Burden for Form 4684

Burden Computation - Individual Forms
Page 1 of 1

January 5, 2009

Product:
Description:
Variables
Responses.......
Line Items......
Pages...........
Words...........
Code References.
Income Records..
Other Records...
Avg Lines used..

4684/
Casualties and Thefts
2008

Changes (+ -)

2008

113,333
______________
48
______________
2.00
______________
4,586.00
______________
5
______________
4.00
______________
18.00
______________
0.00
______________

_____________________________
+61
_____________________________
_____________________________
+2,624.00
_____________________________
-1
_____________________________
_____________________________
_____________________________
_____________________________

113,333
______________
109
______________
2.00
______________
7,210.00
______________
4
______________
4.00
______________
18.00
______________
0.00
______________

Computation of Changes
113,333 x _____________
4.12
Old Computation (Prog. Change) ______________
113,333 x _____________
5.77
New Computation.............. ______________
Balance...

=
=

466,932
_______________
653,932
_______________
_______________
+187,000

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

466,932
_______________
+187,000
_______________
_______________
653,932
_______________

Paperwork Reduction Act Notice
Time Per Response
5.77
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
1.97
______________
0.67
______________
2.55
______________
0.58
______________

Notes:
Changes were made as a result of P.L 110-343.

1 hrs. , 58 min.
___________________
0 hrs. , 40 min.
___________________
2 hrs. , 33 min.
___________________
0 hrs. , 34 min.
___________________