52515-updated.pdf

Previous editions are obsolete 1 HUD-52515 (04/2023)

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.

A. Name and Mailing Address of the Public Housing Agency (PHA) B. PHA Code

C. Number of Vouchers Requested D. 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

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

OMB Approval No. 2577-0169 (exp. 04/30/2026)

Previous editions are obsolete 2 HUD-52515 (04/2023)

E. Capacity of the Organization

F. Need/Extent of the Problem

G. Soundness of Approach

H. Leveraging Resources

I. Achieving Results and Program Evaluation

J. Memorandum of Understanding

K. Other Information Required in the NOFO or Funding Notice

L. Program Specific Certifications (enter here any certification required in the NOFO or Funding Notice)