83-c

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB Control Number

U.S. Department of Housing and Urban Development
Office of Housing, Office of Public and Indian Housing
Enter only items that change
Current record

2502-0496
Expires 06/30/2026
New record

Agency form number(s)
HUD-92541
Annual reporting and recordkeeping 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

166,080
201,736

166,080
201,736

95%

95%

15,130

15,130
0
0
0
0

0
0
0

Program change
Adjustment

Other changes:**
This request is for a non-substantial change to include to:
 add a date field to collect the Building Permit Application Date
 change the references for Box 1.A.3(iii)
 change the field description for Box 4
 change the references for Box 8, and
 update the form revision date at the bottom of all pages.
Signature of Senior Official or designee:

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

Date:

For OIRA Use
_______________
______________

10/95