OMB 83-c

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development      			OMB Control Number: 2577-0229
Enter only items that change		Current Record		New Record**
Agency form number(s): 52767		     		     
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: **

p.2 question #7d - delete scroll arrows that appear. Add more spaces so users can enter up to 8 digits

p.2 question #9 b,c,f,h,i,j - add enough spaces for eight digits/letters

Question #9b - delete everything after "The total number of PH FSS participants"

This is the text that should be deleted "(The total number of families shown in HUD’s PIC data system as enrolled in the applicant’s PH FSS program on the publication date of this NOFA, plus the number of families that successfully completed their PH FSS contracts in the applicant’s program between October 1, 2000, and the publication date of this NOFA.)"

Question #9.d - delete everything in the two parentheses: "(Positive Escrow Percentage – see NOFA for definition) (calculate by dividing c/b)."

Question # 9.g - delete everything in the two parentheses: "(Graduation Percentage – see NOFA for definition) (calculate by dividing f/b)."

Line above box for Question 10 should read: "New Applicants Please Answer Question 10".

delete Question #11 -- "11. Information About Potential Participants: "Percent of target population that is unemployed ________" 

Signature of Senior Official or Designee: X Lillian Deitzer, Departmental Reports Management Officer, OCIO

Date:

For OIRA Use

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

OMB 83-C 10/95