OMB 83c

Att_OMB83C_Att_1820-0659 (Pt B T6) form.doc

Report of the Participation and Performance of Students with Disabilities on State Assessments by Content Area, Grade, and Type of Assessment

OMB 83C

OMB: 1820-0659

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PAPERWORK REDUCTION ACT

CHANGE WORKSHEET


Agency/Subagency

     

Department of Education, Office of Special Education and Rehabilitative Services


OMB Control Number


1820 -0659


Enter only items that change

Current Record New Record

Agency form number(s)






     


     

Annual reporting and record keeping

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 record keeping 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**

     

Clarification of instructions for completing the data collection table. See blanket OMB 83CJustification Memo. No change in burden.




S ignature of Senior Officer or

designee:



     



Date:



     


For OIRA Use

     

     

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

OMB 83-C

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