83c Change Request Justification

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number: 2577-0229
Enter only items that change		Current Record		New Record**
Agency form number(s): HUD-52768		     		     
Annual reporting and keeping hour burden
	Number of respondents	350		350
	Total annual responses	350		350
	Percent of these responses collected electronically	100 %		100 %
	Total annual hours	1907		1907
	Difference			0
	Explanation of difference Program change Adjustment			N/A      
Annual reporting and recordkeeping cost burden (in thousands of dollars)		0		0
	Total annualized Capital/Startup costs	0		0
	Total annual costs (O&M)	0		0
	Total annualized cost requested	0		0
	Difference	0		0
	Explanation of difference Program change Adjustment	N/A		N/A      

Other change: **

On the HUD-52768 form, changes have been made to the form to include more selection for the types of residents to be served. On the original form, applicants could choose to serve Family, Elderly/Disabled, and/or both. Under the revised form applicants can choose education, financial literacy, health and wellbeing, elderly/disabled, reentry, employment, and substance abuse. While this selection has expanded it will not cause greater burden hours.

Signature of Senior Official or Designee: Colette 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