Information Collection

COVID-19 Supplemental Payment Requests

IC 242755 under ICR 202203-2502-001 · OMB 2502-0619.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2502-0619 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD-52671-e COVID-19 Supplemental Payment Requests	Form and Instruction
HUD-52671-e COVID-19 Supplemental Payment Requests 2502-0619 - HUD-52671-e.pdf	Form and Instruction
HUD-52671-e COVID-19 Supplemental Payment Requests 2502-0619 - HUD-52671-e.pdf	Form and Instruction
2502-0619 - CSP Supplemental Certification (DocuSign) 2502-0619 - CSP Supplemental Certification (DocuSign) 5-11-22.docx	Form and Instruction
2502-0619 - CSP Supplemental Certification (DocuSign) 2502-0619 - CSP Supplemental Certification (DocuSign) 5-11-22.docx	Form and Instruction

IC Title:

COVID-19 Supplemental Payment Requests

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 2

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-52671-e	COVID-19 Supplemental Payment Requests	2502-0619 - HUD-52671-e.pdf		Yes	Yes	Fillable Printable
Form and Instruction	N/A	2502-0619 - CSP Supplemental Certification (DocuSign)	2502-0619 - CSP Supplemental Certification (DocuSign) 5-11-22.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	46,400	23,200	23,200
Annual IC Time Burden (Hours)	25,520	0	25,520
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.