NOFO 9906 Charts – Grant Applications

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Overview

Leveraging
Public Reporting Burden

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Sheet 1: Leveraging

Chart B: Leveraged Resources
Instructions: Only include the amount of funds that are exclusively allocated for the housing counseling program and that are available during the grant period.
	A	B	C	D	E
	Names of Applicant, Sub-Grantees/Branch Offices Proposed to be Funded	Organization Providing Leveraged Funds/In-Lind Contributions and Point of Contact (with phone number and/or email)	Type of Contribution	Use of Funds - Describe In-Kind Contributions	Amount of Funds from this Resource
1	ABC Intermediary	ABC Intermediary	Program Income	Pre-purchase Counseling	$100,000.00
3	Housing Affiliate	Jane Dough Foundation/ John Dough 213-555-1212 Jane. Dough@janedoughfoundation.com	Cash	Mortgage Delinquency and Default Resolution Counseling	$10,000.00
4	Housing Affiliate	Chase Bank Foundation/ Sally Clams 213-555-1213 Sally.Clams@chasebankfoundation.com	Cash	Pre-purchase Counseling	$7,500.00
5	Housing Resources	City of Siever/ Pat Culver 213-555-1214 Pat.culver@Sievercity.gov	Cash	Pre-purchase Counseling	$12,000.00
6	Housing Resources	ABC Legal Services/Suzy Council 213-555-1215 Suzy.Council@abclegal.com	In-kind	Legal services for housing counseling	$5,000.00
7
8
9
10
11
12
TOTAL					$134,500.00
	A	B	C	D	E
	Names of Applicant, Sub-Grantees/Branch Offices Proposed to be Funded	Organization Providing Leveraged Funds/In-Kind Contributions and Point of Contact (with phone number/ email)	Type of Contribution	Use of Funds - Describe In-Kind Contributions	Amount of Funds from this Resource
1
2
3
4
5
6
7
8
9
10
11
13
TOTAL					$0.00
13
14
15
16
17
18
19
20
21
22
23
24
TOTAL					$0.00
25
26
27
28
29
30
31
32
33
34
35
36
TOTAL					$0.00
37
38
39
40
41
42
43
44
45
46
47
48
TOTAL					$0.00
49
50
51
52
53
54
55
56
57
58
59
60
TOTAL					$0.00
61
62
63
64
65
66
67
68					s
69
70
71
72
TOTAL					$0.00
73
74
75
76
77
78
79
80
81
82
83
84
TOTAL					$0.00
85
86
87
88
89
90
91
92
93
94
95
96
TOTAL					$0.00
97
98
99
100
101
102
103
104
105
106
107
108
TOTAL					$0.00
109
110
111
112
113
114
115
116
117
118
119
120
TOTAL					$0.00
121
122
123
124
125
126
127
128
129
130
131
132
TOTAL					$0.00
133
134
135
136
137
138
139
140
141
142
143
144
TOTAL					$0.00
145
146
147
148
149
150
151
152
153
154
155
156
TOTAL					$0.00
157
158
159
160
161
162
163
164
165
166
167
168
TOTAL					$0.00
169
170
171
172
173
174
175
176
177
178
179
180
TOTAL					$0.00
181
182
183
184
185
186
187
188
189
190
191
192
TOTAL					$0.00
193
194
195
196
197
198
199
200
201
202
203
204
TOTAL					$0.00
205
206
207
208
209
210
211
212
213
214
215
216
TOTAL					$0.00
217
218
219
220
221
222
223
224
225
226
227
228
TOTAL					$0.00
229
230
231
232
233
234
235
236
237
238
239
240
TOTAL					$0.00
241
242
243
244
245
246
247
248
249
250
251
252
TOTAL					$0.00
253
254
255
256
257
258
259
260
261
262
263
264
TOTAL					$0.00
265
266
267
268
269
270
271
272
273
274
275
276
TOTAL					$0.00
277
278
279
280
281
282
283
284
285
286
287
288
TOTAL					$0.00
289
290
291
292
293
294
295
296
297
298
299
300
TOTAL					$0.00
301
302
303
304
305
306
307
308
309
310
311
312
TOTAL					$0.00
313
314
315
316
317
318
319
320
321
322
323
324
TOTAL					$0.00
325
326
327
328
329
330
331
332
333
334
335
336
TOTAL					$0.00
337
338
339
340
341
342
343
344
345
346
347
348
TOTAL					$0.00
349
350
351
352
353
354
355
356
357
358
359
360
TOTAL					$0.00
361
362
363
364
365
366
367
368
369
370
371
372
TOTAL					$0.00
373
374
375
376
377
378
379
380
381
382
383
384
TOTAL					$0.00
385
386
387
388
389
390
391
392
393
394
395
396
TOTAL					$0.00
397
398
399
400
401
402
403
404
405
406
407
408
TOTAL					$0.00
409
410
411
412
413
414
415
416
417
418
419
420
TOTAL					$0.00
421
422
423
424
425
426
427
428
429
430
431
432
TOTAL					$0.00
433
434
435
436
437
438
439
440
441
442
443
444
TOTAL					$0.00
445
446
447
448
449
450
451
452
453
454
455
456
TOTAL					$0.00
457
458
459
460
461
462
463
464
465
466
467
468
TOTAL					$0.00
469
470
471
472
473
474
475
476
477
478
479
480
TOTAL					$0.00
481
482
483
484
485
486
487
488
489
490
491
492
TOTAL					$0.00
493
494
495
496
497
498
499
500
501
502
503
504
TOTAL					$0.00
505
506
507
508
509
510
511
512
513
514
515
516
TOTAL					$0.00
517
518
519
520
521
522
523
524
525
526
527
528
TOTAL					$0.00
529
530
531
532
533
534
535
536
537
538
539
540
TOTAL					$0.00
541
542
543
544
545
546
547
548
549
550
551
552
TOTAL					$0.00
553
554
555
556
557
558
559
560
561
562
563
564
TOTAL					$0.00
565
566
567
568
569
570
571
572
573
574
575
576
TOTAL					$0.00
577
578
579
580
581
582
583
584
585
586
587
588
TOTAL					$0.00
589
590
591
592
593
594
595
596
597
598
599
600
TOTAL					$0.00
601
602
603
604
605
606
607
608
609
610
611
612
TOTAL					$0.00
613
614
615
616
617
618
619
620
621
622
623
624
TOTAL					$0.00
625
626
627
628
629
630
631
632
633
634
635
636
TOTAL					$0.00
637
638
639
640
641
642
643
644
645
646
647
648
TOTAL					$0.00
649
650
651
652
653
654
655
656
657
658
659
660
TOTAL					$0.00
661
662
663
664
665
666
667
668
669
670
671
672
TOTAL					$0.00
673
674
675
676
677
678
679
680
681
682
683
684
TOTAL					$0.00
685
686
687
688
689
690
691
692
693
694
695
696
TOTAL					$0.00
697
698
699
700
701
702
703
704
705
706
707
708
TOTAL					$0.00
709
710
711
712
713
714
715
716
717
718
719
720
TOTAL					$0.00
721
722
723
724
725
726
727
728
729
730
731
732
TOTAL					$0.00
733
734
735
736
737
738
739
740
741
742
743
744
TOTAL					$0.00
745
746
747
748
749
750
751
752
753
754
755
756
TOTAL					$0.00
757
758
759
760
761
762
763
764
765
766
767
768
TOTAL					$0.00
769
770
771
772
773
774
775
776
777
778
779
780
TOTAL					$0.00
781
782
783
784
785
786
787
788
789
790
791
792
TOTAL					$0.00
793
794
795
796
797
798
799
800
801
802
803
804
TOTAL					$0.00

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Sheet 2: Public Reporting Burden

	OMB Number: 2502-0621
	Expiration Date: 06/30/2023
Burden Statement: Public reporting burden for this collection of information is estimated to average 40 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. The information is being collected for a housing counseling agency to participate in HUD’s Housing Counseling program and is required to obtain or retain benefits. No confidentiality is assured. The information will be used by HUD to ensure that Counselors provide guidance and advice to help families and individuals improve their housing conditions and meet the responsibilities of tenancy and homeownership. Counselors also help borrowers avoid predatory lending practices, such as inflated appraisals, unreasonably high interest rates, unaffordable repayment terms, and other conditions that can result in a loss of equity, increased debt, default, and foreclosure. This agency may not collect this information, and you are not required to complete this form, unless it displays a valid OMB control number.