Family Self-Sufficiency Program (FSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD-52651 Family Self-Sufficiency (FSS) Program Coordinator Funding	Form and Instruction	Modified	Available
Form HUD-52651 Family Self-Sufficiency (FSS) Program Coordinator Funding	Form and Instruction	Modified	Available
Form HUD 52652-Hmong Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-French Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Russian Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Vietname Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Korean Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Cambodia Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Spanish Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Repair queued
Form HUD 52652-Creole Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Chinese Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Arabic Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD 52652-Laotian Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Repair queued
Form HUD 52650- Hmong Family Self-Sufficiency (FSS) Program Contract of Participation	Form	Modified	Repair queued
Form HUD 52650-French Family Self-Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Russian Family Self-Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Vietname Family Self-Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650 -Korean Family Self-Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Cambodia Family Self-Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Spanish Family Self Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Creole Family Self Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Chinese Family Self Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 52650-Laotian Family Self Sufficiency (FSS) Program Contract of Participation	Form	Modified	Repair queued
Form HUD 52650- Arabic Family Self Sufficiency (FSS) Program Contract of Participation	Form	Modified	Available
Form HUD 50058 Family Report	Form and Instruction	Modified	Available
Form HUD 2880 Applicant/Recipient Disclosure/Update Report	Form and Instruction	Modified	Available
Form SF LLL Disclosure of Lobbying Activities	Form and Instruction	Modified	Available
Form SF 424 Application for Federal Assistance	Form and Instruction	Modified	Repair queued
Form HUD-52652 FSS Escrow Account Credit Worksheet	Form and Instruction	Modified	Available
Form HUD-52650 Family Self-Sufficiency program Contract of Participation	Form and Instruction	Modified	Available
83c FSS application form Change Worksheet.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2015-11-25	Available
83-I.doc	Supporting Statement A	Uploaded 2013-08-29	Available
IPA Forms.doc	Supplementary Document	Uploaded 2013-08-29	Available
Published 60-day FR Notice - FR-5690-N-08.pdf	Supplementary Document	Uploaded 2013-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency (FSS) Program Coordinator Funding
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency (FSS) Program Coordinator Funding
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self-Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self-Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self-Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self-Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self-Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self-Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form	Modified	Family Self Sufficiency (FSS) Program Contract of Participation
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Report
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Applicant/Recipient Disclosure/Update Report
27844	Family Self-Sufficiency Program (FSS)	Other-Facsimile Transmittal	Modified
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Disclosure of Lobbying Activities
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Application for Federal Assistance
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	FSS Escrow Account Credit Worksheet
27844	Family Self-Sufficiency Program (FSS)	Form and Instruction	Modified	Family Self-Sufficiency program Contract of Participation

ICR Details

OMB Control No: 2577-0178	ICR Reference No: 201511-2577-004
Status: Historical Active	Previous ICR Reference No: 201306-2577-002
Agency/Subagency: HUD/PIH	Agency Tracking No: 2577-0178
Title: Family Self-Sufficiency Program (FSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/09/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/08/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	01/31/2017	01/31/2017
Responses	100,405	0	100,405
Time Burden (Hours)	36,893	0	36,893
Cost Burden (Dollars)	0	0	0

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Abstract: Housing agencies enter into a Contract of Participation with each eligible family that opts to participate in the program; consult with local officials to develop an Action Plan; and report annually to HUD on implementation of the FSS program. PHAs may apply for funding to pay the salary (including fringe benefits) of FSS program coordinators.`

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Authorizing Statute(s): PL: Pub.L. 101 - 625 23(c) Name of Law: National Affordable Housing Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 45257	07/26/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 59048	09/25/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Family Self-Sufficiency Program (FSS)	HUD 52650- Hmong, HUD 52652-Laotian, HUD 52652-Chinese, HUD 52650- Arabic, HUD 52650-French, HUD 52650-Laotian, HUD 52652-Spanish, HUD 52652-French, HUD 52650 -Korean, HUD 52652-Russian, HUD 52650-Chinese, HUD 52652-Vietnamese, HUD 52652-Hmong, HUD-52650, HUD-52652, SF 424, SF LLL, HUD 2880, HUD 50058, HUD 52650-Creole, HUD 52650-Spanish, HUD 52652-Arabic, HUD 52650-Cambodian, HUD 52650-Vietnamese, HUD 52650-Russian, HUD 52652-Korean, HUD 52652-Cambodian, HUD 52652-Creole, HUD-52651, HUD-52651	Family Self-Sufficiency program Contract of Participation ,   FSS Escrow Account Credit Worksheet ,   Application for Federal Assistance ,   Disclosure of Lobbying Activities ,   Applicant/Recipient Disclosure/Update Report ,   Family Report ,   Family Self Sufficiency (FSS) Program Contract of Participation ,   Family Self Sufficiency (FSS) Program Contract of Participation ,   Family Self Sufficiency (FSS) Program Contract of Participation ,   Family Self Sufficiency (FSS) Program Contract of Participation ,   Family Self Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency (FSS) Program Contract of Participation ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency Program FSS Escrow Account Credit Worksheet ,   Family Self-Sufficiency (FSS) Program Coordinator Funding ,   Family Self-Sufficiency (FSS) Program Coordinator Funding

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	100,405	100,405	0	0	0	0
Annual Time Burden (Hours)	36,893	36,893	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $129,527

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/08/2015

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