Form 6627 Burden Computations

Burden Computation - Business Forms
Page 1 of 1

March 4, 2008

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

6627/Part 1

2008

Changes (+ -)

2008

500
______________
9
______________
0.00
______________
0.85
______________
0
______________

_____________________________
+3
_____________________________
_____________________________
_____________________________
_____________________________

500
______________
12
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
500 x _____________
2.19
Old Computation (Prog. Change) ______________
500
2.92
New Computation.............. ______________ x _____________
Balance...

=
=

1,095
_______________
1,460
_______________
_______________
+365

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

Summary
1,095
_______________
+365
_______________
_______________
1,460
_______________

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

Paperwork Reduction Act Notice
Time Per Response
2.92
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
2.87
______________
0.00
______________
0.05
______________
0.00
______________

Average Time
Per Response
2 hrs. , 52 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 03 min.
___________________
0 hrs. , 00 min.
___________________

Notes:
Added 3 line items to correct errors in previous computations.

Burden Computation - Business Forms
Page 1 of 1

March 4, 2008

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

6627/Part 2

2007

Changes (+ -)

2008

350
______________
10
______________
0.00
______________
0.85
______________
0
______________

_____________________________
+4
_____________________________
_____________________________
_____________________________
_____________________________

350
______________
14
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
350 x _____________
2.43
Old Computation (Prog. Change) ______________
350
3.40
New Computation.............. ______________ x _____________
Balance...

=
=

851
_______________
1,190
_______________
_______________
+339

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

Summary
851
_______________
+339
_______________
_______________
1,190
_______________

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

Paperwork Reduction Act Notice
Time Per Response
3.40
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
3.35
______________
0.00
______________
0.05
______________
0.00
______________

Average Time
Per Response
3 hrs. , 21 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 03 min.
___________________
0 hrs. , 00 min.
___________________

Notes:
Added 4 line items to correct error in previous computations.

Burden Computation - Business Forms
Page 1 of 1

March 4, 2008

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

6627/Part 3

2007

Changes (+ -)

2008

1,260
______________
11
______________
0.00
______________
0.85
______________
1
______________

_____________________________
+9
_____________________________
_____________________________
_____________________________
_____________________________

1,260
______________
20
______________
0.00
______________
0.85
______________
1
______________

Computation of Changes
1,260 x _____________
2.88
Old Computation (Prog. Change) ______________
1,260
5.06
New Computation.............. ______________ x _____________
Balance...

=
=

3,629
_______________
6,376
_______________
_______________
+2,747

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

Summary
3,629
_______________
+2,747
_______________
_______________
6,376
_______________

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

Paperwork Reduction Act Notice
Time Per Response
5.06
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
4.78
______________
0.10
______________
0.18
______________
0.00
______________

Average Time
Per Response
4 hrs. , 46 min.
___________________
0 hrs. , 06 min.
___________________
0 hrs. , 10 min.
___________________
0 hrs. , 00 min.
___________________

Notes:
9 line items added to correct error in previous computations.

Burden Computation - Business Forms
Page 1 of 1

March 4, 2008

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

6627/Part 4

2007

Changes (+ -)

2008

1,284
______________
8
______________
0.00
______________
0.85
______________
0
______________

_____________________________
+5
_____________________________
_____________________________
_____________________________
_____________________________

1,284
______________
13
______________
0.00
______________
0.85
______________
0
______________

Computation of Changes
1,284 x _____________
1.94
Old Computation (Prog. Change) ______________
1,284
3.16
New Computation.............. ______________ x _____________
Balance...

=
=

2,491
_______________
4,058
_______________
_______________
+1,567

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

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

______________ x _____________
______________ x _____________

=
=

_______________
_______________
_______________

Summary
2,491
_______________
+1,567
_______________
_______________
4,058
_______________

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

Paperwork Reduction Act Notice
Time Per Response
3.16
Recordkeeping.............
Learning..................
Preparing.................
Sending...................

Average Hours
Per Response
3.11
______________
0.00
______________
0.05
______________
0.00
______________

Average Time
Per Response
3 hrs. , 06 min.
___________________
0 hrs. , 00 min.
___________________
0 hrs. , 03 min.
___________________
0 hrs. , 00 min.
___________________

Notes:
Added 5 line items to correct error in previous computations.