Supplemental 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: 2577-0075
Enter only items that change		Current Record		New Record**
Agency form number(s): Inventory Removals Application (HUD-52860)				See changes described below to Sections B, C, and signature block of HUD-5837
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 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: **

Section B adds 2 new questions to align with a new HUD notice published on May 24, 2019 as PIH Notice 2019-13. The first question asks how the PHA intends to closeout its public housing program. The second question asks if the PHA has any eligible uses for certain HUD funding that it may be eligible to receive after it removes all of its public housing units.

Section C is modified to reference PIH Notice 2019-13.

A signature block is also added.

These changes will have no significant 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