Signed OMB 83-C Form for HUD-9002-ORCF

Paperwork Reduction Act
Change Worksheet
Agency/Sub agency:

OMB Control Number:

U.S. Department of Housing and Urban Development

2502-0605

Enter only items that change
Agency form number(s):

Current Record

N/A

HUD-9002-ORCF

New Record**

N/A

Annual reporting and keeping hour burden
Number of respondents
Total annual responses
Percent of these responses collected electronically

%

%

Total annual hours
Difference

0

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

0

Explanation of difference
Program change
Adjustment
Other change: **

Here explain/describe the changes to HUD-9002-ORCF form to OMB:
HUD-9002-ORCF – Adding missing language that is the same exact standard language included and approved
on the 9004, 9005, 9005a, 9006, 9007, 9007a.
NO additional burden hours will be added.

Signature of Senior Official or Designee:

John Hartung

Date:

For OIRA Use

Digitally signed by: John Hartung
DN: CN = John Hartung email = John.M.Hartung@hud.
gov C = US O = U.S. Department of Housing and Urban
Development OU = Office of Residential Care Facilities
Date: 2023.03.03 08:10:24 -06'00'

John Hartung, Director, Policy, Risk Analysis and Lender Relations
Division, Office of Residential Care Facilities, HP

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

10/95