Fr 4021 83-c

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB control number

Board of Governors of the Federal Reserve System

7

1

0

0

-

0

3

0 6

Enter only items that change
Current Record

New Record

5

2

5

2

Agency form number(s)

FR 4021
Annual reporting and recordkeeping
hour burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

10

Total annual hours

4

(6)

Difference
Explanation of difference:

%

%

Program change

(6)

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**
The decrease in burden hours reflects an update to the FR 4021 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