HUD- Choice Neighborhoods Implementation Grants: Application

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Overview

Att 1
Att 2
Att 3

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Sheet 1: Att 1

Choice Neighborhoods

U.S. Department of Housing

OMB Approval No. XXX

Application Data Form

and Urban Development

(exp. XXX)

(exp. 12/31/2003)

Office of Public and Indian Housing

CHOICE NEIGHBORHOODS - IMPLEMENTATION GRANTS: Application Data Form: Cover Sheet

Site/Neighborhood Information

Existing Public and/or Assisted Housing Site Name(s):

Existing Project Number & Contract Number (if any) for the Site(s):

Neighborhood/ Area of town Name:

Applicant/Team Information

PHA Code (if Lead or Co- Applicant is PHA):

Lead Applicant:

Type of Eligible Applicant *

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

Co-Applicant (if any):

Type of Eligible Applicant *

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

Principal Team Member - Housing Implementation Entity:

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

Principal Team Member - People Implementation Entity:

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

Principal Team Member - Neighborhood Implementation Entity:

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

Principal Team Member - Education Implementation Entity:

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

Additional Entity (if there is more than one entity for one of the roles above):

Mailing Address:

Executive Officer Name & Title:

Telephone, Fax, Email:

Primary Contact Name & Title:

Telephone, Fax, Email:

* Eligible applicants are PHAs, local governments, nonprofits, and for-profit developers that apply jointly with a public entity.

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Sheet 2: Att 2

Existing Housing Units at the Targeted Public and/or Assisted Site(s) at the Time of Grant Application
Building Type	Size	Number Occupied	Number Vacant	Total Units	Converted to Non-Dwelling	Demo Planned
Row	0 BR			0
	1 BR			0
	2 BR			0
	3 BR			0
	4 BR			0
	5 BR			0
	6 BR			0
	Total	0	0	0	0	0
Detached/	0 BR			0
Semi-Detached	1 BR			0
	2 BR			0
	3 BR			0
	4 BR			0
	5 BR			0
	6 BR			0
	Total	0	0	0	0	0
Walkup	0 BR			0
	1 BR			0
	2 BR			0
	3 BR			0
	4 BR			0
	5 BR			0
	6 BR			0
	Total	0	0	0	0	0
Elevator	0 BR			0
	1 BR			0
	2 BR			0
	3 BR			0
	4 BR			0
	5 BR			0
	6 BR			0
	Total	0	0	0	0	0
Grand Total		0	0	0	0	0

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Sheet 3: Att 3

Replacement Housing

Rental Units: Replacement Housing - Public Housing-Related

PH Only

PH/LIHTC

PH/Other

Other: [enter type name]

Total

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

Rental Units: Replacement Housing - Multifamily Assisted Housing-Related

Section 202

Section 811

Project-based Section 8

Other: [enter type name]

Total

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

Tenant-based Vouchers: Replacement Housing (subject to HUD approval)

Non-Replacement Housing

Rental Units: Non-Replacement Housing - With Choice Neighborhoods Grant Funding Assistance

Type: [enter type name]

Type: [enter type name]

Type: [enter type name]

Total

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

Rental Units: Non-Replacement Housing - Without Choice Neighborhoods Grant Funding Assistance

LIHTC

CDBG, HOME, or other subsidy

No Income Restrictions

Other: [enter type name]

Total

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

Total

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

Other Units (operating subsidy only, etc)

Type: [enter type name]

Type: [enter type name]

Type: [enter type name]

Type: [enter type name]

Total

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood)

Off-Site (outside neighborhood)

Grand Total (Replacement vs. Non-replacement)

Grand Total (Affordable vs. Market Rate)

On-Site

Off-Site (inside neighborhood

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood

Off-Site (outside neighborhood)

0

0

0

0

0

Grand Total - All Units

Grand Total - All Units

Grand Total (Rental vs. Homeownership)

Grand Total (On-Site vs. Off-Site)

On-Site

Off-Site (inside neighborhood

Off-Site (outside neighborhood)

On-Site

Off-Site (inside neighborhood

Off-Site (outside neighborhood)

0

0

0

0

Grand Total - All Units

0

Grand Total - All Units

0

form HUD-