83c

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number: 2535-0102
Enter only items that change		Current Record		New Record**
Agency form number(s): 27054E		     		     
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: **

1. Inserted and highlighted instructions “All fields must be typed in except for signatures and initials.” in red on page 1.

2. Inserted instructions on how to submit the form via secured email on page 1.

3. Broke down checkbox “Revise Authorizations” into two checkboxes “Add or Remove Program Area(s)” and “Add or Remove Tax-ID Number(s)” to reflect the instructions on page 3.

4. Removed all instances of instructions to print text.

5. Inserted instructions that digital signatures and DocuSign will not be accepted on page 1 and 3.

6. Updated hyperlink to new HUD webpage on page 3.

Signature of Senior Official or Designee: X

Date:

For OIRA Use

** This form cannot be used to extend an expiration date.

OMB 83-C 10/95