2577-0286_60day FRN

66723

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices
be lowered from $67.00 to $41.00. The
fee for a new and renewal HME
enrollment at a UES enrollment center
will remain the same at $86.50.
Future changes to HME services and
fees will be published as Notice in the
Federal Register and on the TSA
website at https://www.tsa.gov/forindustry/hazmat-endorsement.
III. Authority To Collect and
Methodology To Calculate Fee Changes
Congress directed TSA to collect user
fees to cover the costs of its
transportation vetting and credentialing
programs.10 TSA must collect fees to
pay for conducting all portions of an
STA; reviewing and adjudicating
requests for correction of records,
appeals, and waivers; information
technology costs; personnel costs; and
any other costs related to conducting the
STA, providing a credential, or
providing states the driver’s eligibility
determination.

The statute requires that any fee
collected must be available only to pay
for the costs incurred in providing
services in connection with performing
the STA. The funds generated by the fee
do not have a limited period of time in
which they must be used; as fee revenue
and service costs do not always match
perfectly for a given period, a program
may need to carry over funding from
one fiscal year to the next to ensure that
sufficient funds are available to
continue normal program operations.
TSA complies with applicable
requirements, such as the Chief
Financial Officers Act of 1990 11 and
Office of Management and Budget
Circular A–25,12 and regularly reviews
the fees to ensure they recover, but do
not exceed the full cost of services.
TSA established the methodology for
calculating the vetting fees for the TWIC
and HME programs through notice and
comment rulemaking, and stated that
any fee changes using that same

methodology would be published in a
Notice.13 TSA uses that same
methodology to evaluate the current fees
and in establishing new fee amounts.
In 2013, TSA revised the TWIC and
HME regulations to remove references to
specific fee amounts and provide TSA
with flexibility to modify fees, as
necessary, to ensure that STA,
enrollment, and credentialing fees
reflect their associated costs and the
programs could continue to operate if
the costs exceeded regulatory caps.14 As
a result of this rulemaking, TSA may
change the fees as appropriate and
provide Notice in the Federal Register
to inform affected stakeholders of the
revised fees and the basis for the
changes.15
IV. Fee Announcements
The vetting fees for the TWIC and
HME programs are set forth below:

TABLE 1—COMPARISON OF CURRENT AND NEW TWIC AND HME FEES AND ENROLLMENT TYPE
TWIC Program Fees

HME Program Fees

Enrollment type
Current
New Enrollment ...............................................................................................
Renewal (In-Person) ........................................................................................
Renewal (Online) .............................................................................................
Comparable STA .............................................................................................
Replacement Card ...........................................................................................

In addition to a notice published in
the Federal Register, TSA will publish
these fees on the TSA website: https://
www.tsa.gov/for-industry/hazmatendorsement and https://www.tsa.gov/
for-industry/twic, as applicable.
Note that applicants may choose the
respective program’s enrollment option
that best meets their needs based on the
convenience of enrollment center
locations and their eligibility for inperson or online renewal options.
Drivers who require an HME in a state
that does not use TSA’s enrollment
agent are subject to fees established by
the state, not TSA.

khammond on DSKJM1Z7X2PROD with NOTICES

Dated: November 1, 2022.
Austin Gould,
Acting Executive Assistant Administrator,
Operations Support.
[FR Doc. 2022–24101 Filed 11–3–22; 8:45 am]
BILLING CODE 9110–05–P

10 See

6 U.S.C. 469(a).
31 U.S.C. 501 et seq.
12 See http://www.whitehouse.gov/omb/circulars_
a025.
11 See

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18:12 Nov 03, 2022

Jkt 259001

$125.25
125.25
N/A
105.25
60.00

New

Current

$125.25
125.25
117.25
93.00
60.00

DATES:

[Docket No. FR–7061–N–18]

ADDRESSES:

Offices of Housing, Public and
Indian Housing, and Community
Planning and Development, HUD.
ACTION: Notice.
AGENCY:

HUD is seeking approval from
the Office of Management and Budget
(OMB) for the information collection
described below. In accordance with the
Paperwork Reduction Act, HUD is
requesting comment from all interested
parties on the proposed collection of
information. The purpose of this notice
is to allow for 60 days of public
comment.

SUMMARY:

13 See 72 FR 55043 (September 28, 2007), 70 FR
2542 (Jan. 13, 2005).
14 See Final Rule, Provisions for Fees Related to
Hazardous Materials Endorsements and

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Frm 00085

Fmt 4703

Sfmt 4703

$86.50
86.50
N/A
41.00
N/A

Comments Due Date: January 3,

DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT

60-Day Notice of Proposed Information
Collection: Implementation of the
Violence Against Women
Reauthorization Act of 2013, OMB
Control No.: 2577–0286

$86.50
86.50
N/A
67.00
N/A

New

2023.
Interested persons are
invited to submit comments regarding
this proposal. Comments should refer to
the proposal by name and/or OMB
Control Number and should be sent to:
Colette Pollard, Reports Management
Officer, REE, Department of Housing
and Urban Development, 451 7th Street
SW, Room 4176, Washington, DC
20410–5000; telephone 202–402–3400
(this is not a toll-free number) or email
at [email protected]. A copy of
the proposed forms is available from
Ms. Pollard. HUD welcomes and is
prepared to receive calls from
individuals who are deaf or hard of
hearing, as well as individuals with
speech and communication disabilities.
To learn more about how to make an
accessible telephone call, please visit
https://www.fcc.gov/consumers/guides/
telecommunications-relay-service-trs.

Transportation Worker Identification Credentials,
78 FR 45353 (April 16, 2013).
15 See 49 CFR 1572.403(a) (State collection of
HME fees), 1572.405(a) (TSA collection of HME
fees), and 1572.501(g) (imposition of TWIC fees).

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Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

Leea
Thornton, Office of Policy, Program and
Legislative Initiatives, PIH, Department
of Housing and Urban Development,
451 7th Street SW, Room 3178,
Washington, DC 20410; telephone 202–
402–6455. HUD welcomes and is
prepared to receive calls from
individuals who are deaf or hard of
hearing, as well as individuals with
speech and communication disabilities.
To learn more about how to make an
accessible telephone call, please visit
https://www.fcc.gov/consumers/guides/
telecommunications-relay-service-trs.
Copies of available documents
submitted to OMB may be obtained
from Ms. Thornton.
SUPPLEMENTARY INFORMATION: This
notice informs the public that HUD is
seeking approval from OMB for the
information collection described in
Section A.

khammond on DSKJM1Z7X2PROD with NOTICES

FOR FURTHER INFORMATION CONTACT:

A. Overview of Information Collection
Title of Information Collection:
Implementation of the Violence Against
Women Reauthorization Act of 2013.
OMB Approval Number: 2577–0286.
Type of Request: Reinstatement, with
change, of previously approved
collection for which approval has
expired.
Form Number: HUD–5380, HUD–
5381, HUD–5382, and HUD–5383.
Other: Emergency transfer reporting,
lease bifurcation, and lease addendum.
Description of the need for the
information and proposed use: The
Violence Against Women
Reauthorization Act of 2013 (VAWA
2013), Public Law 113–4, 127 Stat. 54,
reauthorized and amended the Violence
Against Women Act of 1994, as
previously amended (title IV, sec.
40001–40703 of Pub. L. 103–322, 42
U.S.C. 13925 et seq.). In doing so,
VAWA 2013 expanded the VAWA
protections that applied to HUD’s
Section 8 and Public Housing programs
and widened the range of HUD’s
housing programs that are subject to
VAWA protections. The provisions of
VAWA 2013 that afford protections to
victims of domestic violence, dating
violence, sexual assault, and stalking are
statutory and statutorily directed to be
implemented. Accordingly, on
November 16, 2016, HUD published a
final rule at 81 FR 80724 (VAWA Rule),
implementing VAWA 2013’s provisions
in its housing programs. The Violence
Against Women Act Reauthorization
Act of 2022 (VAWA 2022) was signed
March 15, 2022, however certain
provisions are not self-implementing.
Once VAWA 2022 has been
implemented this PRA will be further
updated, as appropriate.

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Jkt 259001

The HUD programs that include
VAWA protections as required by
VAWA 2013 and the VAWA rule
include:
• Section 202 Supportive Housing for
the Elderly (12 U.S.C. 1701q);
• Section 811 Supportive Housing for
Persons with Disabilities (42 U.S.C.
8013);
• Housing Opportunities for Persons
with AIDS (HOPWA) program (42
U.S.C. 12901 et seq);
• HOME Investment Partnerships
(HOME) program (42 U.S.C. 12741 et
seq.);
• Homeless programs under title IV of
the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11360 et seq.),
including the Emergency Solutions
Grants (ESG) program; the Continuum of
Care (CoC) program; and the Rural
Housing Stability Assistance program;
• Multifamily rental housing under
section 221(d)(3) of the National
Housing Act (12 U.S.C. 17151(d)) with
a below-market interest rate (BMIR)
pursuant to section 221(d)(5);
• Multifamily rental housing under
section 236 of the National Housing Act
(12 U.S.C. 1715z–1);
• HUD programs assisted under the
United States Housing Act of 1937 (42
U.S.C. 1437 et seq.); specifically, public
housing under section 6 of the 1937 Act
(42 U.S.C. 1437d), tenant-based and
project-based rental assistance under
section 8 of the 1937 Act (42 U.S.C.
1437f), and the Section 8 Moderate
Rehabilitation Single Room Occupancy;
and
• The Housing Trust Fund (12 U.S.C.
4568).
To assure covered housing providers
(CHPs) under the programs listed above
comply with VAWA 2013 and the
VAWA Rule, the Department must
provide to all CHPs certain model
documents for use, as follows:
• Form HUD–5380: Notice of
Occupancy Rights Under the Violence
Against Women Act. HUD must provide
this notice to CHPs, which must, in
turn, distribute it to tenants and to
applicants at the times specified in the
VAWA rule at minimum to ensure they
are aware of their rights under VAWA
and its implementing regulations. CHPs
must add specific information to this
form as indicated by the imbedded
instructions. The use of ‘‘we’’ or ‘‘us’’
and use of shorthand will require
customization depending on whether
the provider and the landlord are the
same, and, particularly for the CPD
programs, the program decisions made
by the grantee and subgrantee.
• Form HUD–5381: Model Emergency
Transfer Plan for Victims of Domestic
Violence, Dating Violence, Sexual

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Sfmt 4703

Assault, or Stalking. HUD must provide
this model document to CHPs. CHPs
must develop their own emergency
transfer plans, as required by the VAWA
rule, must make their emergency
transfer plan available upon request,
and, when feasible, must make their
plan publicly available. CHPs may, at
their discretion, use HUD–5381 to
develop these plans. This model
contains only general provisions of an
emergency transfer plan that apply
across the covered HUD programs.
Adoption of this model plan without
further customization and information
concerning how the emergency transfer
plan will operate will not be sufficient
to meet a covered housing provider’s
responsibility to adopt an emergency
transfer plan. CHPs must consult the
applicable regulations and are
encouraged to consult program-specific
HUD guidance when developing their
own emergency transfer plans to ensure
those plans contain all required
elements.
• Form HUD–5382: Certification of
Domestic Violence, Dating Violence,
Sexual Assault, or Stalking, and
Alternate Documentation. HUD must
provide this certification form to CHPs,
which must, in turn, distribute it to
tenants and applicants as a required
complement and extension of the
required Notice of Occupancy Rights
Under the Violence Against Women Act
(Form HUD–5380). As further explained
on the Form HUD–5382, an applicant or
tenant who is asking for or about VAWA
protections may choose to fill out and
submit this certification form as one of
the four legally acceptable options the
VAWA final rule provides for answering
any covered housing provider’s written
request for documentation that an
individual is or has been a victim of
domestic violence, dating violence,
sexual assault, or stalking or that a
covered incident or incidents of
domestic violence, dating violence,
sexual assault, and stalking occurred.
(Note: This is a revision of and
supersedes form HUD–50066. VAWA
2013 required that the form be updated
and made applicable to all covered
housing programs.)
• Form HUD–5383: Emergency
Transfer Request for Certain Victims of
Domestic Violence, Dating Violence,
Sexual Assault, or Stalking. HUD
provides this model emergency transfer
request form to CHPs. CHPs may, at
their discretion, distribute it to tenants
and applicants. This form serves as a
model for use by a CHP to accept
requests for emergency transfers under
its required VAWA 2013 Emergency
Transfer Plan.

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khammond on DSKJM1Z7X2PROD with NOTICES

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices
HUD has, as part of this package,
revised the forms that were published
with HUD’s final rule in order to more
closely align with the rule and to clarify
language. In addition to the minor
changes, HUD makes the following
specific changes:
• Form HUD–5380: Streamline
information and language used in the
notice to reduce pages. Translated
regulatory language into plain language.
Made titles of sections into questions
that directly address the reader. CHPs
must add specific information to this
form as indicated by the imbedded
instructions. Other areas of the form
may be used by the provider to include
customized information as necessary.
The use of ‘‘we’’ or ‘‘us’’ and use of
shorthand will require some
customization depending on whether
the provider (grantee/recipient) and the
landlord are the same, and, particularly
for the Office of HIV/AIDS Housing
(OHH) and Office of Special Needs
Assistance Programs (SNAPS), the
program decisions made by the grantee/
recipient.
• Form HUD–5381: Add a note to
covered housing providers that the use
of the model form without adding
program specific and housing provider
specific policies will not be sufficient to
meet the emergency transfer plan
requirements. Add a definition section
with definitions taken from the
regulation. Rename the section titled
‘‘Emergency Transfer Timing and
Availability’’ to ‘‘Emergency Transfer
Procedures’’ and add two new sections,
‘‘Emergency Transfer Policies’’ section,
which clarifies that the provider must
specify their individual policies for
different categories of transfers (i.e.
internal or external transfers) where
applicable, and a ‘‘Priority for
Transfers’’ section, which requires
providers to provide any type of priority
being provided to a victim consistent
with 24 CFR 5.2005(e)(3) and (e)(6).
Update the ‘‘Confidentiality’’ section to
more closely follow the regulation at 24
CFR 5.2007(c) and put individuals on
notice of confidentiality protections.
Lastly, add a ‘‘Making Plan Available’’
section to describe how the plan will be
made publicly available, where
possible.
• Form HUD–5382: Update the
‘‘Submission of Documentation’’ section
to include information about reasonable
accommodations.
• Form HUD–5383: Update the
‘‘Confidentiality’’ section to use more
plain language. Added information
about family members in household,
current address, best method of contact,
what type of transfer is being requested,

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18:12 Nov 03, 2022

Jkt 259001

what features they want to request in a
safe unit, and optional documentation
to include with form.
In addition, the Department seeks
approval for the following information
collection activities required by VAWA
2013 and HUD’s final rule:
• Lease Addendum: The VAWA
regulation includes certain requirements
that must be incorporated into tenants’
leases.
• Emergency Transfer Reporting:
CHPs must keep a record of all
emergency transfers requested under its
emergency transfer plan, and the
outcomes of such requests, and retain
these records for a period of three years,
or for a period of time as specified in
program regulations. Requests and
outcomes of such requests must also be
reported to HUD annually. Requests and
outcomes of such requests must be
reported to HUD annually. HUD
proposes to include the following data
fields in its program reporting systems
to help standardize the information
CHPs provide on emergency transfer
requests and outcomes of those requests:
Æ Total number of VAWA Emergency
Transfer Requests
Æ Number of requests that resulted in
Internal Transfers
Æ Number of requests that resulted in
External Transfers
Æ Number of requests yet to be placed
Æ Number of approved Emergency
Transfer requests that resulted in no
transfer
Æ Number of requests that did not
qualify for Emergency Transfer and
were denied
Æ Length of time needed to process
emergency transfers
Consistent with House Report 116–
109, part of the fiscal year 2022
Omnibus Spending Bill, Public Law
113–4, HUD is also adding a request as
part of this information collection to
seek information about the extent to
which public housing agencies and
owners, and managers have adopted
VAWA emergency transfer policies
since the publication of the
Department’s model emergency transfer
plan, and the effectiveness of those
emergency transfer policies in allowing
victims to access safe housing. The
information would include the type of
covered housing provider; a request for
sharing their VAWA emergency transfer
plan and whether such plan is publicly
available; how many VAWA emergency
transfer requests were received over the
last three years and outcome of those
requests; a request for indicating if a
waiting list preference is available for
victims of domestic violence, sexual

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66725

assault, dating violence, and stalking;
information about collaborations or
coordination with consortiums or other
providers for purposes of providing
housing and services for victims;
whether a VAWA service coordinator
exists; and whether a VAWA lease
bifurcation policy exists. This
information may be collected by way of
email communication, updated systems,
or survey. This collection is also
consistent with reporting in 24 CFR part
5, subpart L. HUD expects to request
this information annually and it would
take housing providers one hour per
annual submission.
• Lease Bifurcation Option: VAWA
2013 mandates that HUD provide for
lease bifurcation. In other words, CHPs
may, subject to their program rules and
state and local law, bifurcate a lease in
order to evict or remove any member of
a household who has allegedly engaged
in criminal activity directly relating to
domestic violence, dating violence,
sexual assault, or stalking against an
affiliated individual or other individual,
while allowing the victim and other
members of the household to remain.
This is optional.
• Respondents (i.e. affected public):
Public housing agencies, private
multifamily housing owners and
management agents, state and local
agencies, and grant recipients.
Estimated Number of Respondents:
328,485.
Estimated Number of Responses:
7,969,000.
Frequency of Response: Varies. For
the HUD–5380 and HUD–5382 there are
approximately 3,918 Public Housing
and Housing Choice Voucher
respondents with 801 responses per
respondent. For Multifamily Housing
there are approximately 23,000
respondents with 104 responses per
respondent. For HOME there are 1,874
respondents with approximately 62
responses. For HOPWA there are 255
respondents with 176 responses. For
Homelessness programs (CoC, ESG,
Rural Housing Stability) there are 1,040
respondents with 410 responses.
Each respondent indicated will have
to complete an emergency transfer plan
using the HUD–5381 or other format.
For the HUD–5382 certification for
documentation by survivor and
emergency transfer request there are
approximately 210,725 responses. For
the HUD–5382 and HUD–5383
certification for documentation by
professional and emergency transfer
request there are 69,714 responses.

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Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices
Number of
respondents

24 CFR section and description of activity

Frequency of
response
(annual, per
respondent)

Annual
responses

Est. avg. time
for
requirement
(hours)

Annual hour
burden

Cost per hour

Total cost

5.2005(a) Form HUD–5380: Notice of Occupancy Rights and form HUD–5382: Certification Form-Distribution and Review
Public Housing and Housing Choice Voucher (HCV)
Annual Average of Denied Admissions ....................................................
Annual Average of new Households that Move In ...................................
Annual Average of Eviction Notices Sent .................................................

3,918
3,918
3,918

7
55
3

27,426
215,490
11,754

0.08
0.08
0.08

2,194
17,239
940

$24
24
24

$52,658
413,741
22,568

15
9
10

345,000
207,000
230,000

0.08
0.08
0.08

27,600
16,560
18,400

24
24
24

662,400
397,440
441,600

20
16
8

37,480
29,984
14,992

0.08
0.08
0.08

2,998
2,399
1,199

24
24
24

71,962
57,569
28,785

20
20
10

5,100
5,100
2,550

0.08
0.08
0.08

408
408
204

24
24
24

9,792
9,792
4,896

1.5
1.5
1.5

7,800
1,560
1,560

24
24
24

187,200
37,440
37,440

8
8
8
8
4

31,344
184,000
14,992
2,040
4,160

24
24
24
24
24

752,256
4,416,000
359,808
48,960
99,840

0.33
0.33
0.33
0.33
0.5

12,929
45,540
9,276
421
2,080

7.25
7.25
7.25
7.25
7.25

93,738
330,165
67,253
3,050
15,080

5,877
23,000
4,685
255
1,040

24
24
24
24
24

141,048
552,000
112,440
6,120
24,960

12,929
22,770
3,092
421
2,080

7.25
7.25
7.25
7.25
7.25

93,738
165,083
22,418
3,050
15,080

1
1
3
1
1

3,918
23,000
5,622
255
1,040

24
24
24
24
24

94,032
552,000
134,928
6,120
24,960

231,162
552,000
33,732
12,750
419,120

0.5
0.5
0.5
0.5
0.5

115,581
276,000
16,866
6,375
209,560

24
24
24
24
24

2,773,944
6,624,000
404,784
153,000
5,029,440

15,672
92,000
5,622
510
520

8
2
2
2
1.5

125,376
184,000
11,244
1,020
780

24
24
24
24
24

3,009,024
4,416,000
269,856
24,480
18,720

Multifamily Housing
Annual Average of Denied Admissions ....................................................
Annual Average of new Households that Move In ...................................
Annual Average of Eviction Notices Sent .................................................

23,000
23,000
23,000

Annual Average of Denied Admissions ....................................................
Annual Average of new Households that Move In ...................................
Annual Average of Eviction Notices Sent .................................................

1,874
1,874
1,874

Annual Average of Denied Admissions ....................................................
Annual Average of new Households that Move In ...................................
Annual Average of Eviction Notices Sent .................................................

255
255
255

HOME

HOPWA

Homeless (CoC, ESG, and Rural Housing Stability)
Annual Average of Denied Admissions ....................................................
Annual Average of new Households that Move In ...................................
Annual Average of Eviction Notices Sent .................................................

1,040
1,040
1,040

5
1
1

5,200
1,040
1,040

5.2005(e) Form HUD–5381: Emergency Transfer Plan-Completion
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
11,874
255
1,040

1
1
1
1
1

3,918
23,000
1,874
255
1,040

5.2007(b) Form HUD–5382: Certification Form—Documentation by Survivor
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
1,874
255
1,040

10
6
15
5
4

39,180
138,000
28,110
1,275
4,160

5.2007(b)(1)(ii) Form HUD–5382: Certification Form—Documentation by Professional
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
1,874
255
1,040

3
2
5
2
2

11,754
46,000
9,370
510
2,080

0.5
0.5
0.5
0.5
0.5

5.2005(e) Form HUD–5383: Emergency Transfer Request—Documentation by Survivor
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
1,874
255
1,040

10
3
5
5
4

39,180
69,000
9,370
1,275
4,160

0.33
0.33
0.33
0.33
0.5

5.2005(e) Form HUD–5383: Emergency Transfer Request—Annual Reporting
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
1,874
255
1,040

1
1
1
1
1

3,918
23,000
1,874
255
1,040

5.2005(a) Lease Addendum—Distribution and Review
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
1,874
255
1,040

59
24
18
50
403

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5.2009 Lease Bifurcation
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................
HOME ........................................................................................................
HOPWA .....................................................................................................
Homeless (CoC, ESG, and Rural Housing Stability) ................................

3,918
23,000
1,874
255
1,040

4
4
3
2
0.5

NEW: Emergency Transfer Report
Public Housing and Housing Choice Voucher (HCV) ...............................
Multifamily Housing ...................................................................................

3,918
23,000

1
1

3,918
23,000

1
0.5

3,918
11,500

24
24

94,032
276,000

Grand Total ........................................................................................

328,485

Varies

7,968,918

Varies

2,856,717

........................

339,292,658

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Notes:
• This matrix amends the one of the
same titles provided in the OMB
Emergency PRA approval, 2577–0286,
approved 12/13/2016, which provided
for 3,622,370 hours.
• For each category, HUD assumes
the following breakdown of Covered
Housing Provider respondents in
covered programs: 3,918 public housing
agencies that administer either or both
public housing and HCV; 23,000
Multifamily Housing properties; 1,874
HOME Participating Jurisdictions (PJs)
and housing owners; 255 HOPWA grant
recipients, and 1,040 Homeless (CoC,
ESG, and Rural Housing Stability) grant
recipients.
• The ‘‘Frequency of Response
(annual, per respondent)’’, provides the
estimated average of actions anticipated
for each CHP in each program area. For
example, HUD estimates that each
Multifamily Housing property will deny
assistance to 20 applicants each year.
Therefore, the total number of responses
and total number of Multifamily
Housing assistance denials in one year
is 23,000 × 20 = 460,000. Similarly,
HUD estimates that each of the 255
HOPWA grant recipients will receive 5
completed Certification forms each year.
The total number of responses and total
number of certifications received in the
HOPWA program in one year is 255 ×
5 = 1,275.
• The $24 hourly rate is based on an
average salary of $50,000 per annum.
An internet search on 11/5/2020 shows

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housing specialist positions with an
average of $40,000 per annum and
$55,000 per annum for residential
property managers. This dollar amount
is a reasonable average for employees of
CHPs at differing levels of seniority.
• $7.25 is used as the cost to tenants,
as it is the federal minimum hourly
wage amount.
Average Hours per Response: 0.39.
Total Estimated Burdens: 2,856,718.
B. Solicitation of Public Comment
This notice is soliciting comments
from members of the public and affected
parties concerning the collection of
information described in Section A on
the following:
(1) Whether the proposed collection
of information is necessary for the
proper performance of the functions of
the agency, including whether the
information will have practical utility;
(2) The accuracy of the agency’s
estimate of the burden of the proposed
collection of information;
(3) Ways to enhance the quality,
utility, and clarity of the information to
be collected; and
(4) Ways to minimize the burden of
the collection of information on those
who are to respond; including through
the use of appropriate automated
collection techniques or other forms of
information technology, e.g., permitting
electronic submission of responses.
(5) HUD solicits comment on the
implementation of the requirement that
covered housing providers must keep a

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66727

record of all emergency transfers
requested under its emergency transfer
plan, and the outcomes of such requests,
and that such data must be reported to
HUD annually. Specifically, is HUD’s
list of potential outcomes adequate or
are there outcomes that should be added
or modified? Further, HUD proposes to
collect data on the ‘‘length of time’’ for
emergency transfers to be implemented.
What is an appropriate measure for
‘‘length of time’’ for emergency
transfers? Should a covered housing
provider only measure from when the
emergency transfer was requested to
approval/denial and/or should it be
measured to move-in date? If a victim is
issued a Housing Choice Voucher (HCV)
as a result of their emergency transfer
request, should the length of time be
measured from request to voucher
issuance and/or lease-up date? Should
covered housing providers be able to
explain the circumstances that affected
the length of time for emergency
transfers (e.g., the victim turned down
offered units due to safety concerns)?
HUD encourages interested parties to
submit comment in response to these
questions.
C. Authority
Section 3507 of the Paperwork
Reduction Act of 1995, 44 U.S.C. 3507.
Laura Miller-Pittman,
Chief Office of Policy, Programs and
Legislative Initiatives.
BILLING CODE P

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66728

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices
Protections for Victims of Domestic Violence, Dating Violence, Sexual A<1sault or Stalking
What is the Violence Against Women Act (VAWA)? This notice describes protections that may apply to you as
an applicant or a tenant under a housing program covered by the Violence Against Women Act of 1994, as
amended (VAWA). VAWA provides protections for victims of domestic violence, dating violence, sexual assault
or stalking. Applicable protections must be in VAWA-covered leases and other program documents, as
applicable. These protections may be raised at any time. To learn more about these protections or read this
information in Spanish or another language, please contact !INSERT COVERED HOUSING PROVIDER (HP)
CONTACT INFORMATION] or go to [INSERT WEBSITE, IF APPLICABLE].

What the words in this notice mean:
0
0

0

0

VAWA violence/abuse means one or more incidents of domestic violence, dating violence, sexual assault or stalking.
Victim means any victim of VA U'A violence/ abuse, regardless of actual or perceived sexual orientation, gender
identity, sex, or marital status.
Affiliated person means the tenant's spouse, parent, sibling, or child; or any individual, tenant, or lawful
occupant living in the tenant's household; or anyone for whom tenant acts as parent/guardian.
"We" or "us" means [ENTER NAME OF EACH COVERED HOUSING PROVIDER FOR THE HOUSING
OR RENTAL ASSISTANCE AND SPECIFY WHEN DIFFERENT FOR DIFFERENT PURPOSES (E.G.
DOCUMENTATION)].

What if I am an applicant under a program covered by VAWA? You can't be denied assistance covered by
VAWA or admission to any housing covered by VAWA just because you (or a member of your household) are or
were a victim or just because of problems you or a member of your household has had as a direct result of being
or having been a victim

What if I am a tenant under a program covered by VAWA? You can't be removed from a housing program
covered by VAWA, lose your assistance covered by VAWA, or be evicted just because of real or threatened abuse
against you or a member of your household, the fact that you (or a member of your household) are or were a
victim, or problems you (or a member of your household) have as a direct result of being or having been a victim.
Nor can you be evicted or be removed from your housing just because of another person's criminal actions that
direcUy relate to the abuse or threatened abuse against you or an alTtliated person.

How can I remove an abuser from my household? Depending on applicable state law and program rules, your
lease or assistance may be "bifurcated" to remove or evict ONLY the person doing the alleged criminal activity
directly relating to the abuse. [For HOME and housing trust fund programs, INSERT "The remaining tcnant(s)
can keep receiving assistance or living in the assisted housing as applicable." For the Continuum of Care Program
(except for permanent supportive housing), HUD-VASH program, ESG program, Section 22l(d)(3) Program, or
Section22l(d)(5) Program, INSERT "The remaining family member(s) can keep receiving assistance or living in
the assisted housing as applicable." For permanent supportive housing funded by the Continuum of Care Program,
INSERT "If that person is the qualifying member of your household, the remaining household member(s) can still
receive rental assistance until expiration of U1e lease in effect when Ural person is evicted." For the HCV and
public housing proi,>rdllS, INSERT "If a household's elii,>ibility was based on the person removed, the other
household member(s) must be given 30 calendar days to establish program eligibility or find alternative housing.
In all other cases, INSERT the preceding sentence for HCV and Public Housing Programs BUT REPLACE "30
calendar days" WITH: the APPLICABLE time period in the table in Section XVII of Notice H 2017-05 (for HUD
multifamily programs); the APPLICABLE grace period set by the HOPWA Grantee or Project sponsor (for
HOPWA); or "until the end of the lease term or 90 calendar days (whichever is sooner)" for the Rural Housing
Stability Assistance Program.].

Are there any reasons that I can be evicted or lose assistance? Although you can't be held to a more demanding
standard because you or an affiliated person is a victim, you can still be evicted or lose assistance for a lease
violation or program violation or other requirements that is not due to U1e VAWA violence/ abuse collllnitted
against you or an affiliated person. VAWA also will not prevent eviction, termination, or removal if other tenants
or housing staff are shown to be in inunediate, physical danger that could lead to serious bodily harm or death if
you are not evicted or removed from assistance.
request an emergency transfer when: (1) you (or a member of your household) are a victim of VAWA
violence/abuse; (2) you specifically request the emergency transfer; and either (3)(A) you reasonably believe you
(or a member of your household) will soon face more violence if you stay in your housing; or (B) you (or a
member of your household) are a victim of sexual assault that occurred on the premises and you request an
emergency transfer within 90 days (including holidays and weekend days) after the date of that assault. You can
request an emergency trnnsfer even if you owe rent. If you request an emergency trnnsfer, your request, the
information you provided to make the request, and your new unit· s location must be kept strictly confidential. To

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How can tenants request an emergency transfer? An emergency transfer cannot be guaranteed, but you can

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

66729

request an emergency transfer or read the emergency transfer plan we are required to follow and to make available
to you upon request, [ENTER SPECIFIC CONTACT INFORMATION, WEBSITE, AND/OR INSTRUCTIONS
FOR REQUESTING AN EMERGENCY TRANSFER OR A COPY OF THE APPLICABLE EMERGENCY
TRANSFER PLAN]. The emergency transfer plan includes what we do lo make sure your address and other
relevant information arc not disclosed to your abuser.
What do I need to document that I am a victim? If you ask for VAWA protection, we may request documents
showing that you are a victim (which includes if a member of your household is a victim). BUT this request must

be in writing and must give you al least 14 business days (weekends and holidays do not count) to respond, AND
you arc free to choose any ONE of the following:
1. A self-certification fonn, which we must give you along with this notice and either you fill out or someone fills
out for you. The fonn asks for your name; the abuser's name, if known and safe to provide; and a description
of the incident(s). It also further explains your confidentiality rights under VAWA.
2. A statement from a victim service provider, attorney, mental health professional or medical professional who
has helped you address incidents of VAWA violence/ abuse. The professional must state "under penalty of
perjury" that he/she/they believes that the incidents of VA WA violence/ abuse are real and covered by
VAWA. Both you and the professional must sign the statement.
3. A police, administrative, or court record (such as a protective order) that shows you (or a member of your
household) were a victim of VAWA violence/ abuse. [HP MAY INSERT AS #4 ANY OTHER STATEMENT
OR EVIDENCE THAT CAN BE PROVIDED AS DOCUMENTATION THE APPLICANT OR TENANT IS
A VICTIM]
If you do not provide one of these fonns of documentation by the deadline, we do not have to provide the protection
you requested. If the documentation we receive has conflicting information about the abuse, we may require you
to provide documents under #2 or #3 [OR ENTER #4, IF APPLICABLE] above, but we must give you another
30 business days to do so.
Confidentiality If you share infonnation with your housing agency, manager or landlord about why you need
VAWA protections, we will keep the infonnation you share confidential.

Exceptions:
1) IfJ'.QY ask us to share that information;
2) Ifwe need to use that information to try to evict the person accused of being the abuser; or
3) If other laws require us to share the infonnation.
How do other laws apply? VAWA does not prevent or excuse us from following laws that provide more protection

to victims or court orders that concern your home or property. We must follow all applicable fair housing and
civil rights requirements. If you have a disability, we must provide reasonable accommodations to rules, policies,
practices, or services that may be necessary to allow you to equally benefit from VAWA protections (for
example, giving you more time to submit documents, or assistance with filling out fonns). We must ensure
effective communication with individuals with disabilities. If you speak or read in a language other than
English, we must give you language assistance regarding your VAWA protections (for example, oral
interpretation and/or written translation).
Have your protections under VAWA been denied? If you believe we have violated these rights, you may seek

help by contacting [INSERT LOCAL HUD FIELD OFFICE & CONTACT INFORMATION]
Need further help?

For advice concerning an abusive relationship, call the National Domestic Violence Hotline at 1-800-799-7233
or 1-800-787-3224 (TTY).
0 For advice concerning sexual assault, call the National Sexual Assault Hotline at 1-800-656-4673.
° For advice concerning stalking, visit https://victimconnect.org/ or call l-855-4VICTIM (l-855-484-2846).
0
To talk with a housing advocate, contact [ENTER CONTACT INFO FOR LOCAL ADVOCACY AND LEGAL
AID ORGANIZATIONS].
0

housing provider's response, depending on the program. This includes time to print and distribute the fonn.
Comments concerning the accuracy of this burden estimate and any suggestions for reducing tl1is burden can be sent
to the Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7tl1 Street, SW,
Washington, DC 20410. Tl1is notice is required for covered housing programs under section 41411 of VAWA and

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Public reporting burden for this collection of information is estimated to range from 10 to 90 minutes per each

66730

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

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24 CFR 5.2003. Covered housing providers must give this notice to applicants and tenants to inform them of the
VAWA protections as specified in section 4141 l(d)(2). This is a model notice, and no information is being
collected. A Federal agency may not collect this information, and you are not required to complete this form, unless
it displays a currently valid Office of Management and Budget control number.

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

66731

MODEL EMERGENCY TRANSFER PLAN FOR VICTIMS OF DOMESTIC
VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING

[INSERT NAME OF COVER HOUSING PROVIDER [HP ACRONYM]] is concerned about
the safety of its tenants, and such concern extends to tenants who are victims of domestic
violence, dating violence, sexual assault, or stalking. In accordance with the Violence Against
Women Act of 1994, as amended (VAWA), [HP ACRONYM] allows any tenant who is a
victim of domestic violence, dating violence, sexual assault, or stalking to request an emergency
transfer from the tenant's current unit to another unit. Despite this law's name, VAWA
protections are not limited to women, and are available regardless of a victim's sex, actual or
perceived gender identity or sexual orientation, or marital status. Victims cannot be
discriminated against on the basis of any protected characteristic, including race, color, national
origin, religion, sex, familial status, disability, or age. HUD-assisted and HUD-insured housing
must also be made available to all otherwise eligible individuals and families regardless of actual
or perceived gender identity, sexual orientation, or marital status.
This plan identifies tenants who are eligible for an emergency transfer, the documentation
needed to request an emergency transfer, confidentiality protections, how an emergency transfer
may occur, and guidance to tenants on safety and security. This plan is based on Federal
regulations at 24 Code of Federal Regulations (CFR) part 5, subpart L, related program
regulations, and the model emergency transfer plan published by the U.S. Department of
Housing and Urban Development (HUD). HUD is the Federal agency that oversees that
[INSERT NAME OF PROGRAM OR RENTAL ASSISTANCE HERE is in compliance with
VAWA.
Definitions

•

VAWA violence/ abuse means an incident or incidents of domestic violence, dating violence,
sexual assault, or stalking, as those terms are defined in 24 CFR 5.2003 and "Certification of
Domestic Violence, Dating Violence, Sexual Assault, or Stalking" (Form HUD-5382).
Eligibility for Emergency Transfers

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•

External emergency transfer refers to an emergency relocation of a tenant to another unit
where the tenant would be categorized as a new applicant; that is, the tenant must undergo an
application process in order to reside in the new unit.
Internal emergency transfer refers to an emergency relocation of a tenant to another unit
where the tenant would not be categorized as a new applicant; that is, the tenant may reside
in the new unit without having to undergo an application process.
Safe unit refers to a unit that the victim of VAWA violence/abuse believes is safe.

66732

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

A tenant may seek an emergency transfer to another unit if the tenant or a household member is a
victim of VAW A violence/ abuse, as explained in the "Notice of Occupancy Rights Under the
Violence Against Women Act," Form HUD-5380 (VAWA Notice). This Emergency Transfer
Plan provides further information on emergency transfers, and [HP ACRONYM] must provide
a copy if requested. Before allowing an emergency transfer, [HP ACRONYM] may ask for
submission of a written request or form HUD-5383 to certify eligibility.
A Tenant is eligible for an emergency transfer if:

(1) Tenant (or a household member) is a victim ofVAWA violence/abuse;
(2) Tenant specifically requests the emergency transfer, and
(3) Tenant reasonably believes* they will soon face more violence if they stay in their
housing
OR
Tenant is a victim of sexual assault that occurred on the premises and have
requested an emergency transfer within 90 days (including holidays and
weekend days) after the date of that assault.

*Reasonable beliefmay stem from VAWA violence/abuse concerning a household
member.
A housing provider, in response to an emergency transfer request, should not evaluate whether
the tenant is in good standing as part of the assessment or provision of an emergency transfer
Emergency Tran sfer Policies

[INSERT HP' S EMERGENCY TRANSFER POLICIES, INCLUDING THE FOLLOWING,
WHERE APPLICABLE]
Internal transfers when a safe unit is immediately available:

[INSERT HP'S POLICIES, INCLUDING TIME FRAMES, POSSIBLE INTERNAL
TRANSFER LOCATIONS, AND PRIORITY STATUS RELATIVE TO OTHER TENANTS
SEEKING TRANSFERS.]
Internal transfers when a safe unit is not immediately available:

[INSERT HP'S POLICIES, INCLUDING TIME FRAMES, POSSIBLE INTERNAL
TRANSFER LOCATIONS, AND PRIORITY STATUS RELATIVE TO OTHER TENANTS
SEEKING TRANSFERS.]
External transfers:

[INSERT POLICIES AND PROCEDURES FOR ASSISTING TENANTS WITH HOUSING
CHOICE VOUCHERS OR OTHER TENANT-BASED RENTAL ASSISTANCE WHO
QUALIFY FOR AN EMERGENCY TRANSFER TO MOVE QUICKLY WITH THAT
ASSISTANCE.]

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[INSERT HP'S POLICIES, INCLUDING HP'S ROLE IN FACILITATING TRANSFERS;
IDENTIFYING AND DESCRIBING ANY TRANSFER AGREEMENTS WITH OUTSIDE
HPS, PROVIDING REFERRALS TO COMMUNITY PARTNERS AND AFFORDABLE
HOUSING OPTIONS, TIME FRAMES, AND PRIORITY STATUS GIVEN TO V AWA
VICTIMS SEEKING EXTERNAL TRANSFERS INTO HP'S PROPERTY.]

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

66733

VAWA provisions do not supersede eligibility or other occupancy requirements that may
apply under a covered housing program. [HP ACRONYM] may be unable to transfer a
tenant to a particular unit if the tenant cannot establish eligibility for that unit.
Emergency Tran sfer Request Documentation

To request an emergency transfer, the tenant shall notify [ENTER SPECIFIC CONT ACT
INFORMATION, WEBSITE, AND/OR INSTRUCTIONS FOR REQUESTING AN
EMERGENCY TRANSFER OR A COPY OF THE APPLICABLE EMERGENCY TRANSFER
PLAN] and submit a written request for a transfer to [INSERT LOCATION]. Unless [HP
ACRONYM] receives conflicting documentation, as described in 24 CFR 5.2007(b)(2), [HP
ACRONYM] cannot require third-party documentation to determine emergency transfer
eligibility. [HP ACRONYM] will provide reasonable accommodations to this policy for
individuals with disabilities. The tenant's written request for an emergency transfer must include
either:

1. A statement expressing that the tenant reasonably believes that there is a threat of
imminent harm from further violence if the tenant were to remain in the tenant's current
dwelling unit; OR
2. In the case of a tenant who is a victim of sexual assault, either a statement that the tenant
reasonably believes there is a threat of imminent harm from further violence if the tenant
remains within the same dwelling unit that the tenant is currently occupying, or a
statement that the sexual assault occurred on the premises during the 90-calendar-day
period preceding the tenant's request for an emergency transfer.

Priority for Transfers

Tenants who qualify for an emergency transfer under VA WA will be given the following priority
over other categories of tenants seeking transfers and individuals seeking placement on waiting
lists. [INSERT ANY MEASURE OF PRIORITY GIVEN UNDER THIS EMERGENCY
TRANSFER PLAN.]

..DRAFTING NOTES FORHJ>slMllSTNOi APPIJARWORJJ FOR2014

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1

66734

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

Confidentiality
If a tenant inquires about or requests any of the protections described in this Notice or represents
that they are a victim of VAWA violence/abuse entitled to the protections under this Notice, [HP
ACRONYM] must keep any information they provide concerning the VAWA abuse and their
status as a victim strictly confidential. All the information provided by or on behalf of the tenant
to support an emergency transfer request, including information on the Certification form, HUD5382, and the Emergency Transfer Request form, HUD-5383, ( collectively referred to as
"Confidential Information") may only be accessed by [HP ACRONYM] employees or
contractors if explicitly authorized by [HP ACRONYM] for reasons that specifically call for
those individuals to have access to that information under applicable Federal, State, or local law.

Confidential information must not be entered into any shared database or disclosed to any other
entity or individual, except if:
•
•
•

Requested or consented to in writing by the tenant in a time-limited release;
Required for use in an eviction proceeding or hearing regarding termination of assistance,
or
Otherwise required by applicable law.

In addition, HUD's VAWA regulations require Emergency Transfer Plans to provide strict
confidentiality measures to ensure that the location of the victim's dwelling unit is never
disclosed to a person who committed or threatened to commit the VAW A violence/abuse.
Accordingly, [INSERT ANY SPECIFIC MEASURES HERE.]
Emergency Transfer Procedure
[HP ACRONYM] cannot specify how long it will take to process a transfer request. [HP
ACRONYM] will, however, act as quickly as possible to assist a tenant who qualifies for an
emergency transfer. If [HP ACRONYM] identifies an available unit and the tenant believes that
unit would not be safe, the tenant may request a transfer to a different unit. [HP ACRONYM]
may be unable to transfer a tenant to a particular unit if the tenant has not or cannot establish
eligibility for that unit.
If [HP ACRONYM] has no safe and available units for which the tenant is eligible, [HP
ACRONYM] will assist the tenant in identifying other housing providers who may have safe
and available units to which the tenant could move. At the tenant's request, [HP ACRONYM]
will also assist tenants in contacting the local organizations offering assistance to victims of
VA WA violence/abuse that are attached to this plan.
Making Plan Available

All materials must ensure effective communication with individuals with disabilities, including
making materials available in alternative accessible formats, as well as providing reasonable
accommodations.

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[INSERT HP'S POLICY FOR MAKING THE PLAN AVAILABLE UPON REQUEST AND,
WHEN FEASIBLE, PUBLICLY AVAILABLE.]

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

66735

In addition, each provider must have VAWA forms available in multiple languages consistent
with their language access plan to meet limited English proficiency (LEP) obligations.
Safety and Security of Tenants
When [HP ACRONYM] receives any inquiry or request regarding an emergency transfer, [HP
ACRONYM] will encourage the person making the inquiry or request to take all reasonable
precautions to be safe, including seeking guidance and assistance from a victim service provider.
However, tenants are not required to receive guidance or assistance from a victim service
provider.
•

•

•

•

Tenants who are or have been victims of domestic violence will be encouraged to contact
the National Domestic Violence Hotline at 1-800-799-7233, or a local domestic violence
shelter, for assistance in creating a safety plan. For persons with hearing impairments, that
hotline can be accessed by calling 1-800-787-3224 (TTY).
Tenants who have been victims of sexual assault will be encouraged to call the Rape, Abuse
& Incest National Network's National Sexual Assault Hotline at 800-656-HOPE, or visit the
online hotline at https://ohl.rainn.org/online.
Tenants who are or have been victims of stalking seeking help will be encouraged to visit
the National Center for Victims of Crime's Stalking Resource Center at
https://www.victimsofcrime.org/our-programs/stalking-resource-center.
[INSERT CONTACT INFORMATION FOR LOCAL ORGANIZATIONS OFFERING
ASSISTANCE TO VICTIMS OF DOMESTIC VIOLENCE, DATING VIOLENCE,
SEXUAL ASSAULT, OR STALKING.]

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Public reporting burden for this collection of information is estimated to range from four to eight hours per each covered
housing provider's response, depending on the covered housing program. This includes the time to develop program and projectspecific emergency transfer policies and develop contacts with local service providers. Comments concerning the accuracy of
this burden estimate and any suggestions for reducing this burden can be sent to the Reports Management Officer, QDAM,
Department of Housing and Urban Development, 451 7th Street, SW, Washington, DC 20410. This is a model plan and housing
providers in programs covered by VAWA may, at their discretion, use it to develop their own emergency transfer plans, as
required under 24 CFR 5 .2005(e ). While HUD does not intend to collect emergency transfer plans, HUD may access these plans
to ensure compliance with the regulations. A Federal agency may not collect this information, and you are not required to
complete this form, unless it displays a currently valid Office of Management and Budget control number.

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Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

PURPOSE OF FORM: A tenant or applicant who asks for protection under the Violence Against Women
Act (VAWA), referred to in this form as "you," may use this form to fulfill a housing provider's written
request to certify status as a "victim" or document the incident(s) of''VAWA violence/abuse" as explained
in the accompanying "Notice of Occupancy Rights Under the Violence Against Women Act," Form HUD5380 (VAWA Notice). For protections that depend on more than victim status or VAWA violence/abuse,
you (the tenant or applicant) may be asked to provide other information or documentation to show that you
qualify. However, you are not expected and cannot be asked or required-to claim, document, or prove
victim status or VAWA violence/abuse other than as stated in the VAWA Notice.
This form is just one of your available options for responding to a housing provider's written request for
documentation of victim status or the incident(s) of VAWA violence/abuse. If you choose, you may submit
one ofthe types ofthird-party documentation described in the VAWA Notice, in the section titled ''What
do I need to document that I am a victim?".

NOTE: VAWA protects individuals and families regardless of a victim's actual or
perceived sexual orientation, gender identity, or marital status.
CONFIDENTIALITY: Your housing provider will keep strictly confidential any information you
provide about the VAWA violence/abuse or the fact you are a victim, including the information on this
form. This information can only be accessed by a person working for your housing provider if your
housing provider explicitly authorizes that person's access for a reason specifically called for under
applicable law. This information will not be given to others or put in a database shared with others, unless
your housing provider gets your written permission to do so for a limited time, is required to do so as part
of an eviction or termination hearing or is required to do so by law.
Note: Any personal information you share in this form will not be collected nor maintained by HUD and
will only be maintained by your Covered Housing Providers according to the confidentiality provisions
above.
TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC
VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING
1. Date the written request for documentation of VAWA violence/abuse was received:
2. Name(s) of victim(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
3. Name of applicant or tenant making (signing) this certification: _ _ _ _ _ _ _ _ _ _ _ _ _ __
4. Name(s) of other member(s) of the household:
5. Name of the perpetrator (if known and can be safely disclo_se_d~1_:_ _ _ _ _ _ _ _ _ _ _ _ _ __
6. In your own words, briefly describe the incident(s) of domestic violence, dating violence, sexual
assault, or stalking, and include the relevant location(s), date(s), time(s) and the victim's
relationship to the perpetrator (ifknown and can be safely disclosed):

Reasonable Accommodations: If you are an individual with a disability and may need a

reasonable accommodation, please contact [INSERT CONTACT]. A reasonable
accommodation related to this documentation_may include, for example, allowing an oral

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(Please note that you may attach additional pages as needed)

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

66737

statement instead of written documentation, or an extension of time to submit the requested
documentation.
Regulatory VAWA definitions of domestic violence, dating violence, sexual assault, or stalking:

Domestic violence includes felony or misdemeanor crimes of violence committed by a current or former
spouse or intimate partner of the victim by a person with whom the victim shares a child in common, by a
person who lives with or has lived with the victim as a spouse or intimate partner, by a person similarly
situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction, or by any
other person against an adult or youth victim who is protected from that person's acts under the domestic
or family violence laws of the jurisdiction.
Dating violence means violence committed by a person:
( 1) Who is or has been in a social relationship of a romantic or intimate nature with the victim; and
(2) Where the existence of such a relationship shall be determined based on a consideration of the
following factors: (i) The length of the relationship; (ii) The type of relationship; and (iii) The
frequency of interaction between the persons involved in the relationship.
Sexual assault means any nonconsensual sexual act proscribed by Federal, tribal, or State law, including
when the victim lacks capacity to consent.
Stalking means engaging in a course of conduct directed at a specific person that would cause a
reasonable person to:
(1) Fear for the person's individual safety or the safety of others or
(2) Suffer substantial emotional distress.
Certification of Applicant or Tenant: By signing below, I am certifying that the information provided on
this form is true and correct to the best of my knowledge and recollection and that one or more members of
my household is or has been a victim of domestic violence, dating violence, sexual assault, or stalking as
described in the VAWA definitions above.
Signature ______________

Signed on (Date._ _ _ _ _ _ _ _ _ _ __

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Public Reporting Burden for this collection of information is estimated to average 30 minutes per response. Ibis includes the time
for collecting, reviewing, and reporting. Comments concerning the accuracy of this burden estimate and any suggestions for reducing
this burden can be sent to the Reports Management Officer, QDAM, Department of Housing and Urban Development, 4 51 7th Street,
SW, Washington, DC 20410. Housing providers in programs covered by VAWA may request certification that the applicant or
tenant is a victim of VAWA violence/abuse. A Federal agency may not collect this information, and you are not required to complete
this form, unless it displays a currently valid Office of Management and Budget control number.

66738

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

Purpose of Form: If you or a member of your household is a victim of domestic violence, dating
violence, sexual assault, or stalking, and you are seeking an emergency transfer for yourself or your
household, you may use this form to request an emergency transfer and certify that you are eligible for an
emergency transfer under the Violence Against Women Act of 1994, as amended (VAWA). This form
refers to domestic violence, dating violence, sexual assault, or stalking as VA WA violence/ahuse. Despite
this law's name, protections are not limited to women, and are available regardless of a victim's sex,
actual or perceived gender identity, sexual orientation, or marital status. Submitting this fonn does not
necessarily mean that you will receive an emergency transfer. See your housing provider's Emergency
Transfer Plan for more information about emergency transfers. Note: Any personal information you
share in this form will not be collected nor maintained by HUD and will only be maintained by your
Covered Housing Providers according to the confidentiality provisions below.
You may request an emergency transfer when:
( 1) You (or a member of your household) are a victim ofVAWA violence/abuse;
(2) You specifically request the emergency transfer; and
(3) (A) You reasonably believe* you (or a member of your household) will soon face
more violence if you stay in your housing; or
(B) You (or a member of your household) are a victim of sexual assault that
occurred on the premises and you request an emergency transfer within 90 days
(including holidays and weekend days) after the date of that assault.
*Reasonable belief may stem from VAWA violence/abuse impacting a household member.
Submission of Documentation: Tfyou have not already done so, your housing provider may require you
to document that you, or a member of your household, are a victim of VAWA violence/abuse in addition
to completing this emergency transfer request form. This can be met by a self-certification (Form HUD5382) unless there is conflicting information. If you have third-party documentation that demonstrates
why you are eligible for an emergency transfer, you may submit that documentation to your housing
provider if you choose. See HUD-5380 (VAWA Notice) for more infom1ation.
Confidentiality: Your housing provider will keep strictly confidential any information you provide
about the VAWA violence/abuse or the fact you are a victim, including the information on this form.
This information can only be accessed by a person working for your housing provider if your housing
provider explicitly authorizes that person's access for a reason specifically called for under applicable
law. This information will not be given to others or put in a database shared with others, unless your
housing provider gets your written permission to do so for a limited time, is required to do so as part of an
eviction or tennination hearing or is required to do so by law. In addition, your housing provider must
keep your address strictly confidential to ensure that it is not disclosed to a person who committed or
threatened to commit VAWA violence/abuse against you.

TO BE COMPLETED BY OR ON BEHALF OF THE TENANT REQUESTING A
TRANSFER
1. Name(s)ofVictim(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
2. Your Name ((f'd~fferentjrom victim's): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
3. Name(s) of other member(s) of the household:
4.

Name(s) of other household member(s) who would transfer with the victim:

5. Address of location from which the victim seeks to transfer:
Best Method of Contact:

Phone Number~:_ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Is it okay to leave a voicemail? D Yes D No
D Email
Email Address:
D Mail
Mailing Address:

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D Phone

Federal Register / Vol. 87, No. 213 / Friday, November 4, 2022 / Notices

66739

Please List:
D Other
6. Name of the abuser (if known and can be safely disclosed): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
7. Relationship of the abuser to the victim (~f known and can be safely disclosed): _ _ _ _ _ __

8. What features are requested for a safe unit? You may also list here any information that would
facilitate a suitable transfer, such as accessibility needs, and a description of where it is safe/unsafe
for you to live
(Please note, ability to provide is based on availability.)
D New Neighborhood
D Second Floor unit (and above) D Well-lit hallways/walkways
D New Building
D Near an Exit
D 24 Hour Security
First Floor unit
Other:
9. NOTE: Your housing provider might, in certain circumstances, request written documentation that
you are a victim of VAWA violence/abuse. This information can be documented as follows: You can
decide which form to submit.
D HUD Form 5382 Certification ofDomestic Violence, Dating Violence, Sexual Assault, or
Stalking, and Alternate Documentation, which asks your name, the abuser's name, ifknown and
safe to provide, and a description of the incident(s).
D A document signed by a victim service provider, attorney, mental health professional, or medical
professional who has helped you address the V AWA violence/abuse. The professional must state
"under penalty of perjury" that he/she/they believe in the occurrence of the incident of VAWA
violence/abuse and that it is covered by VAWA. Both you and the professional must sign the
statement.
D A police, administrative, or court record (such as a protective order) that shows you (or a member
of your household) are a victim ofVAWA violence/abuse.
D At the discretion of your housing provider, a statement or other documentation provided by you.
D If permitted by your housing provider, a statement or other evidence provided by the tenant.

D

D

Certification of Tenant: By signing below, I certify that the following apply to me and my household:
1. I am requesting an emergency transfer.
AND
2. I believe there is a threat of imminent harm to myself or someone in my household if we stay in the
same housing unit, AND/OR I or a member of my household was sexually assaulted on the
premises of my housing in the last 90 days.
Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signed on'""'(-=D'-"a=t.,._e),. . ._____________
Public reporting burden for this collection of information is estimated to average 30 minutes per response. This includes the time for
collecting, reviewing, and reporting. Comments concerning the accuracy of this burden estimate and any suggestions for reducing this burden
can be sent to the Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street, SW, Washington, DC
20410. Housing providers in programs covered by VAWA may ask for a written request for an emergency transfer for a tenant who is a victim of
domestic violence, dating violence, sexual assault, or stalking. Housing providers may distribute this form to tenants and tenants may use it to
request an emergency transfer. The information is subject to the confidentiality requirements of VAWA. A Federal agency may not collect this
infonnation, and you are not required to complete this fonn, unless it displays a cun-ently valid Office of Management and Budget control
number.

[FR Doc. 2022–24070 Filed 11–3–22; 8:45 am]

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BILLING CODE C