Section 3 Sample Certification Forms

Forms and Documents

Document	Type	Status	Availability
Form HUD-4736D Section 3 Worker Self-Certification Form- Public Housing	Form	Modified	Available
Form HUD-4736C Section 3 Worker Self-Certification-Housing and Community Development	Form	Modified	Available
Form HUD-4736B Section 3 Employer Certification Form-Public Housing	Form	Modified	Available
Form HUD-4736A Section 3 Housing and Community Development Employer Certification Form	Form	Modified	Available
Form HUD-4736 Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Available
Form HUD-4736 Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Repair queued
Final - Supporting Statement OMB-2501-0041.docx	Supporting Statement A	Uploaded 2025-02-28	Repair queued
Final - Supporting Statement OMB-2501-0041.docx	Supporting Statement A	Uploaded 2025-02-28	Repair queued
30 Day FRN.pdf	Supplementary Document	Uploaded 2025-02-28	Repair queued
30 Day FRN.pdf	Supplementary Document	Uploaded 2025-02-28	Repair queued
60-Day FRN OMB 2501-0041.pdf	Supplementary Document	Uploaded 2025-02-05	Repair queued
60-Day FRN OMB 2501-0041.pdf	Supplementary Document	Uploaded 2025-02-05	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
251798	Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Section 3 Worker Self-Certification Form- Public Housing
251798	Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Section 3 Worker Self-Certification-Housing and Community Development
251798	Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Section 3 Employer Certification Form-Public Housing
251798	Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Section 3 Housing and Community Development Employer Certification Form
251798	Section 3 Public Housing/Section 8 Certification Form	Form	Modified	Section 3 Public Housing/Section 8 Certification Form
251798	Section 3 Public Housing/Section 8 Certification Form	Form	Modified

ICR Details

OMB Control No: 2501-0041	ICR Reference No: 202502-2501-002
Status: Active	Previous ICR Reference No: 202202-2501-004
Agency/Subagency: HUD/HUDSEC	Agency Tracking No:
Title: Section 3 Sample Certification Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/31/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/28/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2028	36 Months From Approved	04/30/2025
Responses	2,150	0	2,150
Time Burden (Hours)	1,075	0	1,075
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:
	89 FR 48914	06/10/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 10937	02/28/2025
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Section 3 Public Housing/Section 8 Certification Form	HUD-4736, HUD-4736A, HUD-4736B, HUD-4736C, HUD-4736D	Section 3 Public Housing/Section 8 Certification Form ,   Section 3 Housing and Community Development Employer Certification Form ,   Section 3 Employer Certification Form-Public Housing ,   Section 3 Worker Self-Certification-Housing and Community Development ,   Section 3 Worker Self-Certification Form- Public Housing

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ICR Summary 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	2,150	0	0	0	0
Annual Time Burden (Hours)	1,075	1,075	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $54,464

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: 02/28/2025

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