Information Collection Request

Owner's Certification with HUD Tenant Eligibility and Rent Procedures

ICR 201609-2502-004 · OMB 2502-0204 · Historical Active

⚠️ Notice: This information collection may be outdated.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

2025-09-23 - Reinstatement with change of a previously approved collection

Forms and Documents

Document	Type	Status	Availability
Form HUD 90105 c Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged	Available
Race Ethnicity Form 27061-h 1-03_19_2014.pdf	Supplementary Document	Uploaded 2016-09-15	Available
83C (2502-0204).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2016-09-15	Available
Laws and Regs for 2502-0204.doc	Supplementary Document	Uploaded 2014-03-18	Available
Supporting Statement A.doc	Supporting Statement A	Uploaded 2014-03-18	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
27064	Owner's Certification with HUD Tenant Eligibility and Rent Procedures	Form and Instruction	Unchanged

ICR Details

OMB Control No: 2502-0204	ICR Reference No: 201609-2502-004
Status: Historical Active	Previous ICR Reference No: 201403-2502-004
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Owner's Certification with HUD Tenant Eligibility and Rent Procedures
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: 12/01/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/13/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	06/30/2017	06/30/2017
Responses	4,127,179	0	4,127,179
Time Burden (Hours)	1,658,471	0	1,658,471
Cost Burden (Dollars)	0	0	0

Abstract: Collection of tenant data to ensure owners comply with Federal statutes and regulations that (1) establish policies on who may be admitted to subsidized housing; (2) prohibit discrimination in conjunction with selection of tenants and units; (3) specify how tenantsÂ incomes and rents must be compiled.

Authorizing Statute(s): US Code: 12 USC 1715z-1 Name of Law: Rental and cooperative housing for lower income families
   US Code: 12 USC 1701s Name of Law: Rent supplement payments for qualified lower income families
   US Code: 42 USC 1437 Name of Law: CHAPTER 8--LOW-INCOME HOUSING

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 45946	07/30/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 18047	03/31/2014
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Owner's Certification with HUD Tenant Eligibility and Rent Procedures	HUD9887, HUD 50059 A, HUD 90100, HUD 90104, HUD 90101, HUD 90102, HUD 90103, HUD 90106, HUD 90167, HUD 90105 a, HUD 90105 c, HUD 90105b, HUD 90105d, HUD 50059, HUD 90166, HUD 27061-h, 90012, 90011	Appendix 4-C 202 PRAC Lease , Appendix 4-D 811 PRAC Lease , Race and Ethnic Reporting Form , Document Package for Applicant's/Tenant's Consent to the R , Coordinator Access Authorization Form , Annual Recertification , Certification for Qualified Long-Term Care Insurance Expenses , Exception to Limitations on Admission of Families , Sample Verification of Disability , Sample Verificaiton of disability All Programs , Owner's Certification of Compliance with HUD's Tenant Eligibility and Rent Procedures , Owner's Certification of Compliance - Partial Certificaiton , Appendix 5 - Sample Move-In/Move Out Inspection Form , Lease Addendum , Certificaiton of Domestic Violence, Dating Violence or Stalking , Appendix 4-A Model Lease for Subsidized Programs , Appendix 4-B - Model Lease , User Access Authorization Form

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	4,127,179	4,127,179
Annual Time Burden (Hours)	1,658,471	1,658,471
Annual Cost Burden (Dollars)	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: There are no program changes relative to this submission or adjustments to Items 13 or 14. As a result of new individuals participating in HUD programs, there has been an increase in the number of respondents, responses and burden hours.

Annual Cost to Federal Government: $1,850,810

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

Agency Contact: Lanier Hylton 2024022510

Common Form ICR: No