HomeMy WebLinkAbout2000-162Applicant Certification
(These certified statements are requited by faO
The Applicant hereby ensures and certifies that:
A. For the Supporllve Housing (SHY), Shelter Plus
Care (S+C), and Single Room Occupancy (SRO)
programs-
1. Fair Housing and Equal Opportunity.
!twill complywil6Tuie Vlof the Civil Rights Actor 1964
(42 U.S.C, 2000(d)) and regulations pursuant thereto
(Title 24 CFR Part 1), which state that no person in the
United Stases s hall, o n t he grou nd o r race, color or national
origin, be excluded from participation in, he 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
takeany measures necessary to effectuate this agreement.
With reference to the real properly and structure(&) thereon
which are provided or improved with the aid of Federal
financial assistance extended to theapplicant, this assur-
once shall obligate the applicant, or in the case of any
I ransfer. th a Era nsferee, fo r the p or iod d u r i n g wh is h th a re a)
property and siructure(s) are used fora purpose for which
the Federal financial assistance is extended or for another
purpose involving the provision of similar services or
benefits.
it will comply with the Fair Housing Act (42 U.S.C,
3601-19), as amended, and with implementing regulations
at 24 CFR Parr 100, which prohibit discrimination in
housing no 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-
criminatton because of race,. color, creed, sex or na-
tional origin in housing and related facilities provided
with Federal financial assistance.
i1 will comply with Executive Order 11246 and all
regulations pursuant therein (41 CFR Chapter 60-1),
which state that no person shall bedisctimirtated against
on the basis of race, color, religion, sex or nationalorigin
in all phases of employment during the performance of
Federal contracts and shall take affirmative action to
ensure equal employment opportunity. The applicantwill
tncorparate,arcause to be incorporated. into any contract
for con&trtiClinn wnrk as defined in Section 130.5 of HUD
regulations the equal opportunityclauserequired bySec-
tion 130.15(6) of the HUD regulations.
II will comply with Section 3 of the Housing and
Urban DcvelopmanlAcl of 1968, as amended (12 L.S.C.
1701(u)), and regulations pursuant thereto (24 CFR fart
135), which require that to the greatest extent feasible
opportunities for training and employment be given to
lower-income residents of the project and contracts for
ve) 6 i r t R
work in connection with the project be awarded in
substantial part to persons residing in the area or 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 Executive Orders 11625, 12432,
and 12138, which state tbarprogram participantsshall take
affirmative 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 will comply 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, os
amended.
Additional for S+C:
If applicant has established a preference for taargeted.
populations of disabled persons pursuant to 24 CFR
582.3300), it will comply with this section'snondiscrimi•
nation requirements within the designated populnuon.
2. Drug -Free Workplace.
it will provide drug-free workplaces in accordance
with the Drug -Fret Workplace Act of 1988 (41 U.S.C.
701) by:
(a)publishing a statement notifying employees that the
unlawful manufacture, distribution, dispensing, pos-
session, or use of a controlled sub-taoce is ptobibited
in the grantee's workplace and specifying the actions
that will be taken against employees 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 o f maiawining adrug-free work.
place;
(3)any available drug counseling, rehabilitation, and
employee assistance programs; and
(4)lhe penalties that may be imposed upon employ.
+W
40
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ees for drug abuse violations occurring in the
workplace,
(e)makiog it a requirement that each employee to he
engaged in iheperformance of the grant be given a copy
of the statement required by paragraph (a);
(d)notifying the employee in the statement required by
p arag ra,p h (a) t hat, as a con d tt i o n o f emp loy me n i under
the grant. the employee will:
( l )abide by The terms of the statement; and
t 2 )notify the employer in writing of his or her convic.
lion for a via lation of a criminal drug statute occur-
ring in the workplace on 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 oratherwise receiving actual notice
of suchconviction. Employers of convicted employees
must provide notice, including position title, to every
grant officer or other designee on whose grant activity
the convicted employee was working, unless the Fed.
eral agency has designated a central point for the receipt
ofsuchnouces. Notice shall include theidenlificai3on
number(s) of eachaffected grant:
(f) taking one ofibefollowing actions. within 30calendar
days of receiving notice under subparagraph (d)(2),
with respect to any employee who is so coavicted :
(I ) iaking appropriate personnel action againstsuch an
omployee,up toand including termination, consis.
lent with the requirements of the Rehabilitation Act
of 1473, as amended; or
(2)rcquiring such employee to participate satisfacto-
rily in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal.
State. or local health, law enforcement. or other
appropriate agency:
(g)making 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 t he s i to a r sites where the performance o f work
in connection with the grant will take place. For some
applicants who have funclionscarried outby employ-
ees to several departments or offices, more than one
location may need to be specified. 11 is further recog-
nized that States sod other applicants who become
grantees may add or change sites as a resu 11 of changes
to program activilies during the course of grani-funded
activities. Grantees, in such cases, are required to
advise the HUD Field Office by submitting a revised
Place of performance form. The period covered by the
cerl[fiealion extends until all funds under the specific
grant have been expended.
3. Anti -Lobbying.
(a) No Federally appropriated funds have peen paid or will
be paid, by or on behalf or the undersigned, to any
person for influencing or attempting to influence an
officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an
employee of a Member ofCongress in connection with
the awardingof any Federal contract, the making of any
Federal grant, the making of any Federal loan, the
entering iolo of any cooperative agreement, and The
extension, conlinuation.renewa], amendment, or modi-
ficalton of any Federal contract, grant. loan, or coop-
erative agreement.
(b)lf 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
officer or employee of Congress, or an employee of a
Member of Congress to cooncclion with this Federal
contract, grant, loan, or cooperative agreement, the
undersigned shall completeand submitStandard Form-
LLL, disclosure Form to Report Lobbying, in 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, and
cooperativeagreemeols) and that allsubrecipients sball
cerlify and disclose accordingly.
This certification is a material representation of fact
upon which reliance was placed when this transaction
was made or entered into. Submission of this certifi.
cation is a pre re q u i site for making or entering into this
transaction imposed by scclioo 1.352, title 31, U.S.
Code. Any person who fails to file the required,
codification shall be subject to a civil penalty of nut less
thanS 10,000and of more thaoSL00,000 foreach such
While.
4. Debarment.
It and its principals (see 24 CFR 24.105(p)):
(a)are not presently debarred, suspended, proposed for
debarment, declared ineligible, or volu n taxi ly excluded
from covered transactions (see 24 CFR 24.110) by any
Federal department or agency;
(b)bave not within a lhrcc-year period preceding ibis
proposal been convicted of or had a civil judgment
rendered against them for commission of embezzle-
ment, theft„ forgery, bribery, falsification or destrac-
tion of records, making false statements, or receiving
stolen property;
(c)are not presently indicted for or otherwise criminally
or civilly charged by a governmental entity (Federal.
State or local) with commission of any or the offenses
enumerated in (b) of this certification: and
(d)have not witlito a three-year period preceding this
application/proposal had one or more public transac.
tions (Federal. State or local) terimnalcd for cause or
default.
form Ht10.4od76 -CO C ,
•
4W
Applicant l r0W
Fedusl kMntFW
OMB Approval No, 0348--Do43
Identlrbr
.palHsrne -
Application for Federal.
Drgwdtaduroi Vnl
Assistance
1
2. Dale submitted
Iddress (" CMV, County, aisle, and 2000th):
1 Type of Submission; 3. Date RecoNed by Slab
Name, lolephono number. and IacalnlN nur ber of the person to be contacted on
Application Proappllcatlon
n Construction ❑ Construction 4. tale Reo&gd by Federal Agency
1840 25th St.
U Non•Constwelion El Non -Construction
Louise S. Hubbard MPA
S. Appauntintonnallon
Applicant l r0W
Fedusl kMntFW
OMB Approval No, 0348--Do43
Identlrbr
.palHsrne -
Drgwdtaduroi Vnl
Indian River County
Board of Count Commissioners -.
Iddress (" CMV, County, aisle, and 2000th):
Name, lolephono number. and IacalnlN nur ber of the person to be contacted on
ratters
ilvdvbrp Lhis application (Dive arae Cod")
1840 25th St.
Louise S. Hubbard MPA
Vero Beach, FL 32960
(561) 231»5860x260
FAX Number: 234-52 9A
s.EmployertdanufrullcnHumb►r(SINI:
7. Type of Applicant: ,anter r4pproprlatta letter In Lox)
I L J L_
A. State H. Independent School Dili
.. ..
B. County I. Stale Controlled Instlttltlon of Hlghor Learntnp
_.- ---
5.11ypeofApplkation:
C. Municipal J. Private University
New C) Continuation ❑ Revision
D. Township K, Indian Tribe
E. InterstateL. Individual
If Revision, enter appropriate letter{sl In box(osy
F. Iniarmuniclpal M. Profti Otgatlaatlon
7I
G. Special 46etdct N. Non•proflt
Ll
Other (Specify):
A. Increase Award 8. Decrease Award C. increase Duration
e.NameotFodaralAyermy:
U.S. Dopartmentof Housingand Urban [level opmont
D. Docroass Duration Other (speclly):
10. Cal Mot; oIFWoralDornsetleAsWet once Number.
t1.Ueac.rlptiveThIsofApplicant's Proje :
1 �+ —L2
�
13 11_41
FAMILY OPTIONS TRANSI'T'IONAL
71110
HOUSING FOR FAMILIES WITH CHILDREN
Supportive Housing
Program
rransitional Housing and Support
for up to 12 families at one time
-
12. Areas Atrocted by project (clua . colnlies.. sates, etc.):
o find permnent housing. Families
Indian River St. Lucie,
P
tay 6mos.-2 years and work with a
13.Propoosdprof set;
14.Congrerslonel Dlstrlctsot.
Stan Date EnoingDara
a. Applicant
It. Props
15
15
15. Eellmated Funding;
16. la Applicatlen Subject to Review bV state Exrcutive Otdor 12312 Proceea7
r
a. Yes This preapplication/appiication was made avaltable to the
State Executive Order 12372 Process for review an:
tl
r'
Date:
b. No Program is not Covered by E.O. 12372
C Sialic %.° i
or Program has not been selected by State for review.
17,IttheApplloont Delinquent on Any Federal Debt?
E] Yes If 'Yes. explain Wow or attach an explanation No
Loea a z
F
is Toth c best of my knowledge and belief, all data in thi s appiication/preappl ication are true and co rrr ct, the doc ament. W been duly authorized
by the governing body of the applicant and the applicant will comply with the attached assumnces if Use assistance is awarded.
a Typed Nang or A utnortzed Raprftoal&Ws b. Tpla 1c.Tolophoneflurnbu
d. &9nnlure
Dale Wall
Editions Nr1 Usable Paye i o1 2 form &F -V4 (41'91e)
Pfltrlaibed W OMS 0reu4r A-102
40
i
MInstructions forthuSF-424
This is a standard form used by applicants as a required
faceslreet for pre -applications and applications submitted
for Federal assistance. It will be used by Federal agencies to
obtain applicant certification that States which have estab-
lished a review and comment procedure in response to
executive Order 12372 and have selected the program lobe
included in their process, have been given an opportunity to
review the applicant's submission. .
Item I Self-explanatory.
Item 2. Date application submitted to Federal agency (or
Slate if applicable) and appl icant's control number (if
applicable).
Item 3. State use only (if applicable).
Item 4. If this application is to coati nue or revise an existing
award, enterpresentFederal identifier number. If for
a new project, leave blank.
IIem5. Legal name of applicant, name of primary organiza-
t ions l unit which wilt 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.
Ilcnt 6. Enter Employer Identification Number (EIN) as as-
signed by She Internal Revenue Service.
Item 7. Enter the appropriate letter in the space provided.
[icing. Check appropriate box and enterappropriatelettcr(s)
in the space(s) provided:
- "New" means a new assistance award
• "Conlinuation" means an extension for an addi-
tional funding budget period for a project with a
projected completion date.
"Revision" means any change in the Federal
Government's financial obligation or Contingent li-
ability from an existing obligation.
t'tav*us Editions Not Usable
AutMnZad lot Local Roproducbon
Item 9. Name of Federal agency from which assistance is
being requested with this application.
Item 10. The Catalog of Federal Domestic Assistance num
bcr is not applicable. Enter the title of the program
under which assistance is requested.
Item 11. Enter a brief descriptive title of the project, If more
titan 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
showing project location. For pre -applications, use a
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 District and any
District(s) affected by the program or project.
Item 15. Not applicable.
ltem 16. Applicants should contact the State Single Point of
Contact (SPDC) for Federal Executive Order 1x372 to
determine whether the application is subject to the
State inter -governmental review process.
Item 17. This question applies to the applicant organization,
not the person who signs as the authorized represen-
tative. Categories of debt include delinquent audit
disallowances, loans and taxes.
[tem 18. To be signed by the authorized representative of the
applicant. A copy of the governing body's authors. t -
tion for you to sign this application as official repre-
sentative must be on file in the applicant's office.
(Certain Federal agencies may require that this attiho-
rization be submitted as part of the application.)
Pltto a of 2
lotm SF41 i ON2j
prpseribed by CM8 Circular A -roe
2. Environmental Rule.
For PHA applicants, that it qualifies as a Public
11 will comply with the environmental review require-
Housing. A& Icy as specified in 24 CFR 1392.102 and
went for the SRO Program at 24 CFR 982.804(d).
is legally qualified and authorized to carry out The
proposed projecl(a).
2. f1iA Quauficatfun.
E. For SHP and SRO.
For IHA applicants, that it qualifies as an Indian
1. NonprofltBoard ofDirectors.
Housing Autborilyasspeciftedin24CPR905.126and
par private aonprofitapplicants.members ofitsBoard
is legally qualified and authorized to carry out the
of Directors serve in a voluntary capacity and receive
proposed project(s).
no compensation, other than reimbursement for ex-
penses, for their services.
F. For S11P and S$C.
1. Lead -Based Paint.
11 will co mpl y w i i h The requirements of th a Lead. B m ed
Point Poisoning Prevention Act, 42 U.S.C. 4821-
4846.aad implemeoliog regulations at 24 CFR Part 35.
G. For S+C and SRO+
1. PMA Quallfieatlon.
li. Explanation,.
Where the applicant is unable to certify to any of thestatements in this certification, sucb applicant shall attach an
expianatioo behind this page.
SiQnatuie of Ault-,otized Cortilying Official:
X
Tills:
Data:
May 23, 2000
CIIAIRMAN,BOARD OF COUNTY
Applicant : for PHA Appllpanfa Only:
INDIAN RIVER COUNTY PHA Plumber:
BOARD OF COUNTY COMMISSIONERS
torn HUD -4007e -COC
40
40
40
S. Uniform Act.
It will comply with the Uniform Relocation and Real
Properly Acquisition Policies Act of 1970 (as
amended). and the implementing regulations au 24
CFR 583.310 for SHP.24 CFR 582.335 forS+C, and
24 CFR 882.810 for SRO.
B. ForSHP Only.
1. Maintenance of Effort.
It will comply with the maintenance of efforl require-
ments described at 24 CFR 583.150(x).
2. 20 -Year Operation Rule.
For applicants receiving assistance for acquisition,
rehabilitation, a r ne w construction: The project will be
aperated for na Iessthan 20 years from the date af initial
occupancy orthedate of initial service provision for the
purpose specified in the application.
3. 1 -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: Theprojeclwill beoperatedfor lhepurpose
specified in the application for any year far which such
assistance is provided.
4. Environmental Rule.
(a) If the applicant isa State or other governmental entity
with general governmental powers (see 24 CFR 583.5).
itassumes all (lie environmental review responsibility
that would otherwise be performed by HUD as the
responsible Federal official under the National Envi-
ronmenial Policy Act (42 U.S,C. 4321) (NEPA) and
related environmental laws and authorities listed in 24
CFR Part 58, including acceptanceof jurisdiction of the
Federal courts, and will assess the environmental
effects ofeach application for assistance in accordance
with [be provisions of NEPA and 24 CFR Part 58.
(b) If [be applicant is a private nonprofit organization or
a governmental entity with special ortimiied purpose
powers, it will (i) not enter into a contract for, or
otherwise commit) IUD or local funds for, acquisition.
rehabilitation, conversion, lease, repair, or construc-
t ion of prope n y i o provide housing under the program.
prior to Id U D's co mpletio n of an a nv)ron mental review
in accordance with 24 CFR Part 50 and HUD's ap-
proval of the application; (ii)supply 11 UD with War-
oration necessary for HUD to perform aby applicable
environmental review when requested under 24 CPR
583.225(x); and (iii) carry out mitigating measures
required by HUD or ensure that alternate silos are
utilized.
C. For S+C Only.
1. MaIntenuace of Effort.
It will comply with the maintenance of effort require-
mcnis described at 24 CFR 582.1 l.50).
2. Supportive Services.
It will make available supportive services appropriate
to the needsof the population served and equal in value
t0 the aggregate amount of rental assistance funded by
HUD for the full termaf the rental assistanceand that
i r will fund the supportive services itself i f the ph anned
resources do not become available for any reason.
3. Componerils: Standards, Definitions, and $3,000
Mlalmum.
(a) For the SRO component only, the proposed site meets
}IUD's site and neighborhood standards (24 CFR
882.803(b)(4)), and meets The regulatory definition of
single room occupancy housing (24 CFR 882.802).
(b)For the SRO and PRA with rehabilitation components,
the rehabilitation costs will meet the per unit rebabili-
ration minimum of $3,000.
4. lEnvlronmental Rule.
(a) If the applicant is not a PHA, it assumes all the
environmental review responsibility that would other-
wise beperformed by HUD as theresponsible Federal
official under the National Environmental policy Act
(42 U.S.C. 4321) (NEPA) and related environmental
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.
tion forassistance in accordance wish the provisions of
NEPA and 24 CFR Part 58.
(b)lf the applicant is a PITA, it will (i) not enter into a
contractfor, orotherwisccommit HUD or local finds
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 rev tew in accordance with 24 CFR Far=
50 and }IUD's approval of the application; (ii) supply
HUD with information necessary for HUD to perform
any applicableeavironmeatal review when rcquested
under24 CFR 583.225(a)t and (iii) carry out mitigating
measures required by HUD or ensure that allernate
sites are utilized.
D. For SRO Only.
1. Standards, Definitions, and '$3,000 Minimum.
The proposed site meets H Ws site and neighborhood
standards (24 CFR 882.803(b)(4)), meets the regula.
tory definition of single room occupancy housing (24
CFR 882.802), and the rehabilitation costs will meet
the per unit rebabilitation minimum of suao.
form HUD -W076 -COC
•
40
• Applicant/RecipientU.S. Department of Housing OMB Approval No. 2510.0011 {exp. 1131199}
Disclosure/Update e/Update Report and Urban Development
Instructions, (See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2.)
Appiicant/Reclpient Information Ind tests whether this is on Initaal Report Q or an update Report (]
1, ApphcantlReciplent Name, Address, and Phone (include area code): 2. Social Saatdty Number or
Employer ID Number:
INDIAN RIVER COUNTY
BOARD OF COUNTY COMMISSIONERS
3. HUD Program Name 4, Amount of HUO Assistance
Requested/Recelved
SUPPORTIVE HOUSING PROGRAM
5. Stale the name and location (skeet address, City and State) of the projector activity:
Part i Threshold Determinations
1. Are you applying for assisiance for a specific project or activity? These 2. Have you received w do you expect to receive assistance within the
terms do not include formula grants, such as public arousing operating jurisdiction of the Department (HUD). involving the project or activity in
subsidy or CDBG block grants. (For further inlormation see 24 CFR Sec. this application, in excess or S200,000 during this fiscal year (Oct. 1
4,3), Sep, 30)7 For further Information, see 24 CFR Sec. 4.9
Yes D No L] Yes No.
If you answered "No" to either question 1 or 2, Stopl You do not need to complete the remainder of this form.
However, you must sign the certification at the end of the report.
Part 11 {`Other Government Assistance Provided or Requested ! 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.
DeparlmenUStatell-ocal Agency Name and Address I Type of Assistance J Amount I Expected Uses of the Funds
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
project or activily and
2. any other person who has a financial interest In the project or activity for which the assistance Is sought that exceeds 550,000 or 10 percent of the
a SSa Slance (whichever is lower).
Alphabalical list of all persons with a reporlable financial interest Social Security No. I Type of Participation in Financial Interest fin
in the project or activity (For individuals, give the Iasi name first) or Employee ID No. I Project/Activity I ProjectlActivl ly (S and 1%)
(Note. Use Additional pages if necessary.)
Certification
Warming: If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Title is of the
United States Code. In addition, any person who knowingly and materially violates any required disclosure- of information, Including Intentional non-
dhsclosure, Is subject to civil money penalty net to exceed $10,000 for each violation.
I cerlhty that this information is true and complete.
x
(mmrddlyyyy)
May 23, 2000
Form I1UO.288') (3199)
17-1
Public reporting burden for this collection of information is estimated to average 2.0 hours per response, including the Gine for revievAng Instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and revievnng the Wacuon of Information. This agency rn
not conduct or sponsor, and a person is not required to respond to, a colleclion information unless that collection displays a valid OMB control number.
Privacy Act Statement. Except for Social Security Numbers (SSNs) and Employer Identificahon Numbers (EiNs), the Departme ilof Housing and Urba
Development (HUD) is authonzed to tcnllect an the information required by this form under section 102 of the Department of Housing and Urban
Development Reform Act of 1989. 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 out its responsibilities under Sections 102(b), (c). and (d) of the Department of Housing and Urban
Development Reform Act of 1989, Pub. L. 101.235, approved December 15, 1989. These provisions will help ensure greater accountability and integrity
the provision of certain types of assistance administered by HUD. They will also help ensure that HUD assistance for a spedfie housing project under
Section 102ld) is not more than is necessary to make the project feasible after laking account of olher government assistance. HUD will make available
the public all applicant disclosure reports for five years in the rase of applications for competitive assistance, and for generally three years In the case of
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 avaliable to accordance with the Freedom of Information Act (5 U.S.C. §552) and HUD's
Implemeriling regulations at 24 CFR Pah 15. HUD will use the Information In evaluating individual assistance applications and in performing internal
administrative analyses to assist in the management of specific HUD programs. The informabon will also be used in making the datenminabon under
Section 102(dy whether HUD assistance for a specific housing project is more than is necessary to make the project feaslble cher taking account of othe
government assistance. You must provide all the required information. Failure to provide any required information may delay the processing of your
application, and may result in sanctions and penalties, including imposl8on of the administrative and civil money penalties specified under 24 CFR §4.38
Note: This form only covers assistance made available by the Department. States and units of general focal government fhal Cary out responsibilities
under Sections 102(b) and (c) of the Reform Act must develop their own 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;
(21 You are updating a prior report as discussed below; or
(3) You are submitting an application for assistance to an entity other
than HUD, a State or local government if the application is required
by statute or regulabon to be submitted to HUD for approval or for
any other purpose.
IB. Update reports (filed by "Recipients" of HUD Assistance):
General. All recipients of covered assistance must submit update
reports to the Department to reflect substantial changes to the initial
applicant disclosure reports
Line -by -Line Instructions.
ApplicantlRecl plant Information,
All applicants for HUD competitive assistance, must complete the
information required in blocks 1-5 of form HUD -2880:
1 Enter the full name, address, city. State, zip code, and telephone
numb -or (including area code) of the applicanllrecipient. Where the
applicant/recipient is an individual, the last name, first name, and
middle initial must be entered,
2. Entry of the applicant/recipient's SSN or EIN, as appropriate, is
optional.
3. Applicants enter the HUD program name underwhich 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 documentation. NDTE: In
the case of assistance that is piovided pursuant to contract over a
period of lime (such as projecbbased assistance under section B of
the United Stales Housing Act of 1937), the amount of assistance to
be reported includes all amounts that. are 10 be provided over the term
of the contract, irrespective of when they are to be received.
S. Applicants enter the 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•assisled project or activity to which the update
report relates. The most appropriate government identifying number
must be used (e.g.. RFP No.: IFB No.; grant announcement No.; or
contract, grant, or loan No.) Include prefixes.
Part 1. Threshold Determinations - Applicants Only
Pail I contains information to help the applicant determino whether the
remainder of the form must be completed. Recipients filing Update
Reports should not complete this Part.
If the answer to effhor questions 1 or 2 Is No, the applicant meed not
complete Parts II and III of the report, but must sign the carlificallon at
the and 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 riling update
reports, Applicants and recipients must report any other government
assistance involved in the project or activity for which assistance is
sought. Applicants and recipients must report any other government
assistance involved in the project or activity. Other government
assistance is darned in note 4 on the last page. For purposes of this
definition, other government assistance is expected to he made
available 11, based on an assessment of all the circumst—ces
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 bolore the
request, but that has continuing vitality at the time of the request.
Examples of this latter category include tax credits that provide for a
number of years of tax, henefits, and grant assistance that continues tc
benefit the project at the time of the assistance request.
The following information must be provided:
1. Enter the name and address, city, State, and tip code of the
government agency making the assistance available.
2. Slate the typ . of other government assistance (e.g., loan, grant,
loan insurance).
3. Enter the dollar amount of the other government assistance that is,
or is expected to be, made available with respect to the project or
acl vilies for which the HUD assistance is sought (applicants) or
has been provided (recipients).
4. Uses of funds. Each reportable use of funds must clearly identity
the purpose to which they are to be put. Reasonable aggregaSione
may be used, such as'tutal structure' to include a number of
structural costs, sucil as roof, elevators, exlanor masonry, ale.
D. Non -Government Assislance. Note that tiro applicant and recipient
disclosure report must specify all expected sources and uses of funds
both from HUD and Any other source - that have baert of ere to be.
made available for tho proJecl or activity. Non-government sources of
- - - - -- Form HUD -7890 (3198