OMB83-C_followuptoNA17001

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMS Control Number

JQ22.-QQlJ

National Archives and Records Administration

Enter only items that change
Current record
New record
Agency form number(s)
NA Form 1700la ,NHPRC GRANT OFFER
ACKNOWLEDGMENT

, Annual reporting and recordkeeping hour
burden

Number of respondents
Total annual respondents
Percent of these responses
collected electronically

%

100%

Total annual hours
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**Note: This form would be a follow-up to NA Form 1700 I, NHPRC Budget Form and Instructions,
allowing grantees to vertify indirect costs.

Signature ofSonio' Offkial o' D~

Executive for Information Services/Clo
**This form cannot be used to extend an expiration date.

OMS FORM 83-C, 10/95

Date:

For OIRA Use