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
USEPA/
Office
of
Water/
Office
of
Ground
Water
and
Drinking
Water
2.
OMB
control
number
b.

None
a__
__
__
__
­
__
__
__
__
_
2_
_
0_
_
4_
_
0_

3.
Type
of
information
collection
(
check
one)
a.

New
collection
b.
G
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
4.
Type
of
review
requested
(
check
one)
a.

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

No
For
b­
f,
note
item
A2
of
Supporting
Statement
Instructions
6.
Requested
expiration
date
a.

Three
years
from
approval
date
b.
G
Other
Specify:
/
/

7.
Title
2003
Drinking
Water
Infrastructure
Needs
Survey
8.
Agency
form
number(
s)
(
If
applicable)
EPA
ICR
No.
2085.01
9.
Keywords
Safe
Drinking
Water
Act,
Drinking
Water
State
Revolving
Fund,
Drinking
Water
Infrastructure
Needs
Survey
10.
Abstract
The
Environmental
Protection
Agency
(
EPA)
will
conduct
a
survey
to
estimate
the
capital
investment
needs
for
drinking
water
systems.
The
nationwide
survey
is
authorized
by
Sections
1452(
h)
and
2452(
i)(
4)
of
the
Safe
Drinking
Water
Act
and
will
be
used
to
estimate
the
cost
of
providing
safe
drinking
water
to
consumers
over
a
20­
year
period.
The
data
also
will
be
used
to
allocate
Drinking
Water
State
Revolving
Fund
monies
among
the
states
and
as
part
of
an
allotment
formula
for
the
the
American
Indian
and
Alaska
Native
Village
set­
aside
program.
All
states
have
committed
to
assist
EPA
in
administering
the
survey.

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.
P
State,
Local
or
Tribal
Government
12.
Obligation
to
respond
(
Mark
primary
with
"
P"
and
all
others
that
apply
with
"
X")
a.
X
Voluntary
b.
G
Required
to
obtain
or
retain
benefits
c.
G
Mandatory
13.
Annual
reporting
and
recordkeeping
hour
burden
a.
Number
of
respondents
3,790
b.
Total
annual
responses
3,790
1.
Percentage
of
these
responses
collected
electronically
0
%
c.
Total
hours
requested
14,809
d.
Current
OMB
inventory
0
e.
Difference
14,809
f.
Explanation
of
difference
1.
Program
Change
14,809
2.
Adjustment
0
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
0
2.
Adjustment
0
15.
Purpose
of
information
collection
(
Mark
Primary
With
"
P"
and
all
others
that
apply
with
"
X")
a.
__
Application
for
benefits
e.
_
x_
Program
planning
or
management
b.
x__
Program
evaluation
f.
__
Research
c.
x__
General
purpose
statistics
g.
P__
Regulatory
or
compliance
d.
__
Audit
16.
Frequency
of
recordkeeping
or
reporting
(
check
all
that
apply)
a.
Q
Recordkeeping
b.
Q
Third
party
disclosure
c.

Reporting
1.
Q
On
occasion
2.
Q
Weekly
3.
Q
Monthly
4.
Q
Quarterly
5.
Q
Semi­
annually
6.
Q
Annually
7.
Q
Biannually
8.

Other
(
describe)
One­
time
17.
Statistical
methods
Does
this
information
collection
employ
statistical
methods?

Yes
Q
No
18.
Agency
contact
(
person
who
can
best
answer
questions
regarding
the
content
of
this
submission)
Name:
David
Travers
Phone:
202­
564­
4638
OMB
83­
I
10/
9510/
95
