Form HUD-52650 Family Self-Sufficiency program Contract of Participatio

Family Self-Sufficiency (FSS)
Program Contract of Participation

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

OMB Approval No. 2577-0178
(exp. 04/30/2007)

Housing Choice Voucher
Public and Indian Housing Programs

This Contract of Participation for the Family Self-Sufficiency (FSS) Program is between
, Housing Agency (HA), and
, head of the FSS family.
The FSS family includes everyone in the household, and is
referred to in this contract as “family”.
Type of FSS Program.
The family is a participant in the:(Check only one)
Housing Choice Voucher (HCV) FSS Program
Public Housing FSS Program
Indian Housing FSS Program
Purpose of Contract
The purpose of this contract is to state the rights and responsibilities of the family and the HA, the resources and supportive
services to be provided to the family, and the activities to be
completed by the family.
Term of Contract
This contract will be effective on ________________________.
This contract will expire on ___________________________.
The HA can extend the term of the contract up to 2 years if the
family gives the HA a written request for an extension and the HA
finds that good cause exists for the extension.
Resources and Supportive Services
During the term of the contract, the HA will try to provide the
resources and services listed in the individual training and services plans. If the resources and services are not available, the
HA will try to substitute other resources and services. However,
the HA has no liability to the family if the resources and services
are not provided.
FSS Escrow Account
The HA will establish an FSS escrow account for the family. A
portion of the increases in the family’s rent because of increases
in earned income will be credited to the FSS escrow account in
accordance with HUD requirements.
Listed below are the family’s annual income, earned income, and
family rent when the family begins the FSS program. These
amounts will be used to determine the amount credited to the
family’s FSS escrow account because of future increases in
earned income.
Annual Income
Earned Income

$ _____________
$ _____________

Family Rent (Total Tenant Payment or, for HCV
program, 30% of monthly Adjusted Income)$ ___________
The HA will invest the FSS escrow account funds in HUDapproved investments.

Previous editions are obsolete

The HA will give the family a report on the amount in the family’s
FSS escrow account at least once a year.
If the family is participating in the HCV program and moves
outside the HA’s jurisdiction under HCV portability procedures,
the HA may transfer the balance of the family’s FSS escrow
account to another HA.
Withdrawal of Funds from FSS Escrow Account
The HA may permit the family to withdraw funds from the FSS
escrow account before completion of the contract if the family has
completed specific interim goals, designated by the HA, and
needs some of the FSS escrow account funds to complete the
contract (example: to pay for school costs).
The HA will pay the head of the family the amount in the family’s
FSS escrow account, less any amount owed to the HA, when:
(1) the HA determines that the family has completed this contract, and,
(2) at the time of contract completion, the head of the family
provides written certification to the HA that no member of
the family is receiving welfare assistance. Welfare assistance, for the FSS program, means income assistance from
Federal or state welfare programs, and includes only cash
maintenance payments designed to meet a family's ongoing
basic needs.
If the head of the family leaves the assisted unit, the remaining
family members may, after consulting the HA, name another
family member to receive the FSS escrow account funds.
Loss of FSS Escrow Account
The family will not receive the funds in its FSS escrow account if:
(1) the contract of participation is terminated,
(2) the contract of participation is declared null and void; or
(3) the family has not met its family responsibilities within the
times specified as stated in this contract.
Family Responsibilities
The head of the family must:
o Seek and maintain suitable employment after completion of
the job training programs listed in the individual training and
services plan. The HA, after consulting with the head of the
family, will determine what employment is suitable based on
the skills, education, and job training of that individual and
available job opportunities in the area.
The head of the family and those family members who have
decided, with HA agreement, to execute an individual training
and services plan, must:
o Complete the activities within the dates listed in each individual training and services plan.
o Provide the HA and HUD with information about the

Page 1 of 2

form HUD-52650 (12/2004)
ref. Handbook 7420.8

family’s participation in the FSS program in order to help the
HA and HUD evaluate the FSS program. This could include
information regarding employment, job interviews, training,
educational attendance, and other FSS services and activities.
All family members must:
o Comply with the terms of the lease.
o If receiving welfare assistance, become independent of welfare assistance and remain independent of welfare assistance
for at least 12 consecutive months before the contract expires.
o If participating in the HCV program, the family must comply
with the family obligations under the HCV program and live
in the jurisdiction of the HA that enrolled the family in the
FSS program at least 12 months from the effective date of this
contract, unless the initial PHA has approved the family's
request to move outside its jurisdiction under portability.
Corrective Actions for Failure to meet Family Responsibilities
If any member of the family does not meet his or her responsibilities under this contract, the family will not receive the money in
its FSS escrow account and the HA may:
(1) stop supportive services for the family,
(2) terminate the family’s participation in the FSS program, and
(3) if the family is participating in the HCV program, terminate
the assistance, when allowed by HUD requirements.
HA Responsibilities
o Attempt to obtain commitments from public and private
sources for supportive services for families.
o Establish an FSS escrow account for the family, invest the
escrow account funds, and give the family a report on the
amount in the FSS escrow account at least once a year.
o Determine which, if any, interim goals must be completed
before any FSS escrow funds may be paid to the family; and
pay a portion of the FSS escrow account to the family if the
HA determines that the family has met these specific interim
goals and needs the funds from the FSS escrow account to
complete the contract.
o Determine if the family has completed this contract.
o Pay the family the amount in its FSS escrow account, if the
family has completed the contract and the head of the family
has provided written certification that no member of the
family is receiving welfare assistance.
Completion of the Contract of Participation

Completion of the contract occurs when the HA determines that:
(1) the family has fulfilled all of its responsibilities under the
contract; or
(2) 30 percent of the family’s monthly adjusted income equals or
is greater than the Fair Market Rent amount for the unit size
for which the family qualifies.
Termination of the Contract of Participation
The HA may terminate this contract if:
(1) the family and the HA agree to terminate the contract;
(2) the HA determines that the family has not fulfilled its responsibilities under this contract;
(3) the family withdraws from the FSS program;
(4) an act occurs that is inconsistent with the purpose of the FSS
program; or
(5) the HA is permitted in accordance with HUD requirements.
The HA may declare this contract null and void if the resources
and services necessary to complete the contract are not available.
The HA must give a notice of termination or nullification to the
head of the family. The notice must state the reasons for the HA
decision to terminate or nullify the contract.
If the contract is terminated or declared null and void, the family
has no right to receive funds from the family’s FSS escrow
account. The HA must close the family’s FSS escrow account and
may use the funds for purposes in accordance with HUD requirements.
If the family is participating in the HCV program, the HA will
terminate the contract if the family moves outside the HA’s
jurisdiction under portability procedures and enters the FSS
program of another HA.
If the family is participating in the HCV program, this contract is
automatically terminated if the family’s assistance is terminated
in accordance with HUD requirements.
Conflict with the Public or Indian Housing Lease
If part of this contract conflicts with the public or Indian housing
lease, the lease will prevail.
Compliance with HUD Regulations and Requirements
The contract of participation must be interpreted and administered in accordance with HUD regulations and requirements.
Terms and figures, such as the income and rent amount on page
1, are subject to correction by the HA for compliance with HUD
regulations and requirements. The HA must notify the family in
writing of any adjustments made to the contract.

Signatures:
Housing Agency

Family
______________________________________________
(Signature of head of family)
________________________
(Date Signed)

______________________________________________
(Name of HA)
______________________________________________
(Signature of HA Official)
______________________________________________
(Official Title)
________________________
(Date Signed)

Previous editions are obsolete

Page 2 of 2

form HUD-52650 (12/2004)
ref. Handbook 7420.8

Each Housing Agency (HA) must enter into a contract of participation with
each eligible family that opts to participate in the FSS program. Each HA
must consult with local officials to develop an action plan containing
descriptions of the size, characteristics, and needs of the population to be
served by its proposed FSS program; the services and activities it will
provide; how the program will be implemented; the public and private
resources through which services and activities will be provided; a timetable for implementation; and other data necessary for HUD to ensure
coordinated implementation of program services and activities.
Public reporting burden for this collection of information is estimated to
average 1.0 hours 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 information.

Response to this collection of information is mandatory by law (Section
23 (c) & (g) of the U.S. Housing Act of 1937, as added by Section 554 of the
Cranston-Gonzalez National Affordable Housing Act (PL 101-625) for
participation in the FSS program.
The information collected on this form is considered sensitive and is
protected by the Privacy Act. The Privacy Act requires that these records
be maintained with appropriate administrative, technical, and physical
safeguards to ensure their security and confidentiality. In addition, these
records should be protected against any anticipated threats to their security
or integrity which could result in substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom the information is
maintained.
HUD may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently valid OMB control
number.

HA Instructions for Executing the FSS Contract of Participation
Parties to the Contract/Signatures
The head of the participating family must be the adult member of the
family who is the head of the household for income eligibility and rent
purposes.
Term of Contract
The effective date is the first day of the month following the date the
contract was signed by the family and the HA’s representative.
The expiration date is five years from the effective date of the contract.
If the HA decides to extend the term of the contract, the original expiration
date listed on page one of the contract must be crossed out and the new
expiration date added.
If a family moves under HCV portability procedures and is going to
participate in the receiving HA’s FSS program, the effective date of the
contract between the family and the receiving HA is the first day of the
month following the date the contract was signed by the family and the
HA’s representative. The expiration date of the contract between the
receiving HA and the family must be the same as the expiration date of the
contract between the initial HA and the family.
FSS Escrow Account
The income and rent numbers to be inserted on page one may be taken
from the amounts on the last reexamination or interim determination
before the family’s initial participation in the FSS program, unless more
than 120 days will pass between the effective date of the reexamination
and the effective date of the contract of participation. If it has been more
than 120 days, the HA must conduct a new reexamination or interim
redetermination.
If a family moves under HCV portability procedures and is going to
participate in the receiving HA’s FSS program, the receiving HA must use
the amounts listed for annual income, earned income, and family rent on
page one of the contract between the initial HA and the family.
Changes to the Contract
This contract of participation can only be changed to modify the contract
term, the head of the family, or the individual training and services plans.
Any change of the head of the family under the contract must be included
as an attachment to the contract. The attachment must contain the name
of the new designated head of the family, the signatures of the new head
of the family and an HA representative, and the date signed.
Any change/s to an individual training and services plan must be included
as a revision to the individual training and services plan (attachment) to
which the change applies. The revision must include the item changed,
signatures of the participant and an HA representative, and the date
signed.
For extensions to the contract term, see the “Term of Contract” section.
If, twelve months after the effective date of the contract, a family in the
HCV FSS program moves outside of the HA’s jurisdiction under HCV
portability procedures, an HA may take one of the following actions:
(1) The initial HA may permit the family to continue to participate in its
FSS program, if the family demonstrates to the initial HA’s satisfac-

Previous editions are obsolete

tion that it can meet the family responsibilities of the contract in the
new location. In this case, the existing contract remains in effect with
no change. The initial HA must transfer the family’s FSS escrow
account balance when the family is absorbed by the receiving HA.
(2) The receiving HA may permit the family to participate in its FSS
program. If so, the initial HA must terminate its contract with the
family. The initial HA must also transfer the family’s FSS escrow
account balance when the family is absorbed by the receiving HA.
The receiving HA will execute a new contract with the family.
(3) In cases where the family cannot fulfill its family obligations in the
new location, and the receiving HA does not permit the family to
participate in its FSS program, the contract between the initial HA
and the family shall terminate and the family will lose the funds in its
FSS escrow account.
Individual Training and Services Plans
The contract must include an individual training and services plan for the
head of the family. Other family members age eighteen and older may
choose to execute an individual training and services plan if agreed to by
the HA.
The resources and supportive services to be provided to each family
member must be listed in the individual training and services plans which
are attachments to the contract of participation.
Page one of each participant’s individual training and services plan
includes space for the final goal and the first interim goal needed to
achieve the final goal. The additional pages provide a format for
recording each interim goal and specific information related to its
achievement. The first page of each participant’s plan must be signed by
the participant and an HA representative.
Interim goals must be specified along with the activities and services
needed to achieve them. For example, a single mother with two children
who has an interim goal of completing her secondary education might
require several different activities and services to achieve that goal. These
could include transportation, tutoring, and child care.
All completion dates included in the individual training and services plans
must be on or before the contract of participation expires.
One of the interim goals for families receiving welfare assistance is to
become independent of welfare assistance for at least twelve consecutive
months before the end of the contract. Any family that is receiving
welfare assistance must have this included as an interim goal in the head
of the family’s individual training and services plan.
The final goal listed on the individual training and services plan of the
head of the family must include getting and maintaining suitable employment specific to that individual’s skills, education, job training, and the
available job opportunities in the area.
Incentives
If the HA has chosen to offer other incentives in connection with the FSS
program, these incentives may be included in the individual training and
services plans or as an attachment to this contract.

form HUD-52650 (12/2004)
ref. Handbook 7420.8

Family Self-Sufficiency Program
Individual Training and Services Plan

Attachment ________

Name of Participant

Social Security Number

Final Goal

Interim Goal Number ________

Date Accomplished __________________________
Activities/Services

Responsible Parties

Date/s

Comments

Signatures:
Family

Housing Agency

____________________________________________________

____________________________________________________

(Participant)

(Signature of HA Representative)

___________________________________________________________________
(Date Signed)

Previous editions are obsolete

___________________________________
(Date Signed)

Page 1 of

form HUD-52650 (12/2004)
ref. Handbook 7420.8

Family Self-Sufficiency Program
Individual Training and Services Plan

Attachment ________

Name of Participant

Social Security Number

Interim Goal Number ________

Date Accomplished __________________________
Activities/Services

Responsible Parties

Date/s

Comments

Previous editions are obsolete

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form HUD-52650 (12/2004)
ref. Handbook 7420.8