7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annally/Quarterly Date Prepared: May 8, 2009 
 | ||||||||||
| Section of Regulation 
 (A) | 
			 Title 
 
 (B) | 
			 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually (D) x (E) (E) | Total Annual Responses 
 (F) | Hours Per Response 
 (G) | Total Annual Hours (F) x (G) (H) | Wage Class (per hour) 
 (I) | Cost to the Public (H) x (J) 
 (J) | |
| REPORTING REQUIREMENTS – NO FORMS | ||||||||||
| 
			 1944.651(d) | 
			 Applicants must inform Agency if there is any known relationship of association with a RHS employee. 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative 
 
 
 
 | 
			 
 
 
 
 2 
 
 3 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 2 
 
 3 | 
			 
 
 
 
 0.16 
 
 0.16 | 
			 
 
 
 
 0.32 
 
 0.48 | 
			 
 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 
 $10.00 
 
 $10.00 | |
| 
			 1944.658(a)(3) 1944.666(b)(7) 1944.666(e) 1944.670(a) 1944.676(b)(1)(x) 1944.688(e) 1944.689(a)(3) | 
			 7 CFR 3015, 7 CFR 3016, and OMB Circular A-122 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative 
 
 
 
 | 
			 
 
 
 74 
 
 79 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 74 
 
 79 | 
			 
 
 
 8 
 
 8 | 
			 
 
 
 592 
 
 632 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $5,920 
 
 $6,320 | |
| 
			 1944.661(a) 1944.661(b) | 
			 HPG recipient (individual Homeowners) evidence of income and ownership 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Grantee form documentation 
 
 
 
 | 
			 
 
 
 1,092 
 
 1,166 | 
			 
 
 
 2 
 
 2 | 
			 
 
 
 2,184 
 
 2,332 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 2,184 
 
 2,332 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $21,840 
 
 $23,320 | |
| 
			 1944.662(a) 
 | 
			 HPG recipient (rental property owner or Co-op) requirements of evidence of ownership 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Grantee form documentation 
 
 
 
 | 
			 
 
 
 
 74 
 
 79 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 74 
 
 79 | 
			 
 
 
 
 0.5 
 
 0.5 | 
			 
 
 
 
 37 
 
 40 | 
			 
 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 
 $370 
 
 $400 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annally/Quarterly Date Prepared: May 8, 2009 
 | ||||||||||
| Section of Regulation 
 (A) | 
			 Title 
 
 (B) | 
			 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually 
 (E) | Total Annual Responses (D) x (E) (F) | Hours Per Response 
 (G) | Total Annual Hours (F) x (G) (H) | Wage Class (per hour) 
 (I) | Cost to the Public (H) x (J) 
 (J) | |
| REPORTING REQUIREMENTS – NO FORMS | ||||||||||
| 
			 1944.662(b) | 
			 HPG recipient (tenant in rental property or co-op owner) of income eligibility 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Grantee from and/or documentation 
 
 
 
 | 
			 
 
 
 1,092 
 
 1,166 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 1,092 
 
 1,166 | 
			 
 
 
 0.5 
 
 0.5 | 
			 
 
 
 546 
 
 583 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $5,460 
 
 $5,830 | |
| 
			 1944.663 
 | 
			 Ownership agreement between HPC Grantee and Rental Property Owner or Co-op 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Non-standard form by grantee 
 
 
 
 | 
			 
 
 
 
 24 
 
 26 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 24 
 
 26 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 24 
 
 26 | 
			 
 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 
 $240 
 
 $260 | |
| 
			 1944.665 
 | 
			 Final Inspection Report 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Non-standard 
 
 
 
 | 
			 
 
 1,092 
 
 1,166 | 
			 
 
 1 
 
 1 | 
			 
 
 1,092 
 
 1,166 | 
			 
 
 0.5 
 
 0.5 | 
			 
 
 546 
 
 583 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $5,460 
 
 $5,830 | |
| 
			 1944.667 
 | 
			 Relocation and displacement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative in statement of activities 
 
 
 
 | 
			 
 
 74 
 
 79 | 
			 1 
 
 1 | 
			 
 
 74 
 
 79 | 
			 
 
 0.33 
 
 0.33 | 
			 
 
 24 
 
 26 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $240 
 
 $260 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: May 8, 2009 
 | ||||||||||
| Section of Regulation 
 (A) | 
			 Title 
 
 (B) | 
			 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually 
 (E) | Total Annual Responses (D) x (E) (F) | Hours Per Response 
 (G) | Total Annual Hours (F) x (G) (H) | Wage Class (per hour) 
 (I) | Cost to the Public (H) x (J) 
 (J) | |
| REPORTING REQUIREMENTS – NO FORMS | ||||||||||
| 
			 1944.672(e) 1944.673 1944.676(d)(e) | 
			 Documentation of historic preservation process, determination if unit is located in floodplain/wetland, or an archeological property 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative and Exhibit F-2 
 
 
 
 | 
			 
 
 
 
 
 1,092 
 
 1,166 | 
			 
 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 
 1,092 
 
 1,166 | 
			 
 
 
 
 
 0.16 
 
 0.16 | 
			 
 
 
 
 
 175 
 
 186 | 
			 
 
 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 
 
 $1,750 
 
 $1,860 | |
| 
			 1944.674(c) 1944.676(e-g) | 
			 Documentation that statement of activities submitted to State single point of contact 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative 
 
 
 
 | 
			 
 
 
 
 97 
 
 103 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 97 
 
 103 | 
			 
 
 
 
 0.16 
 
 0.16 | 
			 
 
 
 
 16 
 
 16 | 
			 
 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 
 $160 
 
 $160 | |
| 
			 1944.676(b) 
 | 
			 Statement of Activities (Pre-application Requirement) 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative 
 
 
 
 | 
			 
 
 
 97 
 
 103 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 97 
 
 103 | 
			 
 
 
 8 
 
 8 | 
			 
 
 
 776 
 
 824 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $7,760 
 
 $8,240 | |
| 
			 1944.683(b) 1944.688(a) 
 | 
			 Quarterly and Final Performance Reports 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Exhibit E-1 
 
 
 
 | 
			 
 
 
 74 
 
 79 | 
			 
 
 
 4 
 
 4 | 
			 
 
 
 296 
 
 316 | 
			 
 
 
 2 
 
 2 | 
			 
 
 
 592 
 
 632 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $5,920 
 
 $6,320 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: May 8, 2009 
 | |||||||||||
| Section of Regulation 
 (A) | 
			 Title 
 
 (B) | 
			 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually (D) x (E) (E) | Total Annual Responses 
 (F) | Hours Per Response (F) x (G) (G) | Total Annual Hours 
 (H) | Wage Class (per hour) 
 (I) | Cost to the Public (H) x (J) 
 (J) | ||
| REPORTING REQUIREMENTS – NO FORMS | |||||||||||
| 
			 1944.684(d) | 
			 Amendment to Grant Agreement Extension and/or Revision 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization 
 | 
			 Exhibit B 
 
 
 
 | 
			 
 
 
 18 
 
 20 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 18 
 
 20 | 
			 
 
 
 0.5 
 
 0.5 | 
			 
 
 
 9 
 
 10 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $90 
 
 $100 | ||
| 
			 1944.654(b) | 
			 Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I – for Grantees Other Than Individuals 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization 
 | 
			 AD 1049 
 
 
 
 | 
			 
 
 
 
 
 97 
 
 103 | 
			 
 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 
 97 
 
 103 | 
			 
 
 
 
 
 0.16 
 
 0.16 | 
			 
 
 
 
 
 16 
 
 16 | 
			 
 
 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 
 
 $160 
 
 $160 
 | ||
| 
			 | 
			 REPORTING TOTAL | 
			 | 
			 | 
			 
 | 
			 13,054 | 
			 | 
			 11,444 | 
			 | 
			 | ||
| BURDENS AND FORMS APPROVED UNDER OTHER OMB NUMBERS | |||||||||||
| 
			 1944.672(a) 1944.676(c) | 
			 Request for Environmental Information 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Form 1940-20 (0575-0094) 
 
 
 
 | 
			 
 
 97 
 
 103 | 
			 
 
 1 
 
 1 | 
			 
 
 97 
 
 103 | 
			 
 
 0.25 
 
 0.25 | 
			 
 
 24 
 
 26 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $500 
 
 $500 | ||
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: May 8, 2009 
 | ||||||||||
| Section of Regulation 
 (A) | 
			 Title 
 
 (B) | 
			 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually 
 (E) | Total Annual Responses (D) x (E) (F) | Hours Per Response 
 (G) | Total Annual Hours (F) x (G) (H) | Wage Class (per hour) 
 (I) | Cost to the Public (H) x (J) 
 (J) | |
| BURDENS AND FORMS APPROVED UNDER OTHER OMB NUMBERS | ||||||||||
| 
			 1944.676{a) | 
			 Pre-Application for Federal Assistance 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 424 (4040-0004) 
 | 
			 
 
 
 97 
 103 | 
			 
 
 
 1 
 1 | 
			 
 
 
 97 
 103 | 
			 
 
 
 0.5 
 0.5 | 
			 
 
 
 49 
 51 | 
			 
 
 
 $10.00 
 $10.00 | 
			 
 
 
 $490 
 $510 | |
| 
			 1944.676(h) | 
			 Equal Opportunity Agreement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Form RD 400-1 (0575-0018) 
 
 
 
 | 
			 
 
 97 
 
 103 | 
			 
 
 1 
 
 1 | 
			 
 
 97 
 
 103 | 
			 
 
 0.16 
 
 0.16 | 
			 
 
 16 
 
 16 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $160 
 
 $160 | |
| 
			 1944.6769(h) 
 | 
			 Assurance Agreement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Form RD 400-4 (0575-0018) 
 | 
			 
 
 97 
 
 103 | 
			 
 
 1 
 
 1 | 
			 
 
 97 
 
 103 | 
			 
 
 .25 
 
 .25 | 
			 
 
 24 
 
 26 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $240 
 
 $260 | |
| 
			 1944.681 | 
			 Application for Federal Assistance 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 424 (4040-0004) 
 
 
 
 | 
			 
 
 
 74 
 79 | 
			 
 
 
 1 
 1 | 
			 
 
 
 74 
 79 | 
			 
 
 
 0.5 
 0.5 | 
			 
 
 
 37 
 40 | 
			 
 
 
 $10.00 
 $10.00 | 
			 
 
 
 $370 
 $400 
 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: May 8, 2009 
 | |||||||||
| Section of Regulation 
 (A) | 
			 Title 
 
 (B) | 
			 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually 
 (E) | Total Annual Responses (D) x (E) (F) | Hours Per Response 
 (G) | Total Annual Hours (F) x (G) (H) | Wage Class (per hour) 
 (I) | Cost to the Public (H) x (J) (J) | 
| BURDENS AND FORMS APPROVED UNDER OTHER OMB NUMBERS | |||||||||
| 
			 1944.682{c) | 
			 Request for Advance or Reimbursement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 270 (0348-0004) 
 | 
			 
 
 
 74 
 
 79 | 
			 
 
 
 4 
 
 4 | 
			 
 
 
 296 
 
 316 | 
			 
 
 
 0.5 
 
 0.5 | 
			 
 
 
 148 
 
 158 | 
			 
 
 
 $10.00 
 
 $10.00 | 
			 
 
 
 $1,480 
 
 $1,580 | 
| 
			 1944.682(c) | 
			 Federal Cash Transactions Report 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 272 (0348-0003) 
 
 
 
 | 
			 
 
 74 
 
 79 | 
			 
 
 4 
 
 4 | 
			 
 
 296 
 
 316 | 
			 
 
 0.5 
 
 0.5 | 
			 
 
 148 
 
 158 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $1,480 
 
 $1,580 | 
| 
			 1944.683(a-b) 
 | 
			 Financial Status Report 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 269 (0348-0039) 
 
 
 
 | 
			 
 
 74 
 
 79 | 
			 
 
 4 
 
 4 | 
			 
 
 296 
 
 316 | 
			 
 
 0.5 
 
 0.5 | 
			 
 
 148 
 
 158 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $1,480 
 
 $1,580 | 
| RECORDKEEPING REQUIREMENTS | |||||||||
| 
			 1944.682(a) 
 | 
			 Grant Agreement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Exhibit A 
 | 
			 
 
 74 
 
 79 | 
			 
 
 1 
 
 1 | 
			 
 
 74 
 
 79 | 
			 
 
 0.5 
 
 0.5 | 
			 
 
 37 
 
 40 | 
			 
 
 $10.00 
 
 $10.00 | 
			 
 
 $370 
 
 $400 | 
| 
			 | 
			 RECORDKEEPING TOTAL | 
			 | 
			 | 
			 
 | 
			 153 | 
			 | 
			 77 | 
			 | 
			 | 
| 
			 | 
			 TOTAL DOCKET | 
			 | 
			 | 
			 
 | 
			 15,043 | 
			 | 
			 12,439 | 
			 | 
			 | 
| File Type | application/msword | 
| File Title | 7 CFR 1944-N “Housing Preservation Grant” | 
| Author | Linda | 
| Last Modified By | linda.watts-thomas | 
| File Modified | 2009-06-26 | 
| File Created | 2009-06-01 |