Congregate Housing Services Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SF-424 SF-424	Form and Instruction	Modified	Available
Form SF-425 Federal Financial Report	Form and Instruction	Modified	Available
Form HUD 90006 Annual Reporting Form	Form and Instruction	Modified	Available
Form HUD 91178A Annual Program Budget Grantee	Form	Modified	Available
Form HUD-91180-A Summary Budget Grantee	Form	Modified	Available
Form HUD-90198 Payment Voucher	Form	Modified	Available
Form HUD-90198 Congregate Housing Services Program	Form	Modified	Repair queued
83C Form_2502-0485.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-04-08	Available
83C Form_2502-0485.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-04-08	Missing upstream
2502-0485 30 day.pdf	Supplementary Document	Uploaded 2023-01-24	Available
2502-0485 30 day.pdf	Supplementary Document	Uploaded 2023-01-24	Repair queued
2502-0485 Laws-regs-etc.zipx	Supplementary Document	Uploaded 2022-11-09	Repair queued
2502-0485 Laws-regs-etc.zipx	Supplementary Document	Uploaded 2022-11-09	Repair queued
2502-0485-Supporting Statement-(f).docx	Supporting Statement A	Uploaded 2023-01-24	Available
2502-0485-Supporting Statement-(f).docx	Supporting Statement A	Uploaded 2023-01-24	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27226	Congregate Housing Services Program	Form and Instruction	Modified	SF-424
27226	Congregate Housing Services Program	Form and Instruction	Modified	Federal Financial Report
27226	Congregate Housing Services Program	Form and Instruction	Modified	Annual Reporting Form
27226	Congregate Housing Services Program	Form	Modified	Annual Program Budget Grantee
27226	Congregate Housing Services Program	Form	Modified	Summary Budget Grantee
27226	Congregate Housing Services Program	Form	Modified	Payment Voucher
27226	Congregate Housing Services Program	Form	Modified

ICR Details

OMB Control No: 2502-0485	ICR Reference No: 202503-2502-006
Status: Active	Previous ICR Reference No: 202211-2502-002
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Congregate Housing Services Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/15/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/08/2025
Terms of Clearance: Approved consistent with EO 14168.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	10/31/2026	10/31/2026
Responses	103	0	103
Time Burden (Hours)	613	0	613
Cost Burden (Dollars)	0	0	0

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Abstract: This information is necessary to monitor the use of grant funds for the Congregate Housing Services Program (CHSP) according to statutory, regulatory, and administrative requirements.

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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:
	87 FR 54711	09/07/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 1287	01/09/2023
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
Congregate Housing Services Program	HUD-90198, HUD-91180-A, HUD 91178A, HUD 90006, SF-425, SF-424	Payment Voucher ,   Summary Budget Grantee ,   Annual Program Budget Grantee ,   Annual Reporting Form ,   Federal Financial Report ,   SF-424

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ICR Summary of Burden

table that charts list 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	103	103	0	0	0	0
Annual Time Burden (Hours)	613	613	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: Completion of the Annual Report by grantees provides HUD with essential information about whom the grant is serving and what sort of services the beneficiaries receive using grant funds.

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Annual Cost to Federal Government: $24,696

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: 04/08/2025

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