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Federal forms, ICRs, and supporting documents

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 202108-0920-014 · OMB 0920-1303.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Evictions Declaration Final 28AUG2020.docx Instruction
Evictions Declaration Final 28AUG2020.docx Instruction
Evictions Declaration Final 28AUG2020_FINAL-Spanish.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
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 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 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 - 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
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 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 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 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 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
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_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_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_Hindi.PDF
CDC Evictions Protection Declaration - Hindi		IC Document
NewEvictionNotice_d1_Haitian Creole.PDF
CDC Evictions Protection Declaration - Haitian Creole		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_Russian.PDF
CDC Evictions Protection Declaration - Russian		IC Document
NewEvictionNotice_d1_Amharic.PDF
CDC Evictions Protection Declaration - Amharic		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
323605B_NewEvictionNotice__ESP_06292021.pdf
CDC Evictions Protection Declaration - Spanish		IC Document
NewEvictionNotice_Arabic.PDF
CDC Evictions Protection Declaration - Arabic		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_Korean.PDF
CDC Evictions Protection Declaration - Korean		IC Document
NewEvictionNotice_d1_Tagalog.PDF
CDC Evictions Protection Declaration - Tagalog		IC Document
NewEvictionNotice_d1_Tagalog.PDF
CDC Evictions Protection Declaration - Tagalog		IC Document
NewEvictionNotice_d1_Vietnamese.PDF
CDC Evictions Protection Declaration - Vietnamese		IC Document
NewEvictionNotice_d1_Vietnamese.PDF
CDC Evictions Protection Declaration - Vietnamese		IC Document
Eviction Declaration_Amharic.pdf
CDC Evictions Protection Declaration - Ahmeric 25AUG2021		IC Document
Eviction Declaration_Amharic.pdf
CDC Evictions Protection Declaration - Ahmeric 25AUG2021		IC Document
Eviction Declaration_Arabic.pdf
CDC Evictions Protection Declaration - Arabic 25AUG2021		IC Document
Eviction Declaration_Arabic.pdf
CDC Evictions Protection Declaration - Arabic 25AUG2021		IC Document
Eviction Declaration_Haitian Creole.pdf
CDC Evictions Protection Declaration - Haitian Creole 25AUG2021		IC Document
Eviction Declaration_Haitian Creole.pdf
CDC Evictions Protection Declaration - Haitian Creole 25AUG2021		IC Document
Eviction Declaration_Hindi.pdf
CDC Evictions Protection Declaration - Hindi 25AUG2021		IC Document
Eviction Declaration_Hindi.pdf
CDC Evictions Protection Declaration - Hindi 25AUG2021		IC Document
Eviction Declaration_Korean.pdf
CDC Evictions Protection Declaration - Korean 25AUG2021		IC Document
Eviction Declaration_Korean.pdf
CDC Evictions Protection Declaration - Korean 25AUG2021		IC Document
Eviction Declaration_Russian.pdf
CDC Evictions Protection Declaration - Russian 25AUG2021		IC Document
Eviction Declaration_Russian.pdf
CDC Evictions Protection Declaration - Russian 25AUG2021		IC Document
Eviction Declaration_Somali.pdf
CDC Evictions Protection Declaration - Somali 25AUG2021		IC Document
Eviction Declaration_Somali.pdf
CDC Evictions Protection Declaration - Somali 25AUG2021		IC Document
Eviction Declaration_Spanish.pdf
CDC Evictions Protection Declaration - Spanish 25AUG2021		IC Document
Eviction Declaration_Spanish.pdf
CDC Evictions Protection Declaration - Spanish 25AUG2021		IC Document
Eviction Declaration_Traditional Chinese.pdf
CDC Evictions Protection Declaration - Traditional Chinese 25AUG2021		IC Document
Eviction Declaration_Traditional Chinese.pdf
CDC Evictions Protection Declaration - Traditional Chinese 25AUG2021		IC Document
Eviction Declaration_Vietnamese.pdf
CDC Evictions Protection Declaration - Vietnamese 25AUG2021		IC Document
Eviction Declaration_Vietnamese.pdf
CDC Evictions Protection Declaration - Vietnamese 25AUG2021		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6,400,000 0 0 0 0 6,400,000
Annual IC Time Burden (Hours) 533,333 0 0 0 0 533,333
Annual IC Cost Burden (Dollars) 0 0 0 0 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
CDC Evictions Protection Declaration - Ahmeric 25AUG2021 Eviction Declaration_Amharic.pdf 08/25/2021
CDC Evictions Protection Declaration - Arabic 25AUG2021 Eviction Declaration_Arabic.pdf 08/25/2021
CDC Evictions Protection Declaration - Haitian Creole 25AUG2021 Eviction Declaration_Haitian Creole.pdf 08/25/2021
CDC Evictions Protection Declaration - Hindi 25AUG2021 Eviction Declaration_Hindi.pdf 08/25/2021
CDC Evictions Protection Declaration - Korean 25AUG2021 Eviction Declaration_Korean.pdf 08/25/2021
CDC Evictions Protection Declaration - Russian 25AUG2021 Eviction Declaration_Russian.pdf 08/25/2021
CDC Evictions Protection Declaration - Somali 25AUG2021 Eviction Declaration_Somali.pdf 08/25/2021
CDC Evictions Protection Declaration - Spanish 25AUG2021 Eviction Declaration_Spanish.pdf 08/25/2021
CDC Evictions Protection Declaration - Traditional Chinese 25AUG2021 Eviction Declaration_Traditional Chinese.pdf 08/25/2021
CDC Evictions Protection Declaration - Vietnamese 25AUG2021 Eviction Declaration_Vietnamese.pdf 08/25/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.