(
can
be
+
or
­)

f.
Explanation
of
difference
1.
Program
change
Do
not
use
this
line
unless
there
has
been
a
change
to
the
monitoring
device
in
the
regulation!

2.
Adjustment
#
in
e
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.
EPA
2.
OMB
control
number
b.
G
None
a
2
0
6
0
­
0
2
0
2
__
__
__
__

3.
Type
of
information
collection
(
check
one)
a.
G
New
collection
b.
G
Revision
of
a
currently
approved
collection
c.
X
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
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
For
b­
f,
note
item
A2
of
Supporting
Statement
Instructions
6.
Requested
expiration
date
a.
X
Three
years
from
approval
date
b.
G
Other
Specify:
/
/___

7.
Title
NSPS
Subpart
Dc­
Standards
of
Performance
for
Small
Industrial­
Commercial­
Institutional
Steam
Generating
Units
8.
Agency
form
number(
s)
(
If
applicable)
EPA
ICR
No.
1564
9.
Keywords
Small
steam
generating
units,
boilers,
NSPS
Dc,

10.
Abstract
Owners
or
operators
of
effected
facilities
must
1)
make
one
time
notifications
of
construction/
reconstruction
and
start
up;
2)
submit
reports
containing
information
such
as
monitoring
results
and
excess
emission;
and
3)
maintain
records
of
occurrences
such
as
startups
and
sh
utdowns.

Responses
to
this
information
collection
are
deemed
to
be
mandatory,
per
Section
114
(
a)
of
the
clean
Air
Act.

11.
Affected
public
(
Mark
primary
with
"
P"
and
all
others
that
apply
with
"
X")
a.
Individuals
or
households
d.
Farms
b.
X
Business
or
other
for­
profit
e.
Federal
Government
c.
Not­
for­
profit
institutions
f.
State,
Local
or
Tribal
Government
12.
Obligation
to
respond
(
Mark
primary
with
"
P"
and
all
others
that
apply
with
"
X")
a.
G
Voluntary
b.
G
Required
to
obtain
or
retain
benefits
c.
X
Mandatory
13.
Annual
reporting
and
recordkeeping
hour
burden
a.
Number
of
respondents
478
b.
Total
annual
responses
1912
1.
Percentage
of
these
responses
collected
electronically
0
%
c.
Total
annual
hours
requested
306,727
d.
Current
OMB
inventory
229,673
e.
Difference
77,054
f.
Explanation
of
difference
1.
Program
Change
2.
Adjustment
14.
Annual
reporting
and
recordkeeping
cost
burden
(
in
thousands
of
dollars)

a.
Total
annualized
capital/
startup
costs
8,400
b.
Total
annual
costs
(
O&
M)
4,785
c.
Total
annualized
cost
requested
13,185
d.
Current
OMB
inventory
9,940
e.
Difference
3,245
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.
X
Recordkeeping
b.
Q
Third
party
disclosure
c.
Q
Reporting
1.
Q
On
occasion
2.
Q
Weekly
3.
Q
Monthly
4.
X
Quarterly
5.
X
Semi­
annually
6.
Q
Annually
7.
Q
Biannually
8.
Q
Other
(
describe)

17.
Statistical
methods
Does
this
information
collection
employ
statistical
methods?

Q
Yes
X
No
18.
Agency
contact
(
person
who
can
best
answer
questions
regarding
the
content
of
this
submission)
Name:
Chris
Oh
Phone:
(
202)
564­
7004
OMB
83­
I
10/
95
19.
Certification
for
Paperwork
Reduction
Act
Submissions
On
behalf
of
this
Federal
agency,
1
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
the
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;

©
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
management
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
John
B.
Rasnic,
Director,
Manufacturing,
Energy
and
Transportation
Division
Date
Signature
of
Senior
Official
or
designee
Joseph
Retzer,
Director
Regulatory
Information
Division
Office
of
Regulatory
Management
and
Information
(
OPPE)
Date
OMB
83­
I
10/
95
