Information Collection

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

IC 27064 under ICR 201403-2502-004 · OMB 2502-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2502-0204 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
9887.pdf	Other-Consent to Release Information
HUD 90100 Annual Recertification 90100.pdf	Form and Instruction
HUD 90101 Certification for Qualified Long-Term Care Insurance Exp 90101.pdf	Form and Instruction
HUD 90104 Exception to Limitations on Admission of Families 90104.pdf	Form and Instruction
HUD 90102 Sample Verification of Disability 90103.pdf	Form and Instruction
HUD 90103 Sample Verificaiton of disability All Programs 90103.pdf	Form and Instruction
HUD 50059 Owner's Certification of Compliance with HUD's Tenant El 50059.pdf	Form and Instruction
HUD 50059 A Owner's Certification of Compliance - Partial Certificai 50059-a.pdf	Form and Instruction
HUD 90106 Appendix 5 - Sample Move-In/Move Out Inspection Form 90106.pdf	Form and Instruction
HUD 90167 Lease Addendum 90167-ca.pdf	Form and Instruction
HUD 90166 Certificaiton of Domestic Violence, Dating Violence or S 90066.pdf	Form and Instruction
HUD 90105 a Appendix 4-A Model Lease for Subsidized Programs 90105a.pdf	Form and Instruction
HUD 90105b Appendix 4-B - Model Lease 90105b.pdf	Form and Instruction
HUD 90105 c Appendix 4-C 202 PRAC Lease 90105c.pdf	Form and Instruction
HUD 90105d Appendix 4-D 811 PRAC Lease 90105d.pdf	Form and Instruction
HUD 27061-h Race and Ethnic Reporting Form 27061-h .doc	Form and Instruction
HUD9887 Document Package for Applicant's/Tenant's Consent to the 9887.pdf	Form and Instruction
90011 Coordinator Access Authorization Form HUD-90011.docx	Form and Instruction
90012 User Access Authorization Form HUD-90012.docx	Form and Instruction
TRACS Privacy Impact Assessment.pdf PIA	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 24 CFR 884 24 CFR 886 24 CFR 891 Subpart E 24 CFR Part 5 24 CFR 880 24 CFR 5.233 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent to Release Information			9887.pdf	Yes	No	Fillable Printable
Form and Instruction	HUD 90100	Annual Recertification	90100.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90101	Certification for Qualified Long-Term Care Insurance Expenses	90101.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90104	Exception to Limitations on Admission of Families	90104.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90102	Sample Verification of Disability	90103.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90103	Sample Verificaiton of disability All Programs	90103.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 50059	Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures	50059.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 50059 A	Owner's Certification of Compliance - Partial Certificaiton	50059-a.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90106	Appendix 5 - Sample Move-In/Move Out Inspection Form	90106.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90167	Lease Addendum	90167-ca.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90166	Certificaiton of Domestic Violence, Dating Violence or Stalking	90066.pdf	Yes	No	Fillable Fileable
Form and Instruction	HUD 90105 a	Appendix 4-A Model Lease for Subsidized Programs	90105a.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90105b	Appendix 4-B - Model Lease	90105b.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90105 c	Appendix 4-C 202 PRAC Lease	90105c.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 90105d	Appendix 4-D 811 PRAC Lease	90105d.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 27061-h	Race and Ethnic Reporting Form	27061-h .doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD9887	Document Package for Applicant's/Tenant's Consent to the R	9887.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	90011	Coordinator Access Authorization Form	HUD-90011.docx	Yes	Yes	Fillable Fileable
Form and Instruction	90012	User Access Authorization Form	HUD-90012.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,700,895

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,127,179	825,486	3,301,693
Annual IC Time Burden (Hours)	1,658,471	303,492	1,354,979
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PIA	TRACS Privacy Impact Assessment.pdf	03/18/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.