60-Day Notice of Proposed Information Collection: Implementation of the Violence Against Women Reauthorization Act of 2013, 35788-35817 [2017-16110]
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Federal Register / Vol. 82, No. 146 / Tuesday, August 1, 2017 / Notices
Clinical Laboratories; SmithKline BioScience Laboratories)
Quest Diagnostics Incorporated, 8401
Fallbrook Ave., West Hills, CA 91304,
818–737–6370, (Formerly: SmithKline
Beecham Clinical Laboratories)
Redwood Toxicology Laboratory, 3700
Westwind Blvd., Santa Rosa, CA
95403, 800–255–2159
STERLING Reference Laboratories, 2617
East L Street, Tacoma, Washington
98421, 800–442–0438
US Army Forensic Toxicology Drug
Testing Laboratory, 2490 Wilson St.,
Fort George G. Meade, MD 20755–
5235, 301–677–7085, Testing for
Department of Defense (DoD)
Employees Only
Charles LoDico,
Chemist.
[FR Doc. 2017–16131 Filed 7–31–17; 8:45 am]
BILLING CODE 4160–20–P
DEPARTMENT OF HOMELAND
SECURITY
U.S. Immigration and Customs
Enforcement
Agency Information Collection
Activities: Extension, Without
Changes, of an Existing Information
Collection; Comment Request; OMB
Control No. 1653–0042
U.S. Immigration and Customs
Enforcement, Department of Homeland
Security.
ACTION: 30-Day Notice of Information
collection for review; Form No. I–333,
Obligor Change of Address; OMB
Control No. 1653–0042.
AGENCY:
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The Department of Homeland
Security, U.S. Immigration and Customs
* The Standards Council of Canada (SCC) voted
to end its Laboratory Accreditation Program for
Substance Abuse (LAPSA) effective May 12, 1998.
Laboratories certified through that program were
accredited to conduct forensic urine drug testing as
required by U.S. Department of Transportation
(DOT) regulations. As of that date, the certification
of those accredited Canadian laboratories will
continue under DOT authority. The responsibility
for conducting quarterly performance testing plus
periodic on-site inspections of those LAPSAaccredited laboratories was transferred to the U.S.
HHS, with the HHS’ NLCP contractor continuing to
have an active role in the performance testing and
laboratory inspection processes. Other Canadian
laboratories wishing to be considered for the NLCP
may apply directly to the NLCP contractor just as
U.S. laboratories do.
Upon finding a Canadian laboratory to be
qualified, HHS will recommend that DOT certify
the laboratory (Federal Register, July 16, 1996) as
meeting the minimum standards of the Mandatory
Guidelines published in the Federal Register on
November 25, 2008 (73 FR 71858). After receiving
DOT certification, the laboratory will be included
in the monthly list of HHS-certified laboratories and
participate in the NLCP certification maintenance
program.
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Enforcement (USICE) is submitting the
following information collection request
for review and clearance in accordance
with the Paperwork Reduction Act of
1995. The information collection is
published in the Federal Register to
obtain comments from the public and
affected agencies. This information
collection was previously published in
the Federal Register on May 26, 2017,
Vol. 82 No. 24377 allowing for a 60 day
comment period. USICE did not receive
a comment in connection with the 60day notice. The purpose of this notice
is to allow an additional 30 days for
public comments,
Written comments and suggestions
regarding items contained in this notice
and especially with regard to the
estimated public burden and associated
response time should be directed to the
Office of Information and Regulatory
Affairs, Office of Management and
Budget. Comments should be addressed
to the OMB Desk Officer for U.S.
Immigration and Customs Enforcement,
Department of Homeland Security, and
sent via electronic mail to dhsdesk
officer@omb.eop.gov.
Written comments and suggestions
from the public and affected agencies
concerning the proposed collection of
information should address one or more
of the following four points:
(1) Evaluate whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information will have
practical utility;
(2) Evaluate the accuracy of the
agencies estimate of the burden of the
proposed collection of information,
including the validity of the
methodology and assumptions used;
(3) Enhance the quality, utility, and
clarity of the information to be
collected; and
(4) Minimize the burden of the
collection of information on those who
are to respond, including through the
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses.
Overview of This Information
Collection
(1) Type of Information Collection:
Extension, without changes, of a
currently approved information
collection.
(2) Title of the Form/Collection:
Obligor Change of Address.
(3) Agency form number, if any, and
the applicable component of the
Department of Homeland Security
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sponsoring the collection: Form I–133;
U.S. Immigration and Customs
Enforcement.
(4) Affected public who will be asked
or required to respond, as well as a brief
abstract: Primary: Individual or
Households, Business or other nonprofit. The data collected on this form
is used by ICE to ensure accuracy in
correspondence between ICE and the
obligor. The form serves the purpose of
standardizing obligor notification of any
changes in their address, and will
facilitate communication with the
obligor.
(5) An estimate of the total number of
respondents and the amount of time
estimated for an average respondent to
respond: 12,000 responses at 15 minutes
(.25 hours) per response.
(6) An estimate of the total public
burden (in hours) associated with the
collection: 3,000 annual burden hours.
Dated: July 26, 2017.
Scott Elmore,
PRA Clearance Officer, Office of the Chief
Information Officer, U.S. Immigration and
Customs Enforcement, Department of
Homeland Security.
[FR Doc. 2017–16085 Filed 7–31–17; 8:45 am]
BILLING CODE 9111–28–P
DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT
[Docket No. FR–5997–N–39]
60-Day Notice of Proposed Information
Collection: Implementation of the
Violence Against Women
Reauthorization Act of 2013
Offices of Housing, Public and
Indian Housing, and Community
Planning and Development, HUD.
ACTION: Notice.
AGENCY:
HUD is seeking approval from
the Office of Management and Budget
(OMB) for the information collection
described below. In accordance with the
Paperwork Reduction Act, HUD is
requesting comment from all interested
parties on the proposed collection of
information. The purpose of this notice
is to allow for 60 days of public
comment.
DATES: Comments Due Date: October 2,
2017.
ADDRESSES: Interested persons are
invited to submit comments regarding
this proposal. Comments should refer to
the proposal by name and/or OMB
Control Number and should be sent to:
Colette Pollard, Reports Management
Officer, QDAM, Department of Housing
and Urban Development, 451 7th Street
SW., Room 4176, Washington, DC
SUMMARY:
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20410–5000; email Colette.Pollard@
hud.gov or telephone 202–402–3400
(this is not a toll-free number). Persons
with hearing or speech impairments
may access this number through TTY by
calling the toll-free Federal Relay
Service at (800) 877–8339. Interested
persons may also submit comments
electronically through the Federal
eRulemaking Portal at
www.regulations.gov. HUD strongly
encourages commenters to submit
comments electronically. Electronic
submission of comments allows the
commenter maximum time to prepare
and submit a comment, ensures timely
receipt by HUD, and enables HUD to
make them immediately available to the
public. Comments submitted
electronically through the
www.regulations.gov Web site can be
viewed by other commenters and
interested members of the public.
Commenters should follow the
instructions provided on that site to
submit comments electronically.
FOR FURTHER INFORMATION CONTACT:
Colette Pollard, Reports Management
Officer, QDAM, Department of Housing
and Urban Development, 451 7th Street
SW., Washington, DC 20410; email
Colette Pollard at Colette.Pollard@
hud.gov or telephone 202–402–3400.
This is not a toll-free number. Persons
with hearing or speech impairments
may access this number through TTY by
calling the toll-free Federal Relay
Service at (800) 877–8339.
SUPPLEMENTARY INFORMATION: This
notice informs the public that HUD is
seeking approval from OMB for the
information collection described in
Section A.
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A. Overview of Information Collection
Title of Information Collection:
Implementation of the Violence Against
Women Reauthorization Act of 2013
OMB Approval Number: 2577–0286.
Type of Request (i.e., new, revision or
extension of currently approved
collection): Revision of currently
approved collection.
Form Number: Forms HUD–5380,
HUD–5381, HUD–5382, and HUD–5383.
Other: Emergency transfer reporting,
lease addenda, and lease bifurcation.
Description of the need for the
information and proposed use: The
Violence Against Women
Reauthorization Act of 2013 (VAWA
2013), Public Law 113–4, 127 Stat. 54,
reauthorized and amended the Violence
Against Women Act of 1994, as
previously amended (title IV, sec.
40001–40703 of Public Law 103–322, 42
U.S.C. 13925 et seq.). In doing so,
VAWA 2013 expanded VAWA
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protections from HUD’s Section 8 and
Public Housing programs only to many
of HUD’s housing programs. The
programs now covered under the final
VAWA Rule include:
• Section 202 Supportive Housing for
the Elderly (12 U.S.C. 1701q);
• Section 811 Supportive Housing for
Persons with Disabilities (42 U.S.C.
8013);
• Housing Opportunities for Persons
with AIDS (HOPWA) program (42
U.S.C. 12901 et seq.);
• HOME Investment Partnerships
(HOME) program (42 U.S.C. 12741 et
seq.);
• Homeless programs under title IV of
the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11360 et seq.),
including the Emergency Solutions
Grants (ESG) program, the Continuum of
Care (CoC) program, and the Rural
Housing Stability (RHS) Assistance
program;
• Multifamily rental housing under
section 221(d)(3) of the National
Housing Act (12 U.S.C. 17151(d)) with
a below-market interest rate (BMIR)
pursuant to section 221(d)(5);
• Multifamily rental housing under
section 236 of the National Housing Act
(12 U.S.C. 1715z–1);
• HUD programs assisted under the
United States Housing Act of 1937 (42
U.S.C. 1437 et seq.); specifically, public
housing under section 6 of the 1937 Act
(42 U.S.C. 1437d), tenant-based and
project-based rental assistance under
section 8 of the 1937 Act (42 U.S.C.
1437f), and the Section 8 Moderate
Rehabilitation Single Room Occupancy;
and
• The Housing Trust Fund (12 U.S.C.
4568).
The provisions of VAWA 2013 that
afford protections to victims of domestic
violence, dating violence, sexual
assault, or stalking are statutory and
statutorily directed to be implemented.
Accordingly, on November 16, 2016,
HUD published a final rule at 81 FR
80724 (VAWA Rule), implementing
VAWA 2013’s provisions in its housing
programs.
To fully implement these provisions
under VAWA 2013 and the VAWA
Rule, the Department must provide to
all PHAs, owners and managers, and
grant recipients (collectively ‘‘Covered
Housing Providers’’ or ‘‘CHPs’’) the
three following model documents:
• Form HUD–5380: Notice of
Occupancy Rights Under the Violence
Against Women Act. HUD must provide
this notice to CHPs, which must in turn
distribute it to tenants and to applicants
denied assistance to ensure they are
aware of their rights under VAWA and
its implementing regulations.
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• Form HUD–5381: Model Emergency
Transfer Plan for Victims of Domestic
Violence, Dating Violence, Sexual
Assault, or Stalking. HUD must provide
this model document to CHPs, which
may, at their discretion, use it to
develop their own emergency transfer
plans, as required under VAWA 2013.
• Form HUD–5382: Certification of
Domestic Violence, Dating Violence,
Sexual Assault, or Stalking, and
Alternate Documentation. HUD must
provide this certification form to CHPs,
which must in turn distribute it to
tenants and applicants. An individual
may then optionally submit the form,
certifying that he or she is a victim of
domestic violence, dating violence,
sexual assault, or stalking and that the
incident in question is bona fide. The
certification form serves as one tool for
documenting the incident or incidents
of domestic violence, dating violence,
sexual assault, or stalking. (Note: This is
a revision of and supersedes forms
HUD–50066 and HUD–91066. VAWA
2013 required that the form be updated
and made applicable to all covered
programs.)
Tenants may provide third-party
documentation along with or in lieu of
form HUD–5382. The VAWA regulation
stipulates that one such document—
A. Be signed by an employee, agent,
or volunteer of a victim service
provider, an attorney, or medical
professional, or a mental health
professional (collectively,
‘‘professional’’) from whom the victim
has sought assistance relating to
domestic violence, dating violence,
sexual assault, or stalking, or the effects
of abuse;
B. Be signed by the applicant or
tenant; and
C. Specifies, under penalty of perjury,
that the professional believes in the
occurrence of the incident of domestic
violence, dating violence, sexual
assault, or stalking and that the incident
meets the applicable definition of
domestic violence, dating violence,
sexual assault, or stalking.
If an applicant or tenant submits such
a statement, the corresponding
professional may have to create or
research documentation to accurately
complete and maintain a record of the
form.
HUD provides form HUD–5383:
Emergency Transfer Request for Certain
Victims of Domestic Violence, Dating
Violence, Sexual Assault, or Stalking to
CHPs, which may, at their discretion,
distribute it to tenants and applicants.
This form serves as a model for use by
a CHP to accept requests for emergency
transfers under its required VAWA 2013
Emergency Transfer Plan. This form
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allows an individual to submit and
certify that they are a victim of domestic
violence, dating violence, sexual
assault, or stalking and that the incident
in question is bona fide for purposes of
being eligible for an emergency transfer.
Thus, it serves as another tool for
documenting the incident or incidents
of domestic violence, dating violence,
sexual assault, and stalking.
VAWA 2013 and/or the VAWA rule
require or permit that CHPs also
undertake certain activities as follows:
• Emergency Transfer Reporting:
CHPs must keep a record of all
emergency transfers requested under its
emergency transfer plan, and the
outcomes of such requests, and retain
these records for a period of three years,
or for a period of time as specified in
program regulations. Requests and
outcomes of such requests must also be
reported to HUD annually.
• The VAWA regulation includes
certain requirements that must be
incorporated into the tenant’s lease.
• Lease Bifurcation Option: VAWA
2013 provides CHPs the option to
bifurcate a lease in order to evict,
remove, terminate occupancy rights, or
terminate assistance to any individual
who is a tenant or lawful occupant of
the housing and who engages in
criminal activity directly relating to
domestic violence, dating violence,
sexual assault, or stalking. This option
is designed to minimize the loss of
housing to individual(s) covered under
VAWA.
Respondents (i.e., affected public):
Public housing agencies, private
multifamily housing owners and
management agents, state and local
agencies, and grant recipients.
Estimated Number of Respondents:
30,087.
Estimated Number of Responses:
7,941,827.
Frequency of Response: Varies.
Average Hours per Response: 1.4.
Total Estimated Hour Burden:
3,269,550.
B. Proposed Changes to the Forms
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The OMB approved forms HUD–5380,
HUD–5381, HUD–5382, and HUD–5383
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are being revised to more closely align
with the VAWA regulation and to
clarify language. In addition to minor
changes, HUD proposes to make the
following specific changes:
Form 5380: Clarify the ‘‘Tenant
Protections’’ and ‘‘Removing the Abuser
or Perpetrator from the Household’’
sections to align with the regulations
and provide more information about
bifurcation. Rename ‘‘Moving to
Another Unit’’ to ‘‘Emergency Transfer’’
and include more emergency transfer
language. Add language in the
‘‘Documenting That You Are or Have
Been a Victim’’ section about reasonable
accommodations and update the
language for consistency with the
regulation. Lastly, update the
‘‘Confidentiality’’ section to more
closely follow the regulation and put
individuals on notice of confidentiality
protections.
Form 5381: Add a note to covered
housing providers that the use of the
model form without adding program
specific and housing provider specific
policies will not be sufficient to meet
the emergency transfer plan
requirements. Add a definition section
with definitions taken from the
regulation. Rename the section titled
‘‘Emergency Transfer Timing and
Availability’’ to ‘‘Emergency Transfer
Procedures’’ and add two new sections,
‘‘Emergency Transfer Policies’’ section,
which clarifies that the provider must
specify their individual policies for
different categories of transfers (i.e.
internal or external transfers) where
applicable, and a ‘‘Priority for
Transfers’’ section, which requires
providers to provide any type of priority
being provided to a victim consistent
with 24 CFR 5.2005(e)(3) and (e)(6).
Update the ‘‘Confidentiality’’ section to
more closely follow the regulation and
put individuals on notice of
confidentiality protections. Lastly, add a
‘‘Making Plan Available’’ section to
describe how the plan will be made
publicly available, where possible.
Form 5382: Update the ‘‘Submission
of Documentation’’ section to include
information about reasonable
accommodations. In addition, add a
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warning for making false submissions to
ensure users of the form are aware of the
legal nature of submitting false
information to an entity when seeking
access to Federal funds.
Form 5383: Update the
‘‘Confidentiality’’ section to more
closely follow the regulation and put
individuals on notice of confidentiality
protections. Reframe question number
11 as a ‘‘Yes’’ or ‘‘No’’ question. Lastly,
add a warning for making false
submissions to ensure users of the form
are aware of the legal nature of
submitting false information to an entity
when seeking access to Federal funds.
Drafts of the revised forms are being
published along with this notice for the
public to see the proposed changes.
C. Solicitation of Public Comment
This notice is soliciting comments
from members of the public and affected
parties concerning the collection of
information described in Section A on
the following:
(1) Whether the proposed collection
of information is necessary for the
proper performance of the functions of
the agency, including whether the
information will have practical utility;
(2) The accuracy of the agency’s
estimate of the burden of the proposed
collection of information;
(3) Ways to enhance the quality,
utility, and clarity of the information to
be collected; and
(4) Ways to minimize the burden of
the collection of information on those
who are to respond; including through
the use of appropriate automated
collection techniques or other forms of
information technology, e.g., permitting
electronic submission of responses.
HUD encourages interested parties to
submit comment in response to these
questions.
Authority: Section 3507 of the Paperwork
Reduction Act of 1995, 44 U.S.C. Chapter 35.
Dated: July 26, 2017.
Colette Pollard,
Department Reports Management Officer,
Office of the Chief Information Officer.
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NOTICE OF OCCUPANCY RIGHTS UNDER
THE VIOLENCE AGAINST WOMEN ACT
U.S. Department of Housing and Urban Development
OMB Approval No. 2577-0286
Expires XXXX
Appendix A
[Insert Name of Housing Provider1]
NOTICE OF OCCUPANCY RIGHTS UNDER THE VIOLENCE AGAINST WOMEN
ACT TO ALL TENANTS AND APPLICANTS
The Violence Against Women Act (VAW A) provides protections for victims of domestic
violence, dating violence, sexual assault, or stalking. Notwithstanding the title of the statute,
VAW A protections are not limited to women. Victims cannot be discriminated against on the
basis of any protected characteristic, including race, color, national origin, religion, sex, familial
status, disability, or age. HOD-assisted and HOD-insured housing must also be made available to
all otherwise eligible individuals and families regardless of actual or perceived sexual
orientation, gender identity, or marital status. The U.S. Department of Housing and Urban
Development (HUD) is the Federal agency that oversees that [insert name of program or
rental assistance] is in compliance with V AW A
This Notice explains your rights under
VAW A with respect to housing and assistance 2 funded by HOD. A HOD-approved
certification, form HOD-5382, is attached to this Notice.
If you (the applicant or tenant)
request protection under VAW A and you are asked to document that you are eligible for
Form HUD-5380
xxxx
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1
The notice uses HP for housing provider but the housing provider should insert its name where HP is used.
HUD' s program-specific regulations identify the individual or entity responsible for providing the Notice of
Occupancy Rights.
2
The applicable assistance provided under a covered housing program generally consists of two types of assistance
(one or both may be provided): Tenant-based rental assistance, which is rental assistance that is provided to the
tenant; and project-based assistance, which is assistance that attaches to the unit in which the tenant resides. For
project-based assistance, the assistance may consist of such assistance as operating assistance, development
assistance, and mortgage interest rate subsidy. The form of assistance covered is provided in the program
regulations.
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protection, you can fill out the HOD-approved certification form to show that you are or have
been a victim of domestic violence, dating violence, sexual assault, or stalking.
Protections for Applicants
If you are an applicant for assistance under [insert name of program] you may not be denied
admission to or denied assistance under [insert name of program] on the basis or as a direct result
of the fact that you are or have been a victim of domestic violence, dating violence, sexual
assault, or stalking, if you otherwise qualify for assistance, participation, or occupancy.
Protections for Tenants
If you are a tenant housed or receiving assistance under [insert name of program] you may not
be denied assistance under, terminated from participation in, or be evicted from the housing or
assistance on the basis or as a direct result of the fact that you are or have been a victim of
domestic violence, dating violence, sexual assault, or stalking, if you otherwise qualify for
assistance, participation, or occupancy.
If you are a tenant under a covered housing program, you may not be denied tenancy or
occupancy rights under [insert name of program or rental assistance] solely on the basis of
criminal activity directly relating to domestic violence, dating violence, sexual assault, or
stalking if: (i) the criminal activity is engaged in by a member of your household or any guest or
other person under the control of you (the tenant), and (ii) if you (the tenant) or an affiliated
individual of yours is or has been the victim of domestic violence, dating violence, sexual
Form HUD-5380
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assault, or stalking.
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Affiliated individual means your spouse, parent, brother, sister, or child, or a person to whom
you stand in the place of a parent or guardian (for example, the affiliated individual is in your
care, custody, or control); or any individual, tenant, or lawful occupant living in your household.
An incident of actual or threatened domestic violence, dating violence, sexual assault, or stalking
shall not be construed as: a serious or repeated violation of a lease executed under [insert name
of program or rental assistance] by you if you are the victim or threatened victim of such
incident; or good cause for terminating your assistance, tenancy, or occupancy rights under
[insert name of program or rental assistance] if you are the victim or threatened victim of
such incident.
Removing the Abuser or Perpetrator from the Household
When a member of your household engages in criminal activity directly relating to domestic
violence, dating violence, sexual assault, or stalking, [HPJ may remove the abuser or perpetrator
from your lease or otherwise "bifurcate" your lease in order to evict, remove, terminate
occupancy rights, or terminate assistance to the abuser or perpetrator, without evicting,
removing, terminating assistance to, or otherwise penalizing a victim of such criminal activity
who is also a tenant or lawful occupant.
However, this bifurcation must be carried out in accordance with any requirements or procedures
as may be prescribed by Federal, State, or local law for termination of assistance or leases and in
accordance with any requirements under the relevant covered housing program. If [HPJ
removes the abuser or perpetrator through bifurcation, and that person was the eligible tenant
a period of time, as specified in the regulations that apply to [insert name of covered housing
Form HUD-5380
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under the program, [HPJ must then allow any remaining tenant(s), who were not already eligible,
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program J, to establish eligibility under the same program or under another housing program
covered by VAW A, or find alternative housing.
Before bifurcating a lease, [HPJ may, but is not required to, ask you for documentation or
certification of the incidence of domestic violence, dating violence, sexual assault, or stalking.
Emergency Transfer
If you (or a member of your household) are a tenant who is a victim of domestic violence, dating
violence, sexual assault, or stalking, you may seek an emergency transfer to another unit,
provided that you meet the requirements for an emergency transfer, as further described below.
Before allowing an emergency transfer, [HPJ may ask you to submit a written request or fill out
form HUD-5383 , in which you certify that you meet the criteria for an emergency transfer under
VAW A
The criteria are:
(1) You, the tenant, (or a member of your household) are a victim of domestic
violence, dating violence, sexual assault, or stalking. (If your housing provider
does not already have documentation certifying that you are a victim of domestic
violence, dating violence, sexual assault, or stalking, your housing provider may
ask you for such documentation, as described in the documentation section below.
In response, you may submit Form HUD-5382, or any one of the other types of
documentation listed on that Form).
(2) You expressly request the emergency transfer.
(Submission of form
HUD-5383 confirms that you have expressly requested a transfer. Your housing
Form HUD-5380
xxxx
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provider may require that you submit this form or may accept another written or
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oral request. See your housing provider's Emergency Transfer Plan for more
details).
(3) (A) You reasonably believe you are threatened with imminent harm from
further violence if you remain in your current unit. This means you have a
reason to fear that if you do not receive a transfer you would suffer violence in the
very near future.
OR
(B) You are a victim of sexual assault and the assault occurred on the
premises during the 90-calendar-day period before you request a transfer.
If you are a victim of sexual assault, then in addition to qualifying for an
emergency transfer because you reasonably believe you are threatened with
imminent harm from further violence if you remain in your unit, you also qualify
for an emergency transfer if the sexual assault occurred on the premises of the
property from which you are seeking your transfer, and that assault happened
within the 90-calendar-day period before you expressly request the transfer.
HP] will keep requests for emergency transfers by victims of domestic violence, dating
riolence, sexual assault, or stalking, and the location of any move by such victims and their
amilies in strict confidence.
HP' s] Emergency Transfer Plan provides further information on emergency transfers, and [HP]
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nust make a copy of its emergency transfer plan available to you if you ask to see it.
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Documenting That You Are or Have Been a Victim of Domestic Violence, Dating Violence,
Sexual Assault or Stalking
[HPJ can, but is not required to, ask you (the tenant or applicant) to provide documentation to
"certify" that you are or have been a victim of domestic violence, dating violence, sexual assault,
or stalking. The time period to submit documentation is 14 business days (Saturdays, Sundays,
and Federal holidays do not count) from the date that you receive a written request from your
housing provider asking that you provide documentation of the occurrence of domestic violence,
dating violence, sexual assault, or stalking. Your housing provider may extend the time period
to submit the documentation. If the requested information is not provided within 14 business
days of when you received the request for the documentation, or any extension of the date
provided by your housing provider, VAW A does not limit your housing provider's authority to
deny you admission, assistance, participation, or tenancy. However, other laws or regulations
may require your housing provider to extend the time period to submit the documentation or
have alternative documentation requirements. For example, if you have a disability, your housing
provider must provide reasonable accommodations to afford you an equal opportunity to request
VAW A protections (e.g. providing an extension of time or assisting with written requests).
Failure to timely provide documentation of domestic violence, dating violence, sexual assault, or
stalking does not prevent you from challenging the denial of assistance, termination, or eviction,
nor does it prevent you from raising an incident of domestic violence, dating violence, sexual
assault, or stalking at grievance, eviction, or termination proceedings.
You can provide one of the following to [HPJ as documentation. It is your choice which of the
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following to submit:
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•
A completed HOD-approved certification, form HUD-5382, that is attached to this
Notice and which may be used to document an incident of domestic violence, dating
violence, sexual assault, or stalking. The form will ask for your name, the date, time,
and location of the incident of domestic violence, dating violence, sexual assault, or
stalking, and a description of the incident. The certification requests the name of the
abuser or perpetrator if the name of the abuser or perpetrator is known and is safe to
provide. [HPJ must make the certification form available to you in multiple
languages.
•
A record of a Federal, State, tribal, territorial, or local law enforcement agency, court,
or administrative agency that documents the incident of domestic violence, dating
violence, sexual assault, or stalking. Examples of such records include police
reports, protective orders, and restraining orders, among others.
•
A statement signed by an employee, agent, or volunteer of a victim service provider,
an attorney, a medical professional or a mental health professional from whom you
sought assistance in addressing domestic violence, dating violence, sexual assault, or
stalking, or the effects of abuse. The statement must specify, under penalty of
perjury, that this person believes in the occurrence of the incident of domestic
violence, dating violence, sexual assault, or stalking for which you are seeking
VAW A protection, and that the incident meets the applicable definition of domestic
violence, dating violence, sexual assault, or stalking under HUD's regulations at 24
CFR 5.2003. You must also sign this statement.
Any other statement or evidence that [HPJ has agreed to accept.
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•
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If [HPJ receives conflicting evidence that an incident of domestic violence, dating violence,
sexual assault, or stalking has been committed (such as receiving certification forms from two or
more members of a household each claiming to be a victim and naming one or more of the other
petitioning household members as the abuser or perpetrator), [HPJ has the right to request that
you provide third-party documentation within thirty (30) calendar days to resolve the conflict.
You can satisfy this request by providing any of the documentation described above, (except for
the form HUD-5382). If you fail or refuse to provide third-party documentation when there is
conflicting evidence, VAW A does not limit [HP' sJ authority to deny you admission, assistance,
participation, or tenancy. However, other laws or regulations may require [HPJ to extend the
time period for submitting the documentation or have alternative documentation requirements.
For example, if you have a disability, [HPJ must provide reasonable accommodations to afford
you an equal opportunity to request VAW A protections (e.g. providing an extension of time or
assisting with written requests). Failure to timely provide third-party documentation where
there is conflicting evidence of domestic violence, dating violence, sexual assault, or stalking
does not prevent you from challenging the denial of assistance, termination, or eviction, nor does
it prevent you from raising an incident of domestic violence, dating violence, sexual assault, or
stalking at grievance, eviction, or termination proceedings.
Confidentiality
If you inquire about or request any of the protections described in this Notice or represent that
you are a victim of domestic violence, dating violence, sexual assault, or stalking entitled to the
protections under this Notice, [HPJ must keep strictly confidential any information you provide
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concerning the incident(s) of domestic violence, dating violence, sexual assault, or stalking,
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including the fact that you are a survivor. Information about the incident(s) and your status as a
survivor, such as the information provided on forms HUD-5382 and HUD-5383, may only be
accessed by [HP'sJ employees or contractors if explicitly authorized by [HPJ for reasons that
specifically call for those individuals to have access to the information under applicable Federal,
State, or local law. Information about the incident(s) and your status as a survivor shall not be
entered into any shared database or disclosed to any other entity or individual, except to the
extent that disclosure is: (i) consented to by you in writing in a time-limited release; (ii) required
for use in an eviction proceeding or hearing regarding termination of assistance, or (iii) otherwise
required by applicable law. In addition, HUD' s VAW A regulations require Emergency
Transfer Plans to provide for strict confidentiality measures to ensure that the location of your
dwelling unit is never disclosed to a person who committed or threatened to commit an act of
domestic violence, dating violence, sexual assault, or stalking against you.
VAW A does not limit [HP' sJ duty to honor court orders about access to or control of the
property. This includes orders issued to protect a victim and orders dividing property among
household members in cases where a family breaks up.
Reasons a Tenant Eligible for Occupancy Rights under VAW A May Be Evicted or
Assistance May Be Terminated
You can be evicted and your assistance can be terminated for serious or repeated lease violations
that are not premised on an act or acts of domestic violence, dating violence, sexual assault, or
stalking committed against you or an affiliated individual. However, [HPJ cannot hold tenants
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who have been victims of domestic violence, dating violence, sexual assault, or stalking to a
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more demanding set of rules than it applies to tenants who have not been victims of domestic
violence, dating violence, sexual assault, or stalking.
The protections described in this Notice might not apply, and you could be evicted and your
assistance terminated, if [HPJ can demonstrate that not evicting you or terminating your
assistance would present a real physical danger that:
(1) Would occur within an immediate time frame and
(2) Could result in death or serious bodily harm to other tenants or those who work on
the property.
If [HPJ can demonstrate this kind of danger, [HPJ should only terminate your assistance or evict
you if there are no other actions that could be taken to reduce or eliminate the threat.
Other Laws
VAW A does not replace any Federal, State, or local law that provides greater protection for
victims of domestic violence, dating violence, sexual assault, or stalking. You may be entitled
to additional housing protections for victims of domestic violence, dating violence, sexual
assault, or stalking under other Federal laws, as well as under State and local laws. If you have
a disability, [HPJ must provide reasonable accommodations when necessary to allow you to
equally benefit from VAWA protections.
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Non-Compliance with The Requirements of This Notice
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You may report [HP's] violations of these rights and seek additional assistance, if needed, by
contacting or filing a complaint with [insert contact information for any intermediary, if
applicable] or [insert HUD field office].
For Additional Information
You may view a copy of HUD' s final V AW A rule at [insert Federal Register link].
Additionally, [HP] must make a copy ofHUD's VAWA regulations available to you if you ask
to see them.
For questions regarding VAW A, please contact [insert name of program or rental assistance
contact information able to answer questions on VAW A].
For help regarding an abusive relationship, you may call the National Domestic Violence Hotline
at 1-800-799-7233 or, for persons with hearing impairments, 1-800-787-3224 (TTY). You may
also contact [Insert contact information for relevant local organizations].
For tenants who are or have been victims of stalking seeking help may visit the National Center
for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/ourprograms/ stalking-resource-center.
For help regarding sexual assault, you may contact [Insert contact information for relevant
organizations]
Victims of stalking seeking help may contact [Insert contact information for relevant
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organizations].
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Attachment: Certification form HUD-5382
Form HUD-5380
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Public reporting burden for this collection of information is estimated to range from 10 minutes to 1.5 hours per
each covered housing provider's response, depending on covered housing program. This includes the time for
printing and distributing the form. Housing providers distribute this Notice to tenants and to applicants at the times
specified in 24 CFR 5.2005(a)(2) to ensure they are aware of their rights under VAWA and its implementing
regulations. This is a model notice and no information is being collected. Covered housing programs in the Offices
of Multifamily Housing, Public and Indian Housing, and Community Planning and Development are required to
distribute this Notice. This agency may not collect this information, and you are not required to complete this
form, unless it displays a currently valid Office of Management and Budget control number.
35803
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MODEL EMERGENCY TRANSFER PLAN FOR
VICTIMS OF DOMESTIC VIOLENCE, DATING
VIOLENCE, SEXUAL ASSAULT, OR STALKING
U.S. Department of Housing and Urban Development
OMB Approval No. 2577-0286
Expires XXXX
Appendix B
Note to Covered Housing Providers: This model contains only general provisions of an emergency transfer plan that apply
across the covered HUD programs. Adoption of this model plan without further information will not be sufficient to meet a
covered housing provider's responsibility to adopt an emergency transfer plan. Covered housing providers must consult
applicable regulations and program-specific HUD guidance when developing their own emergency transfer plans to ensure their
plans contain all required elements.
MODEL EMERGENCY TRANSFER PLAN FOR VICTIMS OF DOMESTIC
VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING
[Insert name of housing provider (acronym HP for purposes of this model plan)]
is concerned about the safety of its tenants, and such concern extends to tenants who are victims
of domestic violence, dating violence, sexual assault, or stalking. In accordance with the
Violence Against Women Act of 1994 (VAW A), HP allows any tenant who is a victim of
domestic violence, dating violence, sexual assault, or stalking to request an emergency transfer
from the tenant's current unit to another unit. Notwithstanding the title of the statute, VAW A
protections are not limited to women. Victims cannot be discriminated against on the basis of
any protected characteristic, including race, color, national origin, religion, sex, familial status,
disability, or age. HOD-assisted and HUD-insured housing must also be made available to all
otherwise eligible individuals and families regardless of actual or perceived sexual orientation,
gender identity, or marital status.
This plan identifies tenants who are eligible for an emergency transfer, the documentation
needed to request an emergency transfer, confidentiality protections, how an emergency transfer
may occur, and guidance to tenants on safety and security. This plan is based on Federal
regulations at 24 Code of Federal Regulations (CFR) part 5, subpart L, and a model emergency
FormHUD-5381
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transfer plan published by the U.S. Department of Housing and Urban Development (HUD), the
35804
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Federal agency that oversees that [insert name of program or rental assistance here] is in
compliance with VAW A
Definitions
External emergency transfer refers to an emergency relocation of a tenant to another unit where
the tenant would be categorized as a new applicant; that is the tenant must undergo an
application process in order to reside in the new unit.
Internal emergency transfer refers to an emergency relocation of a tenant to another unit where
the tenant would not be categorized as a new applicant; that is, the tenant may reside in the new
unit without having to undergo an application process.
Safe unit refers to a unit that the victim of domestic violence, dating violence, sexual assault, or
stalking believes is safe.
Eligibility for Emergency Transfers
A tenant who is a victim of domestic violence, dating violence, sexual assault, or stalking is
eligible for an emergency transfer, if:
(1) The tenant expressly requests the transfer, AND
(2)(A) the tenant reasonably believes that there is a threat of imminent harm from further
violence if the tenant remains within the same unit; OR
(2)(B) in the case of a tenant who is a victim of sexual assault, either the tenant
reasonably believes there is a threat of imminent harm from further violence if the tenant
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remains within the same dwelling unit that the tenant is currently occupying, or the
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sexual assault occurred on the premises in the 90-calendar-day period preceding the
request for an emergency transfer.
A tenant's reasonable belief that there is a threat of imminent harm from further violence may
stem from an incident of domestic violence, dating violence, sexual assault, or stalking of a
household member.
Tenants who are not in good standing may still request an emergency transfer if they meet the
eligibility requirements in this section.
Emergency Transfer Policies
[Insert [HPJ's emergency transfer policies, including the following, where applicable:}
Internal transfers when a safe unit is immediately available: [Insert HP 's policies, including time
frames, possible internal transfer locations, and priority status relative to other tenants seeking
transfers.]
Internal transfers when a safe unit is not immediately available: [Insert HP 's policies, including
time frames, possible internal transfer locations, and priority status relative to other tenants
seeking transfers.]
External transfers: [Insert HP 's policies, including HP 's role in facilitating transfers; providing
referrals to community partners and affordable housing options, time frames, and priority status
given to VAWA victims seeking external transfers into HP 's property.]
[Policies and procedures for residents with Housing Choice Vouchers or other tenant-based
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rental assistance.}
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VAW A provisions do not supersede eligibility or other occupancy requirements that may
apply under a covered housing program. [HPJ may be unable to transfer a tenant to a
particular unit if the tenant has not or cannot establish eligibility for that unit.
Emergency Transfer Request Documentation
To request an emergency transfer, the tenant shall notify [HP]'s management office and submit a
written request for a transfer to [HP to insert location]. [HPJ will provide reasonable
accommodations to this policy for individuals with disabilities. The tenant's written request for
an emergency transfer must include either:
1. A statement expressing that the tenant reasonably believes that there is a threat of
imminent harm from further violence if the tenant were to remain in the tenant's current
dwelling unit; OR
2. In the case of a tenant who is a victim of sexual assault, either a statement that the tenant
reasonably believes there is a threat of imminent harm from further violence if the tenant
remains within the same dwelling unit that the tenant is currently occupying, or a
statement that the sexual assault occurred on the premises during the 90-calendar-day
period preceding the tenant's request for an emergency transfer.
NOTE: CHPs are not required to request documentation from a tenant seeking an emergency
transfer. However, if a CHP elects to require documentation from tenants seeking an
emergency transfer then the documentation requirement must be included in the CHP' s
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emergency transfer plan.
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NOTE: CHPs do not have to require that emergency transfer requests be written. The request
may be oral or written, at the CHP's option, but the CHP must make its policy and procedures
clear in this plan.
Priority for Transfers
Tenants who qualify for an emergency transfer under VAW A will be given the following
priority over other categories of tenants seeking transfers and individuals seeking placement on
waiting lists. [HP should explain any measure of priority given under this emergency
transfer plan.]
Confidentiality
[HPJ must follow strict confidentiality measures to ensure that the location of the tenant's dwelling unit is
never disclosed to a person who committed or threatened to commit an act of domestic violence, dating
violence, sexual assault, or stalking against the tenant. In addition, [HPJ must keep strictly confidential
any information the tenant provides concerning the incident(s) of domestic violence, dating violence,
sexual assault, or stalking, including the fact that the tenant is a survivor.
Information about the incident(s) and the tenant's status as a survivor, such as the information provided
on forms HUD-5382 and HUD-5383, may only be accessed by employees or contractors of[HP'sJ if
explicitly authorized by [HPJ for reasons that specifically call for those individuals to have access to the
information under applicable Federal, State, or local law.
Information about the incident(s) and the tenant's status as a survivor shall not be entered into any shared
database or disclosed to any other entity or individual, except to the extent that disclosure is: (i) consented
hearing regarding termination of assistance; or (iii) otherwise required by applicable law.
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to by the tenant in writing in a time-limited release; (ii) required for use in an eviction proceeding or
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Emergency Transfer Procedure
[HPJ cannot specify how long it will take to process a transfer request. [HPJ will, however, act
as quickly as possible to assist a tenant who qualifies for an emergency transfer. If [HPJ
identifies an available unit and the tenant believes that unit would not be safe, the tenant may
request a transfer to a different unit. [HPJ may be unable to transfer a tenant to a particular unit
if the tenant has not or cannot establish eligibility for that unit.
If [HPJ has no safe and available units for which the tenant is eligible, [HPJ will assist the tenant
in identifying other housing providers who may have safe and available units to which the tenant
could move. At the tenant's request, [HPJ will also assist tenants in contacting the local
organizations offering assistance to victims of domestic violence, dating violence, sexual assault,
or stalking that are attached to this plan.
Making Plan Available
[Insert HP 's policy for making the plan publicly available, when feasible. J
Safety and Security of Tenants
When [HPJ receives any inquiry or request regarding an emergency transfer, [HPJ will encourage
the person making the inquiry or request to take all reasonable precautions to be safe, including
seeking guidance and assistance from a victim service provider.
Tenants who are or have been victims of domestic violence will be encouraged to contact the
National Domestic Violence Hotline at 1-800-799-7233, or a local domestic violence shelter, for
assistance in creating a safety plan. For persons with hearing impairments, that hotline can be
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accessed by calling 1-800-787-3224 (TTY).
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Tenants who have been victims of sexual assault will be encouraged to call the Rape, Abuse &
Incest National Network's National Sexual Assault Hotline at 800-656-HOPE, or visit the online
hotline at https://ohl.rainn.org/online/.
Tenants who are or have been victims of stalking seeking help will be encouraged to visit the
National Center for Victims of Crime's Stalking Resource Center at
[HP] will also provide contact information for local organizations offering assistance to victims
of domestic violence, dating violence, sexual assault, or stalking.
NOTE: A section of the plan providing this information is encouraged, but not required.
NOTE: If housing providers have arrangements, including memoranda of understanding with
other covered housing providers to facilitate moves, this information should be attached to the
emergency transfer plan as well.
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Public reporting burden for this collection of information is estimated to range from four to eight hours per each covered
housing provider's response, depending on covered housing program. This includes the time to develop program and projectspecific emergency transfer policies and develop contacts with local service providers. This is a model plan and covered
housing providers in the Offices of Multifamily Housing, Public and Indian Housing, and Community Planning and Development
may, at their discretion, use it to develop their own emergency transfer plans, as required under VAWA 2013. No information is
being collected. This agency may not collect this information, and you are not required to complete this form, unless it displays
a currently valid Office of Management and Budget control number.
35810
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Appendix C
CERTIFICATION OF
U.S. Department of Housing
DOMESTIC VIOLENCE,
and Urban Development
DATING VIOLENCE,
SEXUAL ASSAULT, OR STALKING,
AND ALTERNATE OOCUMENTATION
OMB Approval No. 2577-0286
Exp.XXXX
Purpose ofF orm: The Violence Against Women Act ("VAW A") protects applicants, tenants, and
program participants in certain HUD programs from being evicted, denied housing assistance or
admission, or terminated from housing assistance on the basis or as a direct result of the fact that the
applicant or tenant is or has been a victim of domestic violence, dating violence, sexual assault, or
stalking. Despite the name of this law, V AWA protections are available to victims of domestic
violence, dating violence, sexual assault, or stalking, regardless of sex, gender identity, or sexual
orientation. Tenants and applicants may use this form to certify victim status and request VAW A
protections.
Applicable Definitions Pursuant to HUD's Regulations at 24 CFR 5.2003:
Domestic violence includes felony or misdemeanor crimes of violence committed by a current or former
spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by
a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a
person similarly situated to a spouse of the victim under the domestic or family violence laws of the
jurisdiction, or by any other person against an adult or youth victim who is protected from that person's
acts under the domestic or family violence laws of the jurisdiction. The term "spouse or intimate partner
of the victim" includes a person who is or has been in a social relationship of a romantic or intimate
nature with the victim, as determined by the length of the relationship, the type of the relationship, and the
frequency of interaction between the persons involved in the relationship.
Dating violence means violence committed by a person:
( 1) Who is or has been in a social relationship of a romantic or intimate nature with the victim;
and
(2) Where the existence of such a relationship shall be determined based on a consideration of the
following factors: (i) The length ofthe relationship; (ii) The type of relationship; and (iii) The
frequency of interaction between the persons involved in the relationship.
Sexual assault means any nonconsensual sexual act proscribed by Federal, tribal, or State law, including
when the victim lacks capacity to consent.
Stalking means engaging in a course of conduct directed at a specific person that would cause a
reasonable person to:
(1) Fear for the person's individual safety or the safety of others or
(2) Suffer substantial emotional distress.
Use of This Optional Form: If you are seeking VAWA protections from your housing provider, your
housing provider may give you a written request that asks you to submit documentation about the incident
or incidents of domestic violence, dating violence, sexual assault, or stalking.
following types of third-party documentation to your housing provider:
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In response to this request, you may complete and submit this optional form or you may submit one of the
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( 1) A document signed by you and an employee, agent, or volunteer of a victim service provider, an
attorney, or medical professional, or a mental health professional (collectively, "professionals") from
whom you have sought assistance relating to domestic violence, dating violence, sexual assault, or
stalking, or the effects of abuse. The document must specify, under penalty of perjury, that the
professional believes the incident or incidents of domestic violence, dating violence, sexual assault, or
stalking occurred and meets the regulatory definition of domestic violence, dating violence, sexual
assault, or stalking;
(2) A record of a Federal, State, tribal, territorial or local law enforcement agency, court, or
administrative agency, or
(3) At the discretion of the housing provider, a statement or other evidence provided by the applicant or
tenant.
Submission of Documentation: The time period to submit documentation is 14 business days
(Saturdays, Sundays, and Federal holidays do not count) from the date that you receive a written
request from your housing provider asking that you provide documentation of the occurrence of domestic
violence, dating violence, sexual assault, or stalking. Distribution or issuance of this form does not serve
as a written request for certification. Your housing provider may extend the time period to submit the
documentation. Ifthe requested information is not provided within 14 business days of when you
received the request for the documentation, or any extension of the date provided by your housing
provider, VAW A does not limit your housing provider's authority to deny you admission, assistance,
participation, or tenancy. However, other laws or regulations may require your housing provider to extend
the time period to submit the documentation or have alternative documentation requirements. For
example, if you have a disability, your housing provider must provide reasonable accommodations to
afford you an equal opportunity to request VAWA protections (e.g. providing an extension of time,
assisting with written requests). Failure to timely provide documentation of domestic violence, dating
violence, sexual assault, or stalking does not prevent you from challenging the denial of assistance,
termination, or eviction, nor does it prevent you from raising an incident of domestic violence, dating
violence, sexual assault, or stalking at grievance, eviction, or termination proceedings.
Confidentiality: All information provided to your housing provider concerning the incident(s) of
domestic violence, dating violence, sexual assault, or stalking shall be kept confidential. Employees of
your housing provider shall not have access to this confidential information unless explicitly authorized
by your housing provider for reasons that specifically call for these individuals to have access to this
information under applicable Federal, State, or local law. This confidential information shall not be
entered into any shared database or disclosed to any other entity or individual, except to the extent that
disclosure is: (i) consented to by you in writing in a time-limited release; (ii) required for use in an
eviction proceeding or hearing regarding termination of assistance, or (iii) otherwise required by
applicable law.
Reasonable Accommodation: If you have a disability, your housing provider must provide
reasonable accommodations when necessary to allow you to equally benefit from V AW A
protections.
TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC VIOLENCE,
DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING
Form HUD-5382
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1. Date the written request is received by victim: ____________________
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2. Name of victim: --------------------------------------------------------------3. Name(s) of other family member(s) listed on the lease: _________________
4. Residence of victim: ----------------------------------------------------------5. Name ofthe accused perpetrator (if known and can be safely disclosed): ___________________
6. Relationship of the accused perpetrator to the victim: _________________________________
7. Date(s) and times(s) of incident(s) (if known): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
8. Location of incident(s):
In your own words, briefly describe the incident(s):
This is to certify that the information provided on this form is true and correct to the best of my
knowledge and recollection; that the individual named above in Item 2 is or has been a victim of domestic
violence, dating violence, sexual assault, or stalking, and that the incident(s) described above meets the
applicable regulatory definition of domestic violence, dating violence, sexual assault, or stalking. I
acknowledge that submission of false information could jeopardize program eligibility and could be the
basis for denial of admission, termination of assistance, or eviction.
Signature _______________________________Signed on (Date) _ _ _ _ _ _ _ _ _ _ ___
Public Reporting Burden for this collection of information is estimated to average 30 minutes per
response. This includes the time for collecting, reviewing, and reporting. Housing providers in the
Offices of Multifamily Housing, Public and Indian Housing, and Community Planning and Development
may request certification that the applicant or tenant is a victim of domestic violence, dating violence,
sexual assault, or stalking. Tenants and applicants may use this form to certify victim status and request
VAWA protections. The information is subject to the confidentiality requirements ofVAWA. This
Form HUD-5382
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Warning: 18 U.S.C. 1001 provides, among other things that whoever knowingly and willfully makes or
uses a document or writing containing false, fictitious or fraudulent statement or entry in any matter
within the jurisdiction of a department or agency of the United States shall be fined not more than
$10,000 or imprisoned for not more than five years or both.
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Form HUD-5382
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agency may not collect this information, and you are not required to complete this form, unless it displays
a currently valid Office of Management and Budget control number.
35814
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Appendix D
U.S. Department of Housing
EMERGENCY TRANSFER
REQUEST FOR CERTAIN
and Urban Development
VICTIMS OF DOMESTIC
VIOLENCE, DATING VIOLENCE,
SEXUAL ASSAULT, OR STALKING
OMB Approval No. 2577-0286
Exp.XXXX
Purpose ofF orm: If you (or a member of your household) are a victim of domestic violence, dating
violence, sexual assault, or stalking, and you are seeking an emergency transfer, you may use this form to
request an emergency transfer and certify that you meet the requirements of eligibility for an emergency
transfer under the Violence Against Women Act (V AWA). Although the statutory name references
women, VAW A rights and protections apply to all victims of domestic violence, dating violence, sexual
assault, or stalking. Submitting this form does not necessarily mean that you will receive an emergency
transfer. See your housing provider's Emergency Transfer Plan for more information about emergency
transfers.
The requirements you must meet are:
(1) You (the tenant) are a victim of domestic violence, dating violence, sexual
assault, or stalking. If your housing provider does not already have documentation that
you (or your household member) are a victim of domestic violence, dating violence,
sexual assault, or stalking, your housing provider may ask you for such documentation.
In response, you may submit Form HUD-5382, or any one of the other types of
documentation listed on that Form;
(2) You expressly request the emergency transfer. Submission ofthis form confirms
that you have expressly requested a transfer. Your housing provider may choose to
require that you submit this form, or may accept another written or oral request. See your
housing provider's Emergency Transfer Plan for more details; and
(3) (A) You reasonably believe you are threatened with imminent harm from
further violence if you remain in your current unit. This means you have a reason to
fear that if you do not receive a transfer you would suffer violence in the very near future.
OR
(B) You are a victim of sexual assault and the assault occurred on the premises
during the 90-calendar-day period before you request a transfer. If you are a victim
of sexual assault, then in addition to qualifying for an emergency transfer because you
reasonably believe you are threatened with imminent harm from further violence if you
remain in your unit, you also qualify for an emergency transfer if the sexual assault
occurred on the premises of the property from which you are seeking your transfer, and
that assault happened within the 90-calendar-day period before you submit this form or
otherwise expressly request the transfer.
Form HUD-5383
xxxx
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Your reasonable belief that there is a threat of imminent harm from further violence may stem from an
incident of domestic violence, dating violence, sexual assault, or stalking of a household member.
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Submission of Documentation: If you have third-party documentation that demonstrates why are
eligible for an emergency transfer, you may submit that documentation to your housing provider if it is
safe for you to do so. Examples of third party documentation include, but are not limited to: a letter or
other documentation from a victim service provider, social worker, legal assistance provider, pastoral
counselor, mental health provider, or other professional from whom you have sought assistance; a current
restraining order; a recent court order or other court records; a law enforcement report or records;
communication records from the perpetrator of the violence or family members or friends of the
perpetrator of the violence, including emails, voicemails, text messages, and social media posts.
Confidentiality: Your housing provider must follow strict confidentiality measures to ensure that the
location of your dwelling unit is never disclosed to a person who committed or threatened to commit an
act of domestic violence, dating violence, sexual assault, or stalking against you. In addition, your
housing provider must keep strictly confidential any information you provide concerning the incident(s)
of domestic violence, dating violence, sexual assault, or stalking, including the fact that you are a
survivor. Information about the incident(s) and your status as a survivor, such as the information on this
form, may only be accessed by employees or contractors of your housing provider if explicitly authorized
by your housing provider for reasons that specifically call for those individuals to have access to the
information under applicable Federal, State, or local law. Information about the incident(s) and your
status as a survivor shall not be entered into any shared database or disclosed to any other entity or
individual, except to the extent that disclosure is: (i) consented to by you in writing in a time-limited
release; (ii) required for use in an eviction proceeding or hearing regarding termination of assistance, or
(iii) otherwise required by applicable law.
TO BE COMPLETED BY OR ON BEHALF OF THE PERSON REQUESTING A TRANSFER
1. Name of victim requesting an emergency transfer: __________________
2. Your name (if different from victim's)________________________
3. Name(s) of other family member(s) listed on the lease: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
4. Name(s) of other family member(s) who would transfer with the victim: _ _ _ _ _ _ _ __
5. Address of location from which the victim seeks to transfer: ______________
6. Address or phone number for contacting the victim: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
7. Name ofthe accused perpetrator (if known and can be safely disclosed): _ _ _ _ _ _ _ __
8. Relationship of the accused perpetrator to the victim: _________________
Form HUD-5383
xxxx
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9. Date(s), Time(s) and location(s) of incident(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
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10. Is the person requesting the transfer a victim of a sexual assault that occurred in the past 90
days on the premises of the property from which the victim is seeking a transfer? If yes, skip
question 11. If no, fill out question 11. _ _ _ _ __
11. Does the person requesting the transfer reasonably believe there is a threat of imminent harm
from further violence if the person remains in the same dwelling unit that he or she is currently
occupying?
12. If voluntarily provided, list any third-party documentation you are providing along with this
notice: -------------------------------------------------------------This is to certify that the information provided on this form is true and correct to the best of my
knowledge, and that the individual named above in Item 1 meets the requirement laid out on this form for
an emergency transfer. I acknowledge that submission of false information could jeopardize program
eligibility and could be the basis for denial of admission, termination of assistance, or eviction.
Signature _______________________________Signed on (Date) _ _ _ _ _ _ _ _ _ _ ___
Warning: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willfully
makes or uses a document or writing containing false, fictitious or fraudulent statement or entry
in any matter within the jurisdiction of a department or agency of the United States shall be fined
not more than $10,000 or imprisoned for not more than five years or both.
Form HUD-5383
xxxx
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Public reporting burden for this collection of information is estimated to average 30 minutes per
response. This includes the time for collecting, reviewing, and reporting. Housing providers in the
Offices of Multifamily Housing, Public and Indian Housing, and Community Planning and Development
may ask for a written request for an emergency transfer for a tenant who is a victim of domestic violence,
dating violence, sexual assault, or stalking. Housing providers may distribute this form to tenants and
tenants may use it to request an emergency transfer. The information is subject to the confidentiality
requirements ofVAWA. This agency may not collect this information, and you are not required to
complete this form, unless it displays a currently valid Office of Management and Budget control number.
Federal Register / Vol. 82, No. 146 / Tuesday, August 1, 2017 / Notices
DEPARTMENT OF THE INTERIOR
Service Headquarters, MS: IA; 5275
Leesburg Pike, Falls Church, VA 22041–
3803; telephone 703–358–2023;
facsimile 703–358–2280.
SUPPLEMENTARY INFORMATION:
Fish and Wildlife Service
I. Public Comment Procedures
[Docket No. FWS–HQ–IA–2017–0038;
FXIA16710900000–178–FF09A30000]
A. How do I request copies of
applications or comment on submitted
applications?
Send your request for copies of
applications or comments and materials
concerning any of the applications to
the contact listed under FOR FURTHER
INFORMATION CONTACT. Please include
the Federal Register notice publication
date, the PRT-number, and the name of
the applicant in your request or
submission. We will not consider
requests or comments sent to an email
or address not listed under ADDRESSES.
If you provide an email address in your
request for copies of applications, we
will attempt to respond to your request
electronically.
Please make your requests or
comments as specific as possible. Please
confine your comments to issues for
which we seek comments in this notice,
and explain the basis for your
comments. Include sufficient
information with your comments to
allow us to authenticate any scientific or
commercial data you include.
The comments and recommendations
that will be most useful and likely to
influence agency decisions are: (1)
Those supported by quantitative
information or studies; and (2) those
that include citations to, and analyses
of, the applicable laws and regulations.
We will not consider or include in our
administrative record comments we
receive after the close of the comment
period (see DATES) or comments
delivered to an address other than those
listed above (see ADDRESSES).
[FR Doc. 2017–16110 Filed 7–31–17; 8:45 am]
BILLING CODE 4210–67–C
Foreign Endangered Species; Receipt
of Applications for Permit
Fish and Wildlife Service,
Interior.
ACTION: Notice of receipt of applications
for permit.
AGENCY:
We, the U.S. Fish and
Wildlife Service, invite the public to
comment on the following applications
to conduct certain activities with
endangered species, marine mammals,
or both. With some exceptions, the
Endangered Species Act (ESA) prohibits
activities with listed species unless
Federal authorization is acquired that
allows such activities.
DATES: We must receive comments or
requests for documents on or before
August 31, 2017.
ADDRESSES: Submitting Comments: You
may submit comments by one of the
following methods:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments
on Docket No. FWS–HQ–IA–2017–0038.
• U.S. mail or hand-delivery: Public
Comments Processing, Attn: Docket No.
FWS–HQ–IA–2017–0038, U.S. Fish and
Wildlife Service, MS: BPHC; 5275
Leesburg Pike, Falls Church, VA 22041–
3803.
When submitting comments, please
indicate the name of the applicant and
the PRT# you are commenting on. We
will post all comments on https://
www.regulations.gov. This generally
means that we will post any personal
information you provide us (see the
Public Comments section for more
information).
Viewing Comments: Comments and
materials we receive will be available
for public inspection on https://
www.regulations.gov, or by
appointment, between 8 a.m. and 4
p.m., Monday through Friday, except
Federal holidays, at the U.S. Fish and
Wildlife Service, Division of
Management Authority, 5275 Leesburg
Pike, Falls Church, VA 22041–3803;
telephone 703–358–2095.
FOR FURTHER INFORMATION CONTACT:
Joyce Russell, Government Information
Specialist, Division of Management
Authority, U.S. Fish and Wildlife
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SUMMARY:
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B. May I review comments submitted by
others?
Comments, including names and
street addresses of respondents, will be
available for public review at the street
address listed under ADDRESSES. The
public may review documents and other
information applicants have sent in
support of the application unless our
allowing viewing would violate the
Privacy Act or Freedom of Information
Act. Before including your address,
phone number, email address, or other
personal identifying information in your
comment, you should be aware that
your entire comment—including your
personal identifying information—may
be made publicly available at any time.
While you can ask us in your comment
to withhold your personal identifying
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35817
information from public review, we
cannot guarantee that we will be able to
do so.
II. Background
To help us carry out our conservation
responsibilities for affected species, and
in consideration of section 10(a)(1)(A) of
the Endangered Species Act of 1973, as
amended (16 U.S.C. 1531 et seq.), along
with Executive Order 13576,
‘‘Delivering an Efficient, Effective, and
Accountable Government,’’ and the
President’s Memorandum for the Heads
of Executive Departments and Agencies
of January 21, 2009—Transparency and
Open Government (74 FR 4685; Jan. 26,
2009), which call on all Federal
agencies to promote openness and
transparency in Government by
disclosing information to the public, we
invite public comment on these permit
applications before final action is taken.
III. Permit Applications
We invite the public to comment on
applications to conduct certain
activities with endangered and
threatened species. With some
exceptions, the Endangered Species Act
(16 U.S.C. 1531 et seq.; ESA) prohibits
activities with listed species unless
Federal authorization is acquired that
allows such activities.
Applicant: University of Texas-Austin,
Austin, TX PRT–124346
The applicant requests a permit to
import tissue samples of Verreaux’s
sifaka
(Propithecus verreauxi) from
Morondava, Madagascar, for scientific
research. This notification covers
activities to be conducted by the
applicant over a 5-year period.
Applicant: Wildlife & Environmental
Conservation, Inc., Moorpark, CA;
PRT–29610C
The applicant requests a permit to
purchase in interstate commerce two
captive-born male cheetahs (Acinonyx
jubatus) from Metro Richmond Zoo,
Moseley, Virginia, to enhance the
propagation or survival of the species.
Applicant: Veterinary Initiative for
Endangered Wildlife, Bozeman, MT;
PRT–75654B
The applicant requests amendment of
their permit to import biological
samples from the Ministry of Forestry &
Soil Conservation, Chitwan, Nepal, to
include the following species: Asian
elephant (Elephas maximus), Indian
rhinoceros (Rhinoceros unicornis),
pygmy hog (Sus salvanius), Alpine
musk deer (Moschus chrysogaster),
black musk deer (Moschus fuscus),
seladang (Bos gaurus), Chiru
(Pantholops hodgsonii), Himalayan
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]]>Agencies
[Federal Register Volume 82, Number 146 (Tuesday, August 1, 2017)]
[Notices]
[Pages 35788-35817]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-16110]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
[Docket No. FR-5997-N-39]
60-Day Notice of Proposed Information Collection: Implementation
of the Violence Against Women Reauthorization Act of 2013
AGENCY: Offices of Housing, Public and Indian Housing, and Community
Planning and Development, HUD.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: HUD is seeking approval from the Office of Management and
Budget (OMB) for the information collection described below. In
accordance with the Paperwork Reduction Act, HUD is requesting comment
from all interested parties on the proposed collection of information.
The purpose of this notice is to allow for 60 days of public comment.
DATES: Comments Due Date: October 2, 2017.
ADDRESSES: Interested persons are invited to submit comments regarding
this proposal. Comments should refer to the proposal by name and/or OMB
Control Number and should be sent to: Colette Pollard, Reports
Management Officer, QDAM, Department of Housing and Urban Development,
451 7th Street SW., Room 4176, Washington, DC
[[Page 35789]]
20410-5000; email Colette.Pollard@hud.gov or telephone 202-402-3400
(this is not a toll-free number). Persons with hearing or speech
impairments may access this number through TTY by calling the toll-free
Federal Relay Service at (800) 877-8339. Interested persons may also
submit comments electronically through the Federal eRulemaking Portal
at www.regulations.gov. HUD strongly encourages commenters to submit
comments electronically. Electronic submission of comments allows the
commenter maximum time to prepare and submit a comment, ensures timely
receipt by HUD, and enables HUD to make them immediately available to
the public. Comments submitted electronically through the
www.regulations.gov Web site can be viewed by other commenters and
interested members of the public. Commenters should follow the
instructions provided on that site to submit comments electronically.
FOR FURTHER INFORMATION CONTACT: Colette Pollard, Reports Management
Officer, QDAM, Department of Housing and Urban Development, 451 7th
Street SW., Washington, DC 20410; email Colette Pollard at
Colette.Pollard@hud.gov or telephone 202-402-3400. This is not a toll-
free number. Persons with hearing or speech impairments may access this
number through TTY by calling the toll-free Federal Relay Service at
(800) 877-8339.
SUPPLEMENTARY INFORMATION: This notice informs the public that HUD is
seeking approval from OMB for the information collection described in
Section A.
A. Overview of Information Collection
Title of Information Collection: Implementation of the Violence
Against Women Reauthorization Act of 2013 OMB Approval Number: 2577-
0286.
Type of Request (i.e., new, revision or extension of currently
approved collection): Revision of currently approved collection.
Form Number: Forms HUD-5380, HUD-5381, HUD-5382, and HUD-5383.
Other: Emergency transfer reporting, lease addenda, and lease
bifurcation.
Description of the need for the information and proposed use: The
Violence Against Women Reauthorization Act of 2013 (VAWA 2013), Public
Law 113-4, 127 Stat. 54, reauthorized and amended the Violence Against
Women Act of 1994, as previously amended (title IV, sec. 40001-40703 of
Public Law 103-322, 42 U.S.C. 13925 et seq.). In doing so, VAWA 2013
expanded VAWA protections from HUD's Section 8 and Public Housing
programs only to many of HUD's housing programs. The programs now
covered under the final VAWA Rule include:
Section 202 Supportive Housing for the Elderly (12 U.S.C.
1701q);
Section 811 Supportive Housing for Persons with
Disabilities (42 U.S.C. 8013);
Housing Opportunities for Persons with AIDS (HOPWA)
program (42 U.S.C. 12901 et seq.);
HOME Investment Partnerships (HOME) program (42 U.S.C.
12741 et seq.);
Homeless programs under title IV of the McKinney-Vento
Homeless Assistance Act (42 U.S.C. 11360 et seq.), including the
Emergency Solutions Grants (ESG) program, the Continuum of Care (CoC)
program, and the Rural Housing Stability (RHS) Assistance program;
Multifamily rental housing under section 221(d)(3) of the
National Housing Act (12 U.S.C. 17151(d)) with a below-market interest
rate (BMIR) pursuant to section 221(d)(5);
Multifamily rental housing under section 236 of the
National Housing Act (12 U.S.C. 1715z-1);
HUD programs assisted under the United States Housing Act
of 1937 (42 U.S.C. 1437 et seq.); specifically, public housing under
section 6 of the 1937 Act (42 U.S.C. 1437d), tenant-based and project-
based rental assistance under section 8 of the 1937 Act (42 U.S.C.
1437f), and the Section 8 Moderate Rehabilitation Single Room
Occupancy; and
The Housing Trust Fund (12 U.S.C. 4568).
The provisions of VAWA 2013 that afford protections to victims of
domestic violence, dating violence, sexual assault, or stalking are
statutory and statutorily directed to be implemented. Accordingly, on
November 16, 2016, HUD published a final rule at 81 FR 80724 (VAWA
Rule), implementing VAWA 2013's provisions in its housing programs.
To fully implement these provisions under VAWA 2013 and the VAWA
Rule, the Department must provide to all PHAs, owners and managers, and
grant recipients (collectively ``Covered Housing Providers'' or
``CHPs'') the three following model documents:
Form HUD-5380: Notice of Occupancy Rights Under the
Violence Against Women Act. HUD must provide this notice to CHPs, which
must in turn distribute it to tenants and to applicants denied
assistance to ensure they are aware of their rights under VAWA and its
implementing regulations.
Form HUD-5381: Model Emergency Transfer Plan for Victims
of Domestic Violence, Dating Violence, Sexual Assault, or Stalking. HUD
must provide this model document to CHPs, which may, at their
discretion, use it to develop their own emergency transfer plans, as
required under VAWA 2013.
Form HUD-5382: Certification of Domestic Violence, Dating
Violence, Sexual Assault, or Stalking, and Alternate Documentation. HUD
must provide this certification form to CHPs, which must in turn
distribute it to tenants and applicants. An individual may then
optionally submit the form, certifying that he or she is a victim of
domestic violence, dating violence, sexual assault, or stalking and
that the incident in question is bona fide. The certification form
serves as one tool for documenting the incident or incidents of
domestic violence, dating violence, sexual assault, or stalking. (Note:
This is a revision of and supersedes forms HUD-50066 and HUD-91066.
VAWA 2013 required that the form be updated and made applicable to all
covered programs.)
Tenants may provide third-party documentation along with or in lieu
of form HUD-5382. The VAWA regulation stipulates that one such
document--
A. Be signed by an employee, agent, or volunteer of a victim
service provider, an attorney, or medical professional, or a mental
health professional (collectively, ``professional'') from whom the
victim has sought assistance relating to domestic violence, dating
violence, sexual assault, or stalking, or the effects of abuse;
B. Be signed by the applicant or tenant; and
C. Specifies, under penalty of perjury, that the professional
believes in the occurrence of the incident of domestic violence, dating
violence, sexual assault, or stalking and that the incident meets the
applicable definition of domestic violence, dating violence, sexual
assault, or stalking.
If an applicant or tenant submits such a statement, the
corresponding professional may have to create or research documentation
to accurately complete and maintain a record of the form.
HUD provides form HUD-5383: Emergency Transfer Request for Certain
Victims of Domestic Violence, Dating Violence, Sexual Assault, or
Stalking to CHPs, which may, at their discretion, distribute it to
tenants and applicants. This form serves as a model for use by a CHP to
accept requests for emergency transfers under its required VAWA 2013
Emergency Transfer Plan. This form
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allows an individual to submit and certify that they are a victim of
domestic violence, dating violence, sexual assault, or stalking and
that the incident in question is bona fide for purposes of being
eligible for an emergency transfer. Thus, it serves as another tool for
documenting the incident or incidents of domestic violence, dating
violence, sexual assault, and stalking.
VAWA 2013 and/or the VAWA rule require or permit that CHPs also
undertake certain activities as follows:
Emergency Transfer Reporting: CHPs must keep a record of
all emergency transfers requested under its emergency transfer plan,
and the outcomes of such requests, and retain these records for a
period of three years, or for a period of time as specified in program
regulations. Requests and outcomes of such requests must also be
reported to HUD annually.
The VAWA regulation includes certain requirements that
must be incorporated into the tenant's lease.
Lease Bifurcation Option: VAWA 2013 provides CHPs the
option to bifurcate a lease in order to evict, remove, terminate
occupancy rights, or terminate assistance to any individual who is a
tenant or lawful occupant of the housing and who engages in criminal
activity directly relating to domestic violence, dating violence,
sexual assault, or stalking. This option is designed to minimize the
loss of housing to individual(s) covered under VAWA.
Respondents (i.e., affected public): Public housing agencies,
private multifamily housing owners and management agents, state and
local agencies, and grant recipients.
Estimated Number of Respondents: 30,087.
Estimated Number of Responses: 7,941,827.
Frequency of Response: Varies.
Average Hours per Response: 1.4.
Total Estimated Hour Burden: 3,269,550.
B. Proposed Changes to the Forms
The OMB approved forms HUD-5380, HUD-5381, HUD-5382, and HUD-5383
are being revised to more closely align with the VAWA regulation and to
clarify language. In addition to minor changes, HUD proposes to make
the following specific changes:
Form 5380: Clarify the ``Tenant Protections'' and ``Removing the
Abuser or Perpetrator from the Household'' sections to align with the
regulations and provide more information about bifurcation. Rename
``Moving to Another Unit'' to ``Emergency Transfer'' and include more
emergency transfer language. Add language in the ``Documenting That You
Are or Have Been a Victim'' section about reasonable accommodations and
update the language for consistency with the regulation. Lastly, update
the ``Confidentiality'' section to more closely follow the regulation
and put individuals on notice of confidentiality protections.
Form 5381: Add a note to covered housing providers that the use of
the model form without adding program specific and housing provider
specific policies will not be sufficient to meet the emergency transfer
plan requirements. Add a definition section with definitions taken from
the regulation. Rename the section titled ``Emergency Transfer Timing
and Availability'' to ``Emergency Transfer Procedures'' and add two new
sections, ``Emergency Transfer Policies'' section, which clarifies that
the provider must specify their individual policies for different
categories of transfers (i.e. internal or external transfers) where
applicable, and a ``Priority for Transfers'' section, which requires
providers to provide any type of priority being provided to a victim
consistent with 24 CFR 5.2005(e)(3) and (e)(6). Update the
``Confidentiality'' section to more closely follow the regulation and
put individuals on notice of confidentiality protections. Lastly, add a
``Making Plan Available'' section to describe how the plan will be made
publicly available, where possible.
Form 5382: Update the ``Submission of Documentation'' section to
include information about reasonable accommodations. In addition, add a
warning for making false submissions to ensure users of the form are
aware of the legal nature of submitting false information to an entity
when seeking access to Federal funds.
Form 5383: Update the ``Confidentiality'' section to more closely
follow the regulation and put individuals on notice of confidentiality
protections. Reframe question number 11 as a ``Yes'' or ``No''
question. Lastly, add a warning for making false submissions to ensure
users of the form are aware of the legal nature of submitting false
information to an entity when seeking access to Federal funds.
Drafts of the revised forms are being published along with this
notice for the public to see the proposed changes.
C. Solicitation of Public Comment
This notice is soliciting comments from members of the public and
affected parties concerning the collection of information described in
Section A on the following:
(1) Whether the proposed collection of information is necessary for
the proper performance of the functions of the agency, including
whether the information will have practical utility;
(2) The accuracy of the agency's estimate of the burden of the
proposed collection of information;
(3) Ways to enhance the quality, utility, and clarity of the
information to be collected; and
(4) Ways to minimize the burden of the collection of information on
those who are to respond; including through the use of appropriate
automated collection techniques or other forms of information
technology, e.g., permitting electronic submission of responses.
HUD encourages interested parties to submit comment in response to
these questions.
Authority: Section 3507 of the Paperwork Reduction Act of 1995,
44 U.S.C. Chapter 35.
Dated: July 26, 2017.
Colette Pollard,
Department Reports Management Officer, Office of the Chief Information
Officer.
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[FR Doc. 2017-16110 Filed 7-31-17; 8:45 am]
BILLING CODE 4210-67-C
