7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annally/Quarterly Date Prepared: July 24, 2012 
 | ||||||||||
| 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 (I) 
 (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 | 
			 
 
 
 
 .32 
 
 .48 | 
			 
 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 
 $3.84 
 
 $5.76 | |
| 
			 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 
 
 
 
 | 
			 
 
 
 53 
 
 105 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 53 
 
 105 | 
			 
 
 
 8 
 
 8 | 
			 
 
 
 424 
 
 840 | 
			 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 $5,088 
 
 $10,080 | |
| 
			 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 
 
 
 
 | 
			 
 
 
 796 
 
 1,577 | 
			 
 
 
 2 
 
 2 | 
			 
 
 
 1,592 
 
 3,154 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 1,592 
 
 3,154 | 
			 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 $19,104 
 
 $37,848 | |
| 
			 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 
 
 
 
 | 
			 
 
 
 
 53 
 
 105 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 53 
 
 105 | 
			 
 
 
 
 0.5 
 
 0.5 | 
			 
 
 
 
 27 
 
 53 | 
			 
 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 
 $324 
 
 $636 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annally/Quarterly Date Prepared: July 24, 2012 
 | ||||||||||
| 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 (I) 
 (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 
 
 
 
 | 
			 
 
 
 796 
 
 1,577 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 796 
 
 1,577 | 
			 
 
 
 0.5 
 
 0.5 | 
			 
 
 
 398 
 
 789 | 
			 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 $4,776 
 
 $9,468 | |
| 
			 1944.663 
 | 
			 Ownership agreement between HPG Grantee and Rental Property Owner or Co-op 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Non-standard form by grantee 
 
 
 
 | 
			 
 
 
 
 17 
 
 33 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 17 
 
 33 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 17 
 
 33 | 
			 
 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 
 $204 
 
 $396 | |
| 
			 1944.665 
 | 
			 Final Inspection Report 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Non-standard 
 
 
 
 | 
			 
 
 796 
 
 1,577 | 
			 
 
 1 
 
 1 | 
			 
 
 796 
 
 1,577 | 
			 
 
 0.5 
 
 0.5 | 
			 
 
 398 
 
 789 | 
			 
 
 $12.00 
 
 $12.00 | 
			 
 
 $4,776 
 
 $9,468 | |
| 
			 1944.667 
 | 
			 Relocation and displacement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative in statement of activities 
 
 
 
 | 
			 
 
 53 
 
 105 | 
			 1 
 
 1 | 
			 
 
 53 
 
 105 | 
			 
 
 0.33 
 
 0.33 | 
			 
 
 17 
 
 35 | 
			 
 
 $12.00 
 
 $12.00 | 
			 
 
 $204 
 
 $420 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: July 24, 2012 
 | ||||||||||
| 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 (I) 
 (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 
 
 
 
 | 
			 
 
 
 
 
 796 
 
 1,577 | 
			 
 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 
 796 
 
 1,577 | 
			 
 
 
 
 
 0.16 
 
 0.16 | 
			 
 
 
 
 
 127 
 
 252 | 
			 
 
 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 
 
 $1,524 
 
 $3,024 | |
| 
			 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 
 
 
 
 | 
			 
 
 
 
 94 
 
 186 | 
			 
 
 
 
 1 
 
 1 | 
			 
 
 
 
 94 
 
 186 | 
			 
 
 
 
 0.16 
 
 0.16 | 
			 
 
 
 
 15 
 
 30 | 
			 
 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 
 $180 
 
 $360 | |
| 
			 1944.676(b) 
 | 
			 Statement of Activities (Pre-application Requirement) 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Narrative 
 
 
 
 | 
			 
 
 
 94 
 
 186 | 
			 
 
 
 1 
 
 1 | 
			 
 
 
 94 
 
 186 | 
			 
 
 
 8 
 
 8 | 
			 
 
 
 752 
 
 1,488 | 
			 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 $9,024 
 
 $17,856 | |
| 
			 1944.683(b) 1944.688(a) 
 | 
			 Quarterly and Final Performance Reports 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Exhibit E-1 
 
 
 
 | 
			 
 
 
 53 
 
 105 | 
			 
 
 
 4 
 
 4 | 
			 
 
 
 212 
 
 420 | 
			 
 
 
 2 
 
 2 | 
			 
 
 
 424 
 
 840 | 
			 
 
 
 $12.00 
 
 $12.00 | 
			 
 
 
 $5,088 
 
 $10,080 | |
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
				 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: July 24, 2012 
 | 
 | |||||||||||||||||
| Section of Regulation 
 (A) | 
				 Title 
 
 (B) | 
				 Form Number 
 (C) | Estimated No. of Respondents 
 (D) | Reports Filed Annually (D) x (E) (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 (I) 
 (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 
 
 
 
 | 
				 
 
 
 19 
 
 21 | 
				 
 
 
 1 
 
 1 | 
				 
 
 
 19 
 
 21 | 
				 
 
 
 0.5 
 
 0.5 | 
				 
 
 
 10 
 
 11 | 
				 
 
 
 $12.00 
 
 $12.00 | 
				 
 
 
 $120 
 
 $132 | 
 | ||||||||
| 
				 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 
 
 
 
 | 
				 
 
 
 
 
 94 
 
 186 | 
				 
 
 
 
 
 1 
 
 1 | 
				 
 
 
 
 
 94 
 
 186 | 
				 
 
 
 
 
 0.16 
 
 0.16 | 
				 
 
 
 
 
 15 
 
 30 | 
				 
 
 
 
 
 $12.00 
 
 $12.00 | 
				 
 
 
 
 
 $180 
 
 $360 
 | 
 | ||||||||
| REPORTING REQUIREMENTS – FORMS | 
 | |||||||||||||||||
| 
				 1944.682{c) | 
				 Request for Advance or Reimbursement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
				 SF 270 (0348-0004) 
 | 
				 
 
 
 53 
 
 105 | 
				 
 
 
 4 
 
 4 | 
				 
 
 
 212 
 
 420 | 
				 
 
 
 0.5 
 
 0.5 | 
				 
 
 
 106 
 
 210 | 
				 
 
 
 $12.00 
 
 $12.00 | 
				 
 
 
 $1,272 
 
 $2,520 | |||||||||
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: July 24, 2012 
 | |||||||||||||||||||||
| 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 (I) (J) | 
 | |||||||||||
| 
			 1944.683(a-b) 
 | 
			 Financial Status Report 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 425 (0348-0061) 
 
 
 
 | 
			 
 
 53 
 
 105 | 
			 
 
 4 
 
 4 | 
			 
 
 212 
 
 420 | 
			 
 
 1.5 
 
 1.5 | 
			 
 
 318 
 
 630 | 
			 
 
 $12.00 
 
 $12.00 | 
			 
 
 $3,816 
 
 $7,560 | ||||||||||||
| 
			 | 
			 REPORTING TOTAL | 
			 | 
			 | 
			 
 | 
			 15,170 | 
			 | 
			 13,825 | 
			 | 
			 | ||||||||||||
| 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) 
 
 
 
 | 
			 
 
 94 
 
 186 | 
			 
 
 1 
 
 1 | 
			 
 
 94 
 
 186 | 
			 
 
 6 
 
 6 | 
			 
 
 564 
 
 1,116 | 
			 
 
 $12.00 
 
 $12.00 | 
			 
 
 $6,768 
 
 $13,392 | ||||||||||||
| 
			 1944.676{a) | 
			 Pre-Application for Federal Assistance 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 424 (4040-0004) 
 | 
			 
 
 
 94 
 186 | 
			 
 
 
 1 
 1 | 
			 
 
 
 94 
 186 | 
			 
 
 
 0.5 
 0.5 | 
			 
 
 
 47 
 93 | 
			 
 
 
 $12.00 
 $12.00 | 
			 
 
 
 $564 
 $1,116 | ||||||||||||
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
			 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: July 24, 2012 
 | ||||||||||||||
| 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 (I) (J) | |||||
| 
			 1944.676(h) | 
			 Equal Opportunity Agreement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Form RD 400-1 (0575-0018) 
 
 
 
 | 
			 
 
 94 
 
 186 | 
			 
 
 1 
 
 1 | 
			 
 
 94 
 
 186 | 
			 
 
 .16 
 
 .16 | 
			 
 
 15 
 
 30 | 
			 
 
 $12.00 
 
 $12.00 | 
			 
 
 $180 
 
 $360 | |||||
| 
			 1944.676(h) 
 | 
			 Assurance Agreement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 Form RD 400-4 (0575-0018) 
 | 
			 
 
 94 
 
 186 | 
			 
 
 1 
 
 1 | 
			 
 
 94 
 
 186 | 
			 
 
 .25 
 
 .25 | 
			 
 
 24 
 
 47 | 
			 
 
 $12.00 
 
 $12.00 | 
			 
 
 $288 
 
 $564 | |||||
| 
			 1944.681 | 
			 Application for Federal Assistance 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
			 SF 424 (4040-0004) 
 
 
 
 | 
			 
 
 
 53 
 105 | 
			 
 
 
 1 
 1 | 
			 
 
 
 53 
 105 | 
			 
 
 
 1.5 
 1.5 | 
			 
 
 
 80 
 158 | 
			 
 
 
 $12.00 
 $12.00 | 
			 
 
 
 $960 
 $1,896 
 | |||||
7 CFR 1944-N “Housing Preservation Grant”
OMB No. 0575-0115
| 
				 Reports Filed: Annually/Semi-Annually/Quarterly Date Prepared: July 24, 2012 
 | ||||||||||||||||
| 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 (I) (J) | |||||||
| RECORDKEEPING REQUIREMENTS | 
 | |||||||||||||||
| 
				 1944.682(a) 
 | 
				 Grant Agreement 
 - Local/State Governments (Native American Indian Tribes) 
 - Nonprofit organization | 
				 Exhibit A 
 | 
				 
 
 53 
 
 105 | 
				 
 
 1 
 
 1 | 
				 
 
 53 
 
 105 | 
				 
 
 0.5 
 
 0.5 | 
				 
 
 27 
 
 53 | 
				 
 
 $12.00 
 
 $12.00 | 
				 
 
 $324 
 
 $636 | 
 | ||||||
| 
				 | 
				 RECORDKEEPING TOTAL | 
				 | 
				 | 
				 
 | 
				 158 | 
				 | 
				 80 | 
				 | 
				 960 | 
 | ||||||
| 
				 | 
				 TOTAL DOCKET | 
				 | 
				 | 
				 
 | 
				 15,328 | 
				 | 
				 13,905 | 
				 | 
				 166,858 | 
 | ||||||
*Figures may not up due to rounding.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| File Title | 7 CFR 1944-N “Housing Preservation Grant” | 
| Author | Linda | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-30 |