Burden for Form 4684

Burden Computation - Individual Forms
Page 1 of 1

May 25, 2011

Product:
Description:
Variables
Responses.......
Line Items......
Pages...........
Words...........
Code References.
Income Records..
Other Records...
Avg Lines used..

4684/
Casualties and Thefts
2009

Changes (+ -)

2011

268,350
______________
104
______________
2.00
______________
6,004.00
______________
4
______________
4.00
______________
18.00
______________
0.00
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

268,350
______________
104
______________
2.00
______________
6,004.00
______________
4
______________
4.00
______________
18.00
______________
0.00
______________

Computation of Changes
268,350 x _____________
5.54
Old Computation (Prog. Change) ______________
268,350 x _____________
5.54
New Computation.............. ______________
Balance...

=
=

1,486,659
_______________
1,486,659
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

1,486,659
_______________
0
_______________
_______________
1,486,659
_______________

Paperwork Reduction Act Notice
Time Per Response
5.54
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
1.97
______________
0.56
______________
2.43
______________
0.58
______________

1 hrs. , 58 min.
___________________
0 hrs. , 33 min.
___________________
2 hrs. , 25 min.
___________________
0 hrs. , 34 min.
___________________