83c

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number: 2535-0102
Enter only items that change		Current Record		New Record**
Agency form number(s):      		     		     
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: **

1. Page 1-2, Changed signature fields to electronic signature fields (#5, #6, #8, #11)

2. Page 2, #9 – Removed checkbox for “Add or Remove Program Area(s)”

3. Page 2, #10 – Revised title in blue text

4. Page 2, #10 – Removed checkbox for “Add or Remove Tax-ID Number(s)”

5. Page 2, #10 – Added “(s)” at the end of “Program Area ID” and “Program Area Name”

6. Page 3 - #6 – Updated and added text on “Approving Official”

7. Page 3 - #10 – Updated and added text on “Multiple Organizations”

Signature of Senior Official or Designee: X

Date:

For OIRA Use

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

OMB 83-C 10/95