burden

Burden Computation - Special Business Forms
Page 1 of 1

February 6, 2015

Product:
Description:

8966-C/
Cover Sheet for Form 8966 Paper Submissions

Variables
Responses.......
Line Items......
Forms Prepared..

______________
______________
______________

Changes (+ -)

2015

+1,000
_____________________________
+8
_____________________________
+0.85
_____________________________

1,000
______________
8
______________
0.85
______________

Computation of Changes
1,000 x _____________
Old Computation (Prog. Change) ______________
1,000 x _____________
0.12
New Computation.............. ______________
Balance...

=
=

_______________
120
_______________
+120
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

_______________
+120
_______________
_______________
120
_______________

Paperwork Reduction Act Notice
Time Per Response
0.12
Record Keeping............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
______________
______________
______________
0.12
______________

Average Time
Per Response
___________________
___________________
___________________
0 hrs. , 07 min.
___________________