Household Services and Outcomes Report, 52698

Eviction Protection Grant Program

Documents and Forms

Document Name Document Type
Final - HUD Form 52698 Eviction Protection Client Report.docx Other-Client Services and Outcomes R
Household Services and Outcomes Report_52698.pdf Other-reporting form

Information Collection (IC) Details

IC Title:	Household Services and Outcomes Report, 52698	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Client Services and Outcomes Report, 52698			Final - HUD Form 52698 Eviction Protection Client Report.docx		No		Paper Only
Other-reporting form			Household Services and Outcomes Report_52698.pdf		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	21,000	1,000	20,000
Annual IC Time Burden (Hours)	5,250	250	5,000
Annual IC Cost Burden (Dollars)	321,983	321,983	0

Documents for IC

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.