Burden Computation

Burden Computation - Individual Forms
Page 1 of 1

December 15, 2015

Product:
Description:

5213/
Election to Postpone Determination as To Whether the Presumption

Variables
Responses.......
Line Items......
Pages...........
Words...........
Code References.
Income Records..
Other Records...
Avg Lines used..

______________
______________
______________
______________
______________
______________
______________
______________

Changes (+ -)

2015

+3,541
_____________________________
+7
_____________________________
+1.00
_____________________________
+1,525.00
_____________________________
+3
_____________________________
_____________________________
+1.00
_____________________________
_____________________________

3,541
______________
7
______________
1.00
______________
1,525.00
______________
3
______________
0.00
______________
1.00
______________
0.00
______________

Computation of Changes
3,541 x _____________
Old Computation (Prog. Change) ______________
3,541 x _____________
0.78
New Computation.............. ______________
Balance...

=
=

_______________
2,762
_______________
_______________
+2,762

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

______________ x _____________
3,541 x _____________
______________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

_______________
+2,762
_______________
_______________
2,762
_______________

Paperwork Reduction Act Notice
Time Per Response
0.78
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
0.11
______________
0.17
______________
0.16
______________
0.34
______________

0 hrs. , 06 min.
___________________
0 hrs. , 10 min.
___________________
0 hrs. , 09 min.
___________________
0 hrs. , 20 min.
___________________