HUD-52751 Ross Fund Fact Sheet

ROSS FUNDING

FACT SHEET

OMB Approval No. 2577-0229
Expiration Date 02/28/2007

U.S. DEPARTMENT OF HOUSING
AND URBAN DEVELOPMENT
OFFICE OF PUBLIC AND INDIAN HOUSING

Public reporting burden for the collection of information is estimated to average 2 hours per response. This includes
the time for collecting, reviewing, and reporting the data. The information will be used for the ROSS grant.
Response to this request for information is required in order to receive the benefits to be derived. This agency may
not collect this information, and you are not required to complete this form unless it displays a currently valid OMB
control number.

Instructions for completing this form: All applicants must complete sections A, B, C, D,
and E.
A. Applicant Information
Applicant Name:________________________________________________________
PHA (PHA Code _____), All Applicants must identify a primary PHA.
Applicant Type: ____RA ____Nonprofit ____ Tribe/TDHE
B. Grant to which the applicant is applying: ________________________________
C. Unit Count
_____ Total number of family occupied conventional public housing units.
_____ Total number of elderly/disabled-occupied conventional public housing units.
D. Please list any previous HUD grants, including ROSS grants you have received.
Indicate grant name, (e.g. ROSS Homeownership), Year, and Award Amount.
GRANT NAME

GRANT YEAR

GRANT AMOUNT

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form HUD-52751 (12/2005)

OMB Approval No. 2577-0229
Expiration Date 02/28/2007

ROSS FUNDING
FACT SHEET (continued)
E. Name(s) of public housing development(s) targeted for ROSS Activities (Use
additional pages if necessary.)
Name of Public Housing Development PIH Project # (HA Code and 3-digit project #)

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2

form HUD-52751 (12/2005)