Signed OMB 83-C Form for OMB 2502-0605

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
Agency form number(s):

Current Record

N/A

HUD-90024-ORCF

New Record**

N/A

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
Difference

0

Explanation of difference
Program change
Adjustment
Other change: **

Here explain/describe the changes to HUD-90024-ORCF form to OMB:
The Employee Identification Number (EIN) line was inadvertently left off the categories below. We also left one “Annual FYE Date”
line for the Operator. All of these lines were part of our last approved collection (2014) except for the Master Tenant category, which
was added in this collection. The industry is already used to submitting this line request and NO Additional Burden Hours will be
added.
Borrower (EIN)
Operator (EIN) (Annual FYE Date)
Management Agent (EIN)
Master Tenant (EIN)

Signature of Senior Official or Designee:

Date:

For OIRA Use

10/4/19

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