83-c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

US Department of Justice/Bureau of Justice Statistics

0325
1121
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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

%
6,280

%
16,340

Difference

10,060

Explanation of difference

1 year to 3 year allocation, see below.

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**

For the 3 year generic clearance, 1 year rather than the full 3 year burden request was approved. This change request would
reconcile the difference between the initial request and subsequent allocation, adding the remaining 10,060 hours to the
generic clearance.
Signature of Senior Official or designee:

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

OMB 83-C

Date:

For OIRA Use
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10/95