Housing Choice Voucher Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD 52642 HAP Contract	Form and Instruction	Modified	Available
Form HUD 52672 Financial Form	Form and Instruction	Modified	Available
Form HUD 52646 Voucher	Form and Instruction	Modified	Available
Form HUD 52517 Requst for Tenancy Approval	Form and Instruction	Modified	Available
Form HUD-52681 Financial Form	Form and Instruction	Modified	Available
Form HUD-52681-B Voucher for Payment of Annual Contributions	Form and Instruction	Modified	Available
Form HUD-52642-A Tenancy Addendum Manufactured Home Space Rental	Form and Instruction	Modified	Available
Form HUD-52649 Statement of Homeowner Obligations	Form and Instruction	Modified	Available
Form HUD-52667 Tenant - Furnished Utilities	Form and Instruction	Modified	Available
Form HUD-52665 Family Portability Information	Form and Instruction	Modified	Available
Form HUD-52580 Inspection Checklist	Form and Instruction	Modified	Available
Form HUD-52515 Funding Application	Form and Instruction	Modified	Available
Form HUD-52641 Housing Assistance Contract (HAP)	Form and Instruction	Modified	Available
Form HUD-52641-A Tenancy Addendum	Form and Instruction	Modified	Available
ICR 2577-0169.doc	Supporting Statement A	Uploaded 2007-06-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27839	Housing Choice Voucher Program	Form and Instruction	Modified	HAP Contract
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Financial Form
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Voucher
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Requst for Tenancy Approval
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Financial Form
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Voucher for Payment of Annual Contributions
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Tenancy Addendum Manufactured Home Space Rental
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Statement of Homeowner Obligations
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Tenant - Furnished Utilities
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Family Portability Information
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Inspection Checklist
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Funding Application
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Housing Assistance Contract (HAP)
27839	Housing Choice Voucher Program	Form and Instruction	Modified	Tenancy Addendum

ICR Details

OMB Control No: 2577-0169	ICR Reference No: 200706-2577-002
Status: Historical Active	Previous ICR Reference No: 200701-2577-001
Agency/Subagency: HUD/PIH	Agency Tracking No:
Title: Housing Choice Voucher Program
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: 09/14/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/22/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	36 Months From Approved	09/30/2007
Responses	3,011,426	0	2,997,700
Time Burden (Hours)	1,069,683	0	1,194,575
Cost Burden (Dollars)	0	0	0

---

Abstract: Public Housing Authorities' (PHA) application for funding to a assist very low-income families to lease or purchase housing. PHAs maintain records on participant eligibility, until acceptability, lease and/or housing assistance payments, and budget and payment documentation.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 31	02/15/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 120	06/22/2007
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Housing Choice Voucher Program	HUD 52517, HUD 52672, HUD-52681-B, HUD-52641-A, HUD-52641, HUD-52515, HUD-52580, HUD-52667, HUD-52681, HUD-52665, HUD 52646, HUD-52642-A, HUD-52649, HUD 52642	Tenancy Addendum ,   Housing Assistance Contract (HAP) ,   Funding Application ,   Inspection Checklist ,   Family Portability Information ,   Tenant - Furnished Utilities ,   Statement of Homeowner Obligations ,   Tenancy Addendum Manufactured Home Space Rental ,   Voucher for Payment of Annual Contributions ,   Financial Form ,   Requst for Tenancy Approval ,   Voucher ,   Financial Form ,   HAP Contract

---

ICR Summary of Burden

table that charts list 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	3,011,426	2,997,700	0	13,726	0	0
Annual Time Burden (Hours)	1,069,683	1,194,575	0	-124,892	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: Changing Forms

Short Statement: This revision reflects a decrease in total hours because the hours for the financial documents decreased while additional hours were allocated for HCV transfers and contracts of sale under the homeownership option. The number of financial forms decreased from five to one; however the submissions decreased from five (one submission per form annually) to four quarterly electronic submissions of one form.

---

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: 06/22/2007

---