83C Change Form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

U.S Department of Education
1894

Enter only items that change
Current record

Agency form number (s)

-

0006

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 is a request for two new programs to use the 1894-0006 generic application package. The Mental Health
Service Professional Demonstration Grant Program Application and the School Based Mental Health Application.
Signature of Senior Official or designee:

DANA CARR

Digitally signed by DANA CARR
Date: 2025.09.26 10:05:16 -04'00'

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

OMB 83-C

Date:

For OIRA Use
___________________________________
___________________________________

10/95