Information Collection

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

IC 42121 under ICR 201201-2577-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 HUD 52755 Application for the Resident Opportunities and Self Sufficiency (ROSS) Program	Form and Instruction
HUD 52755 Sample Contract Administrator Partnership Agreement Sample Contract Administrator Partnership Agreement.pdf	Form and Instruction
HUD 52753 ROSS ResCouncBoardElec 52753 ROSS ResCouncBoardElec.rtf	Form and Instruction
HUD 52752 Cert. with Indian Hsng. Plan hud-52752.pdf	Form and Instruction
HUD 52754 Lis of Resid. Assoc. Supporting Nonprofit Applicants hud-52754.pdf	Form and Instruction
SF424 Application for Federal Assistance sf424.doc	Form and Instruction
SF424 Suppplement Survey on Ensuring Equal Opportunity for Applicants sf424sup.doc	Form and Instruction
HUD 2880 Applicant/Recipient Disclosure/Update Report 2880.doc	Form and Instruction
HuD 2990 Certification of Consistency with RC/EZ/EC-II Strategic 2990.pdf	Form and Instruction
SF LLL Disclosure of Lobbying Activities SF LLL.pdf	Form and Instruction
HUD 96010 Logic Model 96010.pdf	Form and Instruction
HUD-52768 Ross Service Coordinators- Funding Request ROSS SC Application Form HUD-52768 .doc	Form and Instruction
HUD-52769 Ross Service Coordinators- Needs and Service Partners ROSS SC needs-providers form HUD-52769 .doc	Form and Instruction
HUD-2993 Acknowledgment of Application Receipt HUD-2993.pdf	Form and Instruction
HUD-2991 Certification of Consistency with the Consolidated Plan HUD-2991.pdf	Form and Instruction
HUD-2994-A Grant Applicant Survey HUD-2994-A.doc	Form and Instruction
HUD 52651 Housing Choice Voucher (HCV) Family Self-Sufficiency (FS 52651.doc	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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: 24 CFR 538

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD 52755	Sample Contract Administrator Partnership Agreement	Sample Contract Administrator Partnership Agreement.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 52753	ROSS ResCouncBoardElec	52753 ROSS ResCouncBoardElec.rtf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 52752	Cert. with Indian Hsng. Plan	hud-52752.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 52754	Lis of Resid. Assoc. Supporting Nonprofit Applicants	hud-52754.pdf	Yes	Yes	Fillable Printable
Form and Instruction	SF424	Application for Federal Assistance	sf424.doc	Yes	Yes	Fillable Fileable
Form and Instruction	SF424 Suppplement	Survey on Ensuring Equal Opportunity for Applicants	sf424sup.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 2880	Applicant/Recipient Disclosure/Update Report	2880.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HuD 2990	Certification of Consistency with RC/EZ/EC-II Strategic	2990.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SF LLL	Disclosure of Lobbying Activities	SF LLL.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 96010	Logic Model	96010.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-52768	Ross Service Coordinators- Funding Request	ROSS SC Application Form HUD-52768 .doc	Yes	No	Fillable Printable
Form and Instruction	HUD-52769	Ross Service Coordinators- Needs and Service Partners	ROSS SC needs-providers form HUD-52769 .doc	Yes	No	Fillable Printable
Form and Instruction	HUD-2993	Acknowledgment of Application Receipt	HUD-2993.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-2991	Certification of Consistency with the Consolidated Plan	HUD-2991.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-2994-A	Grant Applicant Survey	HUD-2994-A.doc	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 52651	Housing Choice Voucher (HCV) Family Self-Sufficiency (FSS) Program Coordinator Funding	52651.doc	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	700	0	50	650
Annual IC Time Burden (Hours)	2,425	-1,552	776	3,201
Annual IC Cost Burden (Dollars)	0	0	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.