Information Collection

Debts Owed To Public Housing Agencies and Terminations

IC 192077 under ICR 201905-2577-001 · OMB 2577-0266.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2577-0266 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD-52675 Debts Owed To Public Housing Agencies and Terminations	Form and Instruction
EIV System Screen Shots 2019.docx	Other-EIV Screen Shots
HUD-52675 Debts Owned to Public Housing Agencies and Terminators Form HUD 52675 .pdf	Form and Instruction

IC Title:

Debts Owed To Public Housing Agencies and Terminations

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 5.233

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD-52675	Debts Owned to Public Housing Agencies and Terminators	Form HUD 52675 .pdf		Yes	Yes	Fillable Fileable Signable
Other-EIV Screen Shots			EIV System Screen Shots 2019.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,834

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	46,008	-1,236	47,244
Annual IC Time Burden (Hours)	24,841	-1,336	26,177
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.