ICR 2502-Assist

Paperwork Reduction Act Submission

Please read the instruction before completing this form. For additional forms or assistance in completing this forms, contact your agency’s Paperwork Reduction Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget, Docket Library, Room 10102, 725 Seventeenth St. NW, Washington, DC 20503.

1. Agency/Subagency Originating Request: U.S. Department of Housing and Urban Development (HUD) Office of Housing		2. OMB Control Number: a.	b. None
3. Type of information collection: (check one) New Collection Revision of a currently approved collection Extension of a currently approved collection Reinstatement, without change, of previously approved collection for which approval has expired Reinstatement, with change, of previously approved collection for which approval has expired Existing collection in use without an OMB control number For b-f, note item A2 of Supporting Statement instructions.	4. 4. Type of review requested: (check one) Regular Emergency - Approval requested by       Delegated 5. Small entities: Will this information collection have a significant economic impact on a substantial number of small entities? Yes No 6. Requested expiration date: a. Three years form approval date b. Other (specify)

7. Title:

Supplement to Application for Federally Assisted Housing

8. Agency form number(s): (if applicable)

HUD form 92006

9. Keywords:

Housing, Federally Assisted Housing, Public Housing, Supportive Housing, Project Rental Assistance Contract (PRAC)

10. Abstract:

Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name, address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such information, if this information is provided, and if the applicant becomes a tenant, is to facilitate contact by the housing provider with the person or organization identified by the tenant, to assist in providing any the delivery of services or special care to the tenant and assist with resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.

11. Affected public: (mark primary with “P” and all others that apply with “X”) a. P Individuals or households e.   Farms b.   Business or other for-profit f.   Federal Government c. X Not-for-profit institutions g. X State, Local or Tribal Government		12. Obligation to respond: (mark primary with “P” and all others that apply with “X”) a. P Voluntary (on the part of the individual or family to respond) b. Required to obtain or retain benefits c. X Mandatory (for the housing provider to provide the option to respond to the individual or family)
13. Annual reporting and recordkeeping hour burden: a. Number of respondents (potential) 552,708 b. Total annual responses (potential) 552,708 Percentage of these responses collected electronically 1% c. Total annual hours requested (potential) 138,177 d. Current OMB inventory 0 e. Difference f. Explanation of difference: 1. Program change: 552,708 2. Adjustment:		14. Annual reporting and recordkeeping cost burden: (in thousands of dollars) a. Total annualized capital/startup costs 0 b. Total annual costs (O&M) 0 c. Total annualized cost requested 0 d. Total annual cost requested 0 e. Current OMB inventory 0 f. Explanation of difference: 1. Program change: 0 2. Adjustment: 0
15. Purpose of Information collection: (mark primary with “P” and all others that apply with “X”) a.   Application for benefits e. X Program planning or management (improve service to residents) b.   Program evaluation f.   Research c.   General purpose statistics g. Regulatory or compliance d.   Audit h. X Statutory compliance		16. Frequency of recordkeeping or reporting: (check all that apply) a. Recordkeeping b. Third party disclosure c. Reporting: 1. On occasion 2. Weekly 3. Monthly 4. Quarterly 5. Semi-annually 6. Annually 7. Biannually 8. Other (describe) Upon application for federally assisted housing, if the individual or family opts to complete this form, or such other time as the individual or family may choose to update information.
17. Statistical methods: Does this information collection employ statistical methods? Yes No	18. Agency contact: (person who can best answer questions regarding the content of this submission) Name: Willie Spearmon Phone: 202-708-3000

19. Certification for Paperwork Reduction Act Submissions

On behalf of this Federal Agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9.

Note: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320/8(b)(3), appears at the end of the instructions. The certification is to be made with reference to those regulatory provisions as set forth in the instructions.

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

1. It is necessary for the proper performance of agency functions;

2. It avoids unnecessary duplication;

3. It reduces burden on small entities;

4. It uses plain, coherent, and unambiguous terminology that is understandable to respondents;

5. Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

6. It indicates the retention periods for recordkeeping requirements;

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

1. Why the information is being collected;

2. Use of the information;

3. Burden estimate;

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

5. Nature and extent of confidentiality; and

6. Need to display currently valid OMB control number;

8. It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to collected (see note in item 19 of the instructions);

9. It uses effective and efficient statistical survey methodology; and

10. It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in item 18 of the Supporting Statement.

Signature of Program Official: X Mike Winiarski, Director, Organizational Policy, Planning and Analysis Division, HROA	Date:
Signature of Senior Officer or Designee: X Lillian Deitzer, Departmental Reports Management Officer	Date:

Supporting Statement for Paperwork Reduction Act Submissions

Supplement to Application for Federally Assisted Applications

A. Justification

1. Explain circumstances that make the collection necessary. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) (Section 644) imposed on HUD the obligation to require housing providers participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option, to include in the application for occupancy the name, address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization.

2. Purpose of the information collection. Housing providers must offer, as part of their application package for assisted housing, the opportunity for applicants to complete HUD-Form 92006, Supplement to Application for Federally Assisted Housing. If the applicant chooses to provide the contact information requested on the form, and if the applicant becomes a tenant, the information will be used by the housing provider to facilitate contact by the housing provider with the person or organization identified by the tenant, to assist in providing any delivery of services or special care to the tenant and assist with resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.

3. Describe if the collection involves the use of automated, electronic or other technological collection techniques. The proposed form is simply designed to accompany an application for housing provided by a housing provider that is covered by Section 644, and can be adapted to an electronic application if the housing provider provides for an application for housing to be completed and submitted electronically.

4. Describe efforts to identify duplication. While this statutory requirement to notify applicants for occupancy in HUD-assisted housing of the option of providing such information is a long-standing one, HUD has discovered that applicants are not being consistently notified of the option to provide this information. Accordingly, HUD has determined that the best way to ensure that HUD-assisted housing providers comply with this requirement is to require compliance through utilization of a standard form for housing providers to give to each applicant for occupancy that notifies the applicant of his or her option to provide the information specified in section 644, and provides for the information to be submitted on this form.

5. Impact on small businesses. There is no significant impact on small businesses.

6. Consequences of noncompliance. The individual applicant does not have to provide the information specified by Section 644. The housing provider, however, must provide the applicant with the option of providing such information. Failure to provide the applicant with the option to provide such information is a violation of Section 644. Upon revision of the forms used for monitoring compliance with HUDs statutory and regulatory requirements it is found during a monitoring review that the housing provider is not in compliance with Section 664, a finding will be issued and the housing provider will be expected to be in compliance with Section 644 within 30 days from issuance of the finding.

7. Explain circumstances that would require information to be reported more frequently or to submit more than one copy, and recordkeeping responsibilities. The only circumstance which may result (not require) the information to be submitted by the applicant more frequently is if the applicant needs to change or update the application that the applicant may have provided to the housing provider originally at the time of application. There is no requirement for completion of more than one copy. If the applicant becomes a tenant, the housing provider must maintain the information provided by the tenant for the period of time in which the tenant is housed by the housing provider. Because the form includes addresses and phone numbers and possibly email addresses, the form contains a confidentiality statement.

8. Publication in Federal Register. In accordance with 5 CFR 1320.8(d), this information collection soliciting public comments was announced in the Federal Register on January 22, 2009, (Volume 74, Number 13, Pages 4048-4050). Thirteen comments were received. Four comments suggested changes to the form HUD-92006, Supplement to Application for Federally Assisted Housing. The language in the instructions and commitment of the Housing Authority or Owner sections was simplified for clarity using much of the suggested language changes provided by the commenters. The form was also changed to include checkboxes allowing the applicant to designate the reason the housing provider can contact the individual or organization listed as the contact. One comment requested that the regulations be changed to adopt the Section 644 requirements. HUD will issue a conforming rule amending the regulations. Two comments requested that the requirements be incorporated into HUDs Guides and Handbooks and forms used for monitoring a housing provider’s compliance with HUD’s statutory and regulatory requirements and that HUD monitor the housing provider’s compliance with Section 644. While HUD is not required to monitor compliance with Section 644, HUD will revise the referenced documents to include Section 644 requirements in future revisions to the forms. One comment requested that form HUD-92006 be made available in alternative formats and languages. As funding permits the form will be translated into other languages and made available in alternative formats. One comment requested that it be mandatory that housing providers provide current tenants the opportunity to provide such contact information. With the issuance of administrative guidance, HUD will state that housing providers should provide current tenants the opportunity to provide such contact information. Three comments requested that use of the form be optional on the part of the housing provider; if use of the form is mandatory that it be provided at the time of admission rather than at the time of application; and that HUD provide a clear description of when and how the form is to be used. Use of the form by the housing provider is mandatory to ensure compliance with Section 644. HUD will issue administrative guidance on implementation of Section 644 and use of the form HUD-92006. One commenter was concerned that identifying organizations with existing relationships to applicants which provide services or special care suggests an infringement on the rights of persons with disabilities who may not wish to or need to disclose their disability as a condition of initial occupancy. Since completion of the form is optional on the part of the applicant, this would not be an infringement on the rights of persons with disabilities.

9. Description of any payment or gifts. There are no payments or gifts to respondents.

10. Assurance of confidentiality. Section 644(a) of the 1992 Housing and Community Development Act requires that the owner treat information received from the applicant as confidential. Since the form HUD-92066, Supplement to Application for Federally Assisted Housing, is included as part of the housing provider’s application package, any information provided by the applicant on the form must be protected under the requirements of the Privacy Act at 24 CFR 16.1, the same as all other information provided by the applicant on the housing provider’s application form.

Because the form includes addresses and phone numbers and possibly email addresses, the form contains a confidentiality statement.

11. Information of a sensitive nature. There is no information of a sensitive nature being requested. No social security numbers, employee identification numbers, date of birth or similar information is requested or obtained.

12. Estimated burden hours. Estimated number of respondents, responses and burden hours.

Information to be collected is supplemental and optional contact information under the following programs	Number of Respondents *	Number of Responses Per Respondent	Estimated Average Time for Requirement (in Hours)	Estimated Annual Burden (in Hours)
Public Housing	98,906	1	.25 min	24,726.50
Tenant-Based Rental Vouchers	188,898	1	.25 min	47,224.50
Section 202 Project Rental Assistance Contracts (PRAC)	17,852	1	.25 min	4,463.00
Section 811 Project Rental Assistance Contracts (PRAC)	5,968	1	.25 min	1,492.00
Section 202/162 Project Assistance Contract (PAC)	197	1	.25 min	49.25
Section 8 Project-Based	230,910	1	.25 min	57,727.50
Section 236	7,504	1	.25 min	1,876.00
Section 221(d)(3) Below Market Interest Rate (BMIR)	499	1	.25 min	124.75
Rent Supplement	831	1	.25 min	207.75
Rental Assistance Payment (RAP)	1,143	1	.25 min	285.75
Totals	552,708			138,177.00

*Note the number of respondents is the estimated number of total new admissions in the covered programs, and therefore the total of potential respondents. However, not all new admitted individuals and families may choose to complete Supplemental and Optional Contact Information for HUD-Assisted Housing Occupants.

13. Annual cost burden to respondents or recordkeepers. The annual estimate of the public burden to collect contact information that consists of either an individual or an organization (particularly those individuals who may have some form of mental or physical disability at the time of admission) is estimated at approximately $11.25 per applicant. This cost is based on the hourly rate of a GS-5, Step 1, which is $11.25 per hour. While an hour is not anticipated to collect the information, the cost includes the housing provider’s need to ensure that the contact information is updated when the applicant/resident requests an update.

13. Annualized costs to the Federal government. There are no costs to the government.

13. Explain reasons for program changes or adjustments. This is a new collection. There is no change in program requirements, but as noted in response to question 4, the statutory requirement is a long-standing one, but HUD has discovered that applicants are not being consistently notified of the option to provide this information. HUD made the determination to ensure compliance with Section 644 through utilization of a standard form that requires for housing providers to give to each applicant for occupancy a form that notifies the applicant of his or her option to provide the information specified in section 644, and provides for the submission of the information.

13. Publication of results of information collection. The results of the information collection will not be published.

13. Display of expiration date of OMB approval. HUD is not seeking exemption from the display date for OMB approval and the expiration date.

13. Exceptions to certification statement. There are no other exceptions to the certification statement identified in item 19 of the OMB 83-I.

B. Collections of Information Employing Statistical Methods

The collection of information does not employ statistical methods.

5

OMB 83-I 10/95