Information Collection

Re-entry Assistance Program

IC 214434 under ICR 201412-2577-004 · OMB 2577-0283.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD-96010 Re-entry Assistance Program	Form and Instruction
HUD-96010 E-Logic Model HUD 96010.xls	Form and Instruction
HUD-2991 Certification of Consistency with the Consolidated Plan HUD-2991.pdf	Form and Instruction
HUD-96011 Third Party Documentation Facsimile Transmittal HUD-96011 Third Party Facsimile Transmittal.pdf	Form and Instruction
HUD-27061 Race and Ethnic Data Reporting Form HUD-27061 Race and Ethnic.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 24 CFR 982

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
Form and Instruction	HUD-96010	E-Logic Model	HUD 96010.xls	Yes	Yes	Fillable Printable
Form and Instruction	HUD-2991	Certification of Consistency with the Consolidated Plan	HUD-2991.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-96011	Third Party Documentation Facsimile Transmittal	HUD-96011 Third Party Facsimile Transmittal.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-27061	Race and Ethnic Data Reporting Form	HUD-27061 Race and Ethnic.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33,023	33,023
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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