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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Application for Healthy Homes and Lead Hazard Control Program Grants
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
24 CFR 84
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
HUD 96012
Capacity of the Applicant and Relevant Organizational Experience
96012.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 96014
Soundness of Approach
96014.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 96015
Leveraging Resources
96015.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
SF 424
Application for Federal Assistance
sf424.doc
Yes
Yes
Fillable Fileable
Other-Survey
sf424sup.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 424 cbw
Grant Application Detailed Budget Worksheet
424-cbw.xls
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 27061
Race and Ethnic Data Reporting Form
27061.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 27300
America's Affordable Communities Initiative
27300.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 2880
Disclosure and Update Report
2880.doc
Yes
Yes
Fillable Fileable
Other-Certifiction
2990.pdf
Yes
Yes
Fillable Fileable
Other-Certificaiton
2991.pdf
Yes
Yes
Fillable Fileable
Other-Acknowledgment
2993.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 2994-A
Client Comments and Suggestins
2994-A.doc
Yes
Yes
Fillable Fileable
Form and Instruction
SF LLL
Disclosure of Lobbying Activities Required
sflllin.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 96010
Logic Model
HH Demo 2007.xls
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 96011
Third Party Documentation
96011.doc
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 96013
Needs/Extent of the Problem
96013_2010-08-10 final.docx
Yes
Yes
Fillable Fileable
Form
HUD 96008
Benchmark Standards (36 Months)
final 36 month benchmark.xls
Yes
Yes
Fillable Fileable
Form
HUD 96009
Benchmark Standards (42 Months)
final 42 month benchmark.xls
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Homeownership Promotion
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
250
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
95 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
330
0
0
0
0
330
Annual IC Time Burden (Hours)
21,760
0
0
0
0
21,760
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
HH Demo QA template v1 1
HH Demo QA template v1 1 Nov05.doc
03/07/2008
HH tech studies QAP template
HH tech studies QAP template v2 1 Nov2005.doc
03/07/2008
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.