Congregate Housing Services Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD 90006 Annual Reporting Form	Form and Instruction	Modified	Available
Form HUD 91178A Annual Program Budget Grantee	Form	Modified	Available
Form SF-269 Financial Status Report	Form	Modified	Repair queued
Form HUD-91180-A Summary Budget Grantee	Form	Modified	Available
Form HUD-90198 Payment Voucher	Form	Modified	Available
Supporting Statement.doc	Supporting Statement A	Uploaded 2011-06-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27226	Congregate Housing Services Program	Form and Instruction	Modified	Annual Reporting Form
27226	Congregate Housing Services Program	Form	Modified	Annual Program Budget Grantee
27226	Congregate Housing Services Program	Form	Modified	Financial Status Report
27226	Congregate Housing Services Program	Form	Modified	Summary Budget Grantee
27226	Congregate Housing Services Program	Form	Modified	Payment Voucher

ICR Details

OMB Control No: 2502-0485	ICR Reference No: 201106-2502-001
Status: Historical Active	Previous ICR Reference No: 200809-2502-003
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Congregate Housing Services Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/20/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/17/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	01/31/2012
Responses	440	0	504
Time Burden (Hours)	688	0	1,103
Cost Burden (Dollars)	0	0	0

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Abstract: This information is necessary to monitor the use of grant funds for the Congregate Housing Services Program (CHSP) according to statutory, regulatory, and administrative requirements.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 31356	05/31/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 70472	11/14/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Congregate Housing Services Program	HUD-90198, HUD-91180-A, SF-269, HUD 91178A, HUD 90006	Payment Voucher ,   Summary Budget Grantee ,   Financial Status Report ,   Annual Program Budget Grantee ,   Annual Reporting Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	440	504	0	0	-64	0
Annual Time Burden (Hours)	688	1,103	0	0	-415	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $14,875

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

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

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

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

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

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

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/17/2011

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