HUD-52753 ROSS Funding Certification of Resident Council Board

ROSS FUNDING

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
OFFICE OF PUBLIC AND INDIAN HOUSING

Approval No. 2577-0229
Expiration Date: 8/31/2020

Certification of Election
of Resident Council Board
Public reporting burden for the collection of information is estimated to average one hour 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.

Instructions for completing this form: Resident associations applying to the ROSS program must
certify that the Board of their Resident Council has been duly elected as required by HUD (24 CFR
Part 964). All resident associations applying to the ROSS program must complete this form and
have it signed by an authorized official from the local PHA.

Applicant Name:
Grant to which you are applying:

Certification of Election of Resident Council Board
I CERTIFY
(name of organization)
located in

has duly elected all
(city & state)

of our Resident Council Officers as required by the U.S. Department of Housing
and Urban Development, 24 Code of Federal Regulations (CFR), Part 964.
Date of Most Recent Resident Council Board Election:
Name and Position of Resident Council officers:

The above information is true and correct to the best of my knowledge.

Signed this

day of

,

By:

Housing Authority Executive Director or Other Authorized Representative
For:

(Housing Authority Name, Address, and Telephone)
Form HUD-52753 (06/2015)