Signed OMB 83-C Form for HUD-9003-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-9003-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-9003-ORCF form to OMB:
HUD-9003-ORCF – Adding missing language that is the same exact standard language included and approved
on the 9001.
NO additional burden hours will be added.

Signature of Senior Official or Designee:

John Hartung

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 10:10:18 -06'00'

Date:

For OIRA Use

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