83-c

Paperwork Reduction Act
Change Worksheet
Agency/Subagency:

OMB Control Number:

U.S. Department of Housing and Urban Development

2501-0034

Enter only items that change
Agency form number(s):

HUD-PRL

Current Record

New Record**

6. Gender Code

6. Sex Code

The gender for the
participant.

The sex for the
participant.

1 = Male
2 = Female
3 = Transgender Male
4 = Transgender Female
5 = Other

1 = Male
2 = Female
77 = Information not
collected
88 = Individual refused.

6 = Non-Binary
77 = Information not
collected
88 = Individual refused.
99 = Individual does not
know
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: **

Fair Housing and Civil Rights Assistance Service Code

The individual received services or participated in programs that promotes racially, ethnically, and economically diverse communities
and integrated living patterns and avoid patterns where persons are forced to live in high poverty areas, or in areas suffering from a
lack of accessible services, or a lack of integration in terms of race, color, national origin, religion, sex (including sexual orientation
and gender identity), familial status, or disability status.

Signature of Senior Official or Designee:

Date:

02/20/2025

For OIRA Use

X

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

10/95