83c

Paperwork Reduction Act
Change Worksheet
Agency/Subagency:

OMB Control Number:

U.S. Department of Housing and Urban Development/Office of Fair Housing and Equal
Opportunity (FHEO)
Enter only items that change

OMB 2529-0011

Current Record

New Record**

Agency form number(s):

Form HUD-903.1 Series: “REPORT HOUSING DISCRIMINATION”
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: Program Change: On 10/1/2022, FHEO was authorized to investigate alleged violations of the Violence Against Women Act of 2022
(VAWA). FHEO is using the previously OMB-approved Form HUD-903.1 Series to collect intake information needed to verify FHEO’s jurisdiction to file &
investigate VAWA complaints. Accordingly, FHEO has revised the Form HUD-903.1 Series to add the following VAWA-related text:
PAGE 1, QUESTION 1: Inserted new BOX #8 to read: “Because of, or as a direct result of, you or someone in your household being a survivor of
domestic violence, dating violence, sexual assault, or stalking (such as having a criminal record, eviction history, or bad credit history), or because you
believe another housing right under the Violence Against Women Act (VAWA) was violated (for example, your landlord did not provide an emergency
transfer, you were penalized for calling 9-1-1 or seeking emergency services). VAWA protections apply regardless of sex, sexual orientation, or gender
identity.” BOX #9 was revised to read: “Because of retaliation, intimidation, or interference related to exercising a fair housing right, or a VAWA right (such
as filing a complaint; testifying in a proceeding) or helping others to do so.”
PAGE 3, QUESTION 5: FHEO revised the 1st sentence to add: “and/or a violation of your VAWA rights.” FHEO added two (2) sentences at line 7: “Denied
a right because of or on the basis of being a survivor of domestic violence or sexual assault? Penalized for calling 9-1-1?”

Signature of Senior Official or Designee:

Date:

3-22-23

For OIRA Use

X

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

10/95