Supplementary Documenyt

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development Office of Public and Indian Housing			OMB Control Number: 2577-0200
Enter only items that change		Current Record		New Record**
HUD-50143 – Section 184 Direct Guarantee Reservation of Funds Request
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: **

1. Removed entire DG certification section (bottom section)

2. Added Sales Price or Acquisition Cost to financial information table

3. Added the verbiage “DG” to line four “Underwriter Name” request.

4. Added the verbiage “Monthly” to Other in table.

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