Information Collection

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

IC 42121 under ICR 201412-2577-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form HUD-52769 - Origin Application for the Resident Opportunities and Self Sufficiency (ROSS) Program Form and Instruction
HUD-52752 Certification of Consistency with the Indian Housing Pla HUD 52752.pdf Form and Instruction
HUD-52753 ROSS Funding - Certification of Election of Resident Cou HUD 52753.pdf Form and Instruction
HUD-52754 List of Resident Organizations Supporting Nonprofit Appl HUD 52754.pdf Form and Instruction
HUD-52755 Sample Contract - Administrative Partnership Agreement HUD 52755.pdf Form and Instruction
HUD-52768 - Revise ROSS Service Coordinators - Funding Request Form HUD-52768 revised for RAs and nonprofits.doc Form and Instruction
HUD-52769 - Revise ROSS Service Coordinators - NEEDS and SERVICE PARTNERS Form HUD-52769 - Needs Providers Form.doc Form and Instruction
HUD-52768 - Origin ROSS Service Coordinators - Funding Request HUD-52768 - Original Version.pdf Form and Instruction
HUD-52769 - Origin ROSS Service Coordinators - NEEDS and SERVICE PARTNERS HUD-52769 - Original Version.pdf 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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD-52769 - Original Version	ROSS Service Coordinators - NEEDS and SERVICE PARTNERS	HUD-52769 - Original Version.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-52752	Certification of Consistency with the Indian Housing Plan	HUD 52752.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-52753	ROSS Funding - Certification of Election of Resident Council Board	HUD 52753.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-52754	List of Resident Organizations Supporting Nonprofit Applicants	HUD 52754.pdf	Yes	Yes	Fillable Printable
Form and Instruction	HUD-52755	Sample Contract - Administrative Partnership Agreement	HUD 52755.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-52768 - Revised Version	ROSS Service Coordinators - Funding Request	Form HUD-52768 revised for RAs and nonprofits.doc	Yes	Yes	Fillable Printable
Form and Instruction	HUD-52769 - Revised Version	ROSS Service Coordinators - NEEDS and SERVICE PARTNERS	Form HUD-52769 - Needs Providers Form.doc	Yes	Yes	Fillable Fileable Signable
Form and Instruction	HUD-52768 - Original Version	ROSS Service Coordinators - Funding Request	HUD-52768 - Original Version.pdf	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	-300	700
Annual IC Time Burden (Hours)	2,200	-225	2,425
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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