HUD-52515 Funding Application

U.S Department of Housing and Urban Development

Office of Public and Indian Housing

OMB Approval No. 2577-0169

(exp. xx/xx/202x)

Funding Application

Housing Choice Voucher Program

OMB Burden Statement. The public reporting burden for this information collection is estimated to be up to 5 hours, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information collection is required to assess the applicant’s capacity and experience for a funding opportunity. Assurances of confidentiality are not provided under this collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Office of Public and Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD may not conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid control number.

Privacy Notice. The Department of Housing and Urban Development (HUD) is authorized to collect the information on this form by Section 8 of the U.S. Housing Act (42 U.S.C. 1437f). The purpose of this form is to assess the applicant’s capacity and experience for a funding opportunity. The Personally Identifiable Information (PII) data collected on this form are not stored or retrieved within a system of record.

Name and Mailing Address of the Public Housing Agency (PHA)			PHA Code
Number of Vouchers Requested	Geographic Area/Jurisdiction (describe the area in which assisted may live)
If directed in the NOFO or Funding Notice, complete additional fields on the next page of this form. PHA Signature
Signature of PHA Representative		Print or Type Name of Signatory
Email Address		Phone Number		Date
Capacity of the Organization
Need/Extent of the Problem
Soundness of Approach
Leveraging Resources
Achieving Results and Program Evaluation
Memorandum of Understanding
Other Information Required in the NOFO or Funding Notice
Program Specific Certifications (enter here any certification required in the NOFO or Funding Notice)

Previous editions are obsolete 1 HUD-52515

(9/2022)