OMB83c_11_2011

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency

National Archives and Records Administration (NARA)

OMB Control Number

3 0 9 5 - 0 0 4 6

Enter only items that change

Current record New record

Agency form number(s) NATF 36
Annual reporting and recordkeeping hour burden Number of respondents Total annual respondents 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**A refund policy was added to the back of this form on November 10, 2011, and this Change Worksheet documents that addition.

Signature of Senior Official or Designee:

Executive for Information Services

Date:

For OIRA Use

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

OMB FORM 83–C, 10/95