Certification of Domestic Violence, Dating Violence, or Stalking

Implementation of the Violence Against Women and Department of Justice Reauthorization Act of 2005

OMB: 2577-0249

IC ID: 46037

Information Collection (IC) Details

View Information Collection (IC)

Certification of Domestic Violence, Dating Violence, or Stalking
 
No Modified
 
Required to Obtain or Retain Benefits
 
24 CFR 5

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HUD-50066 Certification of Domestic Violence, Dating Violence, or Stalking VAWA Certification 50066-CLEAN.docx Yes Yes Fillable Fileable

Community and Social Services Community and Regional Development

 

200 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 0 0 0 200
Annual IC Time Burden (Hours) 200 0 0 0 0 200
Annual IC Cost Burden (Dollars) 4,800 0 0 0 0 4,800

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

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