ITEM 15 WORKSHEET FOR OMB NO. 1215-0160 (April, 2009)
| 
			 REG. NO. | 
			 FORM NO./ PROGRAM | 
			 REASON 
 | 
			 PREVIOUS BURDEN 2003 | 
			 Pervious BURDEN 2006 | 
			 New Burden 2009 | 
			 DIFFERENCE | TYPE OF CHANGE (PC/ADJ) | 
| 
			 0 | ESA-100 | 
			 
 | 840 | 840 | 840 | 0 | 
			 | 
| 0 | LS-200 | 
			 | 2,176 | 2,440 | 2,448 | +8 | ADJ | 
| 
			 | LS-201 | 
			 | 1,125 | 1,260 | 1,150 | -110 | ADJ | 
| 
			 | LS-203 | 
			 | 2,531 | 2,835 | 2,588 | -247 | ADJ | 
| 
			 | LS-204 | 
			 | 45,000 | 50,400 | 46,000 | -4,400 | ADJ | 
| 
			 | LS-262 | 
			 | 60 | 70 | 70 | 0 | ADJ | 
| 
			 | LS-267 | 
			 | 43 | 48 | 48 | 0 | ADJ | 
| 
			 | LS-271 | 
			 | 40 | 40 | 40 | 0 | 
			 | 
| 
			 | LS-274 | 
			 | 412 | 619 | 563 | -56 | ADJ | 
| 
			 | LS-513 | 
			 | 450 | 309 | 282 | -27 | ADJ | 
| 
			 | Liens (702.162) | 
			 | 5 | 5 | 5 | 0 | 
			 | 
| 
			 | Certifications (702.174) | 
			 | 4 | 4 | 4 | 0 | ADJ | 
| 
			 | Reinstatement (702.175) | 
			 | 1 | 1 | 1 | 0 | 
			 | 
| 
			 | Settlements & Applications (702.242) | 
			 | 9,000 | 10,080 | 10,080 | 0 | ADJ | 
| 
			 | Payments (702.321) | 
			 | 2,750 | 2,425 | 2425 | 0 | ADJ | 
| 
			 TOTAL | 
			 | 
			 | 
			 64,437 | 
			 71,376 | 
			 66,544 
 | 
			 -4832 | 
			 ADJ | 
PC – Program Change
ADJ - Adjustment
| File Type | application/msword | 
| File Title | CHANGE WORKSHEET FOR OMB NO | 
| Author | US Department of Labor | 
| Last Modified By | U.S. Department of Labor | 
| File Modified | 2009-04-24 | 
| File Created | 2009-04-24 |