IC Burden Analysis Table (XXXX) XXXX-XXXX vX

**Please enter Name of Instrument here.**

**Respondent Type # of Respondents**  **# of Responses Hours/Response**  **Total Burden Hours**  **Reporting Requirement Cost per**  **Repondent Total Costs** 

**per Respondent**  **Burden by Affected Entity:** Federal Government 0 0 0 0 $0 $0

Individuals or Households 0 0 0 0 $0 $0

Farms 0 0 0 0 $0 $0 **Sub-total** 0 0 0 $0

**Private Sector** Business or other for-profits 0 0 0 0 $0 $0

Not-for profits 0 0 0 0 $0 $0 **Sub-total** 0 0 0 $0

**State, Local, or Tribal Governments** Public Institutions 0 0 0 0 $0 $0 Private Institutions 0 0 0 0 $0 $0 **Sub-total** 0 0 0 0

**Total** 

### 0 **0 0**  **$0**

**CURRENT INVENTORY** Current # of Respondents 0 Current # of Responses 0 Current Inventory of Hours 0 Difference 

### 0 **0 0** 

Document Type Available Electronically? Can be submitted Electronically? Percent Reporting Electronically? Obligation to Respond? Frequency?

Revised: XX/XX/XXXX 1IC Burden Analy sis Table (1464) 1845-0100 v2

IC Title **Af fected**  **Public Reporting** 

**Requirement Av**  **ailable**

**Electronically Can be** 

**Submitted Electronically**  **Percent**

**Reporting Electronically**  **Electronic**

**Capability Obligation to** 

**Respond # of** 

**Respondents # of** 

**Responses Hrs/Resp**  **Total Hours**

34 CFR 674.53 Individua

ls or Househ olds Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 4,808 4,808 0.5 2,404

34 CFR 674.56 Individua

ls or Househ olds Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 7,216 7,216 0.5 3,608

34 CFR 674.57 Individua

ls or Househ olds Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 809 809 0.5 405

34 CFR 674.58 Individua

ls or Househ olds Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 5,561 5,561 0.5 2,781

34 CFR 674.59 Individua

ls or Househ olds Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 43,117 43,117 0.5 21,559

34 CFR 674.53 ForProfit Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 8 337 0.25 84

34 CFR 674.56 ForProfit Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 13 505 0.25 126

34 CFR 674.57 ForProfit Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 1 57 0.25 14

34 CFR 674.58 ForProfit Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 10 389 0.25 97

Revised 11/26/2012 1IC Burden Analy sis Table (1464) 1845-0100 v2

34 CFR 674.59 ForProfit Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 75 3,018 0.25 755

34 CFR 674.53 Private

Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 69 2,740 0.25 685

34 CFR 674.56 Private

Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 104 4,113 0.25 1,028

34 CFR 674.57 Private

Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 9 461 0.25 115

34 CFR 674.58 Private

Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 78 3,170 0.25 793

34 CFR 674.59 Private

Institutio

ns Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 605 24,577 0.25 6,144

34 CFR 674.53 State,

Local or Tribal Govern

me nts Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 45 1,731 0.25 433

34 CFR 674.56 State,

Local or Tribal Govern

me nts Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 67 2,598 0.25 650

34 CFR 674.57 State,

Local or Tribal Govern

me nts Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 5 291 0.25 73

Revised 11/26/2012 2IC Burden Analy sis Table (1464) 1845-0100 v2

34 CFR 674.58 State,

Local or Tribal Govern

me nts Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 50 2,002 0.25 501

34 CFR 674.59 State,

Local or Tribal Govern

me nts Recordkeeping No Yes 15% Required to Obtain or Retain a Benefit 390 15,522 0.25 3,881 0%

- 0%

- 0%

- 0%

- 

### Total 63,040 123,022 0 46,136

**CURRENT INVENTORY** Current # of Respondents 117,162 Current # of Responses 117,162 Current Inventory

of Hours 43,938

**Difference** (54,122) 5,860 2,198

IC Title Instrument Filename Frequency Number of Respondents Cost Per

Respondent Total Cost

Per Respondent $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

Revised 11/26/2012 3IC Burden Analy sis Table (1464) 1845-0100 v2
$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 **Total Costs** $0

Revised 11/26/2012 4