2015 Burden-Form 4136 Line 17

Burden Computation - Business Forms
Page 1 of 1

July 23, 2015

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

4136/Line 17

2015

Changes (+ -)

2015

7
______________
2
______________
0.00
______________
0.85
______________
0
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

7
______________
2
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
7 x _____________
0.49
Old Computation (Prog. Change) ______________
7
0.49
New Computation.............. ______________ x _____________
Balance...

=
=

4
_______________
4
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

4
_______________
0
_______________
_______________
4
_______________

Paperwork Reduction Act Notice
Time Per Response
0.49
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
0.48
______________
0.00
______________
0.01
______________
0.00
______________

Average Time
Per Response
0 hrs. , 28 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 00 min.
___________________