Schedule of Change Orders
U.S. Department of Housing
OMB Approval No. 2577-0157
(exp. 1/31/2017)
and Urban Development
Office of Public and Indian Housing
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collecton displays a valid OMB control number.
This information is collected under the authority of Section 6(c) of the U.S Housing Act of l937 and HUD regulations. HAs are responsible for contract administration to ensure that the work for project development is done in accordance with State laws and HUD requirements. The contractor/subcontractor reports provide details and summaries on payments, change orders, and schedule of materials stored for the project The information will be used to ensure that the total development costs, identified in the ACC, are kept as low as possible and consistent with HUD construction requirements. Responses to
the collection are necessary to obtain a benefit. The information requested does not lend itself to confidentiality.
Instructions: Contractors use this form for reporting the details of approved Change Orders. Attach an original (or a opy) to each copy of the Periodic Estimate for Partial Payment (form HUD-51001) submission, and send to the Public Housing Agency. Complete all entries. Only Change Orders which bear the signatures required by the contract are to be recorded.
Name of Public Housing Agency
Supporting Periodic Estimate for Partial Payment Number
Period
From (mm/dd/yyyy)
to (mm/dd/yyyy)
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|
|
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Approved Change Orders
Additions
Deductions
Change Order
Number
Dated
(mm/dd/yyyy)
Total Amount
of Change Order
Value of Work
Completed to Date
Total Amount
of Change Order
(1)
(2)
(3)
(4)
(5)
$
$
$
Totals
$
$
$
Authorized Project Representative
Date (mm/dd/yyyy)
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Previous editions are obsolete.
form HUD-51002 (1/2014)
Location of Project
Project Number
Name of Contractor
Contract Number
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2021-01-23 |