OMB83 C

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency U.S. Department of Education, NCES		OMB Control Number 1850-0852 v.2
	Enter only items that change Current Record	New Record
Agency form number(s)	NA	NA
Annual reporting and record keeping hour burden
Number of respondent	5009	5009
Total annual responses	5009	5009
Percent of these responses collected electronically	100%	100%
Total annual hours	2032	2032
Difference		0
Explanation of difference
Program change		0
Adjustment		0
Annual reporting and record keeping cost burden (in thousands of dollars)
Total annualized capital/startup costs	NA	NA
Total annual costs (O&M)	NA	NA
Total annualized cost requested	NA	NA
Difference		NA
Explanation of difference
Program change		NA
Adjustment		NA
Other change** The purpose of this change sheet is to request an amendment to the currently approved information collection, HSLS, in order to request that an incentive of $500 to be granted to a school that is participating in both the field test and full scale study.
Signature of Senior Official or designee:	Date:	For OIRA Use _________________________________ _________________________________

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

OMB 83-C