Third-Party Documentation Facsimile Transmittal Form

Forms and Documents

Document	Type	Status	Availability
Form HUD-96011 Third-Party Documentation Facsimile Transmittal Form	Form and Instruction	Unchanged	Repair queued
ICR_2535-0118.DOC	Supporting Statement A	Uploaded 2008-03-11	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
27706	Third-Party Documentation Facsimile Transmittal Form	Form and Instruction	Unchanged

ICR Details

OMB Control No: 2535-0118	ICR Reference No: 201306-2535-002
Status: Historical Active	Previous ICR Reference No: 200803-2535-001
Agency/Subagency: HUD/OA	Agency Tracking No:
Title: Third-Party Documentation Facsimile Transmittal Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/13/2013
	Date Received in OIRA: 09/17/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	36 Months From Approved
Responses	33,000	0	0
Time Burden (Hours)	3,300	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Facsimile transmittal information is necessary for submission of third-party documentation as part of an application for funding competitions.

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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:
	78 FR 25290	04/30/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 49280	08/13/2013
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Third-Party Documentation Facsimile Transmittal Form	HUD-96011	Third-Party Documentation Facsimile Transmittal

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ICR Summary 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	33,000	0	0	0	0	33,000
Annual Time Burden (Hours)	3,300	0	0	0	0	3,300
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: $37,950

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: 09/17/2013

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