Supplementary Document

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development Office of Public and Indian Housing			OMB Control Number: 2577-0229
Enter only items that change		Current Record		New Record**
Agency form number(s): HUD-52768 (ROSS SC Application Form) HUD-52769 (ROSS Needs/Partners Form)
Annual reporting and keeping hour burden
	Number of respondents	400		425
	Total annual responses	400		425
	Percent of these responses collected electronically	100 %		100 %
	Total annual hours	2200		2325
	Difference			125
	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: **

We are making a change request for the existing ROSS PRA (2577-0229) in order to add a variation of the program (education coordinators/navigators).  We anticipate an increase of 25 respondents for each of those 5 forms: HUD-52768 (ROSS application form), HUD-52769 (ROSS Needs/Partners form), the SF-424, HUD-2880 and SF-LLL.  The 424, 2880 and LLL are n/a regarding burden as they are standard forms (not specific to ROSS).

These certification changes will have no significant impact on information collection burden.

Signature of Senior Official or Designee: X Collette Pollard, 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