Change Worksheet

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB Control Number
1894-0006
Enter only items that change
Current Record

Agency form number(s)

New Record
N/A

Annual reporting and record keeping
hour burden
Number of respondents

15

Total annual responses

15

Percent of these responses
collected electronically

100

Total annual hours

1200

Difference

15 (respondents) X 80 (hours) =
1200
New program requesting approval
to use 1894-0006

Explanation of difference
Program Change

1200

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 States, consistent with the purposes of the 21st CCLC
program, the Out-of-School Time Career Pathway program that, in partnership with eligible entities (as defined in
section 4201(b)(3) of the Elementary and Secondary Education Act of 1965, as amended by the Every Student
Succeeds Act (ESEA)) in the State, will provide students expanded options to participate in a career pathway program,
outside regular school hours, that leads to an industry recognized credential in an in demand industry sector or
occupation identified by the State, including, as appropriate, through completion of an apprenticeship or internship.
Signature of Senior Officer or
designee:

For OIRA Use

Date:
June 2, 2020

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