Information Collection

Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)

IC 223106 under ICR 201902-2502-004 · OMB 2502-0613.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2502-NEW Budget-Neutral Demonstration Program for Energy and Water Conservation Improvements at Multifamily Housing Residential Units (Pay for Success Pilot)	Form and Instruction
2502-NEW Pay for Success Pilot Narrative Template 2502-NEW-PFS Narrative Template (00000002).pdf	Form and Instruction
SF-424 Application for Federal Assistance SF-424_OMB_No._4040-0004.pdf	Form and Instruction
Certification of Owner Eligibility 2502-0613 - Certification of Owner Eligibility.docx	Form and Instruction
Cooperative Agreement 2502-0613 - Cooperative Agreement.docx	Form and Instruction
2530 Previous Participation Certification 2502-0118 - HUD-2530 (Previous Participation Certification).pdf	Form and Instruction
SF-424 CBW Grant Application Detailed Budget Worksheet 2501-0017- SF-424-CBW (Grant Application Detailed Budget Worksheet).xls	Form and Instruction
9250 Funds Authorization 2502-0555 - HUD-9250 (Funds Authorizations).pdf	Form and Instruction
2880 Applicant-Recipient Disclosure - Update Report 2510-0011 - HUD-2880 (Applicant-Recipient Disclosure - Update Report).pdf	Form and Instruction
MFH PFS Program Narrative Template 2502-0613 - MFH PFS Program Narrative Template.docx	Form and Instruction
Site-Specific Environmental Review 2502-0613 - Site-Specific Environmental Review.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	2502-NEW	Pay for Success Pilot Narrative Template	2502-NEW-PFS Narrative Template (00000002).pdf	Yes	Yes	Fillable Printable
Form and Instruction	SF-424	Application for Federal Assistance	SF-424_OMB_No._4040-0004.pdf	Yes	Yes	Fillable Printable
Form and Instruction	N/A	Certification of Owner Eligibility	2502-0613 - Certification of Owner Eligibility.docx	Yes	Yes	Fillable Printable
Form and Instruction	N/A	Cooperative Agreement	2502-0613 - Cooperative Agreement.docx	Yes	Yes	Fillable Printable
Form and Instruction	2530	Previous Participation Certification	2502-0118 - HUD-2530 (Previous Participation Certification).pdf	Yes	Yes	Fillable Printable
Form and Instruction	SF-424 CBW	Grant Application Detailed Budget Worksheet	2501-0017- SF-424-CBW (Grant Application Detailed Budget Worksheet).xls	Yes	Yes	Fillable Printable
Form and Instruction	9250	Funds Authorization	2502-0555 - HUD-9250 (Funds Authorizations).pdf	Yes	Yes	Fillable Printable
Form and Instruction	2880	Applicant-Recipient Disclosure - Update Report	2510-0011 - HUD-2880 (Applicant-Recipient Disclosure - Update Report).pdf	Yes	Yes	Fillable Printable
Form and Instruction	N/A	MFH PFS Program Narrative Template	2502-0613 - MFH PFS Program Narrative Template.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Site-Specific Environmental Review	2502-0613 - Site-Specific Environmental Review.docx	Yes	Yes	Fillable Printable

Line of Business: Energy

Subfunction: Energy Conservation and Preparedness

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15	0	15
Annual IC Time Burden (Hours)	4,401	4,101	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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