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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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-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 %

table that charts list of burden
	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

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.