Pay for Success Pilot Application Requirements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Site-Specific Environmental Review	Form and Instruction	Modified	Available
MFH PFS Program Narrative Template	Form and Instruction	Modified	Available
Form 2880 Applicant-Recipient Disclosure - Update Report	Form and Instruction	Modified	Available
Form 9250 Funds Authorization	Form and Instruction	Modified	Available
Form SF-424 CBW Grant Application Detailed Budget Worksheet	Form and Instruction	Modified	Available
Form 2530 Previous Participation Certification	Form and Instruction	Modified	Available
Cooperative Agreement	Form and Instruction	Modified	Available
Certification of Owner Eligibility	Form and Instruction	Modified	Available
Form SF-424 Application for Federal Assistance	Form and Instruction	Modified	Available
Form 2502-NEW Pay for Success Pilot Narrative Template	Form and Instruction	Modified	Available
2502-0613.pdf	Supplementary Document	Uploaded 2019-09-09	Available
2502-0613 - PTA (Signed by Privacy Office).pdf	Supplementary Document	Uploaded 2019-08-22	Available
Congressional Implementation Plan-Energy and Water.pdf	Supplementary Document	Uploaded 2016-08-19	Available
2502-NEW-Pay For Success Authorizing Statute.pdf	Supplementary Document	Uploaded 2016-08-19	Available
2502-0613 Supporting Statement (7-23-19).docx	Supporting Statement A	Uploaded 2019-08-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Site-Specific Environmental Review
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	MFH PFS Program Narrative Template
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Applicant-Recipient Disclosure - Update Report
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Funds Authorization
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Grant Application Detailed Budget Worksheet
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Previous Participation Certification
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Cooperative Agreement
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Certification of Owner Eligibility
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Application for Federal Assistance
223106	Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction	Modified	Pay for Success Pilot Narrative Template

ICR Details

OMB Control No: 2502-0613	ICR Reference No: 201902-2502-004
Status: Historical Active	Previous ICR Reference No: 201608-2502-005
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Pay for Success Pilot Application Requirements
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: 09/10/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/09/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2022	36 Months From Approved	01/31/2020
Responses	15	0	15
Time Burden (Hours)	4,401	0	300
Cost Burden (Dollars)	0	0	0

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Abstract: The Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot) authorizes HUD to establish a competitive process for selecting one or more qualified intermediaries who will, per agreements with HUD, be responsible for initiating and managing an energy and water conservation retrofit program. These retrofits are authorized at properties participating in the project-based rental assistance (PBRA) program under section 8 of the United States Housing Act of 1937; supportive housing for the elderly program operating under section 202 of the Housing Act of 1959; and supportive housing for persons with disabilities under section 811(d)(2) of the Cranston-Gonzalez National Affordable Housing Act. The documents that are the subject of this notice are those used by applicants applying to participate in this program.

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Authorizing Statute(s): PL: Pub.L. 114 - 94 81001 Name of Law: Fixing America’s Surface Transportation Act
  

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:
	84 FR 20167	05/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 39360	08/09/2019
Did the Agency receive public comments on this ICR? Yes

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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
Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	N/A, N/A, SF-424, N/A, N/A, 2530, SF-424 CBW, 9250, 2880, 2502-NEW	Pay for Success Pilot Narrative Template ,   Application for Federal Assistance ,   Certification of Owner Eligibility ,   Cooperative Agreement ,   Previous Participation Certification ,   Grant Application Detailed Budget Worksheet ,   Funds Authorization ,   Applicant-Recipient Disclosure - Update Report ,   MFH PFS Program Narrative Template ,   Site-Specific Environmental Review

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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	15	15	0	0	0	0
Annual Time Burden (Hours)	4,401	300	0	0	4,101	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: This is a revision of a currently approved collection. Intermediaries will work with owners to install energy water conservation retrofits on properties that are eligible to participate in the PFS Pilot. Burden has increased with this revision and is reflected in item 13.

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Annual Cost to Federal Government: $195,817

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 09/09/2019

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