Information Collection

Declaration Under Penalty Of Perjury For The Centers For Disease Control And Prevention's Temporary Halt In Evictions To Prevent Further Spread Of Covid-19

IC 243342 under ICR 202108-0920-003 · OMB 0920-1303.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1303 can be found here:

2021-08-25 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evictions Declaration Final 28AUG2020.docx	Instruction
Evictions Declaration Final 28AUG2020_FINAL-Spanish.docx	Instruction
0920-1303 Evictions Declaration 29DEC2020 EvictionDeclaration_12.29.2020.docx	Form and Instruction
0920-1303 Evictions Declaration 29DEC2020_Spanish EvictionDeclaration_12.29.2020-es.docx	Form and Instruction
0920-1303 Evictions Declaration 29JAN2021 Eviction Declaration Form 1.29.21.docx	Form and Instruction
0920-1303 Evictions Declaration - Spanish 29JAN2021 EvictionDeclarationES 1.29.21.docx	Form and Instruction
0920-1303 Evictions Declaration_Fillable PDF_508 322024_A_EvictionDeclare_508.pdf	Form and Instruction
0920-1303 Evictions Declaration_Fillable PDF_508 - Spanish 322024_B_EvictionDeclare_esp_508.pdf	Form and Instruction
0920-1303 Eviction Protection Declaration 29MAR2021 CDC Eviction Declaration Form FINAL.docx	Form and Instruction
0920-1303 CDC Eviction Protection Declaration 07APR2021 Eviction Protection Declaration 08APR2021.pdf	Form and Instruction
0920-1303 CDC Eviction Protection Declaration 01JUL2021 - English English Declaration 6.24.pdf	Form and Instruction
0920-1303 Evictions Declaration 03AUG2021 Revised CDC Declaration_08.03.2021 final.docx	Form and Instruction
NewEvictionNotice_d1_Somali.PDF CDC Evictions Protection Declaration - Somali	IC Document
NewEvictionNotice_d1_Chinese Hong Kong.PDF CDC Evictions Protection Declaration - Traditional Chinese	IC Document
NewEvictionNotice_d1_Hindi.PDF CDC Evictions Protection Declaration - Hindi	IC Document
NewEvictionNotice_d1_Haitian Creole.PDF CDC Evictions Protection Declaration - Haitian Creole	IC Document
NewEvictionNotice_d1_Russian.PDF CDC Evictions Protection Declaration - Russian	IC Document
NewEvictionNotice_d1_Amharic.PDF CDC Evictions Protection Declaration - Amharic	IC Document
323605B_NewEvictionNotice__ESP_06292021.pdf CDC Evictions Protection Declaration - Spanish	IC Document
NewEvictionNotice_Arabic.PDF CDC Evictions Protection Declaration - Arabic	IC Document
NewEvictionNotice_d1_Korean.PDF CDC Evictions Protection Declaration - Korean	IC Document
NewEvictionNotice_d1_Tagalog.PDF CDC Evictions Protection Declaration - Tagalog	IC Document
NewEvictionNotice_d1_Vietnamese.PDF CDC Evictions Protection Declaration - Vietnamese	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DECLARATION UNDER PENALTY OF PERJURY FOR THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S TEMPORARY HALT IN EVICTIONS TO PREVENT FURTHER SPREAD OF COVID-19

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

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
Instruction			Evictions Declaration Final 28AUG2020.docx	NA	Yes	Yes	Fillable Fileable
Instruction			Evictions Declaration Final 28AUG2020_FINAL-Spanish.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration 29DEC2020	EvictionDeclaration_12.29.2020.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration 29DEC2020_Spanish	EvictionDeclaration_12.29.2020-es.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration 29JAN2021	Eviction Declaration Form 1.29.21.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration - Spanish 29JAN2021	EvictionDeclarationES 1.29.21.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration_Fillable PDF_508	322024_A_EvictionDeclare_508.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration_Fillable PDF_508 - Spanish	322024_B_EvictionDeclare_esp_508.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Eviction Protection Declaration 29MAR2021	CDC Eviction Declaration Form FINAL.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	CDC Eviction Protection Declaration 07APR2021	Eviction Protection Declaration 08APR2021.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	CDC Eviction Protection Declaration 01JUL2021 - English	English Declaration 6.24.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1303	Evictions Declaration 03AUG2021	Revised CDC Declaration_08.03.2021 final.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,400,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,400,000	6,400,000
Annual IC Time Burden (Hours)	533,333	533,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CDC Evictions Protection Declaration - Somali	NewEvictionNotice_d1_Somali.PDF	07/01/2021
CDC Evictions Protection Declaration - Traditional Chinese	NewEvictionNotice_d1_Chinese Hong Kong.PDF	07/01/2021
CDC Evictions Protection Declaration - Hindi	NewEvictionNotice_d1_Hindi.PDF	07/01/2021
CDC Evictions Protection Declaration - Haitian Creole	NewEvictionNotice_d1_Haitian Creole.PDF	07/01/2021
CDC Evictions Protection Declaration - Russian	NewEvictionNotice_d1_Russian.PDF	07/01/2021
CDC Evictions Protection Declaration - Amharic	NewEvictionNotice_d1_Amharic.PDF	07/01/2021
CDC Evictions Protection Declaration - Spanish	323605B_NewEvictionNotice__ESP_06292021.pdf	07/01/2021
CDC Evictions Protection Declaration - Arabic	NewEvictionNotice_Arabic.PDF	07/01/2021
CDC Evictions Protection Declaration - Korean	NewEvictionNotice_d1_Korean.PDF	07/01/2021
CDC Evictions Protection Declaration - Tagalog	NewEvictionNotice_d1_Tagalog.PDF	07/01/2021
CDC Evictions Protection Declaration - Vietnamese	NewEvictionNotice_d1_Vietnamese.PDF	07/01/2021

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