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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.