Fillable Printable Omb83 R

Omb83 R

EXECUTIVE ORDER 12866 SUBMISSION

Important

Please read the instructions on the reverse side before completing this form.

For additional forms or assistance in completing this form, contact the OIRA Docket Library,

(202) 395-6880, or your OIRA Desk Officer.

Send three copies of this form and supporting material (four copies if Economically Significant or an

Unfunded Mandate) to:

Office of Information and Regulatory Affairs

Office of Management and Budget

Attention: Docket Library, Room 10102

725 17th Street N.W.

Washington, DC 20503

1. Agency/Subagency originating request 2. Regulation Identifier Number (RIN)

3. Title

4. Stage of Development

5. Legal Deadline for this submission

Prerule

Proposed Rule

Interim Final Rule

Final Rule

Final Rule - No material change

Notice

Other

Description of Other

a) Yes No

b) Date

DD MM YYYY

c) Statutory Judicial

6. Designations

Yes No

7. Agency Contact (person who can best answer questions

regarding the content of this submission)

Phone ( )

Certification for Executive Order 12866 Submissions

The authorized regulatory contact and the program official certify that the agency has complied with the requirements of

E.O. 12866 and any applicable policy directives.

Signature of Program Official Date

Signature of Authorized Regulatory Contact Date

OMB 83-R

Revision: 12/97 (Previous versions obsolete)

Designed using Perform Pro, WHS/DIOR, Dec 97

a) Economically Significant (E.O. 12866)

Yes No

b) Unfunded Mandate (2 U.S.C. 1532)

If either of the above is "Yes," submit four (4) complete

packages to OIRA

INSTRUCTIONS FOR REQUESTING OMB REVIEW UNDER EXECUTIVE ORDER 12866

GENERAL

Please make sure to answer all questions and have the

appropriate officials sign the form.

If you check "Yes" in question 6a or 6b, you must submit four

copies of both this form and the supporting material.

Otherwise, you only need to submit three copies.

1. Agency/Subagency

Provide the name of the agency or subagency originating the

request. For most Cabinet-level agencies, a subagency

designation is also necessary. For non-Cabinet agencies, the

subagency designation is generally unnecessary. For

example, if you are at the National Park Service, put

"Department of the Interior/National Park Service."

2. Regulation Identifier Number (RIN)

Fill in the RIN for this rulemaking. RINs are assigned by the

Regulatory Information Service Center (RISC) and are a

means of linking rules listed in the Unified Agenda of Federal

Regulatory and Deregulatory Actions, The Regulatory Plan,

and E.O. 12866 reviews. The RIN is a four-digit agency/

subagency code followed by two letters and two numbers,

e.g.; 1024-AA11. If you do not have a RIN for this action,

contact RISC at (202) 482-7340 before you submit it to OIRA.

3. Title

Please provide a brief title that describes, as specifically as

you can, the subject of this rulemaking. Avoid using general

headings or the title of the CFR part for your rulemaking. To

the extent possible, you should keep the title the same as in

the Agenda. Also, you should use the same title for all stages

of a rulemaking.

4. Stage of Development

Check the stage of development for this action:

Check "Prerule" when the action submitted for review seeks

to determine whether or how to initiate rulemaking. Examples

include ANPRMs and reviews of existing regulations.

Check "Proposed Rule" when the action submitted will be

published in the Proposed Rules section of the Federal

Check "Interim Final Rule" when the action submitted will be

published in the Rules and Regulations section of the Federal

Rule.

Check "Final Rule" when the action submitted will be

published in the Rules and Regulations section of the

Federal Register and there have been material changes in

the facts and circumstances upon which the previous action

was based.

Check "Final Rule - No material change" when the action

submitted is associated with a previous request (for example,

an NPRM) and there has been no material change in the

facts and circumstances upon which the previous action was

based.

Check "Notice" when the action submitted will be published

in the Notices section of the Federal Register.

Check "Other" when the action does not meet the criteria of

any of the above categories. (Indicate on the line provided

what type of action you are submitting; for example, a policy

statement.)

5. Legal Deadline for this Submission

This question refers to deadlines for this specific action only,

not deadlines which may exist for future or past actions in the

same rulemaking.

a) Indicate whether the action submitted is subject to any

specific legal deadline. For example, if this submission is for

an NPRM and the Final Rule stage has a deadline, check

No. If this submission is for the Final Rule, check Yes.

b) If 5a is Yes, provide the day, month, and year of the

deadline for this action (whether past or future).

c) If 5a is Yes, indicate whether the deadline is statutory or

judicial.

6. Designations

a) Economically Significant - Check "Yes" if the action

submitted is likely to have an annual effect on the economy

of $100 million or more or adversely affect in a material way

the economy, a sector of the economy, productivity,

competition, jobs, the environment, public health and safety,

or State, local, or tribal governments or communities.

(Section 3 (f)(1) of E.O. 12866.)

b) Unfunded Mandate - Check "Yes" if the agency believes

the rule may constitute an unfunded mandate under 2 U.S.C.

1532(a).

7. Agency Contact

Provide the name and telephone number of the agency

person best able to answer questions regarding the content

of this submission.

12/97