Change Worksheet

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB Control Number

Department of Education / Office of Elementary and Secondary Education

Enter only items that change
Current Record
Agency form number(s)

1894-0006

New Record
N/A

Annual reporting and record keeping
hour burden
Number of respondents

65

Total annual responses

65

Percent of these responses
collected electronically

100
5655

Total annual hours

65 (respondents) X 87 (hours) =
5655

Difference

New program requesting approval
to use 1894-0006

Explanation of difference

5655

Program Change
Adjustment
Annual reporting and record keeping
cost burden (in thousands of dollars)
Total annualized capital/startup
costs

0

Total annual costs (O&M)

0

Total annualized cost requested

0

Difference

0
0

Explanation of difference
Program Change
Adjustment

0

Other change**
This is a new program that will provide competitive grants to State educational agencies (SEAs) to demonstrate
models for providing well-rounded educational opportunities through course-access programs. This program is
being established with funds from the two percent reservation for technical assistance and capacity building
under section 4103(a)(3) of the Elementary and Secondary Education Act of 1965, as amended (ESEA), which is
intended to support SEAs and local educational agencies (LEAs) in carrying out activities authorized under the
Student Support and Academic Enrichment Grants program in title IV, part A of the ESEA.
Signature of Senior Officer or
designee:

Date:

For OIRA Use

April 22, 2020

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