Information Collection

Application for Healthy Homes and Lead Hazard Control Program Grants

IC 27731 under ICR 201711-2539-001 · OMB 2539-0015.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.