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: 2577-0169
Enter only items that change		Current Record		New Record**
Agency form number(s): Family Portability Information Housing Choice Voucher Program Form HUD-52665				Changes are recorded below
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 No change 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 No change Program change Adjustment			           

Other change: **

1. Part I, item 9 has been changed to allow for 90 days instead of 60.

2. Item 10 has been changed to include the current proration factor.

3. 11 is new to obtain 80% of the initial PHA’s ongoing administrative fee.

4. Part I, Attachments: (b) has been amended to add “applicant.”

5. Certification Statement has been amended to add an additional 30 days to the term of the voucher.

6. Under the certification statement, the PHA’s email has been added.

7. Part II.A. line 5 has been added to include receiving PHA’s administrative fee rate.

8. Certification statement now includes the email of the receiving PHA.

9. Part II.B. has been amended to provide one 90-day deadline for initial billings.

10. Under “Check all statements that apply,” under 3 the date of execution of the HAP contract, effective date of HAP contract and effective date of family’s next annual reexamination have been added.

11. Previous item 5 is now items 5 and 6.

12. After item 7, a STOP has been added.

13. Another STOP has been added after item 8.

14. Under item 9, a new line has been added for those families that intend to remain in the receiving PHA’s jurisdiction. A STOP has been added after that line

15. Under Regular Billing Amount, line b.1. has been amended to reflect new billing rules.

16. Comments have been added to the end of the form.

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

Signature of Senior Official or Designee: X Colette Pollard, Departmental Reports Management Officer, OCIO

Date:

For OIRA Use

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

OMB 83-C 10/95