Application for displacement/relocation assistance for person

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD 40058-S Claim for Rental Assistance or Down payment Assistance	Form and Instruction	Unchanged	Available
Form HUD 40030 Claim for Temporary Relocation	Form and Instruction	Unchanged	Available
Form HUD-40072 Claim for Rental of Purchase Assistance	Form and Instruction	Unchanged	Available
Form HUD-40061 Selection of Most Representative Comparable Replacement Dwelling	Form	Unchanged	Available
Form HUD-40058 Claim for Rental Assistance or Down Payment Assistance (49 CFR 24.402 and 24.401 (f))	Form	Unchanged	Available
Form HUD-40057 Claim for Replacement Housing Payment for 180-Day Homeoowner-Occupant (49 CFR 24.401)	Form	Unchanged	Available
Form HUD-40056 Claim for Fixed Payment in Lieu of Payment for Actual Nonresdidential Moving and Related Expenses	Form	Unchanged	Available
Form HUD-40055 Claim for Actual Reasonable Moving and Related Expenses-Nonresidential	Form	Unchanged	Available
Form HUD-40054 Residential Claim for Moving and Related Expenses	Form	Unchanged	Available
30 day notice.pdf	Supplementary Document	Uploaded 2014-11-26	Available
2014 Claim Form IPA_091914.doc	Supplementary Document	Uploaded 2014-10-20	Available
Relocation Claim Forms 2014 OMB-83-I 9-10-14.doc	Supporting Statement A	Uploaded 2014-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27392	Application for displacement/relocation assistance for person	Form and Instruction	Unchanged	Claim for Rental Assistance or Down payment Assistance
27392	Application for displacement/relocation assistance for person	Form and Instruction	Unchanged	Claim for Temporary Relocation
27392	Application for displacement/relocation assistance for person	Form and Instruction	Unchanged	Claim for Rental of Purchase Assistance
27392	Application for displacement/relocation assistance for person	Form	Unchanged	Selection of Most Representative Comparable Replacement Dwelling
27392	Application for displacement/relocation assistance for person	Form	Unchanged	Claim for Rental Assistance or Down Payment Assistance (49 CFR 24.402 and 24.401 (f))
27392	Application for displacement/relocation assistance for person	Form	Unchanged	Claim for Replacement Housing Payment for 180-Day Homeoowner-Occupant (49 CFR 24.401)
27392	Application for displacement/relocation assistance for person	Form	Unchanged	Claim for Fixed Payment in Lieu of Payment for Actual Nonresdidential Moving and Related Expenses
27392	Application for displacement/relocation assistance for person	Form	Unchanged	Claim for Actual Reasonable Moving and Related Expenses-Nonresidential
27392	Application for displacement/relocation assistance for person	Form	Unchanged	Residential Claim for Moving and Related Expenses

ICR Details

OMB Control No: 2506-0016	ICR Reference No: 201410-2506-004
Status: Historical Active	Previous ICR Reference No: 201110-2506-003
Agency/Subagency: HUD/CPD	Agency Tracking No:
Title: Application for displacement/relocation assistance for person
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: 04/06/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/08/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	61,800	0	61,800
Time Burden (Hours)	56,000	0	56,000
Cost Burden (Dollars)	0	0	0

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Abstract: Application for displacement/relocation for person (families, individuals, businesses, nonprofit organizations and farms) displaced by certain HUD programs. Periodically, HUD reviews a random sample of the Agency files to assure that persons did received the relocation payments to which they are entitled.

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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:
	79 FR 56087	09/18/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69877	11/24/2014
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
Application for displacement/relocation assistance for person	HUD-40054, HUD-40055, HUD-40056, HUD-40057, HUD-40058, HUD-40061, HUD-40072, HUD 40030, HUD 40058-S	Residential Claim for Moving and Related Expenses ,   Claim for Actual Reasonable Moving and Related Expenses-Nonresidential ,   Claim for Fixed Payment in Lieu of Payment for Actual Nonresdidential Moving and Related Expenses ,   Claim for Replacement Housing Payment for 180-Day Homeoowner-Occupant (49 CFR 24.401) ,   Claim for Rental Assistance or Down Payment Assistance (49 CFR 24.402 and 24.401 (f)) ,   Selection of Most Representative Comparable Replacement Dwelling ,   Claim for Rental of Purchase Assistance ,   Claim for Temporary Relocation ,   Claim for Rental Assistance or Down payment Assistance

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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	61,800	61,800	0	0	0	0
Annual Time Burden (Hours)	56,000	56,000	0	0	0	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:

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Annual Cost to Federal Government: $57,940

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: 12/08/2014

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