Information Collection

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

IC 27064 under ICR 200902-2502-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form HUD 90105 a Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction
9887.pdf	Other-Consent to Release Information
HUD 90100 Annual Recertification HUD-90100.doc	Form and Instruction
HUD 90101 Certification for Qualified Long-Term Care Insurance Exp HUD-90101.doc	Form and Instruction
HUD 90104 Exception to Limitations on Admission of Families HUD-90104.doc	Form and Instruction
HUD 90102 Sample Verification of Disability 90102.pdf	Form and Instruction
HUD 90103 Sample Verificaiton of disability All Programs 90103.pdf	Form and Instruction
HUD 50059 Owner's Certification of Compliance with HUD's Tenant El 50059.pdf	Form and Instruction
HUD 50059 A Owner's Certification of Compliance - Partial Certificai 50059-a.pdf	Form and Instruction
HUD 90106 Appendix 5 - Sample Move-In/Move Out Inspection Form 90106.pdf	Form and Instruction
HUD 90067 Lease Addendum 90067.pdf	Form and Instruction
HUD 90066 Certificaiton of Domestic Violence, Dating Violence or S 90066.pdf	Form and Instruction
HUD 90105 a Appendix 4-A Model Lease for Subsidized Programs HUD90105a.doc	Form and Instruction
HUD 90105b Appendix 4-B - Model Lease HUD90105b.doc	Form and Instruction
HUD 90105 c Appendix 4-C 202 PRAC Lease HUD90105c.doc	Form and Instruction
HUD 90105d Appendix 4-D 811 PRAC Lease HUD90105d.doc	Form and Instruction
HUD 27061-h Race and Ethnic Reporting Form 27061-h.doc	Form and Instruction
MF HSG - PCAS# 00251780 - PIA 2502-0204.doc PIA	IC Document

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 884 24 CFR 891 Subpart E 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
Form and Instruction	HUD 90105 a	Appendix 4-A Model Lease for Subsidized Programs	HUD90105a.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90104	Exception to Limitations on Admission of Families	HUD-90104.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90100	Annual Recertification	HUD-90100.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90101	Certification for Qualified Long-Term Care Insurance Expenses	HUD-90101.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90102	Sample Verification of Disability	90102.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90105b	Appendix 4-B - Model Lease	HUD90105b.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90105d	Appendix 4-D 811 PRAC Lease	HUD90105d.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90105 c	Appendix 4-C 202 PRAC Lease	HUD90105c.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90066	Certificaiton of Domestic Violence, Dating Violence or Stalking	90066.pdf	Yes	No	Fillable Fileable
Form and Instruction	HUD 50059 A	Owner's Certification of Compliance - Partial Certificaiton	50059-a.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90067	Lease Addendum	90067.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 50059	Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures	50059.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90106	Appendix 5 - Sample Move-In/Move Out Inspection Form	90106.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 27061-h	Race and Ethnic Reporting Form	27061-h.doc	Yes	Yes	Fillable Fileable
Other-Consent to Release Information			9887.pdf	Yes	No	Fillable Printable
Form and Instruction	HUD 90103	Sample Verificaiton of disability All Programs	90103.pdf	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: 2,160,726

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	Previously Approved
Annual Number of Responses for this IC	3,277,693	3,277,693
Annual IC Time Burden (Hours)	1,348,679	1,348,679
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PIA	MF HSG - PCAS# 00251780 - PIA 2502-0204.doc	05/13/2009

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