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pdfOMB Approval No. 2502-0267
(exp. 07/31/2007)
U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
Supportive Housing for the Elderly Section 202
Application for Capital Advance
Summary Information
Public reporting burden for this collection of information is estimated to average 30 minutes 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 may
not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
HUD
202 Project Number
Use Only
PRAC Number
1. Sponsor's Name(s), Address(es) & Telephone Number (s)
1a. Sponsor is a "grassroots" organization
2. Minority Sponsor Designation. A minority sponsor is one in which at least
51 percent of the board members are minority.
Is this sponsor a minority applicant?
Yes
No
Yes
If "Yes," place the numeric code as shown below in this box
Codes: 2 - Black; 3 - Native American; 4 - Hispanic;
5 - Asian Pacific; 6 - Asian Indian
No
3a. Address of Site
3b.Will project be located within the boundaries of a Federally-designated: (1) Empowerment
Zone, (2) Enterprise Community, (3) Urban Enhanced Enterprise Community, (4) Strategic
Planning Community, or (5) Renewal Community?
(Contact local HUD Office for information on these designated areas.)
Yes
No
If "Yes," please place the appropriate number as shown above in this box
4a. Congressional District
5. Type of Area
6. Capital Advance Amount Requested
Metropolitan
Non-metropolitan
4b. Census Tract
8. Total No. of
8a. Number & Type of Resident Units Proposed
Efficiency
202 Units
10. Type of Project
9. Number of Buildings
$
13. Number of Parking Spaces
8b. Resident Manager's Unit (check appropriate type)
Efficiency
Year Built (yyyy)
11. Type of Building(s)
At Site
Water
Heat
Feet from Site
Water
Sewer
Paving
Gas
Electric
Semi-detached
Detached
Gas
16b. Mixed-Finance or Mixed-Use Project
For Additional Units
Yes
No
No. of Additional Units __________
18. Mark one box
17. Unusual Site Features
None
Cuts
Fill
Erosion
Other (specify)
Two bedroom
14. Check utilities and services not included in the rent and to be paid directly by the tenant.
16a. Community Spaces to be included in Project
15. Off-Site Facilities
One bedroom
Row/Townhouse
Walk-up
Elevator
Electric
Public
$
One bedroom
New Construction
Rehabilitation
Acquisition
12. Number of Stories
7. Project Rental Assistance Contract
Amount Requested
Poor Drainage
Retaining Walls
Rock Foundations
High Water Table
Name, Address & Telephone Number
Consultant
Agent
Authorized
Representative
19. If Sponsor is applying for more than one HUD program from the SuperNOFA, indicate which application(s) contain the forms with original signatures.
Program Name
Form
___________________________________________________________________________________________
___________________________
___________________________________________________________________________________________
___________________________
___________________________________________________________________________________________
___________________________
20. Sponsor's Attorney (name, address & telephone number)
By (Signature of Sponsor's Authorized Representative)
Type in Name
Type in Title
Previous editions are obsolete
Date (mm/dd/yyyy)
form HUD-92015-CA (04/2002)
ref: Handbook 4571.3 Rev-1
File Type | application/pdf |
File Title | 92015-CA |
Subject | 92015-CA |
Author | ELK |
File Modified | 2004-07-15 |
File Created | 2002-07-30 |