Change Justification 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)

-

0110

New record

Annual reporting and recordkeeping hour
burden
Number of respondents

801261

Total annual responses

801,261

Percent of these responses
collected electronically
Total annual hours

%

%

400,631

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
The Department is requesting a Simple Change to the Public Service Loan Forgiveness (PSLF) & Temporary Expanded PLSF (TEPSLF) Certification and Application. This change to the
form is needed as the federal student loan servicer for the PSLF and TEPSLF form is changing from FedLoan Servicing to MOHELA and contact information needs to be updated on the
form in preparation of the transfer. There is no change anticipated in the number of respondents/responses/burden hours that have been approved through OMB previously.

Signature of Senior Official or designee:

Beth Grebeldinger

Digitally signed by Beth Grebeldinger
Date: 2022.05.02 07:33:46 -04'00'

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

OMB 83-C

Date:

5/2/2022

For OIRA Use
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10/95