HUD-53151 Resident Involvement Certification

OMB Approval No. 2577-0269

(exp.9/30/2021)

CHOICE NEIGHBORHOODS – PLANNING GRANTS

Resident Involvement Certification

As part of your application for Choice Neighborhoods Planning Grant funding, you, as the executive officer authorized to sign on behalf of your organization, must certify to the following and complete this form. By signing this form, you are stating that to the best of your knowledge and belief, the certification is true and correct.

Lead Applicant:

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

I certify that the Resident Involvement requirement from the Notice of Funding Opportunity under which the agency is applying has been met.

I certify that the information provided on this form and in any accompanying documentation is true and accurate. I acknowledge that making, presenting, or submitting a false, fictitious, or fraudulent statement, representation, or certification may result in criminal, civil, and/or administrative sanctions, including fines, penalties, and imprisonment.

Name of Lead Applicant Executive Officer:

Title:

Signature: Date:

Date of Resident Meeting:

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