Change Request Form

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development      			OMB Control Number: 2577-0265
Enter only items that change		Current Record		New Record**
Agency form number(s):      		     		     
Annual reporting and keeping hour burden
	Number of respondents	90		90
	Total annual responses	90		90
	Percent of these responses collected electronically	0 %		0 %
	Total annual hours	3,760.00		3,760.00
	Difference			0.00
	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 name of the Public Housing Mortgage Program has been changed to Public Housing Authority Mixed Finance Transactions, therefore the title of the information collection needs to be updated. There is no change in burden hours associated with this change.

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