F8921 Burden

Burden Computation - Business Forms
Page 1 of 1

July 2, 2007

Product:
Description:

8921/
Applicable Insurance Contracts Information Return

Variables
Responses.......
Line Items......
Attachments.....
Forms Prepared..
Code References.

______________
______________
______________
______________
______________

Changes (+ -)

2007

+50,000
_____________________________
+141
_____________________________
_____________________________
+0.85
_____________________________
+8
_____________________________

50,000
______________
141
______________
0.00
______________
0.85
______________
8
______________

Computation of Changes
50,000 x _____________
Old Computation (Prog. Change) ______________
50,000 x _____________
35.89
New Computation.............. ______________
Balance...

=
=

_______________
1,794,500
_______________
_______________
+1,794,500

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

_______________
+1,794,500
_______________
_______________
1,794,500
_______________

Paperwork Reduction Act Notice
Time Per Response
35.89
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
New form.

Average Hours
Per Response
33.72
______________
0.79
______________
1.38
______________
0.00
______________

Average Time
Per Response
33 hrs. , 43 min.
___________________
0 hrs. , 47 min.
___________________
1 hrs. , 22 min.
___________________
0 hrs. , 00 min.
___________________