Burden Computation 2013

Burden Computation - Special Business Forms
Page 1 of 1

September 24, 2013

Product:
Description:
Variables
Responses.......
Line Items......
Forms Prepared..

1099LTC/
Long Term Care and Accelerated Death Benefits
2011

Changes (+ -)

2013

79,047
______________
15
______________
0.85
______________

+213,453
_____________________________
_____________________________
_____________________________

292,500
______________
15
______________
0.85
______________

Computation of Changes
292,500 x _____________
0.23
Old Computation (Prog. Change) ______________
292,500 x _____________
0.23
New Computation.............. ______________
Balance...

=
=

67,275
_______________
67,275
_______________
0
_______________

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

79,047 x _____________
0.23
______________
______________
292,500 x _____________
0.23

=
=

18,181
_______________
_______________
67,275
+49,094
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

18,181
_______________
0
_______________
+49,094
_______________
67,275
_______________

Paperwork Reduction Act Notice
Time Per Response
0.23
Record Keeping............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
______________
______________
______________
0.23
______________

Average Time
Per Response
___________________
___________________
___________________
0 hrs. , 13 min.
___________________