Change Request Worksheet

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB Control Number

U.S. Department of Education, Office of Postsecondary Education,
International and Foreign Language Education
Enter only items that change
Current Record

1840-0005

New Record

Agency form number(s)

Annual reporting and record keeping
hour burden
Number of respondents

N/A

N/A

Total annual responses

N/A
N/A

N/A
N/A

N/A

N/A

Percent of these responses
collected electronically
Total annual hours
Difference

N/A
N/A

Explanation of difference
Program Change
0B

Adjustment
Annual reporting and record keeping
cost burden (in thousands of dollars)

N/A

Total annualized capital/startup
costs

N/A

N/A

Total annual costs (O&M)

N/A

N/A

Total annualized cost requested

N/A

N/A

Difference

N/A
N/A

Explanation of difference
Program Change
Adjustment

N/A

Other change**
Text changes to the application are made to reflect that there are now two competitive preference priorities for
the DDRA program, and revised language on the Special Note on Language Acquisition.

Signature of Senior Officer or
designee:

Sara Starke

Digitally signed by Sara Starke
DN: c=US, o=U.S. Government, ou=U.S.
Department of Education, cn=Sara
Starke,
0.9.2342.19200300.100.1.1=9268376850
Date: 2016.03.14 09:19:31 -04'00'

Date:

For OIRA Use

03/14/2016

**This form cannot be used to extend an expiration date
OMB 83-C