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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency
OMB control number
Department of Homeland Security
1
6
0
1
0
0
1
4
Enter only items that change
Current record
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
0
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)
0.00
Total annualized cost requested
0.00
0.00
Difference
Explanation of difference
Program change
Adjustment
Other changes**
This change request is being submitted to include the complete submission form for the I&A IC. The previous submission form for this IC did not
include all pages.
Signature of Senior Official or designee:
Tyrone O. Huff
**This form cannot be used to extend an expiration date.
OMB FORM 83-C, 10/95
Date:
For OIRA Use
01/27/2012
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| File Type | application/pdf |
| File Title | OMB Form 83-C, Paperwork Reduction Act Change Worksheet, October 1995 |
| Author | WHS/ESD/IMD |
| File Modified | 2012-01-26 |
| File Created | 2007-08-09 |