Creating ratings materials for the various ratings boards worldwide is a stressful ordeal even when you know what you're doing. Creating them in this post-"Hot Coffee" world is even more insane.
First, you play through the game, making notes of anything that would be considered "disclosable." Have one guy smoking a cigarette? Disclosable. Have an empty beer bottle in a level? Disclosable. Have bleeped lyrics? Disclosable. Could lyrics have a special meaning if taken out of context? Disclosable. An irreverent image of a priest? Definitely disclosable. A fart noise? Disclosable.
Then, you create your "first draft" of the submission packet, trying to categorize all of your notes into the proper holes.
Then you record yourself playing through the entire game, exposing all secrets.
Then you step through the video and delete any sections that aren't really severe in order to try to get your video under an hour. Walking through a hallway? Cut. Walking through a blood-soaked hallway? Keep it. Walking through a hallway that is bloody, but not as bloody as the last one? Keep it, but make a note in case you need to shave more time off. Don't forget to show what happens when you die, though...even though it may not be pertinent to you, showing player death is important...
Then you watch your final video, looking for anything you missed in your initial notes, and for anything you should have taped, but didn't.
Then you gather the soundtrack together, burn it to a CD, get the lyric sheets pre-bleep, mark which words were bleeped, get the script together, highlight every swear word from "hell" and "damn" on up, prepare a build in case the ratings board wants it along with a full-walkthrough with all cheat codes and secrets documented and save games located at each pertinent location.
Then you pull up the various asset browsing/creation tools looking for anything that is disclosable that isn't in the game and either get it removed from the tree, or get it put in a placeholder area so you can tape it for disclosure and add it to the form.
Finally you submit and pray that you caught it all...and that's just the ESRB.
For other ratings boards, you feel like splitting hairs even more. ("Is this a depiction or a moving image?" "Is saying 'God damn it' bad enough to be blasphemy, does it have to be an image of the anti-Christ violating the Virgin Mary to be blasphemy, or is the line somewhere between?" "Is showing a crime be committed 'encouraging' said crime?")