Burden Computation Sheet

Burden Computation - Business Forms
Page 1 of 1

October 28, 2009

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

5500EZ/
Annual Return of One-Participant (Owners and Their Spouses) Retirement
2006

Changes (+ -)

2009

250,000
______________
77
______________
2.00
______________
0.85
______________
22
______________

_____________________________
+3
_____________________________
_____________________________
_____________________________
+1
_____________________________

250,000
______________
80
______________
2.00
______________
0.85
______________
23
______________

Computation of Changes
250,000 x _____________
27.08
Old Computation (Prog. Change) ______________
250,000
28.02
New Computation.............. ______________ x _____________
Balance...

=
=

6,770,000
_______________
7,005,000
_______________
_______________
+235,000

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

6,770,000
_______________
+235,000
_______________
_______________
7,005,000
_______________

Paperwork Reduction Act Notice
Time Per Response
28.02
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
19.13
______________
3.02
______________
5.32
______________
0.54
______________

Average Time
Per Response
19 hrs. , 07 min.
___________________
3 hrs. , 01 min.
___________________
5 hrs. , 19 min.
___________________
0 hrs. , 32 min.
___________________

Notes:
3 line items were added and once code reference was added to reflect funding under
code section 412.
2 line items