83-C Change Sheet

UNITED STATES DEPARTMENT OF EDUCATION
OFFICE OF MANAGEMENT
CHIEF PRIVACY OFFICE
INFORMATION COLLECTION CLEARANCE DIVISION
PAPERWORK REDUCTION ACT CHANGE WORKSHEET

Agency/Subagency:

OMB Number:

Office of the Secretary (OS)

1894-0001
Enter only items that change.

Annual reporting and recordkeeping hour burden:
Agency form number(s)

Current Record

New Record

1894-0001

1894-0001

Annual reporting and recordkeeping hour burden:
Number of respondents

1

1

Total annual responses

1

1

0%

0%

1

3

Percent of these responses collected electronically
Total annual hours
Difference:

2

Explanation of Difference:
Program Change

2

Adjustment

0

Annual reporting and recordkeeping cost burden
(in thousands of dollars):

Current Record

New Record

Total annualized capital/startup costs

$0

$0

Total annual costs (O&M)

$0

$0

Total annualized costs requested

$0

$0

Difference
$0

Explanation of Difference:
Program Change

$0

Adjustment

$0

Other Change:** (2,000 characters max). An attachment may be included with this form to provide additional information.
This change sheet includes two changes (1) the addition of a no burden requirement for a dissemination plan under §3474.20(d) and
the (2) the addition of the Evidence of Effectiveness Form.

Signature of Senior Officer or Designee:

Stephanie Valentine

For OIRA Use:
**This form cannot be used to extend an expiration date.
OMB 83-C 8/2017

Digitally signed by Stephanie Valentine
DN: c=US, o=U.S. Government, ou=U.S. Department of Education, cn=Stephanie Valentine,
0.9.2342.19200300.100.1.1=9268290280
Date: 2016.07.22 08:11:52 -04'00'

Date: 07/22/2016