HUD 52754 Lis of Resid. Assoc. Supporting Nonprofit Applicants

ROSS - LIST OF RESIDENT
ORGANIZATIONS SUPPORTING
NONPROFIT APPLICANTS

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

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

SAVE

Instructions for completing this form: All nonprofit applicants to the ROSS program must complete this form by listing contact information for each resident
association supporting your application. Nonprofit applicants must have support from at least one resident association in order to receive funding. Nonprofit applicants
can receive funding for working on behalf of one but no more than three resident associations. Attach letters of support to this form.

Grant to which the applicant is applying:
_____ RSDM-Family _____ RSDM-Elderly _____ Homeownership Supportive Services _____ Neighborhood Networks

List of Resident Organization(s)
Name of the Resident Organization/tribe/TDHE

Contact Person, Title, and Telephone Number

Address, City, & State

Housing Authority/Tribe

1.

2.

3.

The above information is true and correct to the best of my knowledge.
Signed this ____________________ day of ______________________,

.

By: ____________________________________________________________
Applicant Executive Director or Other Authorized Representative
For: ____________________________________________________________
Applicant Name

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.

form HUD-52754 (3/2004)