HUD 53001 Actual Modernization Cost Certificate

Actual Modernization
Cost Certificate

U.S. Department of Housing
and Urban Development

OMB Approval No. 2577-0157 (exp. 03/31/2020)

Office of Public and Indian Housing

Capital Fund Program (CFP)
Public reporting burden for this collection of information is estimated to average 2.5 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports
Management Officer, Paperwork Reduction Project (2577-0044 and 0157), Office of Information Technology, U.S. Department of Housing and Urban
Development, Washington, D.C.20410-3600. HUD may not conduct or sponsor, and an applicant is not required to respond to a collection of information unless
it displays a currently valid OMB control number. Do not send this form to the above address. This collection of information requires that each Public
Housing Authority (PHA) submit information to enable HUD to initiate the fiscal closeout process. The information will be used by HUD to determine whether th
e modernization grant is ready to be audited and closed out. The information is essential for audit verification and fiscal close out. Responses to the collection a
re required by regulation. The information requested does not lend itself to confidentiality.

PHA Name:

Modernization Project Number:

The PHA hereby certifies to the Department of Housing and Urban Development as follows:
1. That the total amount of Modernization Cost (herein called the “Actual Modernization Cost”) of the Modernization Grant, is as shown below:

A.

Funds Approved

$

B.

Funds Disbursed

$

C.

Funds Expended (Actual Modernization Cost)

$

D.

Amount to be Recaptured (A–C)

$

E.

Excess of Funds Disbursed (B-C)

$

2. That all modernization work in connection with the Modernization Grant has been completed;
3. That the entire Actual Modernization Cost or liabilities therefor incurred by the PHA have been fully paid;
4. That there are no undischarged mechanics', laborers', contractors', or material-men's liens against such modernization
work on file in any public office where the same should be filed in order to be valid against such modernization work;
5. That the time in which such liens could be filed has expired; and
6. That for any years in which the grantee is subject to the audit requirements of the Single Audit Act, 31 U.S.C. § 7501 et seq., as
amended, the grantee has or will perform an audit in compliance with said requirements.
7. Please mark one:
A. This grant will be included in the PHA’s next fiscal year audit per the requirements of the Single Audit Act.
B. This grant will not be included in the PHA’s next fiscal year audit per the requirements of the Single Audit Act.
I hereby certify all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. WARNING: Anyone who knowingly submits a
false claim, or makes false statements is subject to criminal and civil penalties, including confinement for up to 5 years, fines, and civil penalties. (18 U.S.C. §§ 287, 1001 and 31 U.S.C. §
3729)"

Name & Title of Authorized Signatory (type or print clearly):

Signature of Executive Director (or Authorized Designee):

X

Date:

For HUD Use Only

The Cost Certificate is approved for audit (if box 7A is marked):
Approved for Audit (Director, Office of Public Housing)

X

Date:

The costs shown above agree with HUD verified costs (if box 7A or 7B is marked):
Approved: (Director, Office of Public Housing)

X

Date:

form HUD-53001 (10/96)

Instructions for Preparation of Form HUD-53001
Actual Modernization Cost Certificate

Prepare and submit to the HUD Field Office an original and
one copy of form HUD-53001 for each terminated or completed modernization program under the Capital Fund
Program (CFP).

Heading Instructions:
PHA Name - Enter the name of the Public Housing

Authority (PHA).

Modernization Project Number - Enter the unique 13-digit Mod-

ernization Project Number for the grant for which this form is
being submitted. This number is the same number as on form
HUD-52840-A, ACC Amendment to form HUD-53012, or form
HUD-50075.1, Annual Statement, for the same grant.

Line Instructions:
Line 1A, Funds Approved - For the identified grant, enter the

total Modernization funds currently approved by HUD through a
Modernization ACC Amendment to the Consolidated
Annual Contributions Contract(s).
Line 1B, Funds Disbursed - For the identified grant, enter

the total funds disbursed by HUD. This amount may never
exceed the amount on line 1A.
Line 1C, Funds Expended - For the identified grant, enter the

total funds expended (total cash disbursed) by the PHA. This
amount may never exceed the amount on line 1A.
Line 1D, Amount To Be Recaptured (A minus C) - For the

identified grant, enter the amount to be recaptured by
subtracting line 1C from line 1A.

Line 1E, Excess of Funds Disbursed (B minus C) - For the

identified grant, enter the excess of funds disbursed by subtracting line 1C from line 1B; this is the amount to be
remitted by the PHA to HUD. If line 1C is greater than line
1B, enter the figure in brackets; this is the amount of funds
owed by HUD to the PHA.

form HUD-53001 (10/96)
ref Handbooks 7485.1 &.3