83c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency Department of Housing and Urban Development Office of Public and Indian Housing		OMB Control Number 2577-0300
Enter only items that change Current Record New Record
Agency form number(s)	HUD-50093 HUD-50094 HUD-50095 HUD-50096
Annual reporting and record keeping hour burden
Number of respondents	194	194
Total annual responses	974	974
Percent of these responses collected electronically	100	100
Total annual hours	537.5	537.5
Difference		0
Explanation of difference Program Change
Adjustment		     
Annual reporting and record keeping cost burden (in thousands of dollars)
Total annualized capital/startup costs	NA	NA
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference Program Change		     
Adjustment		     
HUD-50093: Changed the form title to “Shortfall Program Improvement Plan” HUD-50094: Removed text at top of the form and changed the form title of the form to “Shortfall Budget.” HUD-50095: Made edits to the form title. Added field for “PHA Requested Lower Amount.” Made text updates to the Shortfall Tier 1 and Shortfall Tier 2 certification text to improve clarity. HUD-50096: Changed references to the Notice 2021-12 to say the “current Shortfall notice.” Renumbered the list supporting documents.
Signature of Senior Officer or designee:      	Date:      	For OIRA Use            

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

OMB 83-C