HUD Form 40153 Attachment D State CDBG Closeout Checklist

U.S. Department of Housing and Urban Development
Community Planning and Development
OMB Approval No. 2506-0193 (exp 1/31/2015)

Attachment: D

State CDBG Closeout Checklist
For the purposes of expediting the grant closeout process, HUD asks applicants to submit the following
checklist.

Grantee Name ___________________________ Grant Number ___________________________
Official Contact Name _____________________ DUNS Number __________________________
Email Address ___________________________ Fax Number_____________________________
Telephone Number _______________________

1. Criteria for Closeout
1. Regarding the grant to be closed out, the State disbursed all funds to UGLGs as stipulated in the MOD
Yes
No
if no, explain:
2. Pursuant to statutory requirements of the HCDA of 1974 (as amended), the State
(i)

Carried out all of its certifications
Yes
No
if no, explain:

(ii)

Ensured that all CDBG-funded activities were eligible and met a national objective
Yes
No
if no, explain:

(iii)

Monitored UGLGs to determine whether applicable performance criteria were met
Yes
No
if no, explain:

3. As part of the financial review, the state confirmed that:
(i)

15% public services cap was not exceeded
Yes
No
if no, explain:

(ii)

20% planning and administration cap was not exceeded
Yes
No
if no, explain:

(iii)

Administrative costs and technical assistance do not exceed the 3% combined threshold for CDBG funds
received after January 23, 2004 (or regulatory amounts for grants received before January 23, 2004)
Yes
No
if no, explain:

(iv)

The state has met the required match for administration
Yes
No
if no, explain:

4. With regard to audits and monitoring of the State CDBG program
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HUD Form 40153 (1/2012)

U.S. Department of Housing and Urban Development
Community Planning and Development
OMB Approval No. 2506-0193 (exp 1/31/2015)

(i)

No audit findings are outstanding
Yes
No
if no, explain:

(ii)

No monitoring findings are outstanding
Yes
No
if no, explain:

2. Closeout Actions
1. Verify Grants closed out to reconcile records and provide accurate information on the status of State CDBG
funds
(i)

Reviewed grants to be closed out to ascertain that conditions for closeout are met
Yes
No
if no, explain:

(ii)

Provided financial information about grant to be closed out to the CPD Field Office
Yes
No
if no, explain:

Grantee

By:

________________________________

_____________

Authorized Representative’s Signature

Date

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HUD Form 40153 (1/2012)