A) Application For Mortgage Or Rental Payment Assistance B) Mortgagor/landlord Verification Statement C) Recertification For Mortgage Or Rental Payment Assistance

A) APPLICATION FOR MORTGAGE OR RENTAL PAYMENT ASSISTANCE B) MORTGAGOR/LANDLORD VERIFICATION STATEMENT C) RECERTIFICATION FOR MORTGAGE OR RENTAL PAYMENT ASSISTANCE

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3067-0004 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	A) APPLICATION FOR MORTGAGE OR RENTAL PAYMENT ASSISTANCE B) MORTGAGOR/LANDLORD VERIFICATION STATEMENT C) RECERTIFICATION FOR MORTGAGE OR RENTAL PAYMENT ASSISTANCE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	FEMA 90-57	No	No
Form	90-19	No	No
Form	90-33	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	175	175
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.