Health Coverage Tax Credit (HCTC) Advance Payments

Burden Computation - Special Business Forms
Page 1 of 1

January 30, 2007

Product:
Description:
Variables
Responses.......
Line Items......
Forms Prepared..

1099H/
Health Insurance Advance Payments
2003

Changes (+ -)

2006

110,000
______________
19
______________
0.85
______________

_____________________________
_____________________________
_____________________________

110,000
______________
19
______________
0.85
______________

Computation of Changes
110,000 x _____________
0.30
Old Computation (Prog. Change) ______________
110,000 x _____________
0.30
New Computation.............. ______________
Balance...

=
=

33,000
_______________
33,000
_______________
0
_______________

Old Computation (Adjustment)
New Computation..............
Balance...

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

Old Computation..............
New Computation..............
Balance...

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

Summary
Old Burden...................................................
Program Change...............................................
Adjustment...................................................
New Burden...................................................

33,000
_______________
0
_______________
_______________
33,000
_______________

Paperwork Reduction Act Notice
Time Per Response
0.30
Record Keeping............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
______________
______________
______________
0.30
______________

Average Time
Per Response
___________________
___________________
___________________
0 hrs. , 18 min.
___________________