HUD Form 40157 Attachment D CDBG-R 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

CDBG-R 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 Person_________________________ Telephone Number ____________________
Email Address ________________________________ Fax Number___________________________
DUNS NUMBER__________________________
1. Program Income
 Is there any program income on-hand at the time the close out agreement is signed? Yes
If yes, explain:

No

2. CDBG-R Activities
 Are any of the activities ineligible under the Recovery Act, including swimming pools, golf courses,
zoos, aquariums, and casinos or other gambling establishments? Yes
No If yes, explain:


Are any of the activities ineligible under the regular CDBG program or do any of the activities provide
insufficient public benefit per 24 CFR 570.209(b)(3) or 24 CFR 570.482(f)(4)?
Yes
No
If, yes explain:



Do any activities contradict with any of the provisions in President Obama’s Ensuring Responsible
Spending of Recovery Act Funds Memo, including the section on Avoiding Funding of Imprudent
Projects? Yes
No
If yes, explain:



Any unused grant funds cancelled by HUD? Yes

No

If yes, explain:

3. Draw Downs
 Evidence that no more than 10% of the grant amount was spent on administration and planning?
Yes
No
If no, explain:


Evidence that no more than 15% of the grant amount was spent on public services? Yes
explain:



Evidence that at least 70% of the grant amount principally benefitted persons of low- and moderateincome? Yes
No
If no, explain:



Did grantee commingle regular CDBG and CDBG-R funds? Yes



If applicable, did the activities identified meet the public benefit standard underwriting guidelines as
described in 24 CFR 570.209 (a) for entitlements grantees and 24 CFR 570.482(e) for states

No

No

If yes, explain:

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HUD Form 40157 (1/2012)

If no,

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

Yes

No

If no, explain:

4. Activity Eligibility and Meet a National Objective
 Are all activities eligible and does each activity meets a national objective? Yes
explain
5. Audits
 Did the grantee have any open audits prior to CDBG-R allocation? Yes


No

No

, if yes explain

Did the grantee make reviews and audits of subrecipients and/or state recipients? Yes
no explain

6. Monitoring
 Does the grantee have any open monitoring findings? Yes

No

If no,

No

, if

, if yes explain

7. Reporting Systems
 Are all quarterly reports current and accurate in Federal Reporting? Yes

No

, if no explain



Did grantee report on the number of jobs created or retained for each activity carried out? Yes
No , if no explain



Did the grantee report on the name, location, and contact information for the entity that carried out
each activity? Yes
No , if no explain



Does the RAMPS data system indicate that the environmental review is complete? Yes
if no explain



Did the grantee indicate that the grant is complete in Federal Reporting?
explain

Yes

No

No

,

, if no

8. Certifications
 Did the grantee adhere to all certifications regarding the applicable provisions of the CDBG-R Notice?
For example, Buy American provisions, Affirmatively Furthering Fair Housing, Section 3, Lead-based
paint procedures. Yes
No , if no explain

GRANTEE
By:

________________________________

_____________

Grantee Authorized Representative’s Signature

Date

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HUD Form 40157 (1/2012)