2015 Burden-Form 4136 Line 5

Burden Computation - Business Forms
Page 1 of 1

July 23, 2015

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

4136/Line 5

2015

Changes (+ -)

2015

14,217
______________
10
______________
0.00
______________
0.85
______________
1
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

14,217
______________
10
______________
0.00
______________
0.85
______________
1
______________

Computation of Changes
14,217 x _____________
2.63
Old Computation (Prog. Change) ______________
14,217
2.63
New Computation.............. ______________ x _____________
Balance...

=
=

37,391
_______________
37,391
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

37,391
_______________
0
_______________
_______________
37,391
_______________

Paperwork Reduction Act Notice
Time Per Response
2.63
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
2.39
______________
0.10
______________
0.14
______________
0.00
______________

Average Time
Per Response
2 hrs. , 23 min.
___________________
0 hrs. , 06 min.
___________________
0 hrs. , 08 min.
___________________
0 hrs. , 00 min.
___________________