2012 Burden Form 4461

Burden Computation - Business Forms
Page 1 of 1

January 23, 2012

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

4461/
Application for Approval of Master or Prototype or Volume Submitter
2011

Changes (+ -)

2012

1,000
______________
35
______________
3.00
______________
0.85
______________
6
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

1,000
______________
35
______________
3.00
______________
0.85
______________
6
______________

Computation of Changes
1,000 x _____________
15.58
Old Computation (Prog. Change) ______________
1,000
15.58
New Computation.............. ______________ x _____________
Balance...

=
=

15,580
_______________
15,580
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

15,580
_______________
0
_______________
_______________
15,580
_______________

Paperwork Reduction Act Notice
Time Per Response
15.58
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
8.37
______________
1.70
______________
4.71
______________
0.80
______________

Average Time
Per Response
8 hrs. , 22 min.
___________________
1 hrs. , 42 min.
___________________
4 hrs. , 42 min.
___________________
0 hrs. , 48 min.
___________________