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): HUD-52768 (ROSS SC Application Form)		     		     
Annual reporting and keeping hour burden
	Number of respondents	N/A		     N/A
	Total annual responses	350		350
	Percent of these responses collected electronically	100 %		100 %
	Total annual hours	1,376		1,376
	Difference			     
	Explanation of difference Program change Adjustment			           
Annual reporting and recordkeeping cost burden (in thousands of dollars)
	Total annualized Capital/Startup costs	N/A		N/A
	Total annual costs (O&M)	     		     
	Total annualized cost requested	     		     
	Difference			     
	Explanation of difference Program change Adjustment			           

Other change: **

We are making a change request to the existing ROSS PRA (2577-0229) to add one check box for a new Area of Need in Section II of the form. This section of the form tells HUD which areas the applicants will focus their grant program on. We still anticipate 350 respondents for each of the ROSS forms including the HUD-52768 (ROSS application form).

This check box will have no significant impact on the information collection burden.

Signature of Senior Official or Designee: X Collette Pollard, Departmental Paperwork Reduction Act Officer, OCIO

Date:

For OIRA Use

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

OMB 83-C 10/95