2014 Burden

Burden Computation - Special Business Forms
Page 1 of 1

October 27, 2014

Product:
Description:
Variables
Responses.......
Line Items......
Forms Prepared..

5498SA/
HSA, Archer MSA, or Medicare Advantage MSA Information
2011

Changes (+ -)

2014

52,217
______________
11
______________
0.85
______________

_____________________________
_____________________________
_____________________________

9,167
______________
11
______________
0.85
______________

Computation of Changes
9,167 x _____________
0.17
Old Computation (Prog. Change) ______________
9,167 x _____________
0.17
New Computation.............. ______________
Balance...

=
=

1,559
_______________
1,559
_______________
0
_______________

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

52,217 x _____________
0.17
______________
______________
9,167 x _____________
0.17

=
=

8,877
_______________
_______________
1,559
-7,318
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

8,877
_______________
0
_______________
-7,318
_______________
1,559
_______________

Paperwork Reduction Act Notice
Time Per Response
0.17
Record Keeping............
Learning..................
Preparing.................
Sending...................

Notes:

Average Hours
Per Response
______________
______________
______________
0.17
______________

Average Time
Per Response
___________________
___________________
___________________
0 hrs. , 10 min.
___________________