Signed 83c to remove old forms

Paperwork Reduction Act
Change Worksheet
Agency/Subagency:

OMB Control Number:

U.S. Department of Housing and Urban Development

2577-0286
Implementation of the Violence
Against Women Reauthorization
Act of 2013

Enter only items that change

Current Record

New Record**

Agency form number(s):

HUD-5380, HUD-5381, HUD-5382, HUD-5383
Annual reporting and keeping hour burden
Number of respondents

N/A

N/A

Total annual responses

5,044,764

5,044,764

0%

0%

2,230,480.58

2,230,480.58

None

0

N/A

N/A

None

$0.00

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:

The incorrect versions of Forms HUD-5380, HUD-5381, HUD-5382, HUD-5383 were uploaded to ROCIS. The
copies that were approved were from October 2022 and the correct copies are from November 2024. This
change is to remove the old forms from the original submission.
This non-substantive change will have no impact on the information collection burden hours or costs.

Signature of Senior Official or Designee:

MITCHELL
MARGESON

Date:

For OIRA Use

Digitally signed by: MITCHELL MARGESON
DN: CN = MITCHELL MARGESON C = US O = U.S.
Government OU = Department of Housing and Urban
Development, Office of Housing
Date: 2025.01.10 13:59:42 -05'00'

X Mitchell Margeson, Director, Paperwork Reduction Act Division

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

10/95