FORM OF CONTRACTOR'S CERTIFICATE AND RELEASE

Forms and Documents

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Collection	Type	Status	Form
145759	FORM OF CONTRACTOR'S CERTIFICATE AND RELEASE		Migrated

ICR Details

OMB Control No: 2577-0008	ICR Reference No: 198703-2577-004
Status: Historical Active	Previous ICR Reference No: 198312-2577-004
Agency/Subagency: HUD/PIH	Agency Tracking No:
Title: FORM OF CONTRACTOR'S CERTIFICATE AND RELEASE
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/1987
	Date Received in OIRA: 03/02/1987
Terms of Clearance: APPROVED WITH CONDITIONS. HUD MUST: 1) UPDATE AND RESUBMIT "SUMMARY WORKSHEET FOR ESTIMATING REPORTING COSTS" WHEN IT SUBMITS THIS FORM TO OMB FOR ITS NEXT REVIEW, 2) PLACE THE OMB CONTROL NUMBER AND EXPIRATION DATE ON THE FORM, AND 3) PROVIDE OMB WITH A COPY OF THE FORM EXHIBITING THE OMB CONTROL NUMBER AND EXPIRATION DATE AS SOON AS THE FORM HAS BEEN PRINTED. FAILURE TO PLACE THE OMB CONTROL NUMBER ON THE FORM DIRECTLY VIOLATES THE PAPERWORK REDUCTION ACT AND ITS IMPLEMENTING REGULATIONS AT 5 CFR 1320.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1990	03/31/1990	03/31/1987
Responses	240	0	392
Time Burden (Hours)	239	0	392
Cost Burden (Dollars)	0	0	0

---

Abstract: THIS CERTIFICATE AND RELEASE IS PREPARED BY A CONTRACTOR AND SUBMITTED TO A PHA TO RECORD THE AMOUNT DUE THE CONTRACTOR, TO CERTIFY THAT WORK PERFORMED COMPLIES WITH CONTRACT REQUIREMENTS AND PROPER WAGES PAID. IT ALSO RELEASES THE PHA FROM ALL CLAIMS UNDER THE CONTRAC EXCEPT THOSE STATED ON THE CERTIFICATE.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
FORM OF CONTRACTOR'S CERTIFICATE AND RELEASE

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	240	392	0	-152	0	0
Annual Time Burden (Hours)	239	392	0	-153	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/02/1987

---