                                 Attachment F
                                       
   Supporting Statement for a Generic Information Collection Request (ICR) 
                    Under the Paperwork Reduction Act (PRA)

 EXECUTIVE SUMMARY
 Identification of the Information Collection  -  Title and Numbers
      Title: 
	ICR Numbers: EPA ICR No.: XXXX.XX; OMB Control No.: XXXX-XXXX
	Docket ID No.: EPA-HQ-XXXX-XXXX-XXXX


 Abstract


 Explain the circumstances that make the collection of information necessary.
   
   
 Indicate how, by whom, and for what purpose the information is to be used.  Except for a new collection, indicate the actual use the Agency has made of the information received from the current collection

 Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.






 Describe efforts to identify duplication.






 If the collection of information impacts small businesses or other small entities, describe the methods used to minimize burden.

 Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

 Explain any special circumstances that require the collection to be conducted in a manner inconsistent with OMB guidelines.

 If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency's notice, required by 5CFR 320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken in response to the comments. Specifically address comments received on cost and hour burden. Describe efforts to consult with persons outside DOE to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or report.






 Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

 Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

 Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.

  12. Provide estimates of the hour burden of the collection of information.

  13. Provide an estimate for the total annual cost burden to respondents or recordkeepers resulting from the collection of information.


  14. Provide estimates of annualized cost to the Federal government.
     Agency Activities
        Unit Burden for Agency Activities

      
        Total Agency Burden and Cost

    15. Explain the reasons for any program changes or adjustments reported in Items 13 (or 14) of OMB Form 83-I.


    16. For collections whose results will be published, outline the plans for tabulation and publication.

 If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons why display would be inappropriate.

Explain each exception to the certification statement identified in Item 19 of OMB Form 83-I.

