OMB 83-c

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development      			OMB Control Number: 2577-0169
Enter only items that change		Current Record		New Record**
Agency form number(s): Forms HUD 52641 and HUD 52641A		     		     
Annual reporting and keeping 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 change: **

 The forms are being revised to add a section that reflects the statutory requirement that certain protections afforded to victims of domestic violence under the Violence Against Women and Justice Department Reauthorization Act of 2005 (VAWA 2005) are included in Housing Choice Voucher program HAP Contracts and Leases.

The new language in form HUD 52641 is found at Part C, Section 8(e). The new language in form HUD 52641(a) is found at Section 8(e). (See attached.)

These revisions do not require any additional information from or action by the owner or PHA. Furthermore, the revised forms are only used at such times that the PHA would be entering into a new HAP contract under current program requirements, the burden and cost of which are already reflected in 2577-0169. These revisions have no impact on theannual reporting and record-keeping burden hours or costs that are currently reported for these forms. 

Signature of Senior Official or Designee: X Wayne Eddins, Departmental Reports Management Officer, OCIO

Date:

For OIRA Use

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

OMB 83-C 10/95