Congregate Housing Services Program

Forms and Documents

Document Name	Status
Form HUD-90198 Congregate Housing Services Program Form	Modified
2502-0485 Supporting Statement (updated 11-20-18).doc Supporting Statement A	2018-12-20
ELOCCS_REGISTRATION_GUIDE.PDF Supplementary Document	2018-11-21
30 Day Federal Register.pdf Supplementary Document	2018-07-17
2502-0485 PTA (Signed by the Privacy Office) 3-20-18.pdf Supplementary Document	2018-07-03
2502-0485-Laws-regs-etc.zipx Supplementary Document	2014-12-16

IC Document Collections

IC ID	Document Title	Status
27226	Congregate Housing Services Program Form	Modified

ICR Details

OMB Control No: 2502-0485	ICR Reference No: 201709-2502-010
Status: Active	Previous ICR Reference No: 201407-2502-009
Agency/Subagency: HUD/OH	Agency Tracking No:
Title: Congregate Housing Services Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/02/2019
	Date Received in OIRA: 12/20/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved
Responses	196	0	0
Time Burden (Hours)	992	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information is necessary to monitor the use of grant funds for the Congregate Housing Services Program (CHSP) according to statutory, regulatory, and administrative requirements.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 17186	04/18/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 32888	07/16/2018
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Congregate Housing Services Program	HUD-90198, HUD-91180-A, HUD 91178A, HUD 90006, SF-425, SF-424	Payment Voucher ,   Summary Budget Grantee ,   Annual Program Budget Grantee ,   Annual Reporting Form ,   Federal Financial Report ,   SF-424

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ICR Summary of Burden

	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	196	0	0	-196	0	392
Annual Time Burden (Hours)	992	0	0	0	379	613
Annual Cost Burden (Dollars)	0	0	0	0	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: This request seeks a reinstatement with a change. The increase in burden hours and dollar amounts is a correction to the prior submission. Further to comply with standard submission requirements, Form HUD-90003 was deleted and SF-424 form is being added.

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Annual Cost to Federal Government: $41,013

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/20/2018

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