83cC

Paperwork Reduction Act
Change Worksheet
Agency/Subagency:

OMB Control Number:

U.S. Department of Housing and Urban Development

2511-0001

Enter only items that change

Current Record

New Record**

Agency form number(s):

Annual reporting and keeping hour burden
Number of respondents

N/A

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: **

The burden hours for the Generic ICR were put in using all the hours and when
trying to add to the umbrella it exceeded the hours.

Signature of Senior Official or Designee:

Date:

For OIRA Use

X

** This form cannot be used to extend an expiration date.
OMB 83-C

10/95