Burden

Burden Computation - Business Forms
Page 1 of 1

July 31, 2012

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

712/
Life Insurance Statement
2009

Changes (+ -)

60,000
______________
76
______________
0.00
______________
0.85
______________
1
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

2012
60,000
______________
76
______________
0.00
______________
0.85
______________
1
______________

Computation of Changes
60,000 x _____________
18.67
Old Computation (Prog. Change) ______________
60,000 x _____________
18.67
New Computation.............. ______________
Balance...

=
=

1,120,200
_______________
1,120,200
_______________
0
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

1,120,200
_______________
0
_______________
_______________
1,120,200
_______________

Paperwork Reduction Act Notice
Time Per Response
18.67
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
No change.

Average Hours
Per Response
18.18
______________
0.10
______________
0.40
______________
0.00
______________

Average Time
Per Response
18 hrs. , 10 min.
___________________
0 hrs. , 06 min.
___________________
0 hrs. , 24 min.
___________________
0 hrs. , 00 min.
___________________