2012 Burden Worksheet 4

Burden Computation - Individual Forms
Page 1 of 1

April 10, 2013

Product:
Description:
Variables
Responses.......
Line Items......
Pages...........
Words...........
Code References.
Income Records..
Other Records...
Avg Lines used..

8582CR/WKST 4

2009

Changes (+ -)

2009

150,000
______________
7
______________
0.00
______________
89.00
______________
0
______________
0.00
______________
1.00
______________
0.85
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

150,000
______________
7
______________
0.00
______________
89.00
______________
0
______________
0.00
______________
1.00
______________
0.85
______________

Computation of Changes
150,000 x _____________
1.08
Old Computation (Prog. Change) ______________
150,000 x _____________
1.08
New Computation.............. ______________
Balance...

=
=

162,000
_______________
162,000
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

162,000
_______________
0
_______________
_______________
162,000
_______________

Paperwork Reduction Act Notice
Time Per Response
1.08
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
0.52
______________
0.17
______________
0.28
______________
0.11
______________

0 hrs. , 31 min.
___________________
0 hrs. , 10 min.
___________________
0 hrs. , 16 min.
___________________
0 hrs. , 06 min.
___________________