**PAPERWORK REDUCTION ACT**

**CHANGE WORKSHEET**

+------------------------+---------------------+-----------------------+
| **Agency/Subagency**   |                     | **OMB Control         |
|                        |                     | Number**              |
| **     **              |                     |                       |
|                        |                     | **1850 -**            |
| **ED/IES/NCES**        |                     | **0654    **          |
+------------------------+---------------------+-----------------------+
| **Enter only items     |                     |                       |
| that change**          |                     |                       |
|                        |                     |                       |
| **Current Record New   |                     |                       |
| Record**               |                     |                       |
+------------------------+---------------------+-----------------------+
| **Agency form          | **     **           | **     **             |
| number(s)**            |                     |                       |
+------------------------+---------------------+-----------------------+
| **Annual reporting and |                     |                       |
| record keeping**       |                     |                       |
|                        |                     |                       |
| **hour burden**        |                     |                       |
+------------------------+---------------------+-----------------------+
| **Number of            | **320     **        | **400     **          |
| respondents**          |                     |                       |
+------------------------+---------------------+-----------------------+
| **Total annual         | **320     **        | **400     **          |
| responses**            |                     |                       |
+------------------------+---------------------+-----------------------+
| **Percent of these     | **0     **          | **0**                 |
| responses**            |                     |                       |
|                        |                     |                       |
| **collected            |                     |                       |
| electronically**       |                     |                       |
+------------------------+---------------------+-----------------------+
| **Total annual hours** | **1280     **       | **1844     **         |
+------------------------+---------------------+-----------------------+
| **Difference**         |                     | **564     **          |
+------------------------+---------------------+-----------------------+
| **Explanation of       |                     | **564     **          |
| difference**           |                     |                       |
|                        |                     |                       |
| #  Program Chage       |                     |                       |
+------------------------+---------------------+-----------------------+
| **Adjustment**         |                     | **     **             |
+------------------------+---------------------+-----------------------+
| **Annual reporting and |                     |                       |
| record keeping cost    |                     |                       |
| burden (in thousands   |                     |                       |
| of dollars)**          |                     |                       |
+------------------------+---------------------+-----------------------+
| **Total annualized     | **0**               | **0**                 |
| capital/startup**      |                     |                       |
|                        |                     |                       |
| **costs**              |                     |                       |
+------------------------+---------------------+-----------------------+
| **Total annual costs   | **0**               | **0**                 |
| (O&M)**                |                     |                       |
+------------------------+---------------------+-----------------------+
| **Total annualized     | **0**               | **0**                 |
| cost requested**       |                     |                       |
+------------------------+---------------------+-----------------------+
| **Difference**         |                     | **0**                 |
+------------------------+---------------------+-----------------------+
| **Explanation of       |                     | **0**                 |
| difference**           |                     |                       |
|                        |                     |                       |
| **Program Change**     |                     |                       |
+------------------------+---------------------+-----------------------+
| **Adjustment**         |                     | **0**                 |
+------------------------+---------------------+-----------------------+
| **Other change\*\***   |                     |                       |
| **As explained in the  |                     |                       |
| attached, the changes  |                     |                       |
| in number of           |                     |                       |
| respondents and burden |                     |                       |
| hours are due to the   |                     |                       |
| addition of a third    |                     |                       |
| location for this      |                     |                       |
| study. We have added a |                     |                       |
| data collection site   |                     |                       |
| in West Virginia at    |                     |                       |
| which an additional 80 |                     |                       |
| participants will be   |                     |                       |
| trained. This change   |                     |                       |
| results in an          |                     |                       |
| additional 564 burden  |                     |                       |
| hours which consist of |                     |                       |
| 2 hours of training, 2 |                     |                       |
| hours for completing   |                     |                       |
| the diaries, and       |                     |                       |
| travel time for        |                     |                       |
| participants to come   |                     |                       |
| to the data collection |                     |                       |
| site in West           |                     |                       |
| Virginia.**            |                     |                       |
|                        |                     |                       |
| **     **              |                     |                       |
+------------------------+---------------------+-----------------------+
| **Signature of Senior  | **Date:**           | **For OIRA Use**      |
| Officer or**           |                     |                       |
|                        | **     **           | **     **             |
| **designee:**          |                     |                       |
|                        |                     | **     **             |
| **     **              |                     |                       |
+------------------------+---------------------+-----------------------+

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

**OMB 83-C**