Form 52761 Applicant Checklist.HSS

OMB Approval No. 2577-0229

Expiration Date

ROSS FY 2004 FUNDING

HOMEOWNERSHIP SUPPORTIVE SERVICES

APPLICANT CHECKLIST AND SUBMISSION FORMAT

Public reporting burden for the collection of information is estimated to average fifteen minutes 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: The following checklist is provided to ensure you have submitted all required items to receive consideration for funding. You must assemble the application according to the order shown below and include this checklist with your application.

Tab 1: Required forms from the General Section of the SuperNOFA and other ROSS forms.

Applicant Use (please check boxes) HUD Use

• Applicant Checklist _____

• Fact Sheet _____

• Application for Federal Assistance (HUD-424) _____

• Budget Summary for Competitive Grant Programs _____

(HUD-424C)

• Applicant Assurances and Certifications (HUD-424B) _____

• Grant Application Detailed Budget (HUD-424-CB) _____

• Grant Application Detailed Budget Worksheet _____

(HUD-424-CBW)

• Applicant/Recipient Disclosure/Update Report _____

(HUD-2880)

• Certification of Consistency with RC/EZ/EC _____

Strategic Plan (HUD-2990) if applicable

• Certification of Consistency with the Consolidated _____

Plan (HUD-2991) if applicable

• Certification of Consistency with the Indian Housing Plan _____

(if applicable)

• Certification of Resident Council Board of Election _____

(required for resident organization applicants)

• Disclosure of Lobbying Activities (SF-LLL)- _____

if applicable

• Disclosure of Lobbying Activities Continuation Sheet _____

(SF-LLL-A)-if applicable

• Acknowledgement of Application Receipt (HUD-2993) _____

• Client Comments and Suggestions (HUD-2994)-Optional _____

Tab 2: Threshold Requirements

Applicant Use (please check boxes) HUD Use

• Letters from Partners attesting to match _____

• Letter from Applicant’s organization attesting to match _____

• Letters of support from Resident Associations/PHAs _____

indicating support of nonprofit applicants (required

for nonprofit applicants)

• Chart of Resident Associations Participating (required _____

for nonprofit applicants)

• IRS Determination Letter (required for nonprofit organizations) _____

• Contract Administrator Partnership Agreement (required for _____

nonprofit organizations, troubled PHAs, and troubled tribes/TDHEs)

• Past Performance evaluation (submitted separately by HUD _____

Field office to HUD’s Grants Management Center)

Tab 3: Narrative for Rating Factor 1 and Non-Standard ROSS Program Forms

• Narrative _____

• Chart A: Program Staffing _____

• Chart B: Applicant/Administrator Track Record _____

• Resumes/Position Descriptions _____

Tab 4: Narrative for Rating Factor 2

• Narrative _____

Tab 5: Narrative for Rating Factor 3 and Non-Standard ROSS Program Form

• Narrative _____

• Work plan (see sample) _____

Tab 6: Narrative for Rating Factor 4

• Narrative _____

Tab 7: Narrative for Rating Factor 5 and Non-Standard ROSS Program Forms

• Narrative _____

• Logic Model _____

• Performance measures/outcomes _____

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form HUD-52761 ()