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HomeMy WebLinkAbout2000-16111111111111110 � V Applicant Certification - l✓k.l.�l_,I. (These certified statements are required bylaw.) The Applicant hereby ensures and certifies that: A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), rod Single Room Occupancy (SRO) programa: 1. Fair Housing and Equal Opportunity.. 1l will comply with Title Vi of the Civil R ights Acrof 1964 t42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR Part f), which state that no person in the United States shall, on th e g rou nd of race, colorer national origin. be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With refereaceto the real properly and structuic(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assur- ance shall obligate the applicant, or in the case of any transfer. the transferee. for die period during which the real property and siructure(s) are used fora purpose for which the Federal financial assistance is extended or for ano rhe r purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601.19), asamended, and with implementing regulalions at 24 CFR Part M. which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. For Indian tribes, it will comply with the Indian Civil Rights Act (25 U.S.C. 1101 el seq.), instead of Title VI and the Fair Housing Act and their implementing regulations. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit dis- crimination because of race, color, creed, sex or na. tional origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 1 1246 and all regulations pursuant thereto (41 CFR Chapter 60.1), which state that no person shall be discriminated against on the basis of race. color, religion, sex or national origin in all phnses of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employmenl opportunity, The applicant will incorporate,or cause lobe incorporated, into any contract forconstruciiort work as defined in Section 130.5 of HUD regu latlons the equal opportunity clause required by Sec. tion 130.15(b) of the }IUD regulations. II will comply with Section 3 of lbe Housing and Urban Development Act of 1968, as amended (l2 U,S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible Opportunities for training and employment be given to lower-income residents of tr.e project and contracts for work in connection with the project be awarded in substantial pan to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended, and with implementing regulations at 24 CFR Part 8, which pro- hibit discrimination based on disability in Federally - assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101.07). as amended, and implement- ing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. it will comply with ExecutiveOrders 11625, 12432, and 12138, which state that program participants shall take affirmalive action to encourage participation by busi- nesses owned and operated by members of minority groups and women. if persons of any particular race, color religion. sex. age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached. it will establish additional procedures to ensure that interested persons can obtain information concerning The assistance. It willcomply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, as amended. Additional for S+C; If applicant has established a preference for targeled populations of disabled persons pursuant to 24 CFR 582.330(a). itwillcoinply with Ihisseclion's nondiscrimi- nation requirements within the designated population. 2. Drug -Free Workplace. it will provide drug-free workplaces in accordance with the Drug -Free workplace Act of 1988 (41 U.S.C. 701) by: (a)publishing a statement notifying employees that the unlawful manufacture, distribution. dispensing. pos- session, cr useof acontrolled substance is prohibited in the grantee's workplace and specifying the actions that will be lakea against empit yees for violation of such prohibition-, (b)establishing an ongoing drug-free awareness program to inform employees about: (1) the dangers of drug abuse in the workplace-, (2)the grantees policy of maiulaming adrug-free work- place, (3)any available drug counseling, rehabilitation, and employee assistance programs: and (4)lhe penalties [bat may be imposed upon employ- r p r 40 r ees for drug abuse violations occumng in the workplace. (c)makiog it a requvement Thal each employee to be engnged in the performance o f th a grant be given a copy of The statement required by paragraph (a); (d)notifying the employee in the statement required by paragraph (a) that, as a condition of employ me at under The grant. the employee will: ( I labile by the terms of The statement; and (71notify The employer in writing ofhis orhe: convic- I ion for a violation o f a criminal drug stazu to ace u r - ring in the workplace no later Than five calendar days after such conviction; (e) notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee o r a t b erw i se receivio g actual nol ice ofsuchconviclion. Employersofconvicledemployees must provide notice, including position title, to every grant officer or oilier designee on whose grant activity the convicted employee was working, unless the Fed- eral agency has designated a central pointforthereceipT of such notices. Notice shall include the identification numbar(s) of each affected gran i; (f) Taking one of the following actions, within 30 calendar days or receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted : (1)taking appropriate personnel action against such an employee, up to and including termioatioo, coosis- lent with the requircmentsof the. Rehabilitation Act of 1973, as amended; or (2)rcquiring such employee to participate satisfacto- rily in a drug abuse assistance or rehablLtalioa program approved for such purposes by a Federal, Stare.. or local heahh. law enforcement. or other appropriate agency: lg)makmg a good faith effort to continue to maintain a drug-free workplace Through Implementation of para. graphs (a), (b). (c), (d), (e) and (f); (h) providing the street address, city, county, state, and zip code for the site orsites where the performanceof work in connection with The grant will take place. For some applicants who have functionscarricd out by employ. ees in several departments or offices, more than one location may need to be specified, 11 is further reco g- nized That States and nth"applicants who become. granites may add or change sites as a result of changes To program aclivitiesduriog the courscof grant -funded. activities. Grantees, tit such cases, are required to advise the HUD Field Office by submitting a revised placeof performance form. The period covered by the ccrtificalion extends until all funds under the specific grant have been expended. 3. Anti -Lobbying. (it) No Federally appropriated funds have been patdor will he paid, by or an behalf of The undersigned, to tiny person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee or Congress, or an employee o f a Member of Co n gr ess in connection with the awaniiog of any Federal contract.lhe making of any Federal grant, The making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation. renewal, amendment.or modi. fication of any Federal contract, grant, loan, or coop- erative agreement. (b)If any funds other Than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an off -icer or employee of Congress, of an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and su bmi i S sand and Form - LLL. Disclosure Form to Report Lobbying, to accor- dance with its instructions. (c)The undersigned shall require that the language of this certification be included in the award documents forall subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, nod coo perat i ve agmements) and that all su b rec ip ien is shall certify and disclose accordingly. This certification is a material representation of fact upon which reliancewas placed when this Transaction was made or entered into, Submission of ibis ccrtif. cation is a prereq u i s ite for making c r en tori ng into this transaction imposed by section 1352. title 31. U.S. Code. Any person who fails to file the required cerlificationshall besubject loacivil penaltyof not less Than . S 1.0,000 an d o f more than 3100.000 for eac h such failure. 4. Debarment. 11 and lir principals (see 24 CFR 24.105(p)): Ware not presently debarred, suspended, proposed for debarment, declared ineligible,orvoluatviiycxc)uded fromcovered transactions (see 24 CFR 24.110) by any Federal department or agency: (b)have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of embezzle- ment, theft, forgery. bribery, falsification or destruc- lion of records, making false statements. or receiving stolen property; Ware not presently indictei for or otherwise criminally or civilly charged by a governmental entity (Federal, Stareor local) with commission of any orlhe offenses enumerated in (b) of this certification; and (d have not within a tbrcc-year period preceding this applieationlproposal had one or more public transac- tions (Federal. SL -ac or local) terminated for cause or default. form Riff?-4007"Dic i 411111111 40 OMB Approval No. 034^DM .sgalNanw Indian River County Application for Federal organtrarlanar Una --. Board of County Commissioners ' Assistance 2. Data Su ad Applicant W111111i 1 Typo of Submission. 3. Dale RocoNed by Stall State Application Application Preappllcatlon 4. Dole Received byFaderdAWLy FaderalkkMller ❑ Construction (] Construction L � A U Non -Construction © Non•Constructlon A. State H. lnclapandent School Dist -. .AL B. County I. State Contolled Institution of Higher Laarning OMB Approval No. 034^DM .sgalNanw Indian River County - organtrarlanar Una --. Board of County Commissioners lddress (give city, county. Slate, and 41P odds): nahors Name, telophona nurnoer. and lacetml* number of the person Io be eoruacled on nvotving this applcallnn (give arra codes) Louise Hubbard MPA (561)231-5860 FAX Number: 561-234-5298 s. Ern ploys Ida ntiflattonNumber(Elft 7. Type of Applicant: (enter oppropriats letter In box) FLI L � A A. State H. lnclapandent School Dist -. .AL B. County I. State Contolled Institution of Higher Laarning — — - B. Type of Application: C. Municipal J. Privata Lln"mity 0 Now O Continuation Q Revision D, Township K. Indian Tribo It Revision, enter appropriate Wier(s) In boot(es): FJ E. Interstate L. Individual F. tntermunfi; M. Profit Organization J fl. Spodal Distrtcl N. Non-profit Other (Specify): A. Incroase Award B. Decrease Award C. Increase Duraltion g.NamaofFoderstAgorwy: U.S. Dapartmentof Housingand Urban Development D- decrease Duration Other (speeltft 10. Catalog a IF ads rat Damsel lc Assistance Number, 1 �_ Title SLLppay`4112, 9W91117 2)ptions `` 11. Descriptive This of ApplI Cama Project: Team --Supportive Services Only ase Monitoring and Housing Specialist d iupportive Services Team to outreach rko66a4M and refer clients and find housing and services. 12. Areae Affected by project (clues, counties, States, etc.): Indian River Co. FL la.prapoeeo project: 14.Congre*elonal ulemctaol. a. Appticalll b. Ptosed 15 15 18.1* Appllutlon Sub)ace to rtevlaw by State Execullve Order 12'472 Pmeaeey a. Yes This pro applicaticrJapplication was made available to the State Executive Order 12372 Process forraview on: b. No Program is not covered by E.D. 12372 or Program has not been selected by State for review, 17. bl thoA ppllcant nati nq uent en Any Fedarel Debt? Yes 11 'Yes,' explain below or attach an explanahon >U No is To We st of my knowLed ge and W icf, A data in this application/preapplication are tme and correct, the doc Unient has been duly authorized _ by (lie governing body of the applicant and the applicant will comply with the attached assurances if the assistance is awarded. a.. Typed Name a Aulhollzed Reprosenlalive b. Tina c.Tolophena Numoaf Fran B. Adams d. SIgnatutpokAuftrized Nspre „tel, e. atIZ��Q,IA May e 2{}00 FfeYlous Editions Not U/able Page t of 2 forret SF -U4 (4A)2) Prascribad by OMB Citcullt A•102 40 40 i Instructions for the SF -424 This is a standard form used by applicants as a required faceshect for pre -applications and applications submitted for Federal assistance. It will be usedby Federal agencies to obtain applicant certification that States which have estab- lislied a review and comment procedure in response to executive order 12372 and have selected the program to be included in their process, have been given an opportunity to review the applicant's submission. . Item I Self-explanatory. Itern 2. Date application submitted to Federal agency (or Slate ifapplicable)and applicant's control number (if applicable). Item 3. State use only (if applicable). ltem4. If thisapplication istocontinueorrcviscanexisting award, enterpresent Federal identifier number. Iffor a new project, leave blank. Item S. Legal name of applicant, name of primary organiza- tional unit which will undertake the assistance activ- ity, complete address of the applicant, and name and telephone number and facsimile number of the per- son to contact on matters related to this application. ItcuiG. Enter Employer Identification Number (EIN) as as- signed by the Internal Revenue Service. Item 7. Enter the appropriate letter in the space provided. Itcing. Check appropriate box and enter appropriateletter(s) in the space(s) provided: - "New" means a new assistance award. • "Cont{nuation" means an extension for an addi- [tonal funding budget period for a project with a projected completion date. "Revision" means any change in the Federal Government's financial obligation or contingent ii - ability from an existing obligation. Previous Ediboru Not Usable Authorized for Local Reproducbm Item 9. Name of Federal agency from which assistance is being requested with this application. [tem 10. The Catalog of Federal Domestic Assistance num- ber is not applicable. Enter the title of the program under which assistance is requested. Item 1l. Enter abricfdescriptivetitle oftheproject. Ifmore than one program is involved, you should append an explanation on a separate Sheet. if appropriate (e.g., construction or real property projects), attach a map showi ng project location. For pre -applications, use separate sheet to provide a summary description of this project.. Item 12. List the local jurisdiction(s) to be served by the project. Item 13. Self-explanatory. Item 14. List the applicant's Congressional Distriictand any District(s) affected by the program or project. Item IS. Not applicable. Item 16. Applicants shouldcontact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State inter-governrnentalreview process. Item 17. This question applies to the applicant organization. not the person whosignsas the authorized represen- tative. Categories of debt include delinquent audit disallowances, loans and taxes. Item 18. To be signed by the aulhorizedrepresentative ofthe applicant. A copy ofthe governing body's authoriza- t ion for you to sign this application as official repre- sentative must be on file in the applicant's o. -,cc. (Certain Federal agencies may require that this autlto- rization be submitted as part of the application.) Page 2 of 2 term SP 424 (419'2) 4teschbod by ofm Circular A-102 2. Environmental Rule. It will comply with the environmental review require- ment for the SRO Program at 24 CFR 882.804(d). E. For SHP and SRO. i. Nonprofit Board or Directors. For pri va ie n on p ro f it app lic'nts. members of its Board of Directors serve in a voluntary capacity and receive no compensation, other than reimbursement for ex- penses, for their services. F. For SHP and S+C. 1. lead -Based Paint. It will complywith therequiremants of the Lead -Based Paint Poisoning Prevention Act. 42 U.S.C. 4821- 4846, and implementing regulations at 24 CFR Part 35. C. For S+C and SRO. 1. PHA Qualifiention. For PHA applicants, lhal it qualifies as a Public Housing Ageacy as specified in 24 CFR 882.102 and is legally qualified and authorized to carry out the proprsed projcct(sL 2, 111A Qualification. For INA applicants, that it qualifies as an Indian Housing Authority as specified to 24 CFR 905.126 tad is legally qualified and authorized to carry out the proposed project(s). IL Fxplanaflon. Wheretheapplicani is unable to certify to any of lite statements in this certification, such applicant shall attach an explanation behind this page. SignnatCuraa of Authonzad Certifying Official: ©ata: 1-59 May 23, 2000 Tttto.CHAIRMAN, BOARD OF COUNTY COMMISSIONERS Applicant : For PHA Applicants Only: PHA Number: INDIAN RIVER COUNTY ---DQAED QE COUNTY COMMISSIONERS form HVD-4007"OC CID • i S. Uniform Act It will comply with the Uniform Relocation and Real Property Acquisition Policies Act of 1970 (as amended). and The implementing regulations at: 24 VFR 583.310 (orSHP.24 CFR 582.335 fors+C, and 24 CFR 882.810 for SRO. B. For SHP Only. I+ Maintenance or Effort. It will comply with the maintenance of effoil require- ments described at 24 CFR 583.150(x). 2. 20 -Year Operation Rule. For applicants receiving assistance far acquisition, rehabilitation. or new construction: Theproject will be operated for no less Than 20 years from the datcof initial occupancy or The d atc o f initial service provision for the purpose specified in the application. 3. I -Year Operation Rule. For applicants receiving assistance for supportive services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new con- struction: The project will beoperaled for the purpose specified in the application for any year forwhich such assistance is provided. 4. Environmental Rule. (a) If the applicant is a State or other governmental entity with general governmental powers (see 24 CFR 583,5), n assumes all theenviromnenial review responsibility That would otherwise be performed by HUD as The responsible Federal official under the National Envi- ronmental Policy Act (42 U.S.C. 4321) (NEPA) and related environmental laws and authorities listed in 24 CFR Part 58, including acceptanceofjurisdiction of the Federal courts, and will assess the environmental effects of each application for assislancein accordance with the provisions of NEPA and 24 CFR Part 58. (b) If theapplicanl is a private nonprofit organiWton or a governmental entity with special or limited purpose powers. ii will (i) not enter into a contract for, or otherwise commis HUD orlocal funds for, acquisition, rehabilitation, conversion, lease, repair, or construe- lion o f property to provid a housing u oder i be program, prior to HUD's completion of" environmental review in accordance with 24 CFR Pari 50 and HUD's ap- proval of Che application; (ii) supply HUD with infor- mation necessary for HUD to perform any applicable environmental review when requested under 24 CFR 583.225(a); and (iii) carry out mitigating measures required by HUD or ensure that alternate sins are utilized. C. For S+C Only. 1. Maintenance of Effort. It will comply with the maintenance of effort require- ments described at 24 CFR 582.115(d). 2, Supportive Services. It will makeavailable supportive services appropriate to the needs of i he po pu lation served and eq uat in value to t he aggregate amount of rental assistance funded by HUD for the full term of the rental assistance and that i i will fu ad th c s app oil iv a sery ices i tsel f i f Lb e p I anned resources do not become available for any reason. 3. Components: Standard& Definition% and $3,000 Minimum, (a) For the SRO component only, Che proposed site meets HUD's site and neighborhood standards (24 CFR 882.803(b)(4)), aad meets tberegulatory derinottion of single room occupancy housing (24 CFR 882.802). (b) For the SRO and PRA with rehabilitation components, iherehabilitalion costs will meet theper unit rehabih- tation minimum of 53,000. 4. Environmental Rule.. (a)lf the applicant is not a PHA„ it assumes all the environmental review responsibility that would other- wise be performed by HUD as the responsibie Federal Official under the National Environmental Policy Act (42 U.S.C. 4321) (NEPA) and related envirosrmental laws and authorities listed in 24 CFR Part 58, including acceptance of jurisdiction of the Federal courts, and will assess the environmental effects of each applica- lion for assistance in accordance with the provisions of NEPA and 24 CFR Pon 58. (b)If the applicant is a PHA, it will (i) not enter into a contract for, or otherwise commit H U D or local funds for, acquisition. rehabilitation, conversion. lease, re- pair, or construction of property to provide housing under the program. prior to HUD's completion of an environmental review in accordance with 24 CFR Part 50 and HUD's approval of the application.(ii) supply HUD with information necessaryforHUD reperform any applicable environmental review when requested under24 CFR 583.225(x); and (iii) carryout mitigating measures required by HUD or ensure that alternate silex are utilized. D. For SRO Only. 1. Standards, Definillons, and $3,000 Minimum. The proposed site meets I IUD's site and neighborhood standards (24 CFR 882.803(b)(4)), meets the regula. Cory definition of single room Occupancy housing (24 CFR 882.802). and the rehabilitation costs will encel the per unit rehabilitation minimum of S3,000, lorm HUD -40014-000 0 4W 40 �► Applicant/Recipient U.S. Department of Housing OMB Approval No. 2510-0011 (exp. 1131193) and Urban Development DiscicsurelUpdate Report Instructions. (See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2.) ApplicantlReciplent Information Indicate whatherthis Is an Initial Report C] or an update Report 1. Applicant/Recipient Name, Address, and Phone (include area code): 2. Soda? Security Number or INDIAN RIVER COUNTY Employer ID Number. BOARD OF COUNTY COMMISSIONERS - 3, HUD Program Name 4. Amount of HUD Assistance Requeslod/Racelved SUPPORTIVE HOUSING PROGRAM 5. Stale the name and location (street address, City and State) of the project or activity. Parti I Threshold Determinations 1. Are you applying for assistance for a specific project or activity? These 2. Have you received or do you expect to receive assistance within the terms do not include formula grants, such as public housing operating judsdichon of the Department (HUD) , involving the project or activity In subsidy or CDBG black grants. (For lurcher information see 24 CFR Sec. this application, in excess of $200,000 during this fiscal year (Oct, t - 4.3). Sop. 30)7 For further information, see 24 GFR Sec, 4.9 Yes r-1 No ❑ Yes ® No. If you answered "No" to either question t or 2, Stopi You do not need to complete the remainder of this foram. However, you must sign the certification at the end of the report. Part li Other Government Assistance Provided or Requested l Expected Sources and Use of Funds. Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, Insurance, payment, credit, or tax benefit. DepanmentlStaleftOcai Agency Name and Address Type of Ass+stance Amount Expecled Uses of the Funds RequestedlProvlded (Note: Use Additional pages if necessary.) Part III Interested Parties. You must disclose: 1. All developers, contractors, or consultants involved in the application for the assistance or in the planning, development, or implementation of the proiecl or aclnrlly and 2. any other person who has a financial interest in the project or activity for which the assistance Is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower). Aiphauetical list of all persons with a reponabie Financial interest in the protect or activity (Fpr individuals, give the last name first) Social Security NOF or Employee ID No. Type of Participation in ProjecUActivity Flnandal Interest in ProecVAclIvll is ano 1.) tnv¢e use naomonai pages if necessary.) Certification Warning If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of TIOe 18 of the United States Code. in addition, any person who knowingly and materially violates any required disclosures of Information, including intentional non. disclosure, is subject to civil money penalty not to exceed $10,000 for each violation. I certify that this information is true and complete. X (-WddWyy) May 23, 2000 Form HUD -280013199) 4D Public reporting burden for this collection of information is estimated to average 2.0 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. This agency r not Conduct er sponsor, and a person is not required to re5pond lo, a CAtleclion information unless that collection displays a valid OMS control number. Privacy Act Statement. Except for Social Security Numbers (SSNs) and Employer Identification Numbers (EINs), the Department of Housing and Urb; Development (HUD) Is authorized to collect all the Information required by this form under section 102 of the Department of Housing and Urban Development Reform Act of 1gag, 42 U.S.C. 3531. Disclosure of SSNs and EINs is optional. The SSN or EIN is used as a unique identifier. The Information you provide will enable HUD to carry put its responsibilities under Sections 102(b), (c), and (d)of the Department of Housing and Urbari Development Reform Act of 19$9, Pub. L. 101-235, approved December 15, 1989- These provisions will help ensure greater accountability and'integdt the provision of certain types of assistance administered by HUD. They will also rioip ensure that HUD assistance for a specific housing projeCl under Section 102(d) is not more than is necessary to make the project feasible after taking account of other govemmenl assistance. HUD will make availably the public all applicant disclosure reports for rive years in the case of applications for competilrve assistance, and for generally three years in the case c other applications. Update reports will be made available along with the disclosure reports, but in no case for a period generally less than three years reports, both initial reports and update reports. will be made available in accordance with the Freedom of Information Act (5 U.S.C. §552) and HUD's implementing regulations at 24 CFR Part 75. HUD will use Clio information in evaluating Individual assistance applications and in performing internal administrative analyses to assisl in Doe management of specific HUD programs. The Information will also be used in making the determination under Section 102(d) whether HUD assistance for a specific housing project is more than is necessary to make the project feasible after laking account of oth• government assistance. You must provide all the required information. Failure to provide any required information may delay the processing oryour application, and may result in sanctions and penalties, including imposition of the adminlstraUve and civil money penalties specified under 24 CFR §4.3t Note: This form only covers assistance made available by the Departmenl. States and unds of general focal government that carry out responsibilities under Sections 102(b) and (c) of the Reform Act must develop their oven procedures for complying with the Act. Instructions Overview. A. Coverage. You must complete this report if: (1) You are applying for assistance from HUD for a specific project or activity and you have received„ or expect to receive, assistance from HUD in excess of "$200.000 during the during the fiscal year; f21 You are updating a prior report as discussed below: or (3) You are submitting an application for assistance to an enbly ogler Inas HUD. a State or local government if the application is required by stalute or regulation to be submitted to HUD for approval or for any other purpose. S. Update reports (filed by "Reciplents^ of HUD Assistance). General. All recipients of covered assistance musl submit update reports to the Department to reflect substantial changes to the initial applicant disclosure reports. Line -by -Line Instructions. Appl i canURocipf an l Information. All applicants for HUE) competilive assistance, most complete the information required in blocks 1.5 of form HUD -2080: I Enter the full name, address, city, Slate, zip code, and telephone number (including area code) of the applicantfreclpfent. Where the applicantf(ecipienl is an individual., the last name, first name, and middle initial must be entered. 2 Entry of the applicanitrecipienl"s SSN or EIN, as appropriate, is optional. 3. Applicants enter the HUD program name under which the assistance is being requested. 4. Applicants enter the amount of HUD assistance that is being requested. Recipients enter the amount of HUD assistance that has been provided and to which the update report relates. The amounts are those stated in the application or award documentalion. NOTE; In the case of assistance that is provided pursuant to contract over a period of time (such as project -based assistance under section 8 of the United Stales Housing Act of 1937), the amount of assistance to be reported includes all amounts that are to be provided over the term of the conlracl, irrespective of when they are to be received 5. Applicants enter Vie name and full address of the project or activity for which the HUD assistance is sought. Recipients enter the name and full address of the HUD -assisted project or aclivny to which the update report relates. The most appropriate government identifying number must be used ja.g , RFP No.: tFB No.; grant announcement No.; or contract, grant, or loan No.) Include prefixes. Part I. Threshold Determinations • Applicants Only Part I contains mlom+ation to help the applicant determine whether the remainder of the form must be completed. Recipients filing Update Reports should not complete this Part. It the answer to efrherquestfons 1 or 2 is No, the applicant need not complete Paris Ii and 1'II of the report, but must sign the cerllficaWn at the end of the form. Part It. Other Government. Assistance and Expected Sources and Uses of Funds. Other Government Assistance. This Part is to be completed by both applicants and recipients for assistance and recipients filing update reports. Applicants and recipients must report any other government a ssisla rice involved in the projecl or activity for which assistance is sought. Applicants and recipients must report any other government assistance involved in the project or acffvity. Other government assistance is defined in note 4 on the last page. For purposes of thk definition, other government assistance is expected to be made available if, based on an assessment of all the circus -lances involved, there are reasonable grounds to anticipate that the assistance will be forthcoming. Both applicant and recipient disclosures must include all other government assistance involved with the HUD assistance, as well as any other government assistance that was made available before tht request, but that has continuing vitality at the time of the request. Examples of this taller category include tax credits that provide for a number of years of lax benefits, and grant assistance that continues benefit the project al the time of the assistance request. The following information must be provided 1 Enter the name and address, city, Stale, and zip code at ate government agency making the assistance available. 2. Slate the I oe of other government assistance (e.g., loan, grant, loan insurance).. 3 Enter lie dollar amount of the ofhsr government assistance that i or is expected to be, made avaiiaole with respect to the projector activities for which the HUD assistance is sought (applicants) or Inas been provided (recipients). 4 Uses of funds. Each reponab!e use of funds must clearly idenut the purpose to which lney are to be put. Reasonable dggregabor may be used. such as 'total struclui e- to include a number of slruclural Costs, such as rbel, elevators, ., wlanof masonry, etc. B. Non -Government Assistance. Nola that the applicant and recipient disclosure report must specify all expected sources and uses of fund - bout from HUD gild any other source - that have "on or tire, to b made available for the project or activity. NOW90veriment soufoes t Form HUD•2960 (3K