Burden for Form

Burden Computation - Business Forms
Page 1 of 1

August 9, 2013

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

8941/
Credit for Small Employer Health Insurance Premiums
2012

Changes (+ -)

2013

3,046,964
______________
23
______________
0.00
______________
0.85
______________
14
______________

_____________________________
-4
_____________________________
_____________________________
_____________________________
_____________________________

3,046,964
______________
19
______________
0.00
______________
0.85
______________
14
______________

Computation of Changes
3,046,964 x _____________
8.43
Old Computation (Prog. Change) ______________
3,046,964 x _____________
7.46
New Computation.............. ______________
Balance...

=
=

25,685,907
_______________
22,730,352
_______________
_______________
-2,955,555

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

25,685,907
_______________
-2,955,555
_______________
_______________
22,730,352
_______________

Paperwork Reduction Act Notice
Time Per Response
7.46
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
4.54
______________
1.39
______________
1.52
______________
0.00
______________

Average Time
Per Response
4 hrs. , 32 min.
___________________
1 hrs. , 23 min.
___________________
1 hrs. , 31 min.
___________________
0 hrs. , 00 min.
___________________