HUD Form 40161 Attachment A Grant Closeout Review/Checklist

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

Attachment A
Date Open:

Grant Closeout Review/Checklist
Date closed:

GRANTEE:
Grant Amount:

GRANT #:

Method of Distribution:
STATUS OF FUNDS:
Budgeted

Expended

Total Budget per Grant Agreement

__________

_________

Program Administration

__________

_________

Program Income (if applicable)

__________

_________

Total Unliquidated obligations:

__________

_________

Required Targets
Specified Limit or Minimum
Minimum Overall benefit%:_____________ Actual _________
Limit on Public services: _____________ Actual _________
Limit on Admin/Planning:______________ Actual _________
Limit on Grantee Admin: _________________ Actual _________
SUBMISSION OF QUARTERLY PROGRESS REPORTS:
Has the grantee submitted the final and complete QPR in DRGR? ____ Yes ____ No
Is the final QPR accurate, complete, and consistent with LOCCS, the Action Plan, and/or approved Action
Plan amendments? ____ Yes ____ No
STATUS OF MONITORING:
Date of last monitoring visit: ____________________________________

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HUD Form 40161 (1/2012)

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

Were there any findings?
____Yes _____No
Have all issued findings been cleared? _____Yes ___No
If applicable, what is the status of the A-133 Audit?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
________________________________________
Grantee Authorized Representative’s Signature

_________________
Date

RECOMMENDATION
The Grant is ready to close_______ Not ready to close______ (explain if not ready to close)
Action recommended:
Prepare and complete the closeout package. Write a standard letter to grantee regarding specific issues or
concerns related to the acceptability/completeness of the QPR, forms or portions thereof that need to be
submitted, or open findings that need to be addressed prior to completion of grant closeout.

_________________________
CPD Director

__________________
Date

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HUD Form 40161 (1/2012)