HUD-52651 Family Self-Sufficiency (FSS) Program Coordinator Fundin

Family Self-Sufficiency (FSS)
Program Coordinator
Funding

OMB Approval No. 2577-0178
Exp. 08/31/2020

U.S. Department of Housing
and Urban Development
Office of Public and Indian
Housing

Public reporting burden for this collection of information is estimated to average 1 hour. This includes the time for collecting, reviewing, and
reporting the data. Information provided is to determine the eligibility of the applicant for funding for the salary of a program coordinator. HUD uses the
information to determine eligibility of the applicant to receive funding. Information is required to obtain benefit under 24 CFR 984.302.
“Privacy Act Statement. This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a. The authority for collecting personally
identifiable information (PII) in the Regulatory Consistency Communication Board (RCCB) Electronic Feedback Form is based in Section 313 of Public
Law 112-95,” to be included on all forms, prior to being submitted for OMB approval.” The information is subject to the confidentiality requirements of
the HUD Reform Legislation. 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.

PART I: General Information.
A.

State or Regional PHA?

Yes

(To be completed by all applicants.)
No

B. Are you a PHA/Indian Tribe/TDHE that is currently administering an FSS program

Yes

No

Programs
C. Legal Name of PHA/Indian Tribe/TDHE (For joint applicants, lead PHA/Indian Tribe/TDHE name):
Employer/Taxpayer Identification Number (EIN/TIN):):
Organizational DUNS:
Address:
City:
County:
State:
Zip Code:
PHA/ Number of Applicant:

D. Legal Name of Joint Applicant PHA/Indian Tribe/TDHE (If applicable.)
PHA/ Number of Applicant:
Legal Name of Joint Applicant PHA/Indian Tribe/TDHE (If applicable.)
PHA/ Number of Applicant:

Legal Name of Joint Applicant PHA/Indian Tribe/TDHE (If applicable.)
PHA Number of Applicant:

Note: Please use the table on page 9, Appendix A below to list any additional co-applicants.

Page 1 of 10

HUD-52651

PART II: Funding/Positions Requested by PHAs/Indian Tribes/TDHEs that are Currently
Administering FSS Programs
A.

Previously Funded Positions Position
Number

Salary Requested
Per Position
under this NOFA
(Including Fringe
Benefits)

Indicate whether
Full-Time or PartTime
*Required

# of hours worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“Non-Supervisory”
*Required

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Total
Salary
Requested:

B. New Positions - Positions not funded previously under a NOFA
Position
Number

Salary Requested Per
Position under this NOFA
(Including Fringe
Benefits)

Indicate whether
Full-Time or PartTime

# of hours worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“Non-Supervisory”
*Required

1.
2.
3.
4.
5.
Total
Salary
Requested:

NOTE: PLEASE USE THE TABLES ON PAGE 10, APPENDIX A BELOW IF YOU NEED ADDITIONAL SPACE FOR PREVIOUSLY
FUNDED AND/OR NEW POSITIONS.

C. Total Requested
1.
2.

D.

Total number of positions requested in Part II (enter 0.5 for part-time positions)
Total salary requested in Part II (add totals from Part II.A and Part II.B)

Total number of families under FSS contract during the NOFA target period.

Page 2 of 10

HUD-52651

PART III: Requests for PHAs/Indian Tribes/TDHEs that are NOT currently administering
FSS Programs
A. FSS Action Plan Information:
The number of FSS program slots in the HUD-approved Action Plan. (For Joint
applications, provide total approved slots for all joint applicant PHAs/Indian
Tribes/TDHEs.)

B.

Position/Salary Requested:
Position
Number:

Salary Requested under this NOFA
(Including Fringe Benefits) **

Indicate whether
Full-Time or PartTime

# of hours
worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“NonSupervisory”
*Required

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Total
Salary
Requested:

C.

Total Requested.
1.
2.

Total number of positions requested in Part III (enter 0.5 for part-time positions)
Total salary requested in Part III

Page 3 of 10

HUD-52651

PART IV. Salary Comparability
Applicants’ salary requests are subject to salary comparability requirements as prescribed in the most recent FSS NOFA. Salary
requests must be based on local comparables, and demonstrate comparability of the requested salary to similar positions in the local
jurisdiction. Salary comparables must be kept on file in the offices of the PHA or tribe/TDHE. Please review the most recent FSS
NOFA carefully for further instructions on completing the information below.

Please respond to each question below:
Is your agency requesting funding for non-supervisory FSS position(s)?

Yes

No

Is your agency requesting funding for supervisory FSS position(s)?

Yes

No

A. Salary Comparability (Non-Supervisory Position)

Occupation
Title)

Annual
Salary

Fringe
Benefits

Total Amount
(Annual
+Fringe
Benefits)

Source

Name of
Agency Point
of Contact
(POC)

POC
Email
Address

POC
Telephone
Number

1.

2.

3.

B. Salary Comparability (Supervisory Position, if applicable)
Occupation
Title

Annual
Salary

Fringe Benefits

Total Amount
(Annual
+Fringe
Benefits)
Source

Name of
Agency
POC

POC
Email
Address

POC
Telephone
Number

1.

2.

3.

Page 4 of 10

HUD-52651

INSTRUCTIONS:
A. The FSS NOFA supplements this set of instructions. Please read the NOFA carefully
to ensure that you are following all instructions in completing this form.
B. Previously Funded Positions (Part II.A.): The examples below help illustrate how
to enter the information on this table.
Example 1: PHA/Indian Tribe/TDHE is requesting 2 full-time renewal positions at
$55,000 each.
Position
Number

Salary Requested
Per Position
under this NOFA (Including Fringe
Benefits)**

Indicate whether FullTime or Part-Time

1.
2.
3.
Total Salary
Requested

$55,000
$55,000

Full-time
Full-time

# of hours worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“Non-Supervisory”
*Required

40
40

Non-Supervisory
Non-Supervisory

$110,000

Example 2: PHA/Indian Tribe/TDHE is requesting 1 full-time renewal position at
$45,000 and 1 full-time renewal position at $50,000.
Position
Number

Salary Requested
Per Position
under this NOFA (Including Fringe
Benefits)**

Indicate whether FullTime or Part-Time

1.
2.
3.
Total Salary
Requested:

$45,000
$50,000

Full-time
Full-time

# of hours worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“NonSupervisory”
*Required

40
40

Non-Supervisory
Non-Supervisory

$95,000

Example 3: PHA/Indian Tribe/TDHE is requesting 1 part-time renewal position at
$30,000.
Position
Number

Salary Requested
Per Position
under this NOFA (Including Fringe
Benefits)**

Indicate whether FullTime or Part-Time

1.
2.
3.
Total
Salary
Requested:

$30,000

Part-time

# of hours worked
(weekly)
*Required

25

Indicate Position Type “Supervisory” or “NonSupervisory”
*Required
Non-Supervisory

$30,000

Page 5 of 10

HUD-52651

C. New Positions (Part II.B.): Positions not funded previously under a NOFA.


See the NOFA for more information on whether new positions (positions not funded
previously under a NOFA) are allowed and whether applicants may qualify for parttime positions beyond the initial position (for example, whether an applicant can
qualify for 1.5 positions).



The examples below help illustrate how to enter the information on this table.
Example 1: PHA/Indian Tribe/TDHE is requesting 2 new full-time positions at
$55,000 each:
Position Number

1.
2.
3.
Total Salary Requested

Salary Requested Per
Position under this
NOFA
(Including Fringe
Benefits)**
$55,000

Indicate whether FullTime or Part-Time

# of hours worked
(weekly)
*Required

Indicate Position Type “Supervisory” or “NonSupervisory”
*Required

Full-time

40

Non-Supervisory

$55,000

Full-time

40

Non-Supervisory

$110,000

Example 2: PHA/Indian Tribe/TDHE is requesting 1 new full-time position at
$45,000 and 1 new full-time position at $50,000:
Position Number

Indicate whether FullTime or Part-Time

# of hours worked
(weekly)
*Required

1.

Salary Requested Per
Position under this
NOFA
(Including Fringe
Benefits)**
$45,000

Indicate Position Type “Supervisory” or “NonSupervisory”
*Required

Full-time

40

Non-Supervisory

2.

$50,000

Full-time

40

Non-Supervisory

3.
Total Salary Requested

$95,000

Page 6 of 10

HUD-52651

D. Requests for PHAs/Indian Tribes/TDHEs that are NOT currently administering
FSS Programs (Part III.):
 See the NOFA for more information on whether Part III is applicable (i.e. whether
PHAs/Indian Tribes/TDHEs not currently administering an FSS program are
eligible to apply).


Position/Salary Requested (Part III.B.): The examples below help illustrate
how to enter the information on this table.

Example 1: PHA/Indian Tribe/TDHE is requesting 1 new full-time position at
$55,000:
Position Number:

1.
2.
3.
Total Salary
Requested:

Salary Requested under
this NOFA
(Including Fringe Benefits)
**
$55,000

Indicate whether Full-Time
or Part-Time

Full-time

# of hours worked
(weekly)
*Required

Indicate Position Type “Supervisory” or “NonSupervisory”
*Required

35

Non-Supervisory

$55,000

Example 2: PHA/Indian Tribe/TDHE is requesting 1 new part-time position at
$30,000:
Position Number:

1.

Salary Requested under this
NOFA
(Including Fringe Benefits)
**
$30,000

Indicate whether Full-Time
or Part-Time

Part-time

# of hours worked
(weekly)
*Required

20

Indicate Position Type “Supervisory” or “NonSupervisory”
*Required
Non-Supervisory

2.
3.
Total Salary
Requested:

$30,000

Page 7 of 10

HUD-52651

PART IV. Salary Comparability
The information in the examples below is NOT real and is only used to show how to fill the
information in the salary comparability tables under Part IV of this form.
Please respond to each question below:
Is your agency requesting funding for non-supervisory FSS position(s)?
Is your agency requesting funding for supervisory FSS position(s)?

Yes

Yes

No

No

A. Salary Comparability (Non-Supervisory Position)
Occupation Title

Annual
Salary

Fringe
Benefits

Total Amount
(Annual
+Fringe
Benefits)

Source

careerone
stop.org
Agency 1

Joe Smith

[email protected]

(978) 5555555

Agency
2

Jane
Jones

[email protected]

(978) 4346667

1.

Case Worker

$40,990

$15,500

$56,490

2.

Community and
Social Service
Specialist

$45,200

$16,275

$ 61,475

3.

Community
Outreach
Specialist

$ 42,500

$16,500

$ 59,000

Name of
Agency
Point of
Contact
(POC)

POC Email Address

POC
Telephone
Number

B. Salary Comparability (Supervisory Position, if applicable)
Occupation Title

Annual
Salary

Fringe
Benefits

$53,500

$18,180

1.

Residents Services
Director

$50,200

$20,000

2.

Community and
Social Service
Manager

Community Outreach
Manager

$54,230

$16,500

3.

Total Amount
(Annual +Fringe
Benefits)

Source

Name of
Agency
POC

POC
Email
Address

POC
Telephone
Number

Agency 1

James
Smith

jsmith@
agency1.
org

(978) 4501212 ext
125

$70,200

Agency 2

Joe Smith

Joe.smit
h@agen
cy2.org

(978) 5555555

$70,730

Agency 3

Catherine
Jones

c.jones
@agenc
y3.org

(970) 4443244

$ 71,680

Page 8 of 10

HUD-52651

APPENDIX A: USE ONLY IF ADDITIONAL SPACE IS NEEDED
Part I.B. Legal Name of Joint Applicant PHAs/Indian Tribes/TDHEs.
Legal Name of Joint Applicant PHA/Indian Tribe/TDHE (If applicable.)
Address:
City:
County:
State:
Zip Code:
PHA/ Number of Applicant:
Legal Name of Joint Applicant PHA/Indian Tribe/TDHE. (If applicable.)
Address:
City:
County:
State:
Zip Code:
PHA Number of Applicant:
Legal Name of Joint Applicant PHA/Indian Tribe/TDHE. (If applicable.)
Address:
City:
County:
State:
Zip Code:
PHA/ Number of Applicant:
Legal Name of Joint Applicant PHA/Indian Tribe/TDHE. (If applicable.)
Address:
City:
County:
State:
Zip Code:
PHA/ Number of Applicant:
Legal Name of Joint Applicant PHA/Indian Tribe/TDHE. (If applicable.)
Address:
City:
County:
State:
Zip Code:
PHA/ Number of Applicant:

Page 9 of 10

HUD-52651

APPENDIX A (continued)
Part II.A. Previously Funded Positions.
Position Number

Salary Requested
Per Position
under this NOFA
(Including Fringe
Benefits)**

Indicate whether
Full-Time or PartTime

# of hours worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“Non-Supervisory”
*Required

Salary Requested
Per Position under
this NOFA
(Including Fringe
Benefits)**

Indicate whether
Full-Time or PartTime

# of hours
worked
(weekly)
*Required

Indicate Position
Type “Supervisory” or
“Non-Supervisory”
*Required

11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Total Salary
Requested:

Part II.B.
Additional
Positions.
Position Number
9.
10.
11.
12.
13.
14.
15.
16.
Total Salary
Requested:

Page 10 of 10

HUD-52651