Change Justification

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency      		OMB Control Number 1840     -  0619  
Enter only items that change Current Record New Record
Agency form number(s)	     	     
Annual reporting and record keeping hour burden
Number of respondents	     	     
Total annual responses	     	     
Percent of these responses collected electronically	     	     
Total annual hours	     	     
Difference		     
Explanation of difference Program Chage		     
Adjustment		     
Annual reporting and record keeping 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 change**       The changes listed in the McNair Application do not affect the annual reporting and record keeping hour or cost burden, and are intended to both correct and clarify identified information listed in the currently approved application.
Signature of Senior Officer or designee:      	Date:      	For OIRA Use            

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

OMB 83-C