2009 Burden-Form 4136 Line 15

Burden Computation - Business Forms
Page 1 of 1

August 19, 2009

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

4136/Line 15

2007

Changes (+ -)

200
______________
3
______________
0.00
______________
0.85
______________
0
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

2009
200
______________
3
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
200 x _____________
0.73
Old Computation (Prog. Change) ______________
200 x _____________
0.73
New Computation.............. ______________
Balance...

=
=

146
_______________
146
_______________
0
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

146
_______________
0
_______________
_______________
146
_______________

Paperwork Reduction Act Notice
Time Per Response
0.73
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
No change.

Average Hours
Per Response
0.72
______________
0.00
______________
0.01
______________
0.00
______________

Average Time
Per Response
0 hrs. , 43 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 00 min.
___________________