Paperwork Reduction Act

Change Worksheet

Agency/Subagency:

U.S. Department of Housing and Urban Development

OMB Control Number:

2502-0005
Enter only items that change	Current Record	New Record**
Agency form number(s):

N/A
Annual reporting and keeping hour burden
Number of respondents	N/A
Total annual responses	N/A
Percent of these responses collected electronically	%	%
Total annual hours	N/A
Difference
Explanation of difference

Program change

Adjustment
N/A

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	N/A

N/A
Other change: **

The Annual certification document was not uploaded. It was titled correctly but not uploaded

Signature of Senior Official or Designee:

X Wayne Eddins, 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

Paperwork Reduction Act

Preferred User

2019-10-18

Pollard, Colette

HUD