Change Justification Worksheet

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

U.S Department of Education/Federal Student Aid
18450164

Enter only items that change
Current record

Agency form number (s)

-

0164

New record

Annual reporting and recordkeeping hour
burden
Number of respondents

36,000

Total annual responses

36,000

Percent of these responses
collected electronically
Total annual hours

%

%

9,000

Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)

See below

Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes
FSA is requesting this simple change to update the instructions and examples on the web portal for PSLF Reconsideration to provide clarity and ease
of use for the applicant. No new information is being requested or is required to be submitted on the application. There is no paper form, this is a
completely on-line submission process.

Signature of Senior Official or designee:

BETH GREBELDINGER

Digitally signed by BETH GREBELDINGER
Date: 2023.06.28 11:13:14 -04'00'

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

OMB 83-C

Date:

6/28/2023

For OIRA Use
___________________________________
___________________________________

10/95