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
$
38.15
/
hr
Review
instructions
1
1
38.15
0
0
53
53
$
2,021.95
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
38.15
0
0
53
53
$
2,021.95
Gather
information
32
32
1,220.80
0
0
53
1,696
$
6,4702.40
Search
data
sources
2
2
76.30
0
0
53
106
$
4,043.90
Complete
and
review
the
collection
of
information
2
2
76.30
0
0
53
106
$
4,043.90
Transmit
or
otherwise
disclose
the
information
1
1
38.15
0
0
53
53
$
2,021.95
Store,
file,
or
maintain
the
information
1
1
38.15
0
0
53
53
$
2,021.95
TOTALS
40
40
1,526.00
0
0
53
2,120
$
80,878.00
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
$
1,526.00
Number
of
Respondents
53
$
1,526.00
x
53
=
$
80,878.00
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
$
142.29/
hr
GS14
$
120.97/
hr
GS9
$
53.27/
hr
Review/
update
survey
instrument
4
20
16
40
3,840.88
0
0
3,840.88
Maintain
a
master
informational
data
base
0
4
4
8
696.96
0
0
696.96
Answer
respondent
questions
4
24
0
28
3,472.44
0
0
3,472.44
Review
informational
and
data
submissions
for
accuracy
and
completeness
4
32
8
44
4,866.36
0
0
4,866.36
Prepare
Report
to
Congress
8
8
8
24
2,532.24
0
0
2,532.24
Agency
review
and
approval
process
8
24
2
34
4,148.14
0
0
4,148.14
Submit
Report
to
Congress
and
Distribute
8
20
16
44
4,410.04
0
0
4,410.04
TOTALS
36
132
54
216
23,967.06
0
0
23,967.06
WORKSHEET
2B:
ANNUAL
CONTRACTOR
BURDEN/
COST
ESTIMATE
Collection
Activity
Contractor
Burden
Hours
Response
Hours
Per
Year
Total
Labor
Costs
Per
Year
($)
Capital
Costs
($)
O
&
M
Costs
($)
Total
Cost
Per
Year
PL3
$
63.00/
hr
PL2
$
44.00/
hr
Review/
update
survey
instrument
80
40
120
6,800.00
0
402.00
7,270.00
Distribute
Reporting
Form
to
Respondents
0
4
4
176.00
0
0
176.00
Maintain
a
master
informational
data
base
0
8
8
352.00
0
0
352.00
Answer
respondent
questions
40
45
85
4,500.00
0
0
4,500.00
Review
informational
and
data
submissions
for
accuracy
and
completeness
40
0
40
2,520.00
0
0
2,520.00
Process
and
compile
submissions
40
0
40
2,520.00
0
0
2,520.00
Analyze
and
summarize
data
and
other
information
from
submissions
600
0
600
37,800.00
0
0
37,800.00
Prepare
Report
to
Congress
300
80
380
22,420.00
0
700.000
23,120.00
Agency
review
and
approval
process
30
0
30
1,898.00
0
0
1,890.00
Submit
Report
to
Congress
and
Distribute
20
0
20
1,260.00
0
260.00
1,260.00
CONTRACTOR
TOTAL
1,150
177
1327
80,238
0
1,362.00
81,600.00
4%
FEE
TO
GSA
3,400.00
TOTAL
CONTRACTOR
COST
85,000.00
WORKSHEET
2C:
AGENCY
AND
CONTRACTOR
SUMMARIES
ANNUAL
AGENCY
ACTIVITY
TOTALS
Annual
Agency
Burden
216
hours
Annual
Agency
Labor
Cost
$
23,967.06
Annual
Agency
O&
M
Cost
$
0
Total
Agency
Cost
$
23,967.06
ANNUAL
CONTRACTOR
ACTIVITY
TOTALS
Annual
Contractor
Burden
1,327
hours
Annual
Contractor
Labor
Cost
$
80,238.00
Annual
Contractor
O&
M
Cost
$
1,362.00
4%
Fee
to
GSA
$
3,400.00
Total
Contractor
Cost
$
85,000.00
SUMMARY
TOTALS
Total
Agency
Cost
$
23,967.06
Total
Contractor
Cost
$
85,000.00
Total
Annual
Cost
$
111,967.06
