Icr_2535-0118

Paperwork Reduction Act Submission

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

1. Agency/Subagency Originating Request: U.S. Department of Housing and Urban Development Office of Departmental Grants Management and Oversight		2. OMB Control Number: a. 2535-0118	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 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:

Third-Party Documentation Facsimile Transmittal Form

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

Form HUD-96011

9. Keywords:

Housing, Grants management, facsimile

10. Abstract:

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

11. Affected public: (mark primary with “P” and all others that apply with “X”) a.   Individuals or households e.   Farms b. x Business or other for-profit f.   Federal Government c. x Not-for-profit institutions g. P State, Local or Tribal Government		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 hour burden: a. Number of respondents 33,000 b. Total annual responses 33,000 Percentage of these responses collected electronically 100% c. Total annual hours requested 3,300 d. Current OMB inventory 3,300 e. Difference (+,-) f. Explanation of difference: 1. Program change: 2. Adjustment:      		14. Annual reporting and recordkeeping cost burden: (in thousands of dollars) Do not include costs based on the hours in item 13. a. Total annualized capital/startup costs $0.00 b. Total annual costs (O&M) $0.00 c. Total annualized cost requested $0.00 d. Current OMB inventory $0.00 e. Difference $0.00 f. Explanation of difference: 1. Program change: 0 2. Adjustment: 0
15. Purpose of Information collection: (mark primary with “P” and all others that apply with “X”) a. Application for benefits e. X Program planning or management b. X Program evaluation f.   Research c.   General purpose statistics g. P 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: Barbara Dorf, Director, Office of Departmental Grants Management and Oversight Phone: (202)708-3484 ext 4637

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 collections 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      

Date:

Supporting Statement for Paperwork Reduction Act Submissions

A. Justification

1. CIRCUMSTANCES THAT MAKE COLLECTION OF INFORMATION NECESSARY:

The Facsimile Transmittal form is used as an interim solution for third party certification, and other attached documents normally attached to paper submissions of applications, until grants.gov provides a solution for submission of these types of documents.

2. USE OF INFORMATION COLLECTION:

HUD’s Notice of Funding Availability outlined in Factor 4 entitled “Leveraging Resources” asks applicants to provide evidence of leveraging support with their application certifications and required documents signed by third parties and copies of other documents not in electronic format. Letters of matching or leveraged funds, required certifications for consistency with the Consolidate Plan, EZ/EC certifications, Memorandums of Understanding (MOU), or other similar documents requiring signatures by a party other than the applicant must be submitted electronically either by scanning into an electronic attachment to the electronic application(s) or by faxing such required documents using the electronic Third-Party Documentation Facsimile Transmittal form (HUD-96011). The form is available on the grants.gov/APPLY site. Each Program will have a separate fax number specifically for their program. If more than one document is being faxed HUD’s Facsimile form (HUD-96011) will be the beginning page of each document. HUD requests that each document (e.g. Match/Leverage Confirmation Letter, MOU, form, etc.) be faxed as a single submission to avoid problems with the document being faxed. HUD will associate the faxed documentation to the appropriate application received through the grants.gov portal.

The use of this form (HUD-96011) and program specific fax number, which will be contained in each individual Program Notice of Funding Availability (NOFA) instruction, will ensure the documents are linked with the appropriate application after HUD’s retrieval from the grants.gov portal.

3. USE OF INFORMATION TECHNOLOGY:

This data is submitted 100% electronically.

4. DUPLICATION:

The use of HUD’s Third-Party Documentation Facsimile Transmittal form (HUD-96011) and the separate fax number, which will be, listed in each individual Program NOFA instructions. Submissions are unique to grantee or circumstances of the applicant. The individual program fax number will help ensure the documents are linked to the appropriate application.

5. SMALL BUSINESSES AND OTHER SMALL ENTITIES:

This collection of information does not have an impact on Small Business or other entities.

5. CONSEQUENCE TO FEDERAL PROGRAMS IF INFORMATION IS NOT COLLECTED OR COLLECTED LESS FREQUENTLY:

The use of the Third-Party Documentation Facsimile Transmittal Form allows the Department to collect the same information electronically as we would for a paper-based application. It also produces an electronic version of the document that will be matched with the electronic application submitted through grants.gov to HUD.

5. SPECIAL CIRCUMSTANCES:

No special circumstances are associated with this collection of information. .

5. CONSULTATIONS WITH PERSONS OUTSIDE THE AGENCY:

In accordance with 5 CFR 1320.8(d), this collection of information was announced in the Federal Register December 28, 2007, Vol. 72, and No. 248 on pages 73869. No comments were received.

5. PAYMENTS OR GIFTS TO RESPONDENTS:

There are no payments or gifts provided to respondents in this collection of information.

5. ASSURANCES AND CONFIDENTIALITY:

There are no assurances of confidentially provided in this collection of information.

5. QUESTIONS OF A SENSITIVE NATURE:

There are no questions of a sensitive nature asked in this collection.

5. ESTIMATED ANNUAL HOUR BURDENT:

The information is only that necessary to associate faxed, supporting documentation with that submitted through the standard electronic process.

Collection Annual Number of Burden Hours Total Burden

Requirement Frequency Respondents per Respondent Hours

Application 1 33,000 0.1 hours 3,300

There are approximately 33,000 potential respondents. We have no method of determining how many will submit documentation through this process.

5. ESTIMATED ANNUAL COSTS TO RESPONDENTS:

There is no burden cost to the respondents. All respondents are recipients of federal funds provided by HUD.

5. ADDITIONAL COST TO THE FEDERAL GOVERNMENT:

Submissions hrs per submission total hrs Hr cost Total cost

33,000 0.05 1,650 $23 (GS 9) $37,950

5. INCREASE/DECREASE IN BURDEN REPORTED FROM PREVIOUS OMB INFORMATION COLLECTION REQUEST:

This is an extension of a currently approved collection. No adjustments or changes have been made to Item 13 of the OMB 83i.

5. PUBLICATION OF INFORMATION:

Any and all information collected as a result of this form will not be published for any purpose.

5. EXPIRATION DATE DISPLAY:

Upon approval of this information collection, the appropriate OMB number and expiration date will be properly displayed in the upper right hand corner of the form.

5. CERTIFICATION EXCEPTIONS:

No exceptions to the certification in item 19 are requested.

B. Collections of Information Employing Statistical Methods

This information collection will not be used for statistical purposes.

OMB 83-I 10/95