Information Collection

Single Family Application for Insurance Benefits

IC 42065 under ICR 200606-2502-006 · OMB 2502-0429.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Single Family Application for Insurance Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HUD-27011	Yes	Yes
Form	PARTS-A-B-C	Yes	Yes
Form	PARTS-D-E	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	210,000	0	210,000
Annual IC Time Burden (Hours)	150,025	25	150,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.