2011 Burden for Form 8955-SSA

Burden Computation - Special Business Forms
Page 1 of 1

February 7, 2011

Product:
Description:
Variables
Responses.......
Line Items......
Forms Prepared..

8955-SSA/
Annual Registration Statement Identifying Separated Participants with
2010

Changes (+ -)

2011

200,000
______________
53
______________
0.85
______________

_____________________________
_____________________________
_____________________________

200,000
______________
53
______________
0.85
______________

Computation of Changes
200,000 x _____________
0.83
Old Computation (Prog. Change) ______________
200,000 x _____________
0.83
New Computation.............. ______________
Balance...

=
=

166,000
_______________
166,000
_______________
0
_______________

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

200,000 x _____________
0.83
______________
______________
200,000 x _____________
0.83

=
=

166,000
_______________
_______________
166,000
0
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

166,000
_______________
0
_______________
0
_______________
166,000
_______________

Paperwork Reduction Act Notice
Time Per Response
0.83
Record Keeping............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
______________
______________
______________
0.83
______________

Average Time
Per Response
___________________
___________________
___________________
0 hrs. , 49 min.
___________________