83c Change Request Worksheet for HUD-52860

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 Section 1 of HUD-52860
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 1 (General Information) adds 2 new non-substantive questions:

• New Question 8: Name of Local HUD Field Office

• New Question 9: Name of Expeditor at Local HUD Field Office who assisted PHA with application

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