Information Collection

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

IC 42121 under ICR 202103-2577-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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-52752 Application for the Resident Opportunities and Self Sufficiency (ROSS) Program	Form and Instruction
HUD-52752 Certification Of Consistency With The Indian Housing Pla 52752.pdf	Form and Instruction
HUD-52752 Certification Of Consistency With The Indian Housing Pla 52752.pdf	Form and Instruction
HUD-52753 ROSS Funding Certification of Resident Council Board 52753.pdf	Form and Instruction
HUD-52753 ROSS Funding Certification of Resident Council Board 52753.pdf	Form and Instruction
HUD-52755 Sample Contract Administrator Partnership Agreement 52755.pdf	Form and Instruction
HUD-52755 Sample Contract Administrator Partnership Agreement 52755.pdf	Form and Instruction
HUD 52768 Resident Opportunity & Self Sufficiency (ROSS) Service C HUD 52768.pdf	Form and Instruction
HUD 52768 Resident Opportunity & Self Sufficiency (ROSS) Service C HUD 52768.pdf	Form and Instruction
52768 Resident Opportunity & Self Sufficiency (ROSS) Service C HUD 52768 ROSS-SC Funding form FY 2021.docx	Form and Instruction
52768 Resident Opportunity & Self Sufficiency (ROSS) Service C HUD 52768 ROSS-SC Funding form FY 2021.docx	Form and Instruction
83c.ROSS 52768.FY21.dot 83 C	IC Document
83c.ROSS 52768.FY21.dot 83 C	IC Document

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-52752	Certification Of Consistency With The Indian Housing Plan	52752.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-52753	ROSS Funding Certification of Resident Council Board	52753.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD-52755	Sample Contract Administrator Partnership Agreement	52755.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	HUD 52768	Resident Opportunity & Self Sufficiency (ROSS) Service Coordinator Funding	HUD 52768.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	52768	Resident Opportunity & Self Sufficiency (ROSS) Service Coordinator Funding	HUD 52768 ROSS-SC Funding form FY 2021.docx	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Homeownership Promotion

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

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	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	1,376	1,376
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
83 C	83c.ROSS 52768.FY21.dot	03/19/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.