Change Justification Worksheet

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

U.S. Department of Education/Office of Postsecondary Education
Enter only items that change
Current record

0849
1840
___ ___
___ ___ - ___
___ ___ ___

New record

Agency form number (s)

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

This currently approved collection has been modified slightly to include lost revenue as an allowable expense and to clarify
instructions regarding how data should be reported and how reports should be submitted to the U.S. Department of
Education.
Signature of Senior Official or designee:
signed by Lauren Kennedy
Lauren Kennedy Digitally
Date: 2021.04.26 11:35:02 -04'00'

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

OMB 83-C

Date:

4/26/21

For OIRA Use
___________________________________
___________________________________

10/95