WORKSHEET
1:
ANNUAL
RESPONDENT
BURDEN/
COST
ESTIMATE
Collection
Activity
Burden
Hours
Response
Hours
Per
Year
Total
Labor
Costs
Per
Year
Capital
Costs
O
&

M
Costs
Number
of
Respond
.
Total
Hours
Per
Year
(
all
respond.)
Total
Cost
Per
Year
Prof/
Tech
$
43.97
/
hr
Review
instructions
1
1
43.97
0
0
53
53
$
2,330.41
Acquire,
install,
and
utilize
technology
and
systems
0
0
0
0
0
53
0
0
Adjust
existing
ways
to
comply
with
previously
applicable
instructions
and
requirements
1
1
43.97
0
0
53
53
$
2,330.41
Gather
information
32
32
1,407.04
0
0
53
1,696
$
74,573.12
Search
data
sources
2
2
87.94
0
0
53
106
$
4,660.82
Complete
and
review
the
collection
of
information
2
2
87.94
0
0
53
106
$
4,660.82
Transmit
or
otherwise
disclose
the
information
1
1
43.97
0
0
53
53
$
2,330.41
Store,
file,
or
maintain
the
information
1
1
43.97
0
0
53
53
$
2,330.41
TOTALS
40
40
1,758.80
0
0
53
2,120
$
93,216.40
ANNUAL
ACTIVITY
TALLY
TOTALS
Annual
Recordkeeping
Burden
Total
Recordkeeping
Hours
36
Number
of
Respondents
53
36
x
53
=
1,908
hours
Annual
Reporting
Burden
Total
Reporting
Hours
4
Number
of
Respondents
53
4
x
53
=
212
hours
Annual
Burden
Total
Hours
40
Number
of
Respondents
53
40
x
53
=
2,120
hours
Annual
Cost
Total
Cost
$
1,758.80
Number
of
Respondents
53
$
1,758.80
x
53
=

$
93,216.40
WORKSHEET
2A:
ANNUAL
AGENCY
BURDEN/
COST
ESTIMATE
Collection
Activity
Agency
Burden
Hours
Response
Hours
Per
Year
Total
Labor
Costs
Per
Year
Capital
Costs
($)
O
&
M
Costs
($)
Total
Cost
Per
Year
GS15
$
160.37/
hr
GS14
$
136.34/
hr
GS12
$
97.02/
hr
Review/
update
survey
instrument
4
20
130
154
15,980.88
0
0
15,980.88
Maintain
a
master
informational
data
base
0
4
24
28
2,873.84
0
0
2,873.84
Answer
respondent
questions
4
10
20
34
3,945.28
0
0
3,945.28
Review
informational
and
data
submissions
for
accuracy
and
completeness
4
20
28
52
6,084.44
0
0
6,084.84
Prepare
Report
to
Congress
8
8
12
28
3,537.92
0
0
3,537.92
Agency
review
and
approval
process
8
24
20
52
6,495.52
0
0
6,495.52
Submit
Report
to
Congress
and
Distribute
8
20
20
48
5,950.16
0
0
5,950.16
TOTALS
36
106
254
396
44,868.04
0
0
44,868.44
WORKSHEET
2B:
ANNUAL
CONTRACTOR
BURDEN/
COST
ESTIMATE
Collection
activity
Contract
Burden
Hours
Response
hours
per
year
Total
Labor
Costs
Per
year
($)
Other
costs
Total
Costs
Per
year
PL­
4
$
82.40/
hr
PL­
2
$
46.35/
hr
Review/
update
survey
instrument
8
24
32
$
1,771.60
$
0.00
$
1,771.60
Review
Informational
and
data
submissions
for
accuracy
and
completeness
8
48
56
$
2,884.00
$
0.00
$
2,884.00
Process
and
compile
submissions
8
32
40
$
2,142.40
$
0.00
$
2,142.40
Analyze
and
summarize
data
and
other
information
from
submissions
24
160
184
$
9,393.60
$
0.00
$
9,393.60
Prepare
Report
to
Congress
16
96
112
$
5,768.00
$
0.00
$
5,768.00
Agency
review
process
8
24
32
$
1,771.60
$
0.00
$
1,771.60
WORKSHEET
2C:
AGENCY
AND
CONTRACTOR
SUMMARIES
ANNUAL
AGENCY
ACTIVITY
TOTALS
Annual
Agency
Burden
396
Hours
Annual
Agency
Labor
Cost
44,868.04
Annual
Agency
O&
M
Cost
0
Total
Agency
Cost
$
44,868.04
ANNUAL
CONTRACTOR
ACTIVITY
TOTALS
Annual
Contractor
Burden
456
Hours
Annual
Contractor
Labor
Cost
23,731.20
Annual
Contractor
O&
M
Cost
0
4%
Fee
to
GSA
0
Total
Contractor
Cost
23,731.20
SUMMARY
TOTALS
Total
Agency
Cost
$
44,868.04
Total
Contractor
Cost
$
23,731.20
Total
Annual
Cost
$
68,599.24
