OMB83 C form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Education/FSA
1845

Enter only items that change
Current record

Agency form number (s)

-

0136

New record

Annual reporting and recordkeeping hour
burden
Number of respondents

2040

2040

Total annual responses

2040

2040

Percent of these responses
collected electronically
Total annual hours

0

%

90

170

%

170

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)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes
There is no change in the number of questions on the survey, respondents or hours expected to complete the survey. The purpose of this change
request is to add an additional method of data collection for follow up of nonrespondents. Non-responding sample members will be sent an email
offering them the opportunity to fill out the survey on a mobile device.

Signature of Senior Official or designee:

Beth Grebeldinger

Digitally signed by Beth Grebeldinger
DN: c=US, o=U.S. Government, ou=U.S. Department of Education, cn=Beth
Grebeldinger, 0.9.2342.19200300.100.1.1=9268256420
Date: 2015.10.01 12:51:02 -04'00'

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

OMB 83-C

Date:

10-1-2015

For OIRA Use
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10/95