Information Collection

Application for the Resident Opportunities and Self Sufficiency (ROSS) Program

IC 42121 under ICR 200609-2577-001 · OMB 2577-0229.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2577-0229 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 52761 Application for the Resident Opportunities and Self Sufficiency (ROSS) Program	Form and Instruction
52755 Sample Contract Administrator Partnership Agreement Sample Contract Administrator Partnership Agreement.pdf	Form and Instruction
HUD-52751 Ross Fund Fact Sheet 52751.pdf	Form
52767 PHA FSS Request Form 52767.pdf	Form and Instruction
52753 ROSS ResCouncBoardElec 52753 ROSS ResCouncBoardElec.rtf	Form and Instruction
52757 ROSS ChartBAppAdminTrackRec 52757 ROSS ChartB-AppAdminTrackRec.rtf	Form and Instruction
52759 Applicant Checklist RSDM Family 52759 Applicant Checklist.RSDM Family.doc	Form and Instruction
52761 Applicant Checklist.HSS 52761 Applicant Checklist.HSS.doc	Form and Instruction
52763 ROSS Sample Work Plan RSDM Family 52763 ROSS Sample Work Plan.RSDM Family.doc	Form and Instruction
52765 ROSS Sample Work Plan HSS 52765 ROSS Sample Work Plan.HSS.doc	Form and Instruction

IC Title:

Application for the Resident Opportunities and Self Sufficiency (ROSS) Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	52761	Applicant Checklist.HSS	52761 Applicant Checklist.HSS.doc	No	Fillable Printable
Form	HUD-52751	Ross Fund Fact Sheet	52751.pdf	No	Fillable Printable
Form and Instruction	52757	ROSS ChartBAppAdminTrackRec	52757 ROSS ChartB-AppAdminTrackRec.rtf	No	Fillable Printable
Form and Instruction	52753	ROSS ResCouncBoardElec	52753 ROSS ResCouncBoardElec.rtf	No	Fillable Printable
Form and Instruction	52755	Sample Contract Administrator Partnership Agreement	Sample Contract Administrator Partnership Agreement.pdf	No	Fillable Printable
Form and Instruction	52763	ROSS Sample Work Plan RSDM Family	52763 ROSS Sample Work Plan.RSDM Family.doc	No	Fillable Printable
Form and Instruction	52765	ROSS Sample Work Plan HSS	52765 ROSS Sample Work Plan.HSS.doc	No	Fillable Printable
Form and Instruction	52759	Applicant Checklist RSDM Family	52759 Applicant Checklist.RSDM Family.doc	No	Fillable Printable
Form and Instruction	52767	PHA FSS Request Form	52767.pdf	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 850

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	850	850
Annual IC Time Burden (Hours)	41,643	41,643
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.