OMB 83-C PRA Change Worksheet

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number: 2528-0255
Enter only items that change		Current Record		New Record**
Agency form number(s):      		     		     
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: **

ICR 2528-0255 was approved on 9/24/2008 with the following “Terms of Clearance”:

HUD will submit the Privacy Impact Assessment, a Privacy Act System of Records Notice to OMB prior to beginning data collection. This change request addresses these requirements.

Attached are the Privacy Act Notice and Privacy Impact Assessment (PIA). Below are the URLs for the Privacy Act Notice and PIA.

http://www.hud.gov/offices/cio/privacy/pia/piachrt.cfm

http://www.hud.gov/offices/cio/privacy/pia/piachrt.cfm

http://www.hud.gov/offices/cio/privacy/fedreg.cfm

Signature of Senior Official or Designee: X Lillian L. Deitzer 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