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pdfUNITED STATES DEPARTMENT OF EDUCATION
OFFICE OF MANAGEMENT
CHIEF PRIVACY OFFICE
INFORMATION COLLECTION CLEARANCE DIVISION
PAPERWORK REDUCTION ACT CHANGE WORKSHEET
Agency/Subagency:
OMB Number:
Ofc. of Elementary & Secondary Education (OESE)
1810-0646
Enter only items that change.
Annual reporting and recordkeeping hour burden:
Current Record
New Record
Agency form number(s)
Annual reporting and recordkeeping hour burden:
Number of respondents
0
0
Total annual responses
0
0
0%
0%
0
0
Percent of these responses collected electronically
Total annual hours
Difference:
0
Explanation of Difference:
0
Program Change
Adjustment
0
Annual reporting and recordkeeping cost burden
(in thousands of dollars):
Current Record
New Record
Total annualized capital/startup costs
$0
$0
Total annual costs (O&M)
$0
$0
Total annualized costs requested
$0
$0
Difference
$0
Explanation of Difference:
Program Change
$0
Adjustment
$0
Other Change:** (2,000 characters max). An attachment may be included with this form to provide additional information.
The REAP Program office is adding the Form ED-424 Supplemental to the existing SRSA application package under
OMB#1810-0646. This form was inadvertently omitted from last year's approved SRSA application package, and is necessary to
ensure that the mandatory "State Director" field is populated on the G5 Grant Award Notification that is generated once the SRSA
award allocations are obligated to eligible LEAs.
Signature of Senior Officer or Designee:
Jason Botel
For OIRA Use:
**This form cannot be used to extend an expiration date.
OMB 83-C 8/2017
Digitally signed by Jason Botel
DN: c=US, o=U.S. Government, ou=U.S. Department of Education, cn=Jason Botel,
0.9.2342.19200300.100.1.1=9269442290
Date: 2017.12.18 09:50:45 -05'00'
Date: 12/18/2017
| File Type | application/pdf |
| File Modified | 2017-12-18 |
| File Created | 2016-04-07 |