83C Change Justification Form

1845-0163 BD General Application 83C address update 2 Nov 2021.pdf

Borrower Defense to Loan Repayment Universal Form

83C Change Justification Form

OMB: 1845-0163

Document [pdf]
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PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

U.S Department of Education/Federal Student Aid
1845

Enter only items that change
Current record

Agency form number (s)

-

0163

New record

Annual reporting and recordkeeping 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 recordkeeping 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 changes
This request is to update the mailing address and application contact information only on the Borrower Defense to Repayment Application. The
updated information is on page 25 of the application. There are no changes to the items being requested or the number of
respondents/responses/burden hours already approved.

Signature of Senior Official or designee:

Beth Grebeldinger

Digitally signed by Beth Grebeldinger
Date: 2021.11.18 15:14:53 -05'00'

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

11/18/2021

For OIRA Use
___________________________________
___________________________________

10/95



File Typeapplication/pdf
File TitlePaperwork Reduction Act Submission (OMB 83-I)
SubjectPaperwork Reduction Act Submission (OMB 83-I)
AuthorOMB
File Modified2021-11-18
File Created2012-01-09

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