Public Housing Capital Fund Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD-53015 INSTRUCTIONS FOR PREPARATION OF TURNKEY CONTRACT OF SALE FORM HUD-53015, PART I AND PART II	Form and Instruction	Modified	Available
Form HUD-52849 Capital Fund Financing Program Pooled Transaction: List of Participating PHAs	Form and Instruction	Modified	Available
Form HUD-52847 Capital Fund Financing Program (CFFP) Monthly Debt Service Schedule - Formula Funds Only	Form and Instruction	Modified	Repair queued
Form HUD-52846 Capital Fund Financing Program (CFFP) Periodic Payment Debt Service Schedule - Formula Funds Only	Form and Instruction	Modified	Repair queued
Form HUD-52845 Capital Fund Financing Program - Term Sheet	Form and Instruction	Modified	Available
Form HUD-52833 Management Needs Assessment Comprehensive Grant Program (CGP)	Form and Instruction	Modified	Available
Form HUD - 52830 Capital Fund Financing Program Portfolio Schedule Form	Form and Instruction	Modified	Available
Form HUD-52829 Physical Needs Assessment Capital Fund Financing Program Operating Fund Financing Program	Form and Instruction	Modified	Available
Form HUD-52828 GRP Model Version	Form and Instruction	Modified	Available
Form HUD-52651-a Site, Design and Cost Report	Form and Instruction	Modified	Available
Form HUD-52485 Demonstration of Financial Feasibility	Form and Instruction	Modified	Available
Form HUD-52484 Development Cost Budget/ Cost Statement	Form and Instruction	Modified	Available
Form HUD-52483-a Proposal for a Public Housing Project	Form and Instruction	Modified	Available
Form HUD 52482 Guide Form of Turnkey Developer's Packet	Form and Instruction	Modified	Available
Form 52427 Actual Development Cost Certificate	Form and Instruction	Modified	Available
Form HUD-52396 Analysis of Proposed Main Construction Contract	Form and Instruction	Modified	Available
Form HUD 51971-1 and 51 Offer of Sale of Real Property	Form and Instruction	Modified	Available
Form HUD-51915A Contract Provisions Required by Federal Lawor Owner Contract with the	Form and Instruction	Modified	Available
Form HUD-51915 Model Form of Agreement Between Owner and Design Professional	Form and Instruction	Modified	Available
Form HUD-51004 Summary of Materials Stored	Form and Instruction	Modified	Available
Form HUD-51003 Schedule of Materials Stored	Form and Instruction	Modified	Available
Form HUD-51002 Schedule of Change Orders	Form and Instruction	Modified	Available
Form HUD-51001 Periodic Estimate for Partial Payment	Form and Instruction	Modified	Repair queued
Form HUD -51000 Schedule of Amounts for Contract Payments	Form and Instruction	Modified	Available
Form HUD-50075.2 Annual Statement/Performance and Evaluation Report Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital	Form and Instruction	Modified	Available
Form HUD-50075.1 Annual Statement/Performance and Evaluation Report , Capital Fund Program, Capital Fund Program Replacement Housing Factor and ....	Form and Instruction	Modified	Available
Form HUD-50071 Certification of Payments	Form and Instruction	Modified	Available
Form HUD-5460 Insurance Information	Form and Instruction	Modified	Available
Form HUD-5378 Public Housing Construction Report	Form and Instruction	Modified	Available
Form HUD-5372 Construction Progress Schedule	Form and Instruction	Modified	Available
Form HUD-5370-EZ General Contract Conditions for Small Construction/Development Contracts	Form and Instruction	Modified	Available
Form HUD-5370-C2 General Conditions for Non-Construction Contracts - Section 1 (With Maintenance Work)	Form and Instruction	Modified	Available
Form HUD-5370 General Conditions for Construction Contract - Public Housing Programs	Form and Instruction	Modified	Available
Form HUD 5087 Outline Specification	Form and Instruction	Modified	Repair queued
Form HUD-53001 Actual Mordernization Cost Certificate	Form and Instruction	Modified	Available
Form HUD-5370-C1 General Conditions for Non-Construction Contracts - Section 1 - (With or Without Maintenance Work)	Form and Instruction	Modified	Available
83-i revised 01-21-2016 ncm edits revised with hrs for high speed internet.docx	Supporting Statement A	Uploaded 2016-01-21	Available
IPA Form.docm	Supplementary Document	Uploaded 2015-12-07	Available
Published 60-day FR Notice.pdf	Supplementary Document	Uploaded 2015-12-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	INSTRUCTIONS FOR PREPARATION OF TURNKEY CONTRACT OF SALE FORM HUD-53015, PART I AND PART II
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program Pooled Transaction: List of Participating PHAs
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program (CFFP) Monthly Debt Service Schedule - Formula Funds Only
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program (CFFP) Periodic Payment Debt Service Schedule - Formula Funds Only
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program - Term Sheet
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Management Needs Assessment Comprehensive Grant Program (CGP)
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Capital Fund Financing Program Portfolio Schedule Form
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Physical Needs Assessment Capital Fund Financing Program Operating Fund Financing Program
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	GRP Model Version
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Site, Design and Cost Report
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Demonstration of Financial Feasibility
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Development Cost Budget/ Cost Statement
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Proposal for a Public Housing Project
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Guide Form of Turnkey Developer's Packet
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Actual Development Cost Certificate
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Analysis of Proposed Main Construction Contract
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Offer of Sale of Real Property
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Contract Provisions Required by Federal Lawor Owner Contract with the
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Model Form of Agreement Between Owner and Design Professional
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Summary of Materials Stored
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Schedule of Materials Stored
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Schedule of Change Orders
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Periodic Estimate for Partial Payment
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Schedule of Amounts for Contract Payments
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Annual Statement/Performance and Evaluation Report Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Annual Statement/Performance and Evaluation Report , Capital Fund Program, Capital Fund Program Replacement Housing Factor and ....
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Certification of Payments
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Insurance Information
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Public Housing Construction Report
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Construction Progress Schedule
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	General Contract Conditions for Small Construction/Development Contracts
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	General Conditions for Non-Construction Contracts - Section 1 (With Maintenance Work)
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	General Conditions for Construction Contract - Public Housing Programs
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Outline Specification
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	Actual Mordernization Cost Certificate
27829	Public Housing Capital Fund Program	Form and Instruction	Modified	General Conditions for Non-Construction Contracts - Section 1 - (With or Without Maintenance Work)

ICR Details

OMB Control No: 2577-0157	ICR Reference No: 201511-2577-002
Status: Historical Active	Previous ICR Reference No: 201507-2577-003
Agency/Subagency: HUD/PIH	Agency Tracking No: 2577-0157
Title: Public Housing Capital Fund Program
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: 08/24/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/22/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved	01/31/2017
Responses	79,044	0	72,844
Time Burden (Hours)	306,537	0	265,617
Cost Burden (Dollars)	0	0	0

---

Abstract: Each year Congress appropriates funds to approximately 3,100 Public Housing Authorities (PHAs) for modernization, development, financing, and management improvements. The funds are allocated based on a complex formula. The forms in this collection are used to appropriately disburse and utilize the funds provided to PHAs. Additionally, these forms provide the information necessary to approve a financing transaction in addition to any Capital Fund Financing transactions. Respondents include the approximately 3,100 PHA receiving Capital Funds and any other PHAs wishing to pursue financing.

---

Authorizing Statute(s): US Code: 44 USC Chapter 35, as amended Name of Law: Section 3506 of the Paperwork Reduction Act of 1995
  

Citations for New Statutory Requirements: US Code: 42 USC 1437q Name of Law: Section 9 of the U.S. Housing Act of 1937

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2577-AC50	Final or interim final rulemaking	78 FR 206	10/24/2013

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 72095	11/18/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9215	02/24/2016
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Public Housing Capital Fund Program	HUD-52845, HUD-52846, HUD-52849, HUD-50075.1, HUD-52484, HUD-52828 , HUD-53015, HUD-50071, HUD-51002, HUD-51003, HUD-51004, HUD-51915, 52427, HUD-52483-a, HUD 52482, HUD-53001, HUD-5370-EZ, HUD-5370-C1, HUD-52651-a, HUD-5370-C2, HUD-5378, HUD-5460, HUD-50075.2, HUD -51000, HUD-51001, HUD-51915A, HUD 51971-1 and 51971-2, HUD-52396, HUD-52485, HUD 5087, HUD-5372, HUD-52829, HUD-52833, HUD-52847, HUD-5370, HUD - 52830	Actual Mordernization Cost Certificate ,   Outline Specification ,   General Conditions for Construction Contract - Public Housing Programs ,   General Conditions for Non-Construction Contracts - Section 1 - (With or Without Maintenance Work) ,   General Conditions for Non-Construction Contracts - Section 1 (With Maintenance Work) ,   General Contract Conditions for Small Construction/Development Contracts ,   Construction Progress Schedule ,   Public Housing Construction Report ,   Insurance Information ,   Certification of Payments ,   Annual Statement/Performance and Evaluation Report , Capital Fund Program, Capital Fund Program Replacement Housing Factor and .... ,   Annual Statement/Performance and Evaluation Report Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital ,   Schedule of Amounts for Contract Payments ,   Periodic Estimate for Partial Payment ,   Schedule of Change Orders ,   Schedule of Materials Stored ,   Summary of Materials Stored ,   Model Form of Agreement Between Owner and Design Professional ,   Contract Provisions Required by Federal Lawor Owner Contract with the ,   Offer of Sale of Real Property ,   Analysis of Proposed Main Construction Contract ,   Actual Development Cost Certificate ,   Guide Form of Turnkey Developer's Packet ,   Proposal for a Public Housing Project ,   Development Cost Budget/ Cost Statement ,   Demonstration of Financial Feasibility ,   Site, Design and Cost Report ,   GRP Model Version ,   Physical Needs Assessment Capital Fund Financing Program Operating Fund Financing Program ,   Capital Fund Financing Program Portfolio Schedule Form ,   Management Needs Assessment Comprehensive Grant Program (CGP) ,   Capital Fund Financing Program - Term Sheet ,   Capital Fund Financing Program (CFFP) Periodic Payment Debt Service Schedule - Formula Funds Only ,   Capital Fund Financing Program (CFFP) Monthly Debt Service Schedule - Formula Funds Only ,   Capital Fund Financing Program Pooled Transaction: List of Participating PHAs ,   INSTRUCTIONS FOR PREPARATION OF TURNKEY CONTRACT OF SALE FORM HUD-53015, PART I AND PART II

---

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	79,044	72,844	0	0	6,200	0
Annual Time Burden (Hours)	306,537	265,617	0	0	40,920	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: 1. HUD is estimating the hours for the annual submission of forms HUD-50075.1 and HUD-50075.2 will increase the burden by 10,540 hours (HUD-50075.1 - 3,100 responses times 2.4 hours per response, HUD-50075.3 - 3,100 responses times 1 hour per response). These hours were transferred from OMB No. 2577-0274 PHA Plan PRA per the new Capital Fund Rule 24 CFR 905) and the decoupling of the Capital Fund Annual submission from the PHA Plan annual submission. In addition, HUD is adding hours to account for determining whether installation of broadband infrastructure is feasible for new construction of public housing units or modernization of public housing units. This determination is based on a review of the overall costs of the project and the cost of broadband installation, and the location and structure of the building. This information is available from construction estimates; however PHAs will need to prepare a statement justifying the decision and maintain records of the determination; accordingly, HUD is allotting ten hours per PHA to this effort. This is based on an estimate of 5 projects per PHA, and 2 hours per project to review construction estimates and prepare a justification.

---

Annual Cost to Federal Government: $4,326,400

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

---

Common Form ICR:  No

---

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: 06/22/2016

---