Office of Community Services Affordable Housing and Supportive Services Demonstration Data Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 AHSSD PPR Form	Form	Modified	Available
NonSub Change Request - AHSSD 0970-0628.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-02-25	Available
NonSub Change - Update to ACF ICs - Protecting Women EO - Submission 2.10.25.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-10	Available
NonSub Change Request - AHSSD.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-01-07	Available
Attachment E - Study Information Sheet for Individuals Completing Matrix.docx	Supplementary Document	Uploaded 2024-08-28	Available
Attachment D - Self Sufficiency Matrix Instructions & Consent.docx	Supplementary Document	Uploaded 2024-08-28	Available
Attachment C - Interview Consent Form CLEAN.docx	Supplementary Document	Uploaded 2025-01-07	Available
Attachment B - Invitation to Interview CLEAN.docx	Supplementary Document	Uploaded 2025-01-07	Available
Attachment A - Research Questions.docx	Supplementary Document	Uploaded 2024-08-28	Available
Supporting Statement B - AHSSD Revision (CLEAN).docx	Supporting Statement B	Uploaded 2025-02-10	Available
Supporting Statement A - AHSSD Revision (CLEAN).docx	Supporting Statement A	Uploaded 2025-02-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
270496	2024 Version – Semi-Annual Quantitative Report OPTIONAL	Other-Semi Annual Report	Unchanged
270495	2024 Version – Semi-Annual Quantitative Report MANDATORY	Other-Semi Annual Report	Unchanged
264807	Interviews with Caseworkers	Other-Interview	Unchanged
264806	Interviews with Program Directors	Other-Interview	Unchanged
264805	2023 Version – Semi-Annual Quantitative Report OPTIONAL	Other-Semi Annual Report	Unchanged
264804	2023 Version – Semi-Annual Quantitative Report MANDATORY	Other-Semi Annual Report	Unchanged
264803	Quarterly PPR Collections	Form	Modified	AHSSD PPR Form
264803	Quarterly PPR Collections	Instruction	Modified
264802	Resident Interview	Other-Interview	Unchanged
264801	Service Receipt Questionnaire	Other-Questionnaire	Unchanged
264800	Self-Sufficiency Matrix	Other-Questionnaire	Unchanged

ICR Details

OMB Control No: 0970-0628	ICR Reference No: 202602-0970-016
Status: Active	Previous ICR Reference No: 202502-0970-016
Agency/Subagency: HHS/ACF	Agency Tracking No: OCS
Title: Office of Community Services Affordable Housing and Supportive Services Demonstration Data Collection
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: 02/26/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/25/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	10/31/2027	10/31/2027
Responses	1,462	0	1,462
Time Burden (Hours)	1,393	0	1,393
Cost Burden (Dollars)	0	0	0

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Abstract: The Affordable Housing and Supportive Services Demonstration (AHSSD) Data Collection (OMB #0970-0628) was originally approved in March 2024 and then revised in September 2024. The information collection includes individual-level survey instruments and on-site focus groups to collect information from program participants, onsite and virtual interviews to collect information from program staff, and report forms to capture service delivery and outcomes. The Office of Community Services (OCS) Affordable Housing and Supportive Services Demonstration (AHSSD) data collection was approved on March 1, 2024. The approved Quarterly Narrative PPR Guidance requires recipients to provide narrative updates on project activities, accomplishments, challenges, and implementation efforts with question prompts specific to the use of AHSSD funding for the project. The approved guidance document requires grant recipients to provide the AHSSD PPR information using the ACF Standard PPR form (OMB Control #0970-0406). A revision request for the ACF Standard PPR is currently submitted to OMB for review and approval. To minimize changes in reporting format and information collected from AHSSD grant recipients, OCS would like to align the AHSSD-specific PPR form with the currently approved Quarterly Narrative PPR Guidance by incorporating the guidance into the PPR document. This not only minimizes changes but also streamlines reporting by integrating AHSSD-specific prompts with the prompts from the original standard form.

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Authorizing Statute(s): US Code: 42 USC 1310 Name of Law: Social Security Act
  

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 49878	06/12/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 71371	09/03/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
2023 Version – Semi-Annual Quantitative Report MANDATORY
2023 Version – Semi-Annual Quantitative Report OPTIONAL
2024 Version – Semi-Annual Quantitative Report MANDATORY
2024 Version – Semi-Annual Quantitative Report OPTIONAL
Interviews with Caseworkers
Interviews with Program Directors
Quarterly PPR Collections	4	AHSSD PPR Form
Resident Interview
Self-Sufficiency Matrix
Service Receipt Questionnaire

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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	1,462	1,462	0	0	0	0
Annual Time Burden (Hours)	1,393	1,393	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: $43,000

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.     Yes

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: 02/25/2026

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