Housing Discrimination Information Form ("HUD-903.1")

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD 903k Are You a Victim of Housing Discrimination - Korean	Form and Instruction	Modified	Available
Form HUD 903-a Are You a Victim of Housing Discrimination - Spanish	Form and Instruction	Modified	Available
Form HUD 9031cam Are You a Victim of Housing Discrimination - Cambodian	Form and Instruction	Modified	Repair queued
Form HUD 9031rus Are You a Victim of Housing Discrimination - Russian	Form and Instruction	Modified	Available
Form HUD 903-1f Are You a Victim of Housing Discrimination - Vietnamese	Form and Instruction	Modified	Available
Form HUD 903-1c Are You a Victim of Housing Discrimination - Arabic	Form and Instruction	Modified	Available
Form HUD 903-1b Are You a Victim of Housing Discrimination - Chinese	Form and Instruction	Modified	Available
Form HUD-903.1 Are you a Victim of Housing discrimination	Form and Instruction	Modified	Repair queued
ICR 2529-0011.doc	Supporting Statement A	Uploaded 2007-11-20	Available
83-i 2529-0011.doc	Supplementary Document	Uploaded 2007-11-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Korean
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Spanish
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Cambodian
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Russian
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Vietnamese
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Arabic
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are You a Victim of Housing Discrimination - Chinese
27649	Housing Discrimination Information Form ("HUD-903.1")	Form and Instruction	Modified	Are you a Victim of Housing discrimination

ICR Details

OMB Control No: 2529-0011	ICR Reference No: 200711-2529-001
Status: Historical Active	Previous ICR Reference No: 200707-2529-001
Agency/Subagency: HUD/FHEO	Agency Tracking No:
Title: Housing Discrimination Information Form ("HUD-903.1")
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/31/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/20/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	01/31/2008
Responses	9,169	0	10,750
Time Burden (Hours)	6,877	0	3,583
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to receive housing discrimination complaints filed under the Fair Housing Act. The information is needed to contact the complainant, and to assess the complaint.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 127	07/03/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 223	11/20/2007
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Housing Discrimination Information Form ("HUD-903.1")	HUD 903k, HUD 903-1f, HUD 903-1b, HUD 903-a, HUD 9031cam, HUD 9031rus, HUD-903.1, HUD 903-1c	Are you a Victim of Housing discrimination ,   Are You a Victim of Housing Discrimination - Chinese ,   Are You a Victim of Housing Discrimination - Arabic ,   Are You a Victim of Housing Discrimination - Vietnamese ,   Are You a Victim of Housing Discrimination - Russian ,   Are You a Victim of Housing Discrimination - Cambodian ,   Are You a Victim of Housing Discrimination - Spanish ,   Are You a Victim of Housing Discrimination - Korean

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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	9,169	10,750	0	0	-1,581	0
Annual Time Burden (Hours)	6,877	3,583	0	0	3,294	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: No

Burden Reduction Due to:

Short Statement: FHEO has revised the estimated total annual responses for this information collection based on data reported for FY 2006. During FY2006, HUD received approximately 9,169 submissions of potential complaint information by mail.

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Annual Cost to Federal Government: $122,786

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

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Common Form ICR:  No

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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: 11/20/2007

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