Section 3 Sample Certification Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD 4736C Section 3 Worker Self Certifictaion	Form	New	Available
Form HUD 4736B Section 3 Worker Employer Certfication	Form	New	Repair queued
Form HUD 4736A Section 3 Worker Employer Certification	Form	New	Available
Form HUD 4736 Section 3 PH Certificate	Form	New	Repair queued
Form HUD 4736 Section 3 Public Housing/Section 8 Certification Form	Form	New	Repair queued
30 day FRN Section 3.pdf	Supplementary Document	Uploaded 2022-02-25	Repair queued
Section 3 Certification Forms PRA Supporting Statement.docx	Supporting Statement A	Uploaded 2022-02-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251798	Section 3 Public Housing/Section 8 Certification Form	Form	New	Section 3 Worker Self Certifictaion
251798	Section 3 Public Housing/Section 8 Certification Form	Form	New	Section 3 Worker Employer Certfication
251798	Section 3 Public Housing/Section 8 Certification Form	Form	New	Section 3 Worker Employer Certification
251798	Section 3 Public Housing/Section 8 Certification Form	Form	New	Section 3 PH Certificate
251798	Section 3 Public Housing/Section 8 Certification Form	Form	New

ICR Details

OMB Control No: 2501-0041	ICR Reference No: 202202-2501-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HUD/HUDSEC	Agency Tracking No:
Title: Section 3 Sample Certification Forms
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/29/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/25/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	36 Months From Approved
Responses	2,150	0	0
Time Burden (Hours)	1,075	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection is to provide new sample certification forms pursuant to HUD’s Section 3 regulation codified at 24 CFR Part 75, which is the current regulation published pursuant to requirements in 12 USC 1701u. 24 CFR § 75.31 outlines the ways a worker can be certified as a Section 3 worker or Targeted Section 3 worker. These sample certification forms address these options.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 47135	08/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 3322	01/21/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Section 3 Public Housing/Section 8 Certification Form	HUD 4736A, HUD 4736, HUD 4736C, HUD 4736B	Section 3 PH Certificate ,   Section 3 Worker Employer Certification ,   Section 3 Worker Employer Certfication ,   Section 3 Worker Self Certifictaion

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,150	0	0	2,150	0	0
Annual Time Burden (Hours)	1,075	0	0	1,075	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New Collection

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/25/2022

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