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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Owner's Certification with HUD Tenant Eligibility and Rent Procedures
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 891 Subpart E
24 CFR 884
24 CFR 886
24 CFR Part 5
24 CFR 880
24 CFR 5.233
(To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Consent to Release Information
9887.pdf
Yes
No
Fillable Printable
Form and Instruction
HUD 90100
Annual Recertification
90100.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90101
Certification for Qualified Long-Term Care Insurance Expenses
90101.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90104
Exception to Limitations on Admission of Families
90104.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90102
Sample Verification of Disability
90103.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90103
Sample Verificaiton of disability All Programs
90103.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 50059
Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures
50059.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 50059 A
Owner's Certification of Compliance - Partial Certificaiton
50059-a.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90106
Appendix 5 - Sample Move-In/Move Out Inspection Form
90106.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90167
Lease Addendum
90167-ca.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90166
Certificaiton of Domestic Violence, Dating Violence or Stalking
90066.pdf
Yes
No
Fillable Fileable
Form and Instruction
HUD 90105 a
Appendix 4-A Model Lease for Subsidized Programs
90105a.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90105b
Appendix 4-B - Model Lease
90105b.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90105 c
Appendix 4-C 202 PRAC Lease
90105c.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 90105d
Appendix 4-D 811 PRAC Lease
90105d.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
HUD 27061-h
Race and Ethnic Reporting Form
27061-h .doc
Yes
Yes
Fillable Fileable
Form and Instruction
HUD9887
Document Package for Applicant's/Tenant's Consent to the R
9887.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
90011
Coordinator Access Authorization Form
HUD-90011.docx
Yes
Yes
Fillable Fileable
Form and Instruction
90012
User Access Authorization Form
HUD-90012.docx
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:
2,184,726
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
99 %
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
3,301,693
0
24,000
0
0
3,277,693
Annual IC Time Burden (Hours)
1,354,979
0
6,300
0
0
1,348,679
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
PIA
MF HSG - PCAS# 00251780 - PIA 2502-0204.doc
05/13/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.