Burden

Burden Computation - Special Business Forms
July 11, 2018

Product: Form 1099-SA
OMB Number: 1545-1517
Description: Distributions From an HSA, Archer MSA or Medical Advantage MSA
Variables

Changes (+ -)

Responses
Line Items
Percent Paid Preparor

9999

+25,839

25,839

+9

9

+0.85

0.85

Computation of Changes
Old Computation (Prog. Change)

25,839

×

New Computation

25,839

×

=
0.14

Balance
Old Computation (Adjustment)
New Computation

25,839

=

3,618

=

3,617.46

×

=

×

=

Balance

3,618

=

Summary
Old Burden
Program Change

3,617.46

Adjustment
New Burden

0.14

Paperwork Reduction Act Notice
Time Per Response
0.14
Average Hours Per Response
Record Keeping

0.0

Learning

0.0

Preparing

0.14

Sending
Notes:

0.0

0 hrs. , 08 min.