Form 8877 Burden

Burden Computation - Business Forms
Page 1 of 1

July 27, 2007

Product:
Description:
Variables
Responses.......
Line Items......
Attachments.....
Forms Prepared..
Code References.

8877/
Request for Waiver of Annual Income Recertification Requirement for the
2004

Changes (+ -)

2007

200
______________
22
______________
0.00
______________
0.85
______________
13
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

200
______________
22
______________
0.00
______________
0.85
______________
13
______________

Computation of Changes
200 x _____________
7.99
Old Computation (Prog. Change) ______________
200
7.99
New Computation.............. ______________ x _____________
Balance...

=
=

1,598
_______________
1,598
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

1,598
_______________
0
_______________
_______________
1,598
_______________

Paperwork Reduction Act Notice
Time Per Response
7.99
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
No changes made.

Average Hours
Per Response
5.26
______________
1.29
______________
1.43
______________
0.00
______________

Average Time
Per Response
5 hrs. , 15 min.
___________________
1 hrs. , 17 min.
___________________
1 hrs. , 25 min.
___________________
0 hrs. , 00 min.
___________________