2011 Burden

Burden Computation - Business Forms
Page 1 of 1

March 30, 2011

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

2678/
Employer/Payer Appointment Agent
2011

Changes (+ -)

2011

6,130,000
______________
6
______________
0.00
______________
0.00
______________
0
______________

_____________________________
+3
_____________________________
_____________________________
_____________________________
+6
_____________________________

6,130,000
______________
9
______________
0.00
______________
0.00
______________
6
______________

Computation of Changes
6,130,000 x _____________
0.88
Old Computation (Prog. Change) ______________
6,130,000
2.24
New Computation.............. ______________ x _____________
Balance...

=
=

5,394,400
_______________
13,731,200
_______________
_______________
+8,336,800

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

5,394,400
_______________
+8,336,800
_______________
_______________
13,731,200
_______________

Paperwork Reduction Act Notice
Time Per Response
2.24
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
1.09
______________
0.91
______________
0.23
______________
0.00
______________

Average Time
Per Response
1 hrs. , 05 min.
___________________
0 hrs. , 54 min.
___________________
0 hrs. , 13 min.
___________________
0 hrs. , 00 min.
___________________

Notes:
We added 3 lines to account for PL110-289.
accurately report references to the Code.

We added 6 references to the Code to