Owner's Certification with HUD Tenant Eligibility and Rent Procedures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 92236 HUD Form 92236	Form	Modified	Available
Form 90012 User Access Authorization Form	Form and Instruction	Modified	Available
Form 90011 Coordinator Access Authorization Form	Form and Instruction	Modified	Available
Form HUD9887 Document Package for Applicant's/Tenant's Consent to the R	Form and Instruction	Modified	Available
Form HUD 27061-h Race and Ethnic Reporting Form	Form and Instruction	Modified	Available
Form HUD 90105d Appendix 4-D 811 PRAC Lease	Form and Instruction	Modified	Available
Form HUD 90105 c Appendix 4-C 202 PRAC Lease	Form and Instruction	Modified	Available
Form HUD 90105b Appendix 4-B - Model Lease	Form and Instruction	Modified	Available
Form HUD 90105 a Appendix 4-A Model Lease for Subsidized Programs	Form and Instruction	Modified	Available
Form HUD 90166 Certificaiton of Domestic Violence, Dating Violence or Stalking	Form and Instruction	Modified	Available
Form HUD 90167 Lease Addendum	Form and Instruction	Modified	Available
Form HUD 90106 Appendix 5 - Sample Move-In/Move Out Inspection Form	Form and Instruction	Modified	Available
Form HUD 50059 A Owner's Certification of Compliance - Partial Certificaiton	Form and Instruction	Modified	Available
Form HUD 50059 Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Available
Form HUD 90102 Sample Verification of Disability	Form and Instruction	Modified	Available
Form HUD 90104 Exception to Limitations on Admission of Families	Form and Instruction	Modified	Available
Form HUD 90101 Certification for Qualified Long-Term Care Insurance Expenses	Form and Instruction	Modified	Available
Form HUD 90100 Annual Recertification	Form and Instruction	Modified	Available
Final - OMB 2502-0204 Supporting Statement.docx	Supporting Statement A	Uploaded 2025-09-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form	Modified	HUD Form 92236
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	User Access Authorization Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Coordinator Access Authorization Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Document Package for Applicant's/Tenant's Consent to the R
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Race and Ethnic Reporting Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Appendix 4-D 811 PRAC Lease
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Appendix 4-C 202 PRAC Lease
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Appendix 4-B - Model Lease
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Appendix 4-A Model Lease for Subsidized Programs
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Certificaiton of Domestic Violence, Dating Violence or Stalking
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Lease Addendum
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Appendix 5 - Sample Move-In/Move Out Inspection Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Owner's Certification of Compliance - Partial Certificaiton
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Sample Verification of Disability
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Exception to Limitations on Admission of Families
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Certification for Qualified Long-Term Care Insurance Expenses
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Modified	Annual Recertification
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Instruction	Modified

ICR Details

OMB Control No: 2502-0204	ICR Reference No: 202502-2502-006
Status: Received in OIRA	Previous ICR Reference No: 201609-2502-004
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Owner's Certification with HUD Tenant Eligibility and Rent Procedures
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/23/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	6,961,498	0
Time Burden (Hours)	1,625,155	0
Cost Burden (Dollars)	0	0

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Abstract: Collection of tenant data to ensure owners comply with Federal statutes and regulations that (1) establish policies on who may be admitted to subsidized housing; (2) prohibit discrimination in conjunction with selection of tenants and units; (3) specify how tenants’ incomes and rents must be compiled.

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Authorizing Statute(s): US Code: 12 USC 1701s Name of Law: Rent supplement payments for qualified lower income families
   US Code: 42 USC 1437 Name of Law: CHAPTER 8--LOW-INCOME HOUSING
   US Code: 12 USC 1715z-1 Name of Law: Rental and cooperative housing for lower income families
  

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 56399	07/09/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 44836	09/17/2025
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Owner's Certification with HUD Tenant Eligibility and Rent Procedures	HUD9887, HUD 50059 A, HUD 90100, HUD 90104, HUD 90101, HUD 90102, HUD 90106, HUD 90167, HUD 90105 a, HUD 90105 c, HUD 90105b, HUD 90105d, HUD 50059, HUD 90166, HUD 27061-h, 90012, 90011, Form 92236	Annual Recertification ,   Certification for Qualified Long-Term Care Insurance Expenses ,   Exception to Limitations on Admission of Families ,   Sample Verification of Disability ,   Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures ,   Owner's Certification of Compliance - Partial Certificaiton ,   Appendix 5 - Sample Move-In/Move Out Inspection Form ,   Lease Addendum ,   Certificaiton of Domestic Violence, Dating Violence or Stalking ,   Appendix 4-A Model Lease for Subsidized Programs ,   Appendix 4-B - Model Lease ,   Appendix 4-C 202 PRAC Lease ,   Appendix 4-D 811 PRAC Lease ,   Race and Ethnic Reporting Form ,   Document Package for Applicant's/Tenant's Consent to the R ,   Coordinator Access Authorization Form ,   User Access Authorization Form ,   HUD Form 92236

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	6,961,498	0	0	2,834,319	0	4,127,179
Annual Time Burden (Hours)	1,625,155	0	0	-33,316	0	1,658,471
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Reinstatement with change.

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Annual Cost to Federal Government: $58,960,628

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: 09/23/2025

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