HUD 51002 Schedule of Change Orders

Schedule of
Change Orders

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

OMB Approval No. 2577-0157
(exp. 11/30/2023)

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. HUD may not conduct or sponsor, and an applicant is not
required to respond to a collection of information unless it displays a currently valid OMB control number. Comments regarding the accuracy of this burden estimate and any
suggestions for reducing this burden can be sent to the Reports Management Officer, Office of Policy Development and Research, REE, Department of Housing and Urban
Development, 451 7th St SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2577-0157. This information is collected
under the authority of Section 6(c) of the U.S Housing Act of l937 and HUD regulations. HAs are responsible for contract administration to ensure that the work for project
development is done in accordance with State laws and HUD requirements. The contractor/subcontractor reports provide details and summaries on payments, change orders, and
schedule of materials stored for the project. The information will be used to ensure that the total development costs, identified in the ACC, are kept as low as possible and consistent
with HUD construction requirements. Responses to the collection are necessary to obtain a benefit. The information requested does not lend itself to confidentiality.

Instructions: Contractors use this form for reporting the details of approved Change Orders. Attach an original (or a opy) to each copy of the Periodic Estimate
for Partial Payment (form HUD-51001) submission, and send to the Public Housing Agency. Complete all entries. Only Change Orders which bear the
signatures required by the contract are to be recorded.
Supporting Periodic Estimate
for Partial Payment Number

Name of Public Housing Agency

Period
From (mm/dd/yyyy)

to (mm/dd/yyyy)

Location of Project

Project Number

Name of Contractor

Contract Number

Approved Change Orders
Change Order
Dated
Number
(mm/dd/yyyy)
(1)
(2)

Totals
Authorized Project Representative

Additions
Total Amount
of Change Order
(3)

Deductions
Total Amount
of Change Order
(5)

Value of Work
Completed to Date
(4)

$

$

$

$

$

$
Date (mm/dd/yyyy)

I certify that the information provided on this form and in any accompanying documentation is true and accurate. I acknowledge that making, presenting, or
submitting a false, fictitious, or fraudulent statement, representation, or certification may result in criminal, civil, and/or administrative sanctions, including
fines, civil penalties, and confinement for up to 5 years, (18 U.S.C. §§ 287, 1001 and 31 U.S.C. §3729)
form HUD-51002 (1/2014)
Previous editions are obsolete.