Application for Healthy Homes and Lead Hazard Control Program Grants

Application for Healthy Homes and Lead Hazard Control Grant Programs and Quality Assurance Plans

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2539-0015 can be found here:

Documents and Forms

Document Name Document Type
Form HUD 96012 Application for Healthy Homes and Lead Hazard Control Program Grants Form and Instruction
sf424sup.pdf Other-Survey
2990.pdf Other-Certifiction
2991.pdf Other-Certificaiton
2993.pdf Other-Acknowledgment
HUD 96012 Capacity of the Applicant and Relevant Organizational Ex 96012.pdf Form and Instruction
HUD 96014 Soundness of Approach 96014.pdf Form and Instruction
HUD 96015 Leveraging Resources 96015.pdf Form and Instruction
SF 424 Application for Federal Assistance sf424.doc Form and Instruction
HUD 424 cbw Grant Application Detailed Budget Worksheet 424-cbw.xls Form and Instruction
HUD 27061 Race and Ethnic Data Reporting Form 27061.pdf Form and Instruction
HUD 2880 Disclosure and Update Report 2880.doc Form and Instruction
SF LLL Disclosure of Lobbying Activities Required sflllin.pdf Form and Instruction
HUD 96011 Third Party Documentation 96011.doc Form and Instruction
HUD 96013 Needs/Extent of the Problem 96013_2010-08-10 final.docx Form and Instruction
HUD 96008 Benchmark Standards (36 Months) final 36 month benchmark.xls Form
HUD 96009 Benchmark Standards (42 Months) final 42 month benchmark.xls Form
HH Demo QA template v1 1 Nov05.doc HH Demo QA template v1 1 IC Document
HH tech studies QAP template v2 1 Nov2005.doc HH tech studies QAP template IC Document

Information Collection (IC) Details

IC Title:	Application for Healthy Homes and Lead Hazard Control Program Grants	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 84

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD 96012	Capacity of the Applicant and Relevant Organizational Experience	96012.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96014	Soundness of Approach	96014.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96015	Leveraging Resources	96015.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF 424	Application for Federal Assistance	sf424.doc	Yes	Yes	Fillable Fileable
Other-Survey			sf424sup.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 424 cbw	Grant Application Detailed Budget Worksheet	424-cbw.xls	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 27061	Race and Ethnic Data Reporting Form	27061.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2880	Disclosure and Update Report	2880.doc	Yes	Yes	Fillable Fileable
Other-Certifiction			2990.pdf	Yes	Yes	Fillable Fileable
Other-Certificaiton			2991.pdf	Yes	Yes	Fillable Fileable
Other-Acknowledgment			2993.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF LLL	Disclosure of Lobbying Activities Required	sflllin.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96011	Third Party Documentation	96011.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96013	Needs/Extent of the Problem	96013_2010-08-10 final.docx	Yes	Yes	Fillable Fileable
Form	HUD 96008	Benchmark Standards (36 Months)	final 36 month benchmark.xls	Yes	Yes	Fillable Fileable
Form	HUD 96009	Benchmark Standards (42 Months)	final 42 month benchmark.xls	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	330	0	330
Annual IC Time Burden (Hours)	18,680	-3,080	21,760
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
HH Demo QA template v1 1	HH Demo QA template v1 1 Nov05.doc	03/07/2008
HH tech studies QAP template	HH tech studies QAP template v2 1 Nov2005.doc	03/07/2008

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