2016 Burden

Burden Computation - Business Forms
Page 1 of 1

April 13, 2016

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

5306/
Application for Approval of Prototype or Employer Sponsored Individual
2013

Changes (+ -)

2016

600
______________
49
______________
0.00
______________
0.85
______________
9
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

600
______________
49
______________
0.00
______________
0.85
______________
9
______________

Computation of Changes
600 x _____________
13.74
Old Computation (Prog. Change) ______________
600
13.74
New Computation.............. ______________ x _____________
Balance...

=
=

8,244
_______________
8,244
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

8,244
_______________
0
_______________
_______________
8,244
_______________

Paperwork Reduction Act Notice
Time Per Response
13.74
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
11.72
______________
0.89
______________
1.12
______________
0.00
______________

Average Time
Per Response
11 hrs. , 43 min.
___________________
0 hrs. , 53 min.
___________________
1 hrs. , 07 min.
___________________
0 hrs. , 00 min.
___________________