Change Worksheet

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency: Commerce/Census/SSSD		OMB Control Number 0607-0924
Enter only items that change Current Record New Record
Agency form numbers(s)
Annual reporting and recordkeeping hour burden
Number of respondents	200,000	60,000
Total annual responses	200,000	60,000
Percent of these responses collected electronically	%	%
Total annual hours	33,333	10,000
Difference		-23,333
Explanation of difference Program change Adjustment		-23,333
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 Change** Due to budget constraints we will mail this information collection to considerably fewer respondents than we originally expected.
Signature of Senior Official or designee:	Date:	For OIRA Use __________________________ __________________________

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

OMB 83-C 10/95