Information Collection

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

IC 27064 under ICR 200712-2502-002 · OMB 2502-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2502-0204 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HUD-90105 (a-d).doc	Other-Model Lease
HUD-90106.doc	Other-Sample Move in/move out form
9887/9887A Notice and Consent for the Release of Information/Fact S 9887.pdf	Form
HUD 90100 Annual Recertification HUD-90100.doc	Form
HUD 90101 Certificaiton for Qualified Long-Term Care Insurance Exp HUD-90101.doc	Form
HuD 90102 Verification of Disability HUD-90102.doc	Form
HUD 10103 Verfiication of disability - All Programs Except 202/8,S HUD-90103.doc	Form
HUD 90104 Exception to Limitations on Admission of Families HUD-90104.doc	Form
HUD 27061-h Race and Ethnic Reporting Form HUD-27061-h.doc	Form and Instruction
HUD 50059 Owner's Certificaiton of Compliance with HUD's Tenant El HUD-50059.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 24 CFR 886 24 CFR 891 Subpart E 24 CFR 884 24 CFR Part 5 24 CFR 880 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Lease			HUD-90105 (a-d).doc	Yes	No	Paper Only
Other-Sample Move in/move out form			HUD-90106.doc	Yes	No	Paper Only
Form and Instruction	HUD 50059	Owner's Certificaiton of Compliance with HUD's Tenant Eligibility and Rent Procedures	HUD-50059.pdf	Yes	No	Fillable Printable
Form and Instruction	HUD 27061-h	Race and Ethnic Reporting Form	HUD-27061-h.doc	Yes	No	Fillable Printable
Form	HUD 90104	Exception to Limitations on Admission of Families	HUD-90104.doc	Yes	Yes	Fillable Fileable
Form	9887/9887A	Notice and Consent for the Release of Information/Fact Sheet Verification of Information	9887.pdf	Yes	No	Fillable Printable
Form	HUD 90100	Annual Recertification	HUD-90100.doc	Yes	Yes	Fillable Fileable
Form	HUD 90101	Certificaiton for Qualified Long-Term Care Insurance Expenses	HUD-90101.doc	Yes	Yes	Fillable Printable
Form	HuD 90102	Verification of Disability	HUD-90102.doc	Yes	Yes	Fillable Printable
Form	HUD 10103	Verfiication of disability - All Programs Except 202/8,SEC 202 PAC, PRAC, 811/PRAC	HUD-90103.doc	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,936,897

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,964,605	2,754,466	2,210,139
Annual IC Time Burden (Hours)	1,920,431	-187,621	2,108,052
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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