OMB 83C change form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency U.S. Department of Education/ IES/ Impact Evaluation of Teacher and Leader Evaluation Systems		OMB Control Number 1850-0890
	Enter only items that change Current Record	New Record
Agency form number(s)	NA	NA
Annual reporting and record keeping hour burden
Number of respondent
Total annual responses
Percent of these responses collected electronically	0 %	0 %
Total annual hours
Difference		0
Explanation of difference
Program change		0
Adjustment		0
Annual reporting and record keeping cost burden (in thousands of dollars)
Total annualized capital/startup costs	$124,285	$0
Total annual costs (O&M)	$124,285	$ 0
Total annualized cost requested	$124,285	$0.
Difference		($124,285)
Explanation of difference		($124,285) program change
Program change adjustment
Other change** There are no burden related costs for this collection. It was incorrectly put through with these costs – and will be zeroed out to correct.
Signature of Senior Official or designee: Katrina Ingalls	4/3/13	For OIRA Use _________________________________ _________________________________

**This form cannot be used to extend an expiration date

OMB 83-C