Signed OMB 83-C Form (2502-0606)

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Housing and Urban Development (HUD)

0606
2502
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Enter only items that change
Current record
Agency form number (s)

HUD Form: HUD-90005

Annual reporting and recordkeeping hour
burden

New record

4a. Sex
(1) Male
(2) Female

4a. Gender
(1) Male
(2) Female
(3) Transgender
(4) Other

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 changes**

Signature of Senior Official or designee:

Acting Director, OCB, OHC, HSG
** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

2-11-2025

For OIRA Use
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