2012 Burden

Burden Computation - Business Forms
Page 1 of 1

June 7, 2012

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

8905/
Certification of Intent to Adopt a Pre-approved Plan
2009

Changes (+ -)

2012

29,000
______________
14
______________
0.00
______________
0.85
______________
2
______________

_____________________________
-4
_____________________________
_____________________________
_____________________________
_____________________________

29,000
______________
10
______________
0.00
______________
0.85
______________
2
______________

Computation of Changes
29,000 x _____________
3.81
Old Computation (Prog. Change) ______________
29,000
2.84
New Computation.............. ______________ x _____________
Balance...

=
=

110,490
_______________
82,360
_______________
_______________
-28,130

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

29,000 x _____________
3.81
______________
______________
29,000 x _____________
3.81

=
=

110,490
_______________
_______________
110,490
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

110,490
_______________
-28,130
_______________
0
_______________
82,360
_______________

Paperwork Reduction Act Notice
Time Per Response
2.84
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
2.39
______________
0.20
______________
0.24
______________
0.00
______________

Average Time
Per Response
2 hrs. , 23 min.
___________________
0 hrs. , 12 min.
___________________
0 hrs. , 14 min.
___________________
0 hrs. , 00 min.
___________________