burden

Burden Computation - Individual Forms
Page 1 of 1

July 20, 2009

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

2210/SHORT (1,2,3)

2006

Changes (+ -)

2009

200,000
______________
25
______________
0.75
______________
2,450.00
______________
4
______________
0.00
______________
2.00
______________
0.00
______________

_____________________________
+1
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

200,000
______________
26
______________
0.75
______________
2,450.00
______________
4
______________
0.00
______________
2.00
______________
0.00
______________

Computation of Changes
200,000 x _____________
1.35
Old Computation (Prog. Change) ______________
200,000 x _____________
1.37
New Computation.............. ______________
Balance...

=
=

270,000
_______________
274,000
_______________
_______________
+4,000

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

270,000
_______________
+4,000
_______________
_______________
274,000
_______________

Paperwork Reduction Act Notice
Time Per Response
1.37
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
Added 1 line item.

Average Hours
Per Response
0.22
______________
0.26
______________
0.61
______________
0.28
______________

0 hrs. , 13 min.
___________________
0 hrs. , 15 min.
___________________
0 hrs. , 36 min.
___________________
0 hrs. , 16 min.
___________________