Signed OMB 83-C Form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Housing and Urban Development (HUD) OHC

0627
2502
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Enter only items that change
Current record
Agency form number (s)

New record

Clarifying language added to ensure
the applicant understands why the
application form must be completed.
During NOFO Clearance, the Office of
OMB asked that we add this language.
The language is not scored.

HUD Form: 91045

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference

NA

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

NA

Explanation of difference
Program change
Adjustment
Other changes**

Numbering changes were necessitated due to the addition of a question.

Signature of Senior Official or designee:
Terry Carr

Digitally signed by: Terry Carr
DN: CN = Terry Carr email = Terry.m.carr@hud.gov C = US OU = Office of Housing Counseling
Date: 2024.02.22 13:27:50 -05'00'

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

OMB 83-C

Date:

For OIRA Use
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10/95