83c

Paperwork Reduction Act
Change Worksheet
Agency/Subagency:

OMB Control Number:

U.S. Department of Housing and Urban Development

2506-0197

Enter only items that change

Current Record

New Record**

Agency form number(s):

HUD 4138
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: **

No changes to the burden hours, this form was including on the supporting statement, but forgot to upload in the IC.
Community Compass- Monthly Report HUD xxxx this is the number HUD 4138

Signature of Senior Official or Designee:

Date:

For OIRA Use

X Lillian L. Deitzer, Departmental Paperwork Reduction Act Officer, OCIO

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

10/95