Public reporting burden for the collection of information is estimated to average 4 hours per response. This includes the time for collecting, reviewing, and reporting the data. The information will be used for the ROSS grant. Response to this request for information is required in order to receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number. This information will allow HUD to determine eligibility for the ROSS SC Program. This information does not lend itself to confidentiality.
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PART I: General Information.
***Please read the ROSS NOFA carefully for instructions and minimum requirements. ***
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PART II: Resident Associations Only
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Site Based RA Non- Site Based RA
Locally incorporated nonprofit status 501 (c)(3) designated by the IRS
PART III: Service Coordinator Information (Budget Form)
SC positions
requested
Project(s) to be
served
(See
NOFA for limits. If different PHAs, list all.)
Number of units
to be served
(See
NOFA for minimum number of units)
Clients to be
served -
families -
elderly -
both
Year
Salary/Fringe
(See
NOFA for limits.)
Admin
(See
NOFA for limits.)
Training
(See
NOFA for limits.)
1
Family
Elderly
Both
1
$
$
$
2
$
$
$
3
$
$
$
2
Family
Elderly
Both
1
$
$
$
2
$
$
$
3
$
$
$
3
Family
Elderly
Both
1
$
$
$
2
$
$
$
3
$
$
$
Total
$
$
$
Total Number
of Units
Total Grant Requested $
Note: If you are currently eligible to receive funding for one or more Elderly/Disabled Service Coordinators (EDSC) Grant and you request Elderly through this NOFA, you will forgo any future EDSC renewal funding. |
PART IV. Salary Comparability |
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Applicants’ salary requests are subject to salary comparability requirements as prescribed in the most recent ROSS NOFA. Salary requests must be based on local comparability information, and support the amount requested for salary and fringe to similar positions in the local jurisdiction. Salary comparability must be kept on file in the offices of the PHA or tribe/TDHE. Please review the most recent ROSS NOFA carefully for further instructions on completing the information below.
Salary Comparability
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PART V: Match
The match for the ROSS program should represent the needs assessed and the mandatory metrics on the logic model. Provide the need that you are proposing to meet, the source of the match and the value of the match. All applicants are required to have in place a firmly committed match contribution equivalent to 25% of the total grant amount requested in order to be considered for funding. All match letters must be kept on file and may be requested by HUD if awarded funding.
*Please read the ROSS NOFA carefully for instructions and minimum requirements. *
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C.
I , certify that the match recorded here is supported by letters on file from community or other partners which certify to this amount of match funding (cash or in-kind) and that this represents the total match for the term of the grant.
Signature of Authorized Representative
Title |
Page
File Type | application/msword |
File Title | Reporting burden Language here… |
Author | Dennis Vearrier |
Last Modified By | Youmans, Tremayne E |
File Modified | 2016-11-29 |
File Created | 2016-11-29 |