Form Hud-50080-Rmbd - Resident Opportunities And Self Sufficiency (Ross) Program Page 2

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9. Line Item No.

Type of Funds Requested

Amount (dollars)

(cents)

1042

Secure Training/Skills/Expertise (RM Training)

1043

Develop MOU

1044

Secure T/A to Draft Contract (Draft Contract T/A)

1045

Negotiate Contract with PHA (PHA Contract Negotiation)

1046

Conduct Resident Training/Preparation (Resident Training)

1050

Self Sufficiency Program

1051

Employment and Job Readiness

1052

Job Training

1053

Management Related Employment Training (Mgmt. Employment Training)

1054

Vocational Training

1055

Technical Assistance

1060

Supportive Services

9100

Travel Costs

9200

Other Resident Costs (Stipends, Reimbursements) – (Resident Costs)

9300

Contract Administrator

9400

Administrative and Other Costs

10. Voucher Total

I certify the data reported and funds requested on this voucher are correct and the amount requested is not in excess of immediate disbursement needs

for this program. In the event the funds provided become more than necessary, such excess will be promptly returned, as directed by HUD.

11. Name & Phone Number (including area code)

12. Name & Title of Authorized Signatory (type or print clearly)

of the person who completed this form

13. Signature

14. Date of Request

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Department of Housing and Urban Development (HUD) to collect

all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The purpose of the

data is to safeguard the Line of Credit Control System (LOCCS) from unauthorized access. The data are used to ensure that individuals who no longer require access

to LOCCS have their access capability promptly deleted. Failure to provide the information requested on the form may delay the processing of your approval for

access to LOCCS. While the provision of the SSN is voluntary, HUD uses it as a unique identifier for safeguarding the LOCCS from unauthorized access. This

information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law.

Previous versions obsolete

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form HUD-50080-RMBD (11/2001)