Icr-83i

Paperwork Reduction Act Submission

Please read the instructions before completing this form. For additional forms or assistance in completing this forms, contact your agency’s Paperwork Clearance 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 Street, NW, Washington, DC 20503.

1. Agency/Subagency Originating Request: U.S. Department of Housing and Urban Development Office of Public and Indian Housing 		2. OMB Control Number: a. 2577-0169	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. 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 from approval date b. Other (specify)      

7. Title:

Housing Choice Voucher Program

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

Agency form numbers: HUD-52515, HUD-52667, HUD-52580, HUD-52580-A, HUD-52681, HUD-52681-B, HUD-52672, HUD-, HUD-52517, HUD-52646, HUD-52665, HUD-52641, HUD-52641-A, HUD 52642, HUD 52642-A, HUD 52649, HUD 52531A and B,

HUD 52530A, HUD 52530B, HUD 52530C, HUD 52578B.

9. Keywords:

Housing Choice Vouchers (HCV), Rent subsidies, Low-income housing, Homeownership, HCV Transfers; Project-Based Vouchers

10. Abstract:

Public Housing Authorities (PHA) apply for funding to assist very low-income families to lease or purchase housing. PHAs maintain records on participant eligibility, unit acceptability, lease and/or housing assistance payments, and budget and payment documentation. In some cases PHAs voluntarily divest their voucher programs to a receiving PHA. PHAs may also project-base a portion of their vouchers or use their vouchers under the Homeownership Option.

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.   Not-for-profit institutions g. X State, Local or Tribal Govt.		12. Obligation to respond: (mark primary with “P” and all others that apply with “X”) a.   Voluntary b. P Required to obtain or retain benefits c.   Mandatory
13. Annual reporting and recordkeeping hours burden: a. Number of respondents 492,450 b. Total annual responses 3,037,954 Percentage of these responses collected electronically 0.3% c. Total annual hours requested 1,223,748 d. Current OMB inventory 1,070,603 e. Difference (+,-) +153,145 f. Explanation of difference: 1. Program change: +153,145 2. Adjustment:		14. Annual reporting and recordkeeping costs 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:       2. Adjustment:      
15. Purpose of Information collection: (mark primary with “P” and all others that apply with “X”) a. X Application for benefits e. P Program planning or management b. Program evaluation f.  Research c.   General purpose statistics g. X Regulatory or compliance d.   Audit		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)      
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: Phyllis Smelkinson Phone: 202-402-4138

19. Certification for Paperwork Reduction Act Submissions

On behalf of the U.S. Department of Housing and Urban Development, 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), appear 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 collection 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 William O. Russell, DAS for Public Housing and Voucher Program

Date:

Supporting Statement for the

Housing Choice Voucher Program 2577-0169

A. Justification

1. Reason for collection. The housing choice voucher (HCV) program is the federal government's major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments.

The participant is free to choose any housing that meets the requirements of the program and is not limited to units located in subsidized housing projects.

HCVs are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from the U.S. Department of Housing and Urban Development (HUD) to administer the voucher program.

A family that is issued a HCV is responsible for finding a suitable housing unit of the family's choice where the owner agrees to rent under the program. This unit may include the family's present residence. Rental units must meet minimum standards of health and safety as determined by the PHA.

A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Under certain circumstances, if authorized by the PHA, a family may use its voucher to purchase a modest home.

Section 8(o) of the United States Housing Act of 1937 (USHA), as amended by Section 545 of the Quality Housing and Work Responsibility Act of 1998 (QHWRA) authorized the merger of the Section 8 tenant-based programs (certificate and voucher programs) into a single market-driven program (entitled the HCV program). Section 8(y) of the USHA, as amended by Section 555 of QHWRA authorized the “homeownership option” under the HCV program.

Under the HCV program, the Department enters into an Annual Contributions Contract (ACC) with PHAs to assist very low-income families to lease or purchase safe, decent, and affordable housing. PHAs are required to maintain complete and accurate program and accounting records in accordance with HUD requirements; in a manner that permits a speedy and effective audit. PHAs must maintain records on eligibility (e.g., verification of income, disability status and citizenship); records of subsidized units (e.g., unit inspection reports, rent reasonableness documentation, tenant leases and housing assistance payments (HAP) contracts); and accounts and other records supporting PHA budget and financial statements for the program (e.g. HAP registers which document payments to landlords).

Voluntary transfers of HCV program units and budget authority include notification of both the divesting PHA and receiving PHA to their respective field office. Receiving PHAs are responsible for notifying all affected landlords and families of the transfer.

Section 8(o)(13) of the USHA allows PHAs to project-base a portion of their tenant-based vouchers. The main purpose of this revision is to add PBV forms and other paperwork that will add PHA burden hours

2. Use of information. The requested information requirements (how, by whom and for what purpose the information is to be used) for the voucher program consists of the following:

Information Collections Required of PHAs

Funding Application, Form HUD-52515, Regulatory References 982.54, 982.103, and 982.158. HUD collects information from the PHA on Form HUD-52515, which is the HCV program funding application that specifies the number of units requested, as well as the PHA's objectives and plans for administering the HCV program. The application is reviewed by HUD and ranked according to the PHA's administrative capability, the need for housing assistance, and other factors specified in the Notice of Funding Availability. PHAs are required to prepare an Administrative Plan that states local PHA policy on matters for which the PHA has discretion to establish local policies. The PHA must discuss in these plans how it will operate the HCV program, e.g., organization of the waiting list, opening and closing of the waiting list, selection of families from the waiting list, terms of the voucher and occupancy policies. Standard forms were added to the funding application process. Purpose: Application for benefits.

Allowances for Tenant Furnished Utilities and Other Services, Form HUD-52667, Regulatory References 982.158 and 982.517. The PHA must establish a utility allowance schedule for all utilities and other services. The utility allowance is used in determining the family's monthly HAP and rental or homeownership share. The allowance is provided for those utilities paid by the family. The utility allowance schedule is determined based on the typical cost of utilities and services paid by energy-conservative households that occupy housing of a similar size and type in the same locality. The PHA must submit its initial utility allowance schedule and supporting documentation to HUD in order for HUD to ensure that the costs are reasonable. Thereafter, the updated form is not sent to HUD unless requested. Purpose: Program planning or management; Regulatory compliance. This purpose will remain applicable to remaining forms and documents.

Inspection Form, HUD-52580, Regulatory References 982.158, 982.401, 982.405 and 982.631. Form HUD-52580 (form HUD-52580-A is the same form as 52580 with the addition of detailed instructions on the form) is the inspection form used by the PHA to determine if a unit meets the housing quality standards (HQS) of the HCV program. The goal of the HCV program is to provide decent, safe and sanitary housing to very low-income families. In keeping with that goal, the primary objective of the HQS is to protect the family receiving assistance under the program by guaranteeing a basic level of assisted housing. The units must pass inspection before HAP may be paid to owners and must be re-inspected at least once a year when an assisted family continues occupancy. Annual re-inspections are not required under the homeownership option. The inspection reports are not submitted to HUD.

Financial Forms, HUD- 52672, 52681, 52681-B, Regulatory References 982.157 and 982.158. PHAs that administer the HCV program are required to maintain financial reports in accordance with accepted accounting standards in order to permit timely and effective audits. The HUD-52672 and 52681 financial records identify the amount of annual contributions that are received and disbursed by the PHA and are used by PHAs that administer the five-year Mainstream Program. The required financial statements are similar to those prepared by any responsible business or organization at the end of the fiscal year. Form HUD-52681-B is entered by the PHA into the Voucher Management System (VMS) on a monthly basis during each calendar year to track HAP and administrative fee expenses as well as portability families, fraud recovery, Family Self-Sufficiency escrow accounts, etc. Through submission of these reports, HUD is able to ensure that PHAs do not over or under utilize their baseline unit months or annual budget authority. HCV funding is provided to PHAs each calendar year on a formula basis in accordance with recent Congressional Appropriations Acts.

Voucher, Form HUD-52646, Regulatory References 982.158, 982.302 and 982.629. The voucher is the document that authorizes the family to look for an eligible unit and specifies the appropriate unit size necessary to meet the family's needs. The voucher also sets forth the family's obligations under the HCV program. This form is not sent to HUD.

HAP Contracts and Tenancy Addenda, Forms HUD-52641, 52641A, 52642 and 52642A -Regulatory References, 982.158, 982.305, 982.308, 982.309, 982.451, 982.454, 982.620. The HAP contract is a written agreement between the PHA and the owner of a unit or manufactured home space occupied by a voucher participant. The HAP contract must be executed before the PHA can make payment on behalf of an eligible family. The HAP contract consists of three parts: Part A (Contract Information); Part B (Body of the Contract); and Part C (Tenancy Addendum). Separate tenancy addenda forms are provided to the landlord for attachment to the tenant’s lease. The PHA must be provided a copy of any revisions to the lease agreed to by the owner and the tenant. This information is not submitted to HUD. Below is an explanation of each contract form.

HAP Contract for Section 8 Tenant-Based Assistance Housing Choice Voucher Program, Form HUD-52641 -- This contract form is used for all program, participants except manufactured homeowners leasing the manufactured home space. This form is not sent to HUD.

Tenancy Addendum, Form HUD-52641-A-- This form must be attached to a copy of the lease that is provided to the tenant by the landlord. If there is any conflict between the tenancy addendum and any other provisions of the lease, the language of the tenancy addendum shall control. This form is not sent to HUD.

HAP Contract for Manufactured Home Space Rental, Form HUD-52642-- This contract form is used for manufactured homeowners who lease the manufactured home space. This form is not sent to HUD.

Tenancy Addendum, Form HUD-52642-A-- This form is to be attached to a copy of the lease provided to the tenant by the landlord, for manufactured home space rental. If there is any conflict between the tenancy addendum and any other provisions of the lease, the language of the tenancy addendum shall control. This form is not sent to HUD.

Information Collected by PHAs from Program Participants / Tenant-Based Owners

Request for Tenancy Approval, Form HUD-52517, Regulatory References 982.158 and 982.302. The Request for Tenancy Approval is completed and submitted by the family to the PHA when the family finds a unit that is suitable for its needs. The PHA reviews the request to determine if the owner is eligible to participate in the program, if the unit is eligible, and if the lease complies with the program and statutory requirements governing prohibited and required lease provisions. This form is not sent to HUD.

Statement of Homeowner Obligations Housing Choice Homeownership Voucher Program, Form HUD-52649, Regulatory Reference 982.625 and 982.633. The PHA and family participating in the homeownership voucher program must execute a “statement of homeowner obligations” before HAP begin. This statement describes the types of information to be provided by the family during the process for determining a family’s eligibility for participation in the program, and the program requirements a family must comply with as a condition of participation. The statement indicates the homeowner’s acknowledgment of obligations to provide various types of information to the PHA for the purpose of determining general eligibility for participation in the program, income eligibility, or compliance with stated program requirements.

Information Requirement from PHA to PHA

Family Portability Information, Form HUD-52665, Regulatory Reference 982.158 and 982.355. This form standardizes the portability information submitted to the receiving PHA by the initial PHA. In addition, this form is used for monthly portability billing by the receiving PHA. After the payment amount is established, the form does not need to be resubmitted until the annual recertification or if the payment amount changes between annual recertifications. This information is not provided to HUD.

Information Requirement from PHA to Owner

PHA Preparation of Information about the Tenant for the Owner, Regulatory Reference 982.307. When the PHA is approving a new unit selected by the family, the PHA must advise the owner that the PHA has not screened the family and provide the name and address of previous landlords if such information is readily available. This information is not provided to HUD.

Information Requirement for Voucher Transfers

PHA Notification Letters. Regulatory Reference 982.151. HUD uses the notification letters to initiate the transfer process. Families and owners use their notification letters to be aware of changes in policies (such as occupancy and subsidy standards that may affect the family’s tenancy under a different PHA).

Information Requirement for Homeownership Voucher Contract of Sale

Required Contract of Sale Provisions, Housing Choice Homeownership Voucher Program, Regulatory Reference 982.631(c)(2). Before commencement of monthly homeownership assistance, a member or members of the family must enter into a contract of sale with the seller of the unit to be acquired by the family. The family must give the PHA a copy of the contract of sale. The contract of sale must specify the price and other terms of sale by the seller to the purchaser; provide that the purchaser will arrange for a pre-purchase inspection of the dwelling unit by an independent inspector selected by the purchaser; provide that the purchaser is not obligated to purchase the unit unless the inspection is satisfactory to the purchaser; provide that he purchaser is not obligated to pay for any necessary repairs; and contain a certification from the seller that the seller has not been debarred, suspended, or subject to a limited denial of participation under part 24 of this title.

Information Requirements for Additional Renewal Funding (subject annually to Congressional Appropriations Acts)

Plans from Disaster PHAs. Regulatory reference 982.102. PHAs that were eligible for assistance under Section 901 in Public Law 109-148 or are located in the same counties as those eligible for Section 901 and operate voucher programs, but do not operate public housing programs, and any other PHA that otherwise qualifies under this category must demonstrate they have experienced a loss of rental housing stock as a result of the 2005 hurricanes to receive additional renewal funding. To receive funding, the PHA must submit a plan, to be approved by the Secretary, demonstrating that the PHA can effectively use the funding under this provision within 12 months of HUD approval of the plan.

Plans from PHAs in Receivership or in Breach of an ACC by June 1. 2007. Regulatory reference 982.102

These PHAs that would receive less funding under the method provided in Public Law 110-5 (re-benchmarking) than they would receive under the special provisions of the Supplemental 2007 (Public Law 110-28) must submit a plan, to be approved by the Secretary, demonstrating that the PHA can effectively use the funding under this methodology within 12 months of HUD approval of the plan.

Application/Certification and Evidence of Unforseen Circumstances for Set-Aside Funding. Regulatory reference 982.102. The revised Continuing Resolution 2007 provided $100 million to be set aside for renewal funding for PHAs that experienced an increase in costs due to unforeseen circumstances.

Application/Certification and Evidence of Decrease in Funding due to Re-benchmarking for Set-Aside Funding. Regulatory reference 982.102. The revised Continuing Resolution 2007 provided that part of the $100 million will be set aside for renewal funding for PHAs that would experience a decrease in funding due to re-benchmarking.

Information Requirements for Project-Based Voucher (PBV) Program

Public Notice of PHA Request for PBV Proposals. Regulatory reference 983.51(c). If the PHA must select proposals competitively through public notice. The public notice procedures may include publication of the notice in a local newspaper of general circulation and other means for broad circulation.

PHA Notice of Owner Selection. Regulatory reference 983.51(d). The PHAmust give prompt written notice to the party that submitted a selected proposal and must also give prompt public notice of such selection.

Agreement to Enter into a Housing Assistance Payments Contract. Form HUD-52531A&B. Regulatory reference 983.152. For PBV units that will be newly constructed or substantially rehabilitated, the PHA must enter into an Agreement prior to development or rehabilitation activities begin.

PBV HAP Contract for New Construction or Substantial Rehabilitation. Form HUD-52530A. Regulatory reference 983.202. The PHA must enter into a HAP contract with the owner in order for housing assistance to be paid to the owner for occupied units.

PBV HAP Contract for Existing Units. Form HUD-52530B. Regulatory reference 983.202. The PHA must enter into a HAP contract with the owner in order for housing assistance to be paid to the owner for occupied units.

Tenancy Addendum. Form HUD-52530C. Regulatory reference 983.256((b)(3). The lease under the PBV program must include a HUD-required tenancy addendum with all provisions required by HUD.

Statement of Family Responsibilities. Form HUD-52578B . Regulatory reference 983.1, 982.551. Each family participating in the PBV program must sign this form which includes family obligation.

3. Use of automated collection techniques. Financial Form HUD-52681-B has been automated. Submissions are entered quarterly into the Voucher Management System (VMS). None of the other data under this submission is automated.

4. Efforts to identify duplication. There is no duplication of the subject information.

5. Methods to minimize the burden on small entities. No small entities are impacted.

6. Consequences if collected less frequently. The burden associated with Parts 982 and 983 is the minimum needed for program monitoring and implementation and incorporates program applications for funding, program financial reporting, and contractual and other documents necessary to program administration and implementation. The information cannot be collected less frequently because it is either (1) information necessary to ensure housing is adequate and occupancy is by eligible families (2) information necessary to comply with contractual arrangements or (3) information necessary to ensure compliance with a statutory mandate. In regard to voluntary transfers, notification letters to the field office, families and owners are only required once.

7. Special circumstances. PHAs will submit data in the VMS for each month, but will submit the data after the end of each month. Validation will occur online as the PHA prepares its submission. Items that fail specified edit checks will be immediately identified and the PHA will review and either correct or confirm the data.

8. To be completed after publication of FR. Agency notice of proposed information collection was published for public comment in the Federal Register on xxxxxxxxxx, xxxx, page xxxx. A 60-day comment period was provided for both information collections.

The Department received comments ………..

9. Payment to respondents. No payments were offered.

10. Assurance of confidentiality. No assurance of confidentiality is provided, nor is it needed.

11. Questions of a sensitive nature. No sensitive questions are asked.

12. Estimated hour burden.

Description	Number of Respondents	Responses per Respondent	Total Annual Responses	Hours per Response	Total Hours	Regulatory Reference
Application (HUD –52515)	1,000	1	1,000	1	1,000	982.103
Application for Federal Assistance (SF-424)	1,000	1	1,000	0.75	750	982.103
Applicant/Recipient Disclosure/Update Report (HUD-2880)	1,000	1	1,000	0	0	982.103
Acknowledgement of Application Receipt (HUD-2993)	1,000	1	1,000	0	0	982.103
Third Party Documentation Facsimile Transmittal (HUD-96011)	500	1	500	0	0	982.103
Certification of Consistency with the Consolidated Plan (HUD-2991)	1,000	1	1,000	0	0	982.103
Disclosure of Lobbying Activities (SF-LLL)	500	1	500	0.17	85	982.103
Tenant-Furnished Utilities (HUD-52667)	1,500	1	1,500	1.5	2,250	982.517
Inspection Form (HUD-52580)	2,450	200	1,470,000	0.5	735,000	982.401
Inspection Form (HUD-52580-A)	2,450	600	490,000	0.5	245,000	982.401
Financial Forms (HUD- 52681-B)	2,450	12	29,400	1.5	44,100	982.157, 982.158
Financial Forms (HUD- 52672)	190	1	190	1.5	285	982.157, 982.158
Financial Form (HUD-52681	190	1	190	1.5	285	982.157, 982.158
Request for Tenancy Approval (HUD-52517)	2,450	100	245,000	0.08	19,600	982.302
Voucher (HUD-52646)	2,450	100	245,000	0.05	12,250	982.305
PHA Information to Owner	2,450	100	245,000	0.05	12,250	982.307
Portability Information (HUD-52665)	2,450	20	49,000	0.5	24,500	982.355
HAP Contracts (HUD-52641, 52641-A, 52642, 52642-A)	2,450	100	245,000	0.5	122,500	982.451
Statement of Homeowner Obligation (HUD-52649)	250	10	2,500	0.25	625	982.625
Program and Accounting Recordkeeping	2,450	1	2,450	0.5	1,225	982.158
Field Office Notification of Voucher Transfers	10	1	10	1	10	982.151
Receiving PHA Notice to Owerns of HCV Transfer	10	143	1,143	0,25	286	982.151
Receivng PHA Notice to Families of HCV Transfer	10	143	1,143	0,25	286	982.151
Homeownership: Required Contract of Sale Provisions	2500	1	2500	0.25	625	982.631(c)(2)
Renewal funding plans from disaster and receivership PHAs	38	1	38	1	38	982.102
Renewal funding of set-aside for unforseen circumstances	100	1	100	2	200	982.102
Renewal funding of set-aside for re-benchmarking	600	1	600	0,25	150	982.102
PHA PBV Public Notice	50	1	50	3	150	983.51(c)
PHA PBV Notice of Owner Selection	50	1	50	0.5	25	983.51(c)
PBV Agreement to enter into a HAP Contract (HUD-52531A and B)	50	0.8	40	0.25	10	983.152
PBV NC/SR HAP Contract (HUD-52530A)	50	0.8	40	0.25	10	983.202
PBV Existing HAP Contract (HUD-52530B)	50	0.2	10	0.25	2.5	983.202
PBV Tenancy Addendum (HUD-52530C)	50	10	500	0.25	125	983.256(b)(3)
PBV Statement of Family Responsibilities (HUD-52578B)	50	10	500	0,25	125	983.1, 982.551
Totals	492,450*		3,037,954		1,223,748

Estimated annual cost. 1,223,748 hours times average hourly costs of $20 = $2,447,960.

*2,450 PHAs + 245,000 families + 245,000 owners

** Note that since the divesting PHA is only required to notify the field office of the transfer, there are no burden hours recorded for that action. It would also skew the cost per respondent if added to the burden hours recorded for the receiving PHA. It is estimated that the preparation of the notification letter to the field office should take no more than one hour to prepare. It is further estimated that notification letters to owners and families should take no more than 15 minutes each as PHAs can use the mail merge feature when preparing these letters.

13. Respondents will not incur any additional costs.

14. Federal Government Costs

Requirement Annual Cost Total

Burden Hours per hour Cost

Funding Application 1,500 $33.00 $49,500

Tenant-Furnished Utilities 1,500 $33.00 $ 49,500

Financial Forms 12,250 $33.00 $404,250

Totals 17,250 $503,250

There is no additional cost to the government for the transfer of voucher programs or contracts of sale under the homeownership option.

15. Reason for program changes. This revision reflects burden hours associated with the project-based voucher program under 24 CFR Part 983. All project-based voucher forms and other paperwork are included in this submission.

16. Plans for publication of information collected. Not applicable; information will not be published for statistical use.

17. Approval to not display expiration date for OMB approval. The OMB approval number and expiration date are displayed on the forms. They will be updated once approval is received.

18. Exceptions to certification. There are no exceptions to the certification statement identified in item 19.

B. Collection of Information Employing Statistical Methods:

Section B is not applicable since statistical methods are not used.

OMB 83-I 10/95