83c

Paperwork Reduction Act
Change Worksheet
Agency/Sub agency:

OMB Control Number:

U.S. Department of Housing and Urban Development

2502-0605

Enter only items that change

Current Record

N/A

Agency form number(s):

New Record**

N/A

See Below
Annual reporting and keeping hour burden
Number of respondents
Total annual responses

%

Percent of these responses collected electronically

%

Total annual hours
Difference

0

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

0

Difference
Explanation of difference
Program change
Adjustment
Other change: **Here

explain/describe the changes to OMB:

The current forms listed below are used for 241(a) only. They have been updated in minor ways so that the forms may be
used for both the 241(a) and 223(d) programs. In some forms, the words “241(a)” were removed altogether so the forms
can be used for both 241(a) and 223(d). In other forms, the words “or 223(d)” were added, so the forms can be used for
both programs. Other forms added legal language d such as, [Delete IF Not Applicable] or project specific language, so that
the forms can be used for both programs.
NO Additional Burden Hours will be added.
HUD-94001A-ORCF
HUD-94000A-ORCF
HUD-92467-ORCF
HUD-92323A-ORCF
HUD-92467A-ORCF
HUD-92340A-ORCF
HUD-92211A-ORCF

HUD-92333A-ORCF
HUD-91116A-ORCF
HUD-92324A-ORCF
HUD-92334A-ORCF
HUD-92338-ORCF
HUD-92476C-ORCF
HUD-92455-ORCF

Signature of Senior Official or Designee:

Date:

For OIRA Use

3/26/21

John Hartung, Director, Policy, Risk Analysis and Lender Relations
Division, Office of Residential Care Facilities , HP

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

10/95