83C Change Justification Form

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

0854
1840
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___ ___ - ___
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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**

Form needed to be updated to amend the dates window in which grantees could request a match waiver. A correction was
also made to an error at the top of page 2.
Signature of Senior Official or designee:

Craig Pooler

Digitally signed by Craig Pooler
Date: 2022.01.19 11:28:54 -05'00'

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

OMB 83-C

Date:

For OIRA Use
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10/95