[Federal Register Volume 60, Number 76 (Thursday, April 20, 1995)]
[Notices]
[Pages 19719-19720]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9696]



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DEPARTMENT OF COMMERCE


Agency Information Collection Under Review by the Office of 
Management and Budget

    DOC has submitted to the Office of Management and Budget (OMB) for 
clearance the following proposal for collection of information under 
the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). 
An expedited review has been requested.

Agency: National Telecommunications and Information Administration 
(NTIA).
Title: Reviewer Information Form
Form Number: Agency--None; OMB Approval Number--None.
Type of Request: New Collection--Expedited Review Requested.
Burden: 100 hours; 400 responses; Avg. Hours Per Response is 15 
minutes.
Needs and Uses: NTIA will be collecting administrative information 
necessary to select reviewers for the Telecommunications and 
Information Infrastructure Assistance Program grant application 
process.
Affected Public: Individuals.
Frequency: Annually.
Obligation: Voluntary.
OMB Desk Officer: Virginia Huth, (202) 395-3785.

    A copy of the form is published below. Other information can be 
obtained by calling or writing DOC Clearance Officer, Gerald Tache, 
(202) 482-3271, Department of Commerce, Room 5327, 14th and 
Constitution Avenue, N.W., Washington, D.C. 20230.
    Written comments and recommendations for the proposed information 
collection should be sent to Virginia Huth, OMB Desk Officer, Room 
10236, New Executive Office Building, Washington, D.C. 20503.

    Dated: April 13, 1995.
Gerald Tache,
Departmental Clearance Officer, Office of Management and Organization.

TIIAP, NTIA, U.S. Dept. of Commerce--1995
[OMB Approval #   ]

Reviewer Information Form

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Name

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Title

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Organization

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Dept/Org Unit

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Street Address

City-------------------------------------------------------------------

State------------------------------------------------------------------

ZIP--------------------------------------------------------------------

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FedEx Address (if different)

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Telephone (office)    (home)    FAX

e-mail

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Current resume on file with TIIAP? If not, please enclose.

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Where will you be traveling from?

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Available dates between May 23 and September 1, 1995 (Circle all 
that apply)

May 23-26
May 30-June 2
June 6-9
June 13-16
June 20-23
June 27-30
July 11-14
July 18-21
July 25-28
August 1-4
August 8-11
August 15-18
August 22-25
August 29-Sept. 1

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Application Domains (rank your top three choices, if applicable)

____ Arts & Culture
____ Community Networking
____ Economic Development
____ Health
____ Higher Education
____ Human Services
____ K-12 Education
____ Library Services
____ Public & Govt. Information
____ Public Safety
____ Statewide/Local Infras. Plan
____ Other (indicate what)

    Please assist us by identifying any grant applications with 
which you are familiar and that may represent a conflict of interest 
or the appearance of a conflict of interest. Use additional paper as 
needed.

List of grants:
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Admin. Use Only

[[Page 19720]] Resume on File------------------------------------------

Panel No.--------------------------------------------------------------

Local------------------------------------------------------------------

COI on File------------------------------------------------------------

Domain(s)--------------------------------------------------------------

Travel-----------------------------------------------------------------

Dates Available:-------------------------------------------------------

PO:--------------------------------------------------------------------

Federal Employee-------------------------------------------------------

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    Public reporting burden for this voluntary collection of 
information is estimated to average fifteen minutes per request, 
including the time for reviewing instructions and completing and 
reviewing the collection of information. Send comments regarding 
this burden estimate or any other aspect of this collection of 
information, including suggestions for reducing this burden, to 
TIIAP, NTIA, Rm 6043, U.S. Dept. of Commerce, 14 and Constitution 
Ave NW, Washington DC 20230 and to the Office of Management and 
Budget (OMB), Office of Information and Regulatory Affairs, 
Washington DC 20503 (Attn: NTIA Paperwork Reduction Desk Officer). 
Do not send completed forms to OMB.
[FR Doc. 95-9696 Filed 4-19-95; 8:45 am]
BILLING CODE 3510-60-M