Form Ttb F 5000.30 - Supplemental Information On Water Quality Considerations Page 2

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PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to determine whether a certification

from a State of multi-state authority is needed for discharge of effluent into navigable water of the U.S. This information is required to obtain a benefit.

The estimated average burden associated with this collection of information is .5 hour per respondent or recordkeeper, depending on individual

circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports

Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control

number.

TTB F 5000.30 (10/2008)