Federal Labor Standards Questionnaire(s); Complaint Intake Form

Forms and Documents

Document Name	Status
Form HUD-4730 Federal Labor Standards Questionnaire Form and Instruction	Modified
Form HUD-4731 Federal Labor Standards Complaint Intake Form Form and Instruction	New
Form HUD-4730- Spanish Federal Labor Standards Questionnaire Spanish version Form and Instruction	New
SS-2501-0018 11.21.16.docx Supporting Statement A	2016-11-21
30 day FRN.pdf Supplementary Document	2016-11-21

IC Document Collections

IC ID	Document Title	Status
26959	Federal Labor Standards Questionnaire Form and Instruction	Modified
224330	Federal Labor Standards Complaint Intake Form Form and Instruction	New
224329	Federal Labor Standards Questionnaire Spanish version Form and Instruction	New

ICR Details

OMB Control No: 2501-0018	ICR Reference No: 201611-2501-002
Status: Historical Active	Previous ICR Reference No: 201307-2501-001
Agency/Subagency: HUD/HUDSEC	Agency Tracking No:
Title: Federal Labor Standards Questionnaire(s); Complaint Intake Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/01/2017
	Date Received in OIRA: 11/21/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	01/31/2017
Responses	1,800	0	2,500
Time Burden (Hours)	900	0	1,250
Cost Burden (Dollars)	0	0	0

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Abstract: The information is used by HUD to fulfill its obligation to enforce Federal Labor stanards provisions, especially to act upon allegations of labor standards violations.

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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:
	81 FR 62170	09/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 83276	11/21/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Federal Labor Standards Questionnaire	HUD-4730	Federal Labor Standards Questionnaire
Federal Labor Standards Questionnaire Spanish version	HUD-4730- Spanish version	Federal Labor Standards Questionnaire Spansh Version
Federal Labor Standards Complaint Intake Form	HUD-4731	Federal Labor standards Complaint Intake Form

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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	1,800	2,500	0	-700	0	0
Annual Time Burden (Hours)	900	1,250	0	-350	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: HUD forms 4730 and 4730E serve the same purpose – one is electronic(4730E) and the other is manual (4730) that can be submitted by mail. The electronic version of this form allows the user to print and mail or directly submit online. Therefore, the 4730E will be the only form used for this purpose and the other will be eliminated. The HUD 4730E will be renamed HUD 4730 replacing the older version.

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Annual Cost to Federal Government: $72,828

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

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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: 11/21/2016

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