ROSS 2004

Chart B: Applicant/Contract Administrator Track Record  (Past Performance)
Applicant: _________________________  	

Instructions for completing this form:  Applicants must use this form to provide information about previous HUD grants you  have administered over the most recent five-year period.  Applicants with few or no HUD grants should provide information about other federal grants you have received.  Applicants should list state, local, or private grants should you have no HUD or federal grant experience.  Applicants should clearly indicate the organization from which you received grants and indicate whether you were the grantee or whether your contract administrator was the grantee.  Applicants should list grants starting with the most recent HUD grants, proceeding next with federal, state, local, and/or private grants.  Applicants should not list grants that are 10 years old or older.

Public reporting burden for the collection of information is estimated to average two 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.

Grant Program and Grantor Agency	Grantee
(Applicant or CA)	Project No.	% of Funds Draw Down	Major Goal #1	%
Complete	Major Goal #2	%
Complete