FR 4004 83-C justification

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB control number

Board of Governors of the Federal Reserve System

7

1

0

0

-

0

1

1

2

Enter only items that change
Current Record

New Record

45

26

45

26

Agency form number(s)

FR 4004
Annual reporting and recordkeeping
hour burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

23

Total annual hours

26

3

Difference
Explanation of difference:

%

%

Program change

3

Adjustment
Annual reporting and recordkeeping
cost burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference:

Program change
Adjustment

Other Change**

Based on recent experience, the Board has determined that the estimated total time per response needs
to be increased to one hour. The burden adjustment also includes an update to the respondent count.
Signature of Senior Official or designee:

Date:

For OIRA Use

** This form cannot be used to extend an expiration date.
OMB 83-C

10/95