OMB 83-I PRA Worksheet

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number:      
Enter only items that change		Current Record		New Record**
Agency form number(s): HUD 40030		     		40030
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: **

This package was submitted as a revision. A new claim form HUD 40030 as added. The new claim form is to be used by persons who must move temporarily for a HUD-assisted program or project. Authority for making a relocation payment to persons who are temporarily relocated for a HUD-assisted project is found at 49 CFR 24.1 and 24.2(a)(9)(ii)(D), Appendix A

A copy of the HUD 40030 erroneously was left off the IC list. There is no burden increase as it was already added to this submission.

It is request to include the HUD 40030 in the current form inventory for this ICR

Signature of Senior Official or Designee: X Wayne Eddins, Departmental Paperwork Reduction Act Officer, OCIO

Date:

For OIRA Use

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

OMB 83-C 10/95