2577-0178 - PRA Change Worksheet

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development Office of Public and Indian Housing			OMB Control Number: 2577-0178
Enter only items that change		Current Record		New Record**
Agency form number(s): HUD-52651, Housing Choice Voucher (HCV) Family Self Sufficiency (FSS) Program Coordinator Funding
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: **

Change title of form from “HUD-52651, Housing Choice Voucher (HCV) Family Self Sufficiency (FSS) Program Coordinator Funding” to “HUD-52651, Housing Choice Voucher (HCV)/Public Housing (PH) Family Self Sufficiency (FSS) Program Coordinator Funding”

Add new question, II.D: Total number of families under FSS contract during the NOFA target period: ________.

Note: PHAs are already required to track the number of families participating in the HCV FSS program.

Signature of Senior Official or Designee: X Colette Pollard, Departmental Reports Management Officer, OCIO

Date:

For OIRA Use

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

OMB 83-C 10/95