HUD Supportive Services Demonstration/Integrated Wellness in Supportive Housing (IWISH)

Forms and Documents

Document Name	Status
2-15-18 IWISH_ReleaseInformation.docx Supplementary Document	2018-02-15
2-15-18 IWISH_InformedConsent.docx Supplementary Document	2018-02-15
SORN Final Scanned SSD_IWISH.pdf Supplementary Document	2018-02-15
IWISH_InformedConsent_06Feb2018_HUD_CLEAN.docx Supplementary Document	2018-02-15
10-27-17 HUD SSD Informed Consent.docx Supplementary Document	2017-10-30
IPA-Final.pdf Supplementary Document	2017-10-30
2-15-18 final SSD Supporting Statement B.docx Supporting Statement B	2018-02-15
2-15-18 final SSD Supporting Statement A.docx Supporting Statement A	2018-02-15
Supportive Services Demonstration-I WISH 30 Day Notice.pdf Supplementary Document	2017-10-25
60-Day Notice Supportive Services Resident Assessment Form.pdf Supplementary Document	2017-02-01

IC Document Collections

IC ID	Document Title	Status
228834	HUD Residents Living Alone (4-person household) Other-SSD/IWISH Assessment	New
228833	HUD Residents Living Alone (3-person household) Other-SSD/IWISH Assessment	New
228832	HUD Residents Living Alone (2-person household) Other-SSD/IWISH Assessment	New
228831	HUD Resident Living Alone (Single Household) Other-SSD/IWISH Assessment	New

ICR Details

OMB Control No: 2528-0315	ICR Reference No: 201702-2528-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HUD/PD&R	Agency Tracking No:
Title: HUD Supportive Services Demonstration/Integrated Wellness in Supportive Housing (IWISH)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/20/2018
	Date Received in OIRA: 10/31/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	4,420	0	0
Time Burden (Hours)	6,629	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: HUD assists a large vulnerable senior population in its Section 202 and other elderly-designated properties. By virtue of their advanced ages, low-incomes and other demographic characteristics, residents in these communities have complex social, health and functional situations. The quality affordable housing provided by HUD provides a fundamental base for these individuals to age safely in their community. With housing as a key social determinant of health, HUD wishes to leverage its properties as a platform for the coordination and delivery of services to better address the interdependent health and supportive service needs of its older residents.

---

Authorizing Statute(s): US Code: 12 USC 1701z-1 Name of Law: null
  

Citations for New Statutory Requirements: None

---

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:
	82 FR 2390	01/09/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 49414	10/25/2017
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
HUD Resident Living Alone (Single Household)
HUD Residents Living Alone (2-person household)
HUD Residents Living Alone (3-person household)
HUD Residents Living Alone (4-person household)

---

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	4,420	0	0	4,420	0	0
Annual Time Burden (Hours)	6,629	0	0	6,629	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: No

Burden Reduction Due to:

Short Statement: This is a new study.The Fiscal Year (FY) 2014 Consolidated Appropriations Act gave the U.S. Department of Housing and Urban Development (HUD) authority to develop a demonstration to test a model of housing and supportive services for low-income elderly residents in HUD-assisted housing. In FY 2015, HUD announced the availability of a funding opportunity under the Supportive Services Demonstration that will provide grants to property owners to participate in the demonstration. HUD has the authority to conduct research and demonstrations under 12 U.S.C. 1701z-1.

---

Annual Cost to Federal Government: $222,105

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     Yes

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.     Yes

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: 10/31/2017

---