83 C

83c.ROSS 52768.FY21.dot

Application for the Resident Opportunities and Self Sufficiency (ROSS) Program

83 C

OMB: 2577-0229

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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 (ROSS SC Application Form)


     

     

Annual reporting and keeping hour burden




Number of respondents

N/A

     N/A


Total annual responses

350

350


Percent of these responses collected electronically

100 %

100 %


Total annual hours

1,376

1,376


Difference


     


Explanation of difference

Program change

Adjustment


     

     

Annual reporting and recordkeeping cost burden (in thousands of dollars)




Total annualized Capital/Startup costs

N/A

N/A


Total annual costs (O&M)

     

     


Total annualized cost requested

     

     


Difference


     


Explanation of difference

Program change

Adjustment


     

     

Other change: **

We are making a change request to the existing ROSS PRA (2577-0229) to add one check box for a new Area of Need in Section II of the form. This section of the form tells HUD which areas the applicants will focus their grant program on. We still anticipate 350 respondents for each of the ROSS forms including the HUD-52768 (ROSS application form).


This check box will have no significant impact on the information collection burden.

Signature of Senior Official or Designee:





X Collette 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

File Typeapplication/msword
File TitlePaperwork Reduction Act
AuthorPreferred User
Last Modified ByLehmann-Kim, Dina
File Modified2021-03-15
File Created2021-03-15

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