2019 Burden-Form 4136 Line 3

Burden Computation - Business Forms
Page 1 of 1

July 21, 2015

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

4136/Line 3

2015

Changes (+ -)

2015

25,375
______________
11
______________
0.00
______________
0.85
______________
0
______________

_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

25,375
______________
11
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
25,375 x _____________
2.67
Old Computation (Prog. Change) ______________
25,375
2.67
New Computation.............. ______________ x _____________
Balance...

=
=

67,752
_______________
67,752
_______________
_______________
0

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

67,752
_______________
0
_______________
_______________
67,752
_______________

Paperwork Reduction Act Notice
Time Per Response
2.67
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
2.63
______________
0.00
______________
0.04
______________
0.00
______________

Average Time
Per Response
2 hrs. , 37 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 02 min.
___________________
0 hrs. , 00 min.
___________________