Change Justification Worksheet

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

1810-0753

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 Department is requesting to make a change to the language in the Safer Schools and Campuses Best
Practices Clearinghouse solicitation document. This change to the solicitation document will add language that
is more expressly inclusive of the early childhood area and will ensure the solicitation reflects the language in
EO 14000: Supporting the Reopening and Continuing Operation of Schools and Early. This change request will
not result in any change to the burden for this collection.
Signature of Senior Officer or
designee:

Date:

For OIRA Use
April 28, 2021

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