Reporting and Recordkeeping Requirement

Reporting and Recordkeeping Requirements 2023.xlsm

Power of Attorney

Reporting and Recordkeeping Requirement

OMB: 0560-0190

Document [xlsx]
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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO. 0560-0190










Power of Attorney



DATE PREPARED


July 31, 2023











IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN











REPORTS
RECORDS RESPONDENT COST



















TOTAL BURDEN HOURS

TOTAL







FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS (Col. F x G) NO. OF ANNUAL RECORD- COST TOTAL
SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER (H) RECORD- HOURS PER KEEPING HOURS PER COST
REGS.




so state)
PER (Col. D x E) RESPONSE

KEEPERS RECORD- (Col. I x J) HOUR (Col. H x L)








RESPONDENT

EXEMPT NON-EXEMPT
KEEPER


(A) (B) (C) (D) (E) (F) (G)

(I) (J) (K) (L) (M)

Power of Attorney FSA-211 15,000 1 15,000 0.50
7,500


$62.55 469,125

Power of Attorney -Continuation FSA-211A 1,000 1 1,000 0.25
250


$62.55 15,638













































































































































SUBTOTAL


16,000
0 7,750

0.00
484,763

TOTAL OF ALL PAGES


16,000
0 7,750

0.00
484,763
TOTAL - COLUMNS "F" AND "I" = OMB 83-I, 13b; COLUMNS "H" AND "K" = OMB 83-I, 13c


16,000

7,750




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