2015 Burden-Form 4136 Line 12

Burden Computation - Business Forms
Page 1 of 1

July 23, 2015

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

4136/Line 12

2015

Changes (+ -)

2015

233
______________
19
______________
0.00
______________
0.85
______________
0
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

233
______________
19
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
233 x _____________
4.62
Old Computation (Prog. Change) ______________
233
4.62
New Computation.............. ______________ x _____________
Balance...

=
=

1,077
_______________
1,077
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

1,077
_______________
0
_______________
_______________
1,077
_______________

Paperwork Reduction Act Notice
Time Per Response
4.62
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
4.54
______________
0.00
______________
0.07
______________
0.00
______________

Average Time
Per Response
4 hrs. , 32 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 04 min.
___________________
0 hrs. , 00 min.
___________________