Change Justification Work Form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

U.S Department of Education
1845

Enter only items that change
Current record

Agency form number (s)

-

0153

New record

Work Colleges Application and
Agreement
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 is a request for a simple change review to the approved 1845-0153 collection. There are no changes to the data that is collected. The form and instructions
are updated annually to reflect the new award year for which funding is being requested and new date references. The mailing address for the signature page has
been updated. The respondents, responses and burden hours remain the same at 10 responses and 20 burden hours. This collection expires 4/30/2024.

Signature of Senior Official or designee:

Beth Grebeldinger

Digitally signed by Beth Grebeldinger
Date: 2023.01.20 19:41:45 -05'00'

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

OMB 83-C

Date:

1/20/2023

For OIRA Use
___________________________________
___________________________________

10/95