Public Housing Capital Fund Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD 53001 Actual Modernization Cost Certificate (3 Changes)	Form and Instruction	Modified	Available
Form HUD-52828 Physical Needs Assessment form	Form	Modified	Available
Form HUD-52836 PHA Board Resolution Approving Emergency Natural Disaster Grant Application - Qualified PHAs	Form and Instruction	Modified	Available
Form HUD 50071 Certification of Payments to Influence Federal Transactions	Form	Modified	Available
Form HUD 53015 Turnkey Contract of Sale Parts 1&2	Form and Instruction	Modified	Available
Form HUD 52830 Portfolio Schedule Form	Form and Instruction	Modified	Available
Form HUD 52829 Physical Needs Assessment Form	Form and Instruction	Modified	Available
Form HUD 52849 Capital Fund Financing Program Pooled Transaction:List of Participating PHSs	Form and Instruction	Modified	Available
Form HUD 52847 Capital Fund Financing Program (CFFP) Monthly Debt Service-Formula Funds Only	Form and Instruction	Modified	Available
Form HUD 52846 Capital Fund Financing Program (CFFP) Periodic Payemnt Debt Service Schedule	Form and Instruction	Modified	Available
Form HUD 52845 Capital Fund Fiancing Program U S Department of HUD	Form and Instruction	Modified	Available
Form HUD 52833 Management Needs Assessment	Form and Instruction	Modified	Available
Form HUD 52832 Physical Needs Assessment	Form and Instruction	Modified	Available
Form HUD 52484 Development Cost Budget/Cost Statement	Form and Instruction	Modified	Available
Form HUD 52427 Actual Development Cost Certificate	Form and Instruction	Modified	Available
Form HUD 52396 Analysis of Proposed Main Contruction Contract	Form and Instruction	Modified	Available
Form HUD 51004 Summary of Material Stored	Form and Instruction	Modified	Available
Form HUD 51003 Schedule of Material Stored	Form and Instruction	Modified	Available
Form HUD 51002 Schedule of Change Orders	Form and Instruction	Modified	Available
Form HUD 51001 Periodic Estimate for Partial Payment	Form and Instruction	Modified	Available
Form HUD 51000 Schedule of Amount for Contract Payments	Form and Instruction	Modified	Available
Form HUD 50030 Mixed Finance Rental term Sheet	Form and Instruction	Modified	Available
Form HUD 50029 Homeowership Term Sheet	Form and Instruction	Modified	Available
Form HUD 5460 Insurance Information	Form and Instruction	Modified	Available
Form HUD 5372 Construction Progess Schedule	Form and Instruction	Modified	Available
Form HUD 5370-EZ General Contract Conditions for Small Contructions/Development Contracts	Form and Instruction	Modified	Available
Form HUD 5370-C1 General Conditions for Non-Construction Contracts with or without Maintenance Work	Form and Instruction	Modified	Available
Form HUD 5370 General Conditions for Contruction Contract-Public Housing Programs	Form and Instruction	Modified	Available
Form HUD 5084 Contract for Inspection Services	Form and Instruction	Modified	Available
Form HUD 53001 Actual Modernization Cost Certificate	Form and Instruction	Modified	Available
Form HUD-52651-A Site, Design and Cost Report	Form	Modified	Available
Form HUD-52485 Demonstration of Financial Feasibility	Form and Instruction	Modified	Available
Form HUD-52483-A Proposal for a Public Housing Project	Form and Instruction	Modified	Available
Form HUD-52482 Guide Form of Turnkey Developer's Packet	Form and Instruction	Modified	Available
Form HUD-51971-I-II Offer of Sales of Real Property and Purchase Agreement	Form and Instruction	Modified	Available
Form HUD-5378 Public Housing Construction Report	Form and Instruction	Modified	Available
Form HUD-51915-A Contract Provisions Required by Federal Law or Owner Contract with the US Department of HUD	Form and Instruction	Modified	Available
Form HUD-51915 Model Form of Agreement Between Owner and Design Professional	Form and Instruction	Modified	Available
Form HUD-5087 Outline Specifications	Form and Instruction	Modified	Available
83-i.docx	Supporting Statement A	Uploaded 2012-12-19	Available
IPA Forms.docm	Supplementary Document	Uploaded 2012-03-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27829	Capital Fund Program	Form and Instruction	Modified	Actual Modernization Cost Certificate (3 Changes)
27829	Capital Fund Program	Form	Modified	Physical Needs Assessment form
27829	Capital Fund Program	Form and Instruction	Modified	PHA Board Resolution Approving Emergency Natural Disaster Grant Application - Qualified PHAs
27829	Capital Fund Program	Form	Modified	Certification of Payments to Influence Federal Transactions
27829	Capital Fund Program	Form and Instruction	Modified	Turnkey Contract of Sale Parts 1&2
27829	Capital Fund Program	Form and Instruction	Modified	Portfolio Schedule Form
27829	Capital Fund Program	Form and Instruction	Modified	Physical Needs Assessment Form
27829	Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program Pooled Transaction:List of Participating PHSs
27829	Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program (CFFP) Monthly Debt Service-Formula Funds Only
27829	Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program (CFFP) Periodic Payemnt Debt Service Schedule
27829	Capital Fund Program	Form and Instruction	Modified	Capital Fund Fiancing Program U S Department of HUD
27829	Capital Fund Program	Form and Instruction	Modified	Management Needs Assessment
27829	Capital Fund Program	Form and Instruction	Modified	Physical Needs Assessment
27829	Capital Fund Program	Form and Instruction	Modified	Development Cost Budget/Cost Statement
27829	Capital Fund Program	Form and Instruction	Modified	Actual Development Cost Certificate
27829	Capital Fund Program	Form and Instruction	Modified	Analysis of Proposed Main Contruction Contract
27829	Capital Fund Program	Form and Instruction	Modified	Summary of Material Stored
27829	Capital Fund Program	Form and Instruction	Modified	Schedule of Material Stored
27829	Capital Fund Program	Form and Instruction	Modified	Schedule of Change Orders
27829	Capital Fund Program	Form and Instruction	Modified	Periodic Estimate for Partial Payment
27829	Capital Fund Program	Form and Instruction	Modified	Schedule of Amount for Contract Payments
27829	Capital Fund Program	Form and Instruction	Modified	Mixed Finance Rental term Sheet
27829	Capital Fund Program	Form and Instruction	Modified	Homeowership Term Sheet
27829	Capital Fund Program	Form and Instruction	Modified	Insurance Information
27829	Capital Fund Program	Form and Instruction	Modified	Construction Progess Schedule
27829	Capital Fund Program	Form and Instruction	Modified	General Contract Conditions for Small Contructions/Development Contracts
27829	Capital Fund Program	Form and Instruction	Modified	General Conditions for Non-Construction Contracts with or without Maintenance Work
27829	Capital Fund Program	Form and Instruction	Modified	General Conditions for Contruction Contract-Public Housing Programs
27829	Capital Fund Program	Form and Instruction	Modified	Contract for Inspection Services
27829	Capital Fund Program	Form and Instruction	Modified	Actual Modernization Cost Certificate
27829	Capital Fund Program	Form	Modified	Site, Design and Cost Report
27829	Capital Fund Program	Form and Instruction	Modified	Demonstration of Financial Feasibility
27829	Capital Fund Program	Form and Instruction	Modified	Proposal for a Public Housing Project
27829	Capital Fund Program	Form and Instruction	Modified	Guide Form of Turnkey Developer's Packet
27829	Capital Fund Program	Form and Instruction	Modified	Offer of Sales of Real Property and Purchase Agreement
27829	Capital Fund Program	Form and Instruction	Modified	Public Housing Construction Report
27829	Capital Fund Program	Form and Instruction	Modified	Contract Provisions Required by Federal Law or Owner Contract with the US Department of HUD
27829	Capital Fund Program	Form and Instruction	Modified	Model Form of Agreement Between Owner and Design Professional
27829	Capital Fund Program	Form and Instruction	Modified	Outline Specifications

ICR Details

OMB Control No: 2577-0157	ICR Reference No: 201212-2577-001
Status: Historical Active	Previous ICR Reference No: 201202-2577-003
Agency/Subagency: HUD/PIH	Agency Tracking No: 2577-0157
Title: Public Housing Capital Fund Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/16/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/12/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved	01/31/2014
Responses	72,844	0	72,844
Time Burden (Hours)	265,617	0	264,067
Cost Burden (Dollars)	0	0	0

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Abstract: Each year Congress appropriates funds to approximately 3,100 Public Housing Authorities (PHAs) for modernization, development, financing, and management improvements. The funds are allocated based on a complex formula. The forms in this collection are used to appropriately disburse and utilize the funds provided to PHAs. Additionally, these forms provide the information necessary to approve a financing transaction in addition to any Capital Fund Financing transactions. Respondents include the approximately 3,100 PHA receiving Capital Funds and any other PHAs wishing to pursue financing.

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Authorizing Statute(s): US Code: 44 USC Chapter 35, as amended Name of Law: Section 3506 of the Paperwork Reduction Act of 1995
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2577-AC50	Final or interim final rulemaking	78 FR 63748	10/24/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 13619	03/07/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 33760	06/07/2012
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
Capital Fund Program	HUD-52836, HUD 52847, HUD 52849, HUD 52829, HUD 52830, HUD 53015, HUD 51001, HUD 51002, HUD 51003, HUD 51004, HUD 53001, HUD 5372, HUD 5370-EZ, HUD 5084, HUD-52828, HUD 50071, HUD 53001, HUD 5370, HUD 5370-C1, HUD 50029, HUD 5460, HUD 52427, HUD 52484, HUD 52832, HUD 52396, HUD 52833, HUD-5087, HUD-51915, HUD-51915-A, HUD-5378, HUD-51971-I-II, HUD-52482, HUD-52483-A, HUD-52485, HUD-52651-A, HUD 52845, HUD 52846, HUD 50030, HUD 51000	Outline Specifications ,   Model Form of Agreement Between Owner and Design Professional ,   Contract Provisions Required by Federal Law or Owner Contract with the US Department of HUD ,   Public Housing Construction Report ,   Offer of Sales of Real Property and Purchase Agreement ,   Guide Form of Turnkey Developer's Packet ,   Proposal for a Public Housing Project ,   Demonstration of Financial Feasibility ,   Site, Design and Cost Report ,   Actual Modernization Cost Certificate ,   Contract for Inspection Services ,   General Conditions for Contruction Contract-Public Housing Programs ,   General Conditions for Non-Construction Contracts with or without Maintenance Work ,   General Contract Conditions for Small Contructions/Development Contracts ,   Construction Progess Schedule ,   Insurance Information ,   Homeowership Term Sheet ,   Mixed Finance Rental term Sheet ,   Schedule of Amount for Contract Payments ,   Periodic Estimate for Partial Payment ,   Schedule of Change Orders ,   Schedule of Material Stored ,   Summary of Material Stored ,   Analysis of Proposed Main Contruction Contract ,   Actual Development Cost Certificate ,   Development Cost Budget/Cost Statement ,   Physical Needs Assessment ,   Management Needs Assessment ,   Capital Fund Fiancing Program U S Department of HUD ,   Capital Fund Financing Program (CFFP) Periodic Payemnt Debt Service Schedule ,   Capital Fund Financing Program (CFFP) Monthly Debt Service-Formula Funds Only ,   Capital Fund Financing Program Pooled Transaction:List of Participating PHSs ,   Physical Needs Assessment Form ,   Portfolio Schedule Form ,   Turnkey Contract of Sale Parts 1&2 ,   Certification of Payments to Influence Federal Transactions ,   PHA Board Resolution Approving Emergency Natural Disaster Grant Application - Qualified PHAs ,   Physical Needs Assessment form ,   Actual Modernization Cost Certificate (3 Changes)

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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	72,844	72,844	0	0	0	0
Annual Time Burden (Hours)	265,617	264,067	0	0	1,550	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: Revisions: 1. HUD is estimating the revisions on the HUD Form 53001 Actual Modernization Cost Certificate (AMCC) will increase the labor burden by 30 minutes per AMCC for a total increase of 1,550 hrs (3,100 responses X .5 hrs). 2. The AMCC has three proposed changes that will update the form to bring in-line with current Capital Fund Program requirements. a. Changes on AMCC i. Program name change to Capital Fund Program ii. Removed 1 of 3 HUD signature areas – retained "Approved for Audit" and "HUD Approved Verified Costs" iii. Added 2 check mark boxes for Single Audit Act A-133 Compliance

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Annual Cost to Federal Government: $4,160,000

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: 11/12/2013

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