HUD-53152 Choice Neighborhoods Planning Grants Key Eligibility Dat

Choice Neighborhoods

HUD 53152 CN Planning Application Key Eligibility form

OMB: 2577-0269

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Choice Neighborhoods
PLANNING GRANTS
Key Eligibility Data Form

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

OMB Approval No. 2577-0269
(exp. 4/30/2018)

CHOICE NEIGHBORHOODS PLANNING GRANTS APPLICATION INFORMATION
ELIGIBLE NEIGHBORHOOD
Name of Neighborhood
ELIGIBLE APPLICANT
You must provide the following information for the Lead Applicant and, if applicable, the Co-Applicant
Lead Applicant:
Type of Eligible Applicant
(check one)

Public Housing Agency
PHA Code:

Local Government

Tribal Entity

Nonprofit
Mailing Address:
Executive Officer Name & Title:
Telephone:

Fax:

Email:

Fax:

Email:

Primary Contact Name & Title:
Telephone:

Co-Applicant (if any):
Type of Eligible Applicant
(check one)

Public Housing Agency
PHA Code:

Local Government

Tribal Entity

Nonprofit
Mailing Address:
Executive Officer Name & Title:
Telephone:

Fax:

Email:

Fax:

Email:

Primary Contact Name & Title:
Telephone:
Co-Applicant DUNS and EIN/TIN:
If you have selected an outside Planning Coordinator, provide the following information:
Planning Coordinator:
Mailing Address:
Executive Officer Name & Title:
Telephone:

Fax:

Email:

Fax:

Email:

Primary Contact Name & Title:
Telephone:

HUD form 53152 (3/2011)

CHOICE NEIGHBORHOODS- Key Eligibility Data Form

ELIGIBLE TARGET HOUSING
Your application must focus on severely distressed public and/or HUD-assisted housing. See section
I.A.3 for defintions of "public housing," "assisted housing," and "severely distressed housing."
Provide the following information for each target housing project. List each site separately.

Project #1
Project Name:
Type of Eligible Housing
(check one)
Public Housing (section 9)
Project-based section 8
Project-based vouchers
If Public Housing

section 202
section 811
section 221(d)(3)

section 236
Indian Housing

PIC AMP Number:
"old" Project Number:

If Assisted Housing Contract Number:
REMS Number:
If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)

Unit Information as of Application Date
Total Number of Units in Project
Number of Public and/or Assisted Units in Project
Project #2 (if applicable)
Project Name:
Type of Eligible Housing
(check one)
Public Housing (section 9)
Project-based section 8
Project-based vouchers
If Public Housing

Number Occupied
Number Vacant

section 202
section 811
section 221(d)(3)

section 236
Indian Housing

PIC AMP Number:
"old" Project Number:

If Assisted Housing Contract Number:
REMS Number:
If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)

Unit Information as of Application Date
Total Number of Units in Project
Number of Public and/or Assisted Units in Project

Number Occupied
Number Vacant

HUD Form 53152 (3/2011)

Project #3 (if aplicable)
Project Name:
Type of Eligible Housing
(check one)
Public Housing (section 9)
Project-based section 8
Project-based vouchers
If Public Housing

section 202
section 811
section 221(d)(3)

section 236
Indian Housing

PIC AMP Number:
"old" Project Number:

If Assisted Housing Contract Number:
REMS Number:
If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)

Unit Information as of Application Date
Total Number of Units in Project
Number of Public and/or Assisted Units in Project
Project #4 (if applicable)
Project Name:
Type of Eligible Housing
(check one)
Public Housing (section 9)
Project-based section 8
Project-based vouchers
If Public Housing

Number Occupied
Number Vacant

section 202
section 811
section 221(d)(3)

section 236
Indian Housing

PIC AMP Number:
"old" Project Number:

If Assisted Housing Contract Number:
REMS Number:
If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)

Unit Information as of Application Date
Total Number of Units in Project
Number of Public and/or Assisted Units in Project

Number Occupied
Number Vacant

HUD Form 53152 (3/2011)


File Typeapplication/pdf
File TitleHUD 53152 CN Planning Application Key Eligibility form.xlsx
AuthorH15953
File Modified2018-01-31
File Created2018-01-31

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