Burden

Burden Computation - Business Forms
Page 1 of 1

August 2, 2011

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

8621-A/
Return by a Shareholder Making Certain Late Elections to End Treatment as
2011

Changes (+ -)

2011

667
______________
95
______________
17.00
______________
0.85
______________
45
______________

-655
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

12
______________
95
______________
17.00
______________
0.85
______________
45
______________

Computation of Changes
12 x _____________
65.40
Old Computation (Prog. Change) ______________
12
65.40
New Computation.............. ______________ x _____________
Balance...

=
=

785
_______________
785
_______________
_______________
0

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

667 x _____________
65.40
______________
______________
12 x _____________
65.40

=
=

43,622
_______________
_______________
785
_______________
-42,837

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

43,622
_______________
0
_______________
-42,837
_______________
785
_______________

Paperwork Reduction Act Notice
Time Per Response
65.40
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
22.72
______________
10.73
______________
27.40
______________
4.56
______________

Average Time
Per Response
22 hrs. , 43 min.
___________________
10 hrs. , 43 min.
___________________
27 hrs. , 24 min.
___________________
4 hrs. , 33 min.
___________________

Notes:
Deleted 655 estimated responses to more accurately reflect filing of form.