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 1
IC Burden Analysis Table

(1464) 1845-0100 v2

IC Title

Affected 

Public

Reporting 

Requirement

Available 

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 1
IC Burden Analysis 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

ments 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

ments 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

ments Recordkeeping No Yes 15%

Required to 

Obtain or 

Retain a 

Benefit 

5 291 0.25 73

Revised 11/26/20122
IC Burden Analysis Table

(1464) 1845-0100 v2

34 CFR 674.58

State, 

Local or 

Tribal 

Govern

ments 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

ments 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 3
IC Burden Analysis 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 11/26/20124