OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Office of Community Services Affordable Housing and Supportive Services Demonstration Data Collection

ICR 202602-0970-016 · OMB 0970-0628 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 4 AHSSD PPR Form Form Modified Available
NonSub Change Request - AHSSD 0970-0628.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-02-25 Available
NonSub Change - Update to ACF ICs - Protecting Women EO - Submission 2.10.25.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-02-10 Available
NonSub Change Request - AHSSD.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-01-07 Available
Attachment E - Study Information Sheet for Individuals Completing Matrix.docx Supplementary Document Uploaded 2024-08-28 Available
Attachment D - Self Sufficiency Matrix Instructions & Consent.docx Supplementary Document Uploaded 2024-08-28 Available
Attachment C - Interview Consent Form CLEAN.docx Supplementary Document Uploaded 2025-01-07 Available
Attachment B - Invitation to Interview CLEAN.docx Supplementary Document Uploaded 2025-01-07 Available
Attachment A - Research Questions.docx Supplementary Document Uploaded 2024-08-28 Available
Supporting Statement B - AHSSD Revision (CLEAN).docx Supporting Statement B Uploaded 2025-02-10 Available
Supporting Statement A - AHSSD Revision (CLEAN).docx Supporting Statement A Uploaded 2025-02-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
270496 2024 Version – Semi-Annual Quantitative Report OPTIONAL Other-Semi Annual Report Unchanged
270495 2024 Version – Semi-Annual Quantitative Report MANDATORY Other-Semi Annual Report Unchanged
264807 Interviews with Caseworkers Other-Interview Unchanged
264806 Interviews with Program Directors Other-Interview Unchanged
264805 2023 Version – Semi-Annual Quantitative Report OPTIONAL Other-Semi Annual Report Unchanged
264804 2023 Version – Semi-Annual Quantitative Report MANDATORY Other-Semi Annual Report Unchanged
264803 Quarterly PPR Collections Form ModifiedAHSSD PPR Form
264803 Quarterly PPR Collections Instruction Modified
264802 Resident Interview Other-Interview Unchanged
264801 Service Receipt Questionnaire Other-Questionnaire Unchanged
264800 Self-Sufficiency Matrix Other-Questionnaire Unchanged
ICR Details
0970-0628 202602-0970-016
Active 202502-0970-016
HHS/ACF OCS
Office of Community Services Affordable Housing and Supportive Services Demonstration Data Collection
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/26/2026
Retrieve Notice of Action (NOA) 02/25/2026
  Inventory as of this Action Requested Previously Approved
10/31/2027 10/31/2027 10/31/2027
1,462 0 1,462
1,393 0 1,393
0 0 0
The Affordable Housing and Supportive Services Demonstration (AHSSD) Data Collection (OMB #0970-0628) was originally approved in March 2024 and then revised in September 2024. The information collection includes individual-level survey instruments and on-site focus groups to collect information from program participants, onsite and virtual interviews to collect information from program staff, and report forms to capture service delivery and outcomes. The Office of Community Services (OCS) Affordable Housing and Supportive Services Demonstration (AHSSD) data collection was approved on March 1, 2024. The approved Quarterly Narrative PPR Guidance requires recipients to provide narrative updates on project activities, accomplishments, challenges, and implementation efforts with question prompts specific to the use of AHSSD funding for the project. The approved guidance document requires grant recipients to provide the AHSSD PPR information using the ACF Standard PPR form (OMB Control #0970-0406). A revision request for the ACF Standard PPR is currently submitted to OMB for review and approval. To minimize changes in reporting format and information collected from AHSSD grant recipients, OCS would like to align the AHSSD-specific PPR form with the currently approved Quarterly Narrative PPR Guidance by incorporating the guidance into the PPR document. This not only minimizes changes but also streamlines reporting by integrating AHSSD-specific prompts with the prompts from the original standard form.
US Code: 42 USC 1310 Name of Law: Social Security Act
  
None
Not associated with rulemaking
  89 FR 49878 06/12/2024
89 FR 71371 09/03/2024
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,462 1,462 0 0 0 0
Annual Time Burden (Hours) 1,393 1,393 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$43,000
No
    Yes
    No
No
No
No
No
Molly Buck 202 205-4724 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/25/2026