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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HUD-52768 Application for the Resident Opportunities and Self Sufficiency (ROSS) Program	Form and Instruction	Modified	Available
83i 1-11-2017.doc	Supporting Statement A	Uploaded 2017-01-11	Available
IPA Forms.docx	Supplementary Document	Uploaded 2016-12-30	Available
Published 60-day FRN.pdf	Supplementary Document	Uploaded 2016-12-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
42121	Application for the Resident Opportunities and Self Sufficiency (ROSS) Program	Form and Instruction	Modified

ICR Details

OMB Control No: 2577-0229	ICR Reference No: 201611-2577-001
Status: Historical Active	Previous ICR Reference No: 201508-2577-001
Agency/Subagency: HUD/PIH	Agency Tracking No: 2577-0229
Title: Application for the Resident Opportunities and Self Sufficiency (ROSS) Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/09/2017
	Date Received in OIRA: 07/11/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved	06/30/2018
Responses	350	0	425
Time Burden (Hours)	1,907	0	2,325
Cost Burden (Dollars)	0	0	0

---

Abstract: Application for the ROSS Service Coordinator grant program for Public Housing; Eligible applicants are PHAs, Tribes/TDHEs, Non-Profits and Resident Associations. Information collected will be used to evaluate applications and award grants.

---

Authorizing Statute(s): PL: Pub.L. 105 - 276 112 Stat. 2461 Name of Law: Public Housing Reform Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 92843	12/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28087	06/20/2017
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for the Resident Opportunities and Self Sufficiency (ROSS) Program	HUD-52755, HUD-52768, HUD-52752, HUD-52753, HUD-52768 (Revised Version)	Ross Service Coordinators - Funding Request ,   Resident Opportunity & Self-Sufficiency (ROSS) Service Coordinator Funding ,   Certification of Consistency with the Indian Housing Plan ,   Sample Contract - Administrative Partnership Agreement ,   Certification of Election of Resident Council Board

---

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	350	425	0	0	-75	0
Annual Time Burden (Hours)	1,907	2,325	0	0	-418	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: 15. This collection package is a revision of a previously approved collection. This revision is necessary in order to submit the revisions to the HUD-52768 (ROSS SERVICE COORDINATORS – FUNDING REQUEST). The revisions include adding salary comparability information onto the form, combining portions of the HUD-52769 with the HUD-52768 form, and simplifying the format of how the applicants report their match. Other revisions to the HUD-52768 include eliminating redundancy and making the application form electronic on grants.gov. In addition, forms that were previously under the ROSS PRA that will not be needed in future NOFAs are being removed under this PRA. Those forms include the HUD-52754 and the HUD-52769. The burden hours have been reduced from a total of 2,325 hours to a total of 1907 due to this streamlining.

---

Annual Cost to Federal Government: $0

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

---

Common Form ICR:  No

---

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: 07/11/2017

---