Instructions
for
Completing
OMB
Form
83­
I
Please
answer
all
questions
and
have
a
Senior
Official
or
a
designee
sign
the
form.
These
instructions
should
be
used
in
conjunction
with
5
CFR
1320,
which
provides
information
on
coverage,
definitions,
and
other
matters
of
procedure
and
interpretation
under
the
Paperwork
Reduction
Act
of
1995.

Once
completed,
submit
one
copy
of
your
OMB
83­
I
form,
with
an
original
signature,
to
the
OEI
Collection
Strategies
Division
(
CSD)
as
part
of
your
ICR
package.

The
comment
fields
("
clouds,"
appear
in
the
left
margin)
provide
context
sensitive
help.
To
open
a
comment
field
simply
click
your
mouse
once
on
the
cloud
to
open
the
cloud,
click
again
to
close
the
comment.
For
longer
comments,
double
clicking
on
a
comment
field
enables
a
reader
to
see
the
entire
comment
using
the
vertical
scroll
bar
(
use
file/
close
to
return
to
the
document.)

The
margins
and
lines
are
NOT
block
protected,
so
you
must
fill
in
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
should
delete
a
space
for
each
letter
you
add.

­
To
place
an
"
X"
in
a
box
(

)
go
to
the
"
Insert/
Symbol"
pull
down
menu,
select
"
Iconic
Symbols"
in
the
dialogue
box,
and
look
for
the
"

"
.
Double
click
on
the
character
to
place
it
on
your
form.

­
Use
the
same
font.

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

­
We
do
not
recommend
that
you
convert
this
form
to
WP5.1,
some
of
these
features
are
not
available
in
WP5.1,
so
the
text
will
scramble.

OPPTS
staff
originally
created
this
OMB
form
in
WP6.0
format.
The
help
fields
were
added
and
it
was
converted
to
WP6.1
by
OEI.

If
you
have
any
problems
or
questions,
please
call
your
ICR
Desk
Officer.
They
are:
Rick
Westlund
(
Team
Leader),
260­
2745
OPPTS
Monica
Lewis,
260­
4522
OSWER
Phil
Silverstein,
260­
2728
Air
ICR
renewals
Delores
Evans,
260­
1625
Air
rules
and
rule
amendments
Lynn
Johnson,
260­
2964
Water,
OP,
ORD,
OARM,
OECA
(
not
airrelated
OA,
Regions
(
not
media
specific)
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__
__
__
__
­
__
__
__
__
_
2040
__

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

New
collection
b.

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?

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
Information
Collection
Request
for
Filter
Backwash
Recycling
Rule
(
Final
Rule)

8.
Agency
form
number(
s)
(
If
applicable)
1928.02
9.
Keywords
Cryptosporidium,
Giardia,
protozoan,
filter
backwash
recycle,
direct
filtration
reports,
conventional
filtration
10.
Abstract
The
information
collection
burden
resulting
from
promulgation
of
the
FBRR,
in
the
first
3
years
after
promulgation
involves
rule
start­
up
activities
to
meet
requirements
of
ther
rule.
The
total
burden
generated
by
this
rule
allows
States
to
maintain
program
oversight
and
track
compliance
to
ensure
protection
of
public
health.

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.
X
Federal
Government
c.
X
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.
G
Voluntary
b.

Required
to
obtain
or
retain
benefits
c.
P
Mandatory
13.
Annual
reporting
and
recordkeeping
hour
burden
a.
Number
of
respondents
1,986
b.
Total
annual
responses
7,942
1.
Percentage
of
these
responses
collected
electronically
0
%
c.
Total
hours
requested
66,363
d.
Current
OMB
inventory
0
e.
Difference
66,363
f.
Explanation
of
difference
1.
Program
Change
66,363
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.
_
General
purpose
statistics
g.
P_
Regulatory
or
compliance
d.
__
Audit
16.
Frequency
of
recordkeeping
or
reporting
(
check
all
that
apply)
a.

Recordkeeping
b.

Third
party
disclosure
c.

Reporting
1.
Q
On
occasion
2.

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?

Q
Yes

No
18.
Agency
contact
(
person
who
can
best
answer
questions
regarding
the
content
of
this
submission)
Name:
Jini
Mohanty
Phone:
(
202)
260­
6415
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;

(
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
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
Official
Cynthia
Dougherty,
Director,
Office
of
Ground
Water
and
Drinking
Water
Date
Signature
of
Senior
Official
or
designee
Oscar
Morales,
Director
Collection
Strategies
Division
Office
of
Information
Collection
Office
of
Environmental
Information
Date
OMB
83­
I
10/
95
Certification
Requirement
for
Paperwork
Reduction
Act
Submissions
5
CFR
1320.9
reads
"
As
part
of
the
agency
submission
to
OMB
of
a
proposed
collection
of
information,
the
agency
(
through
the
head
of
the
agency,
the
Senior
Official
or
their
designee)
shall
certify
(
and
provide
a
record
supporting
such
certification)
that
the
proposed
collection
of
information
­­

"(
a)
is
necessary
for
the
proper
performance
of
the
functions
of
the
agency,
including
that
the
information
to
be
collected
will
have
practical
utility;

"(
b)
is
not
unnecessarily
duplicative
of
information
otherwise
reasonably
accessible
to
the
agency;

"(
c)
reduces
to
the
extent
practicable
and
appropriate
the
burden
on
persons
who
shall
provide
information
to
or
for
the
agency,
including
with
respect
to
small
entities,
as
defined
in
the
Regulatory
Flexibility
Act
5
U.
S.
C.
§
601(
6)),
the
use
of
such
techniques
as:

"(
1)
establishing
differing
compliance
or
reporting
requirements
or
timetables
that
take
into
account
the
resources
available
to
those
who
are
to
respond;
"(
2)
the
clarification,
consolidation,
or
simplification
of
compliance
and
reporting
requirements;
or
collection
of
information
,
or
any
part
thereof;
"(
3)
an
exemption
from
coverage
of
the
collection
of
information,
or
any
part
thereof;

"(
d)
is
written
using
plain,
coherent,
and
unambiguous
terminology
and
is
understandable
to
those
who
are
to
respond;

"(
e)
is
to
be
implemented
in
ways
consistent
and
compatible,
to
the
maximum
extent
practicable,
with
the
existing
reporting
and
recordkeeping
practices
of
those
who
are
to
respond;

"(
f)
indicates
for
each
recordkeeping
requirement
the
length
of
time
persons
are
required
to
maintain
the
records
specified;

"(
g)
informs
potential
respondents
of
the
information
called
for
under
§
1320.8(
b)(
3);
[
see
below]

"(
h)
has
been
developed
by
an
office
that
has
planned
and
allocated
resources
for
the
efficient
and
effective
management
and
use
of
the
information
to
be
collected,
including
the
processing
of
the
information
in
a
manner
which
shall
enhance,
where
appropriate,
the
utility
of
the
information
to
agencies
and
the
public;

"(
I)
uses
effective
and
efficient
statistical
survey
methodology
appropriate
to
the
purpose
for
which
the
information
is
to
be
collected;
and
"(
j)
to
the
maximum
extent
practicable,
uses
appropriate
information
technology
to
reduce
burden
and
improve
data
quality,
agency
efficiency
and
responsiveness
to
the
public."

NOTE:
5
CFR
1320.8(
b)(
3)
requires
that
each
collection
of
information:

"(
3)
informs
and
provides
reasonable
notice
to
the
potential
persons
to
whom
the
collection
of
information
is
addressed
of:
"(
I)
the
reasons
the
information
is
planned
to
be
and/
or
has
been
used
to
further
the
proper
performance
of
the
functions
of
the
agency;
"(
ii)
the
way
such
information
is
planned
to
be
and/
or
has
been
used
to
further
the
proper
performance
of
the
functions
of
the
agency;
"(
iii)
an
estimate,
to
the
extent
practicable,
of
the
average
burden
of
the
collection
(
together
with
a
request
that
the
public
direct
to
the
agency
any
comments
concerning
the
accuracy
of
this
burden
estimate
and
any
suggestions
for
reducing
this
burden);
"(
iv)
whether
responses
to
the
collection
of
information
are
voluntary,
required
to
obtain
or
retain
a
benefit
(
citing
authority),
or
mandatory
(
citing
authority);
"(
v)
the
nature
and
extent
of
confidentiality
to
be
provided,
if
any
(
citing
authority);
and
"(
vi)
the
fact
that
any
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
a
collection
of
information
unless
it
displays
a
currently
valid
OMB
control
number."

OMB
83­
I
(
Instructions)
10/
95
