52651-C FSS Annual Survey

OMB Number: 2577-0178

Expiration Date: xx/xx/xxxx

FSS Annual Survey

(to be sent and collected electronically via Google Forms or Survey Monkey or similar)

PHA Name/Name of Multifamily Property

PHA Number

Name of Primary Point of Contact

Email of Primary Point of Contact

Phone Number of Primary Point of Contact

The following data points will be pulled from PIC (for PIH programs) or from Multifamily FSS Program Reporting (for PBRA owners)

1. Number of families enrolled

2. Number of families graduated

3. Number of participants with escrow accounts

4. Number of participants with positive escrow balances

Please answer the following:

1. Which of the following services does your agency coordinate for FSS participants?

Check all that apply

(1) Child care—child care (on an as-needed or ongoing basis) of a type that provides sufficient hours of operation and serves an appropriate range of ages;

(2) Transportation—transportation necessary to enable a participating FSS family member to receive available services, or to commute to their places of employment;

(3) Education—remedial education; education for completion of high school or attainment of a high school equivalency certificate; education in pursuit of a post-secondary degree or certification;

(4) Employment Supports—job training, preparation, and counseling; job development and placement; and follow-up assistance after job placement and completion of the CoP;

(5) Personal welfare—substance/alcohol abuse treatment and counseling, and health, dental, mental health and health insurance services;

(6) Household management—training in household management;

(7) Homeownership and housing counseling— homeownership education and assistance and housing counseling;

(8) Financial Empowerment—training in financial literacy, such as financial coaching, training in financial management, asset building, and money management, including engaging in mainstream banking, reviewing and improving credit scores, etc.;

(9) Other services—any other services and resources, including case management, reasonable accommodations for individuals with disabilities, that are determined to be appropriate in assisting FSS families to achieve economic independence and self-sufficiency.

2. What are your participants’ top three most needed services? (choose three)

(1) Child care—child care (on an as-needed or ongoing basis) of a type that provides sufficient hours of operation and serves an appropriate range of ages;

(2) Transportation—transportation necessary to enable a participating FSS family member to receive available services, or to commute to their places of employment;

(3) Education—remedial education; education for completion of high school or attainment of a high school equivalency certificate; education in pursuit of a post-secondary degree or certification;

(4) Employment Supports—job training, preparation, and counseling; job development and placement; and follow-up assistance after job placement and completion of the CoP;

(5) Personal welfare—substance/alcohol abuse treatment and counseling, and health, dental, mental health and health insurance services;

(6) Household management—training in household management;

(7) Homeownership and housing counseling— homeownership education and assistance and housing counseling;

(8) Financial Empowerment—training in financial literacy, such as financial coaching, training in financial management, asset building, and money management, including engaging in mainstream banking, reviewing and improving credit scores, etc.;

(9) Other services—any other services and resources, including case management, reasonable accommodations for individuals with disabilities, that are determined to be appropriate in assisting FSS families to achieve economic independence and self-sufficiency.

3. Please describe any other needed services that are not listed above, if applicable.

4. Does your FSS Action Plan policy allow for interim escrow withdrawals? Yes/No

   1. If yes, what are your top three uses of Escrow while a family is still in the program (i.e. interim withdrawals)? (choose up to 3)

1. Transportation – car purchase, car repair, drivers license test/fees, fees associated with the restoration of a license, funds for transportation to training, interviews, and/or employment etc.

2. Credit Repair/Debt Reduction

3. Educational Expenses including tuition, books, fees, etc. for FSS participant

4. Educational Expenses including tuition, books, fees, etc. for child

5. Employment Start-Up Costs including uniforms, tools, shoes, business attire, etc.

6. Start-up Entrepreneurial Business Expenses

7. Other (please name)

Please describe any other uses of interim escrow withdrawals that are not listed above, if applicable.

5. Do you cap the number of times a participant may make an interim withdrawal? (Please note: this is not a best practice.)

   1. Yes

   2. No

(If yes) Please describe the cap you place on the number of times a participant can make an interim withdrawal.

6. Do you cap the amount of money that a participant can take for an interim withdrawal?

   1. Yes

   2. No

(If yes) Please describe the limits that you set for the amount of money a participant can take for an interim withdrawal.

(If no to questions about restrictions on withdrawals) How many times during their time in the program does the average participant make an interim withdrawal?

3. 0

4. 1

5. 2

6. 3

7. 4

8. 5

9. More than 5 times

7. Do you allow for CoP extensions with good cause?

   1. Yes

   2. No

8. Do you track participants’ uses of escrow after graduation? Yes/No

If yes, what are your top three uses of Escrow after FSS graduation? (choose up to 3)

1. Homeownership

2. Move-in/moving costs (e.g. first/last month’s rent, security deposit, movers etc.) for affordable or market rate rental (not with a voucher)

3. Transportation – car purchase, car repair, drivers license test/fees, fees associated with the restoration of a license, funds for transportation to training, interviews, and/or employment etc.

4. Credit Repair/Debt Reduction

5. Educational Expenses including tuition, books, fees, etc. for HoH

6. Educational Expenses including tuition, books, fees, etc. for child

7. Employment Start-Up Costs including uniforms, tools, shoes, business attire, etc.

8. Start-up Entrepreneurial Business Expenses

9. Vacation or other entertainment

10. Keep in savings

11. Other (please name)

Please list any other uses of escrow after FSS graduation that are not listed above.

9. Which of the following uses of forfeited escrow do your FSS Action Plan policies allow? Select as many options as apply.

   1. Providing assistance in reaching CoP goals, for example, by assisting them with the cost of transportation, childcare, training, education, or otherwise helping them achieve the goals in their CoP

   2. Evenly distributing escrow among FSS families in good standing on a regular basis

   3. Training for FSS Coordinators

   4. Matching non-escrow savings for FSS participants in a savings program

   5. Other

10. Last calendar year, what percentage of participants exited the program without graduating and forfeit their escrow?

    1. Zero

    2. Less than 5% of participants

    3. 5-9% of participants

    4. 10-19% of participants

    5. 20-24% of participants

    6. 25-49% of participants

    7. 50-75% of participants

    8. More than 75% of participants

11. Is at least one person at your organization trained in Trauma-Informed Care? Yes/No

Are you implementing Trauma-Informed Care best practices in your FSS program?

1. Yes

2. No

Are you implementing Trauma-Informed Care best practices at your agency in general?

3. Yes

4. No

12. Does your FSS program include participants with a FUP-youth and/or FYI voucher? Yes/No

(if yes) Remember that you must implement the Fostering Stable Housing Opportunities (FSHO) rules for FUP/FYI voucher holders also enrolled in FSS to extend their voucher eligibility. For more information, see: https://www.federalregister.gov/documents/2022/01/24/2022-01285/implementation-of-the-fostering-stable-housing-opportunities-amendments

13. The NOFO/funding notice allowed for training to be part of the calculation of fringe benefits. Did your PHA include a training allowance/stipend in your Coordinator(s) fringe benefits in 2022?

    1. Yes

    2. No, we didn’t know about the training stipend

    3. No, we didn’t ask for enough money to include a stipend

    4. No, we decided not to include a training stipend

    5. No, we fund training in another way

    6. No, we are not a funded program

    7. Other

(If Yes) How much did you spend per coordinator on training last year?

(If Yes) What training did your Coordinator(s) receive using the training stipend?

14. What is the background of your coordinator(s)? Please check all that apply

    1. MSW/LCSW/LMFT (or similar)

    2. BSW (or similar)

    3. Former FSS participant

    4. Current resident

    5. Administrative staff

    6. TANF/child welfare/other benefit program

    7. Workforce programs

    8. Former ROSS or Jobs Plus Coordinator

    9. Previous FSS Coordinator experience

    10. Other coaching/case management work

    11. Other

15. Does your PHA use a triage system to determine the regularity of meetings that the Coordinator should have with the participant? (Yes/No)

16. How often do most participants meet with their FSS Coordinator/Case Manager/Coach? (choose one)

    1. Weekly

    2. Monthly

    3. Quarterly

    4. Every 6 months

    5. Once per year

    6. Less often than once per year

17. How many HUD-funded FSS coordinators do you have?

18. How many unfunded FSS coordinators do you have?

19. Who is primarily responsible for preparing the funding request for your organization?

    1. External grant writer

    2. Program Coordinator

    3. FSS Supervisor

    4. Finance office

    5. Internal grants office

    6. Executive Director

    7. We are not a funded program

    8. Other

20. Which of the following HUD resources does your program utilize? Choose all that apply.

    1. FSS Guidebook

    2. FSS Listserv

    3. Monthly Office Hours

    4. FSS Resources Website Page

    5. Other

21. Are there additional resources you would like for the FSS Team to provide?

22. What are your top 3 recommendations for legislative or administrative action that would improve the FSS program and ensure the effectiveness of the program? (open answer)

23. Are there any barriers to operating a successful program that you have encountered?

If you have participant success stories, please send them (in no more than two paragraphs) to the FSS mailbox.

24. Reserved for annual-specific question

25. Reserved for annual-specific question

26. Reserved for annual-specific question

27. Reserved for annual-specific question

28. Reserved for annual-specific question

Each Housing Agency (PHA/owner) must implement the FSS Program in compliance with 24 CFR 984 and 24 CFR 877.

This collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of the requested information. Comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to: U.S. Department of Housing and Urban Development, Office of the Chief Data Officer, R, 451 7th St SW, Room 8210, Washington, DC 20410-5000. Do not send completed forms to this address. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid OMB control number. This agency is authorized to collect this information under Section 102 of the Department of Housing and Urban Development Reform Act of 1989. The information you provide will enable HUD to carry out its responsibilities under this Act and ensure greater accountability and integrity in the provision of certain types of assistance administered by HUD. This information is required to obtain the benefit sought in the grant program. Failure to provide any required information may delay the processing of your application and may result in sanctions and penalties including the administrative and civil money penalties specified under 24 CFR §4.38. This information will not be held confidential and may be made available to the public in accordance with the Freedom of Information Act (5 U.S.C. §552). The information contained on the form is not retrieved by a personal identifier, therefore it does not meet the threshold for a Privacy Act Statement.

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HUD form 52651-C

Version 2025