Change Justification Form

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB Control Number

US Department of Education / Office of Elementary and Secondary Education

Enter only items that change
Current Record

1810-0657

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 Change
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 Impact Aid Discretionary Construction Grant program is requesting a change to its approved application
collection, 1810-0657, in order to use the Grants.gov website to collect applications. 1810-0657 is a program
specific application that does utilize the SF-424. Grants.gov requires the use of the SF-424 so the information
collected by the SF-424 will be removed from 1810-0657. The remaining program specific information will be
collected through a supplemental form. This change will not result in any new information or data being collected
for this application, nor will it result in additional burden.
Signature of Senior Officer or
designee:

Date:

For OIRA Use

April 19, 2021

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