HUD 40076-RHED Checklist for Forms and Certifications

Appendix A
Checklist of Forms and Certifications
Page Number
Transmittal Letter
Checklist and Submission Table of Contents
Standard Form for Application for Federal Assistance (SF-424)
Federal Assistance Funding Matrix (HUD-424-M)
Assurances - Non-Construction Program (SF-424-B)
Assurances - Construction Program (SF-424-D)
Statement of Work, including summary and responses to factors for
award
Budget in support of Rating Factor 3 (HUD-424-CB)
Documentation of Funds/In-Kind Services pledged in support of Rating
Factor 4
Required Certifications (signed)
Certification for a Drug-Free Workplace
(HUD-50070)
Certification of Payments to Influence Federal Transac
tions (HUD-50071) (see 24 CFR part 87, Appendix A)
Disclosure of Lobbying Activities (SF-LLL)
(If required, see 24 CFR part 87, Appendix B)
Applicant/Recipient Disclosure/Update Report
(HUD-2880)
Certification Regarding Debarment and Suspension
(HUD-2992)
Certification of Consistency with the EZ/EC Strategic Plan
(HUD-2990)

form HUD-40076-RHED (03/2002)

Appendix A (continued)

Acknowledgment of Application Receipt (HUD-2993)
(to be returned to applicant)
For nonprofit organizations, a copy of the IRS ruling providing taxexempt status under section 501 of the IRS Code of 1996, as amended
Documentation that area served is rural area, as defined in this NOFA
The Environmental Review Assurance
Client Comments and Suggestions (HUD-2994)

form HUD-40076-RHED (03/2002)

Environmental Review Assurances
The award of funds under this program is subject to the environmental review requirements of 24 CFR part
50. These requirements only apply to grant-funded projects fully or partially funded by HUD, undertaken by
grantees and all tiers of subgrantees and subcontractors.
When a project is limited to activities described in 24 CFR 50.19, it does not require an environmental review.
All other activities (for example, acquisition of real property, construction and alteration) are subject to an
environmental review. Since the approval of the initial grants in this program must occur prior to the
identification of properties to be treated, as is provided for in 24 CFR 50.3(h), the applicant hereby agrees
that it will assist HUD to comply with 24 CFR part 50, and that the applicant shall:
1. Advise HUD of all projects requiring a review under 24 CFR part 50 prior to their approval and supply
HUD with all available and relevant information necessary for HUD to perform for each property any
environmental review required by 24 CFR part 50;
2.

Carry out mitigating measures required by HUD or select an alternate property or project;

3. Not acquire, rehabilitate, convert, lease, repair or construct property, nor commit or expend HUD or
local funds for these program activities on a HUD-assisted project until HUD has completed an
environmental review to the extent required under 24 CFR 50 and has given notification of its approval
in accordance with 24 CFR 50.3(h)(3); and
4.

Include the above requirements in all subgrants and subcontracts.

Signature of Authorized Certifying Official

Applicant

X
Title

Date

form HUD-40076-RHED (03/2002)