Owner's Certification with HUD Tenant Eligibility and Rent Procedures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 90012 User Access Authorization Form	Form and Instruction	Unchanged	Available
Form 90011 Coordinator Access Authorization Form	Form and Instruction	Unchanged	Available
Form HUD9887 Document Package for Applicant's/Tenant's Consent to the R	Form and Instruction	Unchanged	Available
Form HUD 27061-h Race and Ethnic Reporting Form	Form and Instruction	Unchanged	Available
Form HUD 90105d Appendix 4-D 811 PRAC Lease	Form and Instruction	Unchanged	Available
Form HUD 90105 c Appendix 4-C 202 PRAC Lease	Form and Instruction	Unchanged	Available
Form HUD 90105b Appendix 4-B - Model Lease	Form and Instruction	Unchanged	Available
Form HUD 90105 a Appendix 4-A Model Lease for Subsidized Programs	Form and Instruction	Unchanged	Available
Form HUD 90166 Certificaiton of Domestic Violence, Dating Violence or Stalking	Form and Instruction	Unchanged	Available
Form HUD 90167 Lease Addendum	Form and Instruction	Unchanged	Available
Form HUD 90106 Appendix 5 - Sample Move-In/Move Out Inspection Form	Form and Instruction	Unchanged	Available
Form HUD 50059 A Owner's Certification of Compliance - Partial Certificaiton	Form and Instruction	Unchanged	Available
Form HUD 50059 Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Available
Form HUD 90103 Sample Verificaiton of disability All Programs	Form and Instruction	Unchanged	Available
Form HUD 90102 Sample Verification of Disability	Form and Instruction	Unchanged	Available
Form HUD 90104 Exception to Limitations on Admission of Families	Form and Instruction	Unchanged	Available
Form HUD 90101 Certification for Qualified Long-Term Care Insurance Expenses	Form and Instruction	Unchanged	Available
Form HUD 90100 Annual Recertification	Form and Instruction	Unchanged	Available
Race Ethnicity Form 27061-h 1-03_19_2014.pdf	Supplementary Document	Uploaded 2016-09-15	Available
83C (2502-0204).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2016-09-15	Available
Laws and Regs for 2502-0204.doc	Supplementary Document	Uploaded 2014-03-18	Available
Supporting Statement A.doc	Supporting Statement A	Uploaded 2014-03-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	User Access Authorization Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Coordinator Access Authorization Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Document Package for Applicant's/Tenant's Consent to the R
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Race and Ethnic Reporting Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Appendix 4-D 811 PRAC Lease
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Appendix 4-C 202 PRAC Lease
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Appendix 4-B - Model Lease
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Appendix 4-A Model Lease for Subsidized Programs
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Certificaiton of Domestic Violence, Dating Violence or Stalking
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Lease Addendum
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Appendix 5 - Sample Move-In/Move Out Inspection Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Owner's Certification of Compliance - Partial Certificaiton
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Sample Verificaiton of disability All Programs
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Sample Verification of Disability
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Exception to Limitations on Admission of Families
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Certification for Qualified Long-Term Care Insurance Expenses
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Annual Recertification
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Other-Consent to Release Information	Unchanged

ICR Details

OMB Control No: 2502-0204	ICR Reference No: 201609-2502-004
Status: Historical Active	Previous ICR Reference No: 201403-2502-004
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Owner's Certification with HUD Tenant Eligibility and Rent Procedures
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/01/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/13/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	06/30/2017	06/30/2017
Responses	4,127,179	0	4,127,179
Time Burden (Hours)	1,658,471	0	1,658,471
Cost Burden (Dollars)	0	0	0

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Abstract: Collection of tenant data to ensure owners comply with Federal statutes and regulations that (1) establish policies on who may be admitted to subsidized housing; (2) prohibit discrimination in conjunction with selection of tenants and units; (3) specify how tenants’ incomes and rents must be compiled.

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Authorizing Statute(s): US Code: 12 USC 1715z-1 Name of Law: Rental and cooperative housing for lower income families
   US Code: 12 USC 1701s Name of Law: Rent supplement payments for qualified lower income families
   US Code: 42 USC 1437 Name of Law: CHAPTER 8--LOW-INCOME HOUSING
  

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:
	78 FR 45946	07/30/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 18047	03/31/2014
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
Owner's Certification with HUD Tenant Eligibility and Rent Procedures	HUD9887, HUD 50059 A, HUD 90100, HUD 90104, HUD 90101, HUD 90102, HUD 90103, HUD 90106, HUD 90167, HUD 90105 a, HUD 90105 c, HUD 90105b, HUD 90105d, HUD 50059, HUD 90166, HUD 27061-h, 90012, 90011	Annual Recertification ,   Certification for Qualified Long-Term Care Insurance Expenses ,   Exception to Limitations on Admission of Families ,   Sample Verification of Disability ,   Sample Verificaiton of disability All Programs ,   Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures ,   Owner's Certification of Compliance - Partial Certificaiton ,   Appendix 5 - Sample Move-In/Move Out Inspection Form ,   Lease Addendum ,   Certificaiton of Domestic Violence, Dating Violence or Stalking ,   Appendix 4-A Model Lease for Subsidized Programs ,   Appendix 4-B - Model Lease ,   Appendix 4-C 202 PRAC Lease ,   Appendix 4-D 811 PRAC Lease ,   Race and Ethnic Reporting Form ,   Document Package for Applicant's/Tenant's Consent to the R ,   Coordinator Access Authorization Form ,   User Access Authorization Form

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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	4,127,179	4,127,179	0	0	0	0
Annual Time Burden (Hours)	1,658,471	1,658,471	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: There are no program changes relative to this submission or adjustments to Items 13 or 14. As a result of new individuals participating in HUD programs, there has been an increase in the number of respondents, responses and burden hours.

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Annual Cost to Federal Government: $1,850,810

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: 10/13/2016

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