Change Justification Form

UNITED STATES DEPARTMENT OF EDUCATION
OFFICE OF MANAGEMENT
CHIEF PRIVACY OFFICE
INFORMATION COLLECTION CLEARANCE DIVISION
PAPERWORK REDUCTION ACT CHANGE WORKSHEET

Agency/Subagency:

OMB Number:

Office of Career, Technical & Adult Education (OCTAE)

1830-0027

Enter only items that change.
Annual reporting and recordkeeping hour burden:
Agency form number(s)

Current Record
N/A

New Record
N/A

Annual reporting and recordkeeping hour burden:
Number of respondents

57

57

Total annual responses

57

57

Percent of these responses collected electronically

100%

100%

Total annual hours

5,700

5,700

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.
Conforming technical edits were made to the instructions for three tables in order to align with the reporting of measurable skill
gains approved by OMB on February 4, 2021.

Signature of Senior Officer or Designee:

Richard Smith

For OIRA Use:
**This form cannot be used to extend an expiration date.
OMB 83-C 8/2017

Digitally signed by Richard Smith
Date: 2021.08.17 15:50:56 -04'00'

Date: 08/17/2021