83-c

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number: 2528-0337
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: **

This submission includes a series of non-substantive changes to the instruments to be administered as part of the Community Choice Demonstration. The proposed changes to the instruments have been made in response to feedback from the research study team and with approval from the Institutional Review Board (IRB). Proposed edits have been made for the purposes of clarifying language to enhance participant comprehension and streamlining the interview process. We do not anticipate these revisions to affect either the annual reporting and recordkeeping hour burden or the annual reporting and recordkeeping cost burden for the data collection. Please see the second page for details on the proposed changes to each item.

Attachment: Proposed Edits to Instruments for the Community Choice Demonstration

Instrument	Summary of Revisions
Revised - Attachment B Head of Household Existing Voucher Holder Informed Consent	The Informed Consent forms for Community Choice Demonstration (CCD) Phase 1 participants - Head of Household Existing Voucher Holder, Head of Household Waitlist Family, and Other Adult Household Member - were edited with minimal changes for clarity.
Revised - Attachment C Head of Household Waitlist Family Informed Consent
Revised - Attachment D Other Adult Household Member Informed Consent
Revised - Attachment N Phase 2 HoH Existing Voucher Holders Informed Consent	The Informed Consent forms for Community Choice Demonstration (CCD) Phase 2 participants - Head of Household (HoH) Existing Voucher Holder, HoH Waitlist Families, and Other Adult Household Member - were edited with minimal changes for clarity.
Revised - Attachment O Phase 2 Head of Household Waitlist Families Informed Consent
Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent
Attachment B.2_The Home Assessment_Follow-up Phone Call Script	The Home Assessment Follow-up Phone Call Script was revised with a few edits to streamline the interview scheduling process.
Attachment C_The Home Assessment_Consent	The Home Assessment Consent form was edited to include a couple of minimal changes to enhance participant comprehension.
Attachment D_The Home Assessment_Direct Measurements	The Home Assessment was edited to correct a clerical error regarding the threshold value of an environmental measure.
Attachment K.2_The Child Assessment and The Obesity & Type II Diabetes Risk Assessment_Follow-up Phone Call Script	The Child Assessment/Obesity & Type II Diabetes Risk Assessment Follow-up Phone Call Script was revised with a few edits to streamline the interview scheduling process.
Attachment L_The Child and MOVED Assessments_Consent	The Child and MOVED Assessment was modified with minimal plain language edits to improve clarity and participant comprehension.
Attachment M.1_The Obesity Type II Diabetes Risk Assessment_Survey_Baseline	The Obesity Type II Diabetes Risk Assessment Surveys - Baseline and Follow-up - were revised to include a question to refine collection of respondent health information. Minimal edits were also made to recapture information already reported (respondent email/address) to facilitate timely delivery of the incentive to the respondent. However, we do not expect these changes to substantively affect respondent burden.
Attachment M.2_The Obesity Type II Diabetes Risk Assessment_Survey_Follow-up
Attachment N_The Obesity & Type II Diabetes Risk Assessment_Anthropometric Assessments_Adult	The Obesity & Type II Diabetes Risk Assessment Anthropometric Assessments - Adult and Child - were revised with minimal edits to streamline interviewer instructions and ensure use of field-standard measurement practices.
Attachment O_The Obesity & Type II Diabetes Risk Assessment_Anthropometric Assessments_Child

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