2009 burden estimate

Burden Computation - Business Forms
Page 1 of 1

November 14, 2009

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

1041/28% Rate Gain WK L-15e

2007

Changes (+ -)

2009

37,500
______________
7
______________
0.00
______________
0.85
______________
1
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

37,500
______________
7
______________
0.00
______________
0.85
______________
1
______________

Computation of Changes
37,500 x _____________
1.90
Old Computation (Prog. Change) ______________
37,500
1.90
New Computation.............. ______________ x _____________
Balance...

=
=

71,250
_______________
71,250
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

71,250
_______________
0
_______________
_______________
71,250
_______________

Paperwork Reduction Act Notice
Time Per Response
1.90
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
1.67
______________
0.10
______________
0.13
______________
0.00
______________

Average Time
Per Response
1 hrs. , 40 min.
___________________
0 hrs. , 06 min.
___________________
0 hrs. , 07 min.
___________________
0 hrs. , 00 min.
___________________