Information Collection

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

IC 27064 under ICR 200712-2502-002 · OMB 2502-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2502-0204 can be found here:

Documents and Forms

Document Name Document Type
HUD-90105 (a-d).doc Other-Model Lease
HUD-90106.doc Other-Sample Move in/move out form
9887/9887A Notice and Consent for the Release of Information/Fact S 9887.pdf Form
HUD 90100 Annual Recertification HUD-90100.doc Form
HUD 90101 Certificaiton for Qualified Long-Term Care Insurance Exp HUD-90101.doc Form
HuD 90102 Verification of Disability HUD-90102.doc Form
HUD 10103 Verfiication of disability - All Programs Except 202/8,S HUD-90103.doc Form
HUD 90104 Exception to Limitations on Admission of Families HUD-90104.doc Form
HUD 27061-h Race and Ethnic Reporting Form HUD-27061-h.doc Form and Instruction
HUD 50059 Owner's Certificaiton of Compliance with HUD's Tenant El HUD-50059.pdf Form and Instruction

Information Collection (IC) Details

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 886 24 CFR 891 Subpart E 24 CFR 884 24 CFR Part 5 24 CFR 880 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Lease			HUD-90105 (a-d).doc	Yes	No	Paper Only
Other-Sample Move in/move out form			HUD-90106.doc	Yes	No	Paper Only
Form and Instruction	HUD 50059	Owner's Certificaiton of Compliance with HUD's Tenant Eligibility and Rent Procedures	HUD-50059.pdf	Yes	No	Fillable Printable
Form and Instruction	HUD 27061-h	Race and Ethnic Reporting Form	HUD-27061-h.doc	Yes	No	Fillable Printable
Form	HUD 90104	Exception to Limitations on Admission of Families	HUD-90104.doc	Yes	Yes	Fillable Fileable
Form	9887/9887A	Notice and Consent for the Release of Information/Fact Sheet Verification of Information	9887.pdf	Yes	No	Fillable Printable
Form	HUD 90100	Annual Recertification	HUD-90100.doc	Yes	Yes	Fillable Fileable
Form	HUD 90101	Certificaiton for Qualified Long-Term Care Insurance Expenses	HUD-90101.doc	Yes	Yes	Fillable Printable
Form	HuD 90102	Verification of Disability	HUD-90102.doc	Yes	Yes	Fillable Printable
Form	HUD 10103	Verfiication of disability - All Programs Except 202/8,SEC 202 PAC, PRAC, 811/PRAC	HUD-90103.doc	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,936,897	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,964,605	2,754,466	2,210,139
Annual IC Time Burden (Hours)	1,920,431	-187,621	2,108,052
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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