Information Collection

COVID-19 Supplemental Payment Requests

IC 242755 under ICR 202212-2502-001 · OMB 2502-0619.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD-52671-e (12-1- COVID-19 Supplemental Payment Requests	Form and Instruction
HUD-52671-e (12-1- COVID-19 Supplemental Payment Requests 2502-0619 - HUD-52671-e.pdf	Form and Instruction
HUD-52671-e (12-22 COVID-19 Supplemental Payment Requests 52671-e_Round V Final Draft for Posting_12-22.pdf	Form and Instruction

IC Title:

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 (12-22-22)	COVID-19 Supplemental Payment Requests	52671-e_Round V Final Draft for Posting_12-22.pdf		Yes	Yes	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	46,400	46,400
Annual IC Time Burden (Hours)	25,520	25,520
Annual IC Cost Burden (Dollars)	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.