Implementation of the Violence Against Women and Department of Justice Reauthorization Act of 2005

Forms and Documents

Document Name	Status
Form HUD-50066 Certification of Domestic Violence, Dating Violence, or Stalking Form	Modified
Supporting Statement 2577-0249.docx Supporting Statement B	2011-02-09
Published FR Notice 2577-0249.pdf Supplementary Document	2010-11-02
DOJ Reauthor Act.DOC Supplementary Document	2007-07-25
Supporting Statement 2577-0249.docx Supporting Statement A	2011-02-17

IC Document Collections

IC ID	Document Title	Status
46037	Certification of Domestic Violence, Dating Violence, or Stalking Form	Modified

ICR Details

OMB Control No: 2577-0249	ICR Reference No: 201011-2577-001
Status: Historical Active	Previous ICR Reference No: 200707-2577-005
Agency/Subagency: HUD/PIH	Agency Tracking No: 2577-0249
Title: Implementation of the Violence Against Women and Department of Justice Reauthorization Act of 2005
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/17/2011
	Date Received in OIRA: 11/09/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2014	36 Months From Approved	02/28/2011
Responses	200	0	200
Time Burden (Hours)	200	0	200
Cost Burden (Dollars)	4,800	0	4,800

---

Abstract: Residents residing In the public housing and Section 8 voucher programs will submit a HUD approval certification form that attest that the individual is a victim of abuse and that the incidences of abuse are bona fide. Without the certification, a PHA or owner may terminate assistance. The information provided to the PHA and owner is confidential.

---

Authorizing Statute(s): US Code: 42 USC 1437 -Section 6(u)(1)(A) Name of Law: U.S. Housing Act of 1937
   PL: Pub.L. 109 - 271 606, Section 8(ee)(1)(A)) - Name of Law: U.S.. Housing Act of 1937
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 162 606 Name of Law: Violence Against Women and Department of Justice Reauthorization Act of 2005

---

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:
	75 FR 56129	09/15/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 68812	11/09/2010
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Certification of Domestic Violence, Dating Violence, or Stalking	HUD-50066	Certification of Domestic Violence, Dating Violence, or Stalking

---

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	200	200	0	0	0	0
Annual Time Burden (Hours)	200	200	0	0	0	0
Annual Cost Burden (Dollars)	4,800	4,800	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:

---

Annual Cost to Federal Government: $4,800

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

---

Common Form ICR:  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:

(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: 11/09/2010

---