2012 Form 5304-SIMPLE Burden

Burden Computation - Business Forms
Page 1 of 1

December 4, 2012

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

5304SIMPLE/
Savings Incentive Match Plan for Employees of Small Employers
2009

Changes (+ -)

100,000
______________
27
______________
0.00
______________
0.00
______________
16
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

2012
100,000
______________
27
______________
0.00
______________
0.00
______________
16
______________

Computation of Changes
100,000 x _____________
6.40
Old Computation (Prog. Change) ______________
100,000 x _____________
6.40
New Computation.............. ______________
Balance...

=
=

640,000
_______________
640,000
_______________
0
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

640,000
_______________
0
_______________
_______________
640,000
_______________

Paperwork Reduction Act Notice
Time Per Response
6.40
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
No change.

Average Hours
Per Response
3.27
______________
2.43
______________
0.70
______________
0.00
______________

Average Time
Per Response
3 hrs. , 16 min.
___________________
2 hrs. , 25 min.
___________________
0 hrs. , 42 min.
___________________
0 hrs. , 00 min.
___________________