2015 Burden

Burden Computation - Business Forms
Page 1 of 1

October 21, 2015

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

5495/
Request for Discharge From Personal Liability Under Internal Revenue
2012

Changes (+ -)

2015

25,000
______________
23
______________
3.00
______________
0.85
______________
4
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

25,000
______________
23
______________
3.00
______________
0.85
______________
4
______________

Computation of Changes
25,000 x _____________
12.26
Old Computation (Prog. Change) ______________
25,000
12.26
New Computation.............. ______________ x _____________
Balance...

=
=

306,500
_______________
306,500
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

306,500
_______________
0
_______________
_______________
306,500
_______________

Paperwork Reduction Act Notice
Time Per Response
12.26
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:
No Change

Average Hours
Per Response
5.50
______________
1.50
______________
4.45
______________
0.80
______________

Average Time
Per Response
5 hrs. , 30 min.
___________________
1 hrs. , 30 min.
___________________
4 hrs. , 27 min.
___________________
0 hrs. , 48 min.
___________________