burden

Burden Computation - Business Forms

January 15, 2010

Page 1 of 1

Computation of Changes

Summary

Old Burden................................................... _______________

Program Change............................................... _______________

Adjustment................................................... _______________

New Burden................................................... _______________

Old Computation (Prog. Change) ______________ x _____________ = _______________

New Computation.............. ______________ x _____________ = _______________

Balance... _______________

Old Computation (Adjustment). ______________ x _____________ = _______________

New Computation.............. ______________ x _____________ = _______________

Balance... _______________

Old Computation.............. ______________ x _____________ = _______________

New Computation.............. ______________ x _____________ = _______________

Balance... _______________

0

1,098

1,098

Paperwork Reduction Act Notice

Time Per Response

Average Hours

Per Response

Notes:

Recordkeeping............. ______________ ___________________

Learning.................. ______________ ___________________

Preparing................. ______________ ___________________

Sending................... ______________ ___________________

Average Time

Per Response

9.81

0.50

0.68

0.00

9 hrs. , 48 min.

0 hrs. , 30 min.

0 hrs. , 40 min.

0 hrs. , 00 min.

10.98

No change.

Responses....... ______________ _____________________________ ______________

Line Items...... ______________ _____________________________ ______________

Attachments..... ______________ _____________________________ ______________

Forms Prepared.. ______________ _____________________________ ______________

Code References. ______________ _____________________________ ______________

0.00

100

0.85

5

41

100

41

0.00

0.85

5

Variables

Changes (+ -)

2006

2009

Product:

Description:

4720/SCH I

100

10.98

1,098

100

10.98

1,098

0