FR 4004 Justification

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB control number

Board of Governors of the Federal Reserve System

7

1

0

-

0

0

1

1 2

Enter only items that change
Current Record

New Record

54

70

54

70

Agency form number(s)

FR 4004
Annual reporting and recordkeeping
hour burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%
27

Total annual hours

35

8

Difference
Explanation of difference:

Program change

8

Adjustment
Annual reporting and recordkeeping
cost burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference:

Program change
Adjustment

Other Change**

Increase in burden reflects an update to the FR 4004 respondent count.
Signature of Senior Official or designee:

Date:

For OIRA Use

** This form cannot be used to extend an expiration date.
OMB 83-C

10/95