2010 Burden Form 5300

Burden Computation - Business Forms
Page 1 of 1

February 23, 2011

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

5300/
Application for Determination for Employee Benefit Plan
2007

Changes (+ -)

2010

85,000
______________
172
______________
5.00
______________
0.85
______________
62
______________

_____________________________
-30
_____________________________
+2.00
_____________________________
_____________________________
+14
_____________________________

85,000
______________
142
______________
7.00
______________
0.85
______________
76
______________

Computation of Changes
85,000 x _____________
64.15
Old Computation (Prog. Change) ______________
85,000
63.60
New Computation.............. ______________ x _____________
Balance...

=
=

5,452,750
_______________
5,406,000
_______________
_______________
-46,750

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

5,452,750
_______________
-46,750
_______________
_______________
5,406,000
_______________

Paperwork Reduction Act Notice
Time Per Response
63.60
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
33.96
______________
10.12
______________
17.64
______________
1.88
______________

Average Time
Per Response
33 hrs. , 57 min.
___________________
10 hrs. , 07 min.
___________________
17 hrs. , 38 min.
___________________
1 hrs. , 52 min.
___________________