OMB83-c_0072_2015

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB Control Number

National Archives and Records Admi istration

lQ22-QQ12
Enter only items that change

Current record

Ne w reco r d

Agency form number(s)
NA Form 17003

�

Annual reporting and recordkeepi g hour
burden
Number of respondents
Total annual respondents
Percent of these responses

%

collected electronically

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeepi �g cost
burden (in thousands of dollars)
Total annualized Capital/Startup co ts
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference

Program change
Adjustment

��

Other changes** Federal Audit data nu� bers changed so this current form reflects that. In a couple of cases, respondents
need t o provide a URL and those data field have been added. Finally, Time and Effort Reporting needed to be it's own line
item and so has been added to this revised orm.

s;g

s ;gc e:

Ex cutive for Information Servi es/CIO
**This form cannot be used to extend

OMB FORM 83-C,

10/95

1an expiration date.

Date:

J

{6{Jul{

For OIRA Use