Form HUD 424-B HUD 424-B Applicant and Recipient Assurances and Certifications

Applicant and Recipient
Assurances and Certifications

OMB Number: 2510-0017
Expiration Date: 1/31/2026

U.S. Department of Housing
and Urban Development

Instructions for the HUD 424-B Assurances and Certifications
As part of your application for HUD funding, you, as the official authorized to sign on behalf of your organization or as an individual,
must provide the following assurances and certifications. The Responsible Civil Rights Official has specified this form for use for
purposes of general compliance with 24 CFR §§ 1.5, 3.115, 8.50, and 146.25, as applicable. The Responsible Civil Rights Official
may require specific civil rights assurances to be furnished consistent with those authorities and will specify the form on which such
assurances must be made. A failure to furnish or comply with the civil rights assurances contained in this form may result in the
procedures to effect compliance at 24 CFR §§ 1.8, 3.115, 8.57, or 146.39.
By submitting this form, you are stating that all assertions made in this form are true, accurate, and correct.
As the duly representative of the applicant, I certify that the
applicant: [Insert below the Name and title of the Authorized
Representative, name of Organization and the date of
signature]:
*Authorized Representative Name:
*Title:
*Applicant/Recipient Organization:
1. Has the legal authority to apply for Federal assistance,
has the institutional, managerial and financial capability
(including funds to pay the non-Federal share of program
costs) to plan, manage and complete the program as
described in the application and the governing body has duly
authorized the submission of the application, including these
assurances and certifications, and authorized me as the
official representative of the application to act in connection
with the application and to provide any additional information
as may be required.
2. Will administer the grant in compliance with Title VI of
the Civil Rights Act of 1964 (42 U.S.C 2000(d)) and
implementing regulations (24 CFR part 1), which provide that
no person in the United States shall, on the grounds of race,
color or national origin, be excluded from participation in, be
denied the benefits of, or otherwise be subject to
discrimination under any program or activity that receives
Federal financial assistance OR if the applicant is a
Federally recognized Indian tribe or its tribally designated
housing entity, is subject to the Indian Civil Rights Act (25
U.S.C. 1301-1303).
3. Will administer the grant in compliance with Section 504
of the Rehabilitation Act of 1973 (29 U.S.C. 794), as
amended, and implementing regulations at 24 CFR part 8,
the American Disabilities Act (42 U.S.C. §§ 12101 et.seq.),
and implementing regulations at 28 CFR part 35 or 36, as
applicable, and the Age Discrimination Act of 1975 (42
U.S.C. 6101-07) as amended, and implementing regulations
at 24 CFR part 146 which together provide that no person in
the United States shall, on the grounds of disability or age,
be excluded from participation in, be denied the benefits of,
or otherwise be subjected to discrimination under any
program or activity that receives Federal financial
assistance; except if the grant program authorizes or limits
participation to designated populations, then the applicant
will comply with the nondiscrimination requirements within
the designated population.
4. Will comply with the Fair Housing Act (42 U.S.C. 360119), as amended, and the implementing regulations at 24
CFR part 100, which prohibit discrimination in housing on the
basis of race, color, religion sex (including gender identity
and sexual orientation), disability, familial status, or national
origin and will affirmatively further fair housing; except an

applicant which is an Indian tribe or its instrumentality which
is excluded by statute from coverage does not make this
certification; and further except if the grant program
authorizes or limits participation to designated populations,
then the applicant will comply with the nondiscrimination
requirements within the designated population.
5. Will comply with all applicable Federal nondiscrimination
requirements, including those listed at 24 CFR §§ 5.105(a)
and 5.106 as applicable.
6. Will comply with the acquisition and relocation
requirements of the Uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970, as amended (42
U.S.C. 4601) and implementing regulations at 49 CFR part
24 and, as applicable, Section 104(d) of the Housing and
Community Development Act of 1974 (42 U.S.C. 5304(d))
and implementing regulations at 24 CFR part 42, subpart A.
7. Will comply with the environmental requirements of the
National Environmental Policy Act (42 U.S.C. 4321 et.seq.)
and related Federal authorities prior to the commitment or
expenditure of funds for property.
8. That no Federal appropriated funds have been paid, or
will be paid, by or on behalf of the applicant, to any person
for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, and officer
or employee of Congress, or an employee of a Member of
Congress, in connection with the awarding of this Federal
grant or its extension, renewal, amendment or modification.
If funds other than Federal appropriated funds have or will
be paid for influencing or attempting to influence the persons
listed above, I shall complete and submit Standard FormLLL, Disclosure Form to Report Lobbying. I certify that I shall
require all subawards at all tiers (including sub-grants and
contracts) to similarly certify and disclose accordingly.
Federally recognized Indian Tribes and tribally designated
housing entities (TDHEs) established by Federallyrecognized Indian tribes as a result of the exercise of the
tribe’s sovereign power are excluded from coverage by the
Byrd Amendment, but State-recognized Indian tribes and
TDHs established under State law are not excluded from the
statute’s coverage.
I/We, the undersigned, certify under penalty of perjury
that the information provided above is true and correct.
WARNING: Anyone who knowingly submits a false claim
or makes a false statement is subject to criminal and/or
civil penalties, including confinement for up to 5 years,
fines, and civil and administrative penalties. (18 U.S.C.
§§287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802).
* Signature:

* Date: (mm/dd/yyyy):

Form HUD 424-B (1/27/2023)

Public Reporting Burden Statement: The public reporting burden for this collection of information is estimated to average 0.5
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. Comments regarding the accuracy of this burden estimate
and any suggestions for reducing this burden can be sent to: U.S. Department of Housing and Urban Development, Office of the
Chief Data Officer, R, 451 7th St SW, Room 4176, Washington, DC 20410-5000. Do not send completed HUD-424B forms to this
address. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the
collection displays a valid OMB control number. The Department of Housing and Urban Development is authorized to collect this
information under the authority cited in the Notice of Funding Opportunity for this grant program. The information collected provides
assurances and certifications for legal requirements related to the administration of this grant program. HUD will use this
information to ensure compliance of its grantees. This information is required to obtain the benefit sought in the grant program.
This information will not be held confidential and may be made available to the public in accordance with the Freedom of Information
Act (5 U.S.C. §552).

Form HUD 424-B (1/27/2023)