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

Forms and Documents

Document Name	Status
Form HUD-50066 Certification of Domestic Violence, Dating Violence, or Stalking Form	Modified
83-i and Supporting Statement.doc Supporting Statement A	2014-02-25
Initial Privacy Assessment (IPA).doc Supplementary Document	2014-01-13
DOJ_Reauthor_Act.doc Supplementary Document	2013-12-04

IC Document Collections

IC ID	Document Title	Status
46037	Certification of Domestic Violence, Dating Violence, or Stalking Form	Modified

ICR Details

OMB Control No: 2577-0249	ICR Reference No: 201312-2577-003
Status: Historical Active	Previous ICR Reference No: 201011-2577-001
Agency/Subagency: HUD/PIH	Agency Tracking No: 2577-0249
Title: Implementation of the Violence Against Women and Department of Justice Reauthorization Act of 2005
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: 07/31/2014
	Date Received in OIRA: 02/28/2014
Terms of Clearance: HUD shall update this collection with any future VAWA rulemaking.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	07/31/2014
Responses	200	0	200
Time Burden (Hours)	200	0	200
Cost Burden (Dollars)	4,800	0	4,800

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Abstract: The Violence Against Women Reauthorization Act of 2013 ("VAWA") protects qualified tenants, participants, applicants, and affiliated individuals, who are victims of domestic violence, dating violence, sexual assault or stalking. This is an optional form. A PHA, owner, or management agent presented with a claim for continued or initial tenancy or assistance based on status as a victim of domestic violence, dating violence, sexual assault or stalking has the option to request that the victim document or provide written evidence to demonstrate that the violence occurred.

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Authorizing Statute(s): US Code: 42 USC 1437 -Section 6(u)(1)(A) Name of Law: U.S. Housing Act of 1937
   PL: Pub.L. 109 - 271 606, Section 8(ee)(1)(A)) - Name of Law: U.S.. Housing Act of 1937
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 162 606 Name of Law: Violence Against Women and Department of Justice Reauthorization Act of 2005

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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 78375	12/26/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 11458	02/28/2014
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Certification of Domestic Violence, Dating Violence, or Stalking	HUD-50066 (Revised Version), HUD-50066	Certification of Domestic Violence, Dating Violence, or Stalking ,   Certification of Domestic Violence, Dating Violence, or Stalking

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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	200	200	0	0	0	0
Annual Time Burden (Hours)	200	200	0	0	0	0
Annual Cost Burden (Dollars)	4,800	4,800	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: $0

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: 02/28/2014

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