                 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 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:  Federal Implementation Plans Under the Clean Air Act for Indian Reservations in ID, OR, and WA
2. Is this a common form? 
  Yes
  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):
       Voluntary
       Required to obtain or retain benefits
        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): 


  Hourly
  Daily
  Weekly
  Monthly
  Yearly
    Every Decade
    Quarterly
    Semi-Annually
  Biennially
  Once
  Occasionally
5.  CFR Citation(s) for the information collection under review (if applicable):

Title  Rule for non-Title V operating permits  Part  40  Section  49.139                       
Title              Part              Section            
Title              Part              Section            
Title              Part              Section                                   
6. Information Collection Instruments/Forms (if applicable) :


Form Name:  Permit application		
Form Number:  7630-9
URL (required if electronic) :  http://yosemite.epa.gov/R10/tribal.nsf/programs/farr-nontitleV
Is this form available electronically?        Yes        No
If yes, can this form be submitted electronically?        Yes        No


Form Name:            		
Form Number:            
URL (required if electronic) :            
Is this form available electronically?        Yes        No
If yes, can this form be submitted electronically?        Yes        No


Form Name:            		
Form Number:            
URL (required if electronic) :            
Is this form available electronically?        Yes        No
If yes, can this form be submitted electronically?        Yes        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) :
  Environmental Management
  Environmental Monitoring and Forecasting
  Environmental Remediation
  Pollution Prevention and Control
  Health
  Illness Prevention
  Immunization Management
  Public Health Monitoring
  Health Care Services
  Consumer Health and Safety
  Natural Resources
  Water Resource Management
  Conservation, Marine and Land Management
  Recreational Resource Management and Tourism
  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: http://www.whitehouse.gov/omb/egov/documents/FY07_Ref_Model_Mapping_QuickGuide.pdf.
8. Privacy Act System of Records (if applicable) :

Title:            
Federal Register Citation:    Volume                Page Number                Publication Date            
9. Respondents

Total Number:  35
Small Entity Number:  7
Percentage of responses collected electronically:  0

Affected Public (check one) :

  Individuals or Households
  Private Sector (if private sector, check all that apply)
                  Business or other for-profit
                  Not-for-profit institutions
                  Farms
  State, Local, or Tribal Governments
  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:  1 
   (responses per respondent per year)

Calculated Annual Number of Responses:  35
  Year

  Hour    
  Business hour
  Day      
  Business Day
  Week
  Month
  Decade
  Quarter
  Half-year
                                       

Number of Respondents 1  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
                                      20
                                      700
                                          
                                          
Recordkeeping
                                      30
                                     1050
                                          
                                          
Third Party Disclosure
                                          
                                          
                                          
                                          
Total
                                      50
                                     1750
                                          
                                          

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
                                      35
                                          
                                          
                                       5
                                          
                                      30
Annual Hour Burden
                                     1750
                                          
                                          
                                     -750
                                          
                                     2500
Annual Cost Burden
                                       0
                                          
                                          
                                       0
                                          
                                       0


                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       

