HomeMy WebLinkAboutCOR-2000-Request for Capitol Funds - Request for Release of Funds U.S. Department of Housing OMB No.2506-0087(exp.6/3012001)
and C-Ortiflcation and Urban Development
This form is to be used by Responsible Entities and Recipients(as defined in 24 CFR part 58.2)when requesting the release of funds,and requesting the authority
to use such funds, for HUD programs identified by statutes that provide for the assumption of the environmental review responsibility by units of general local
government and States. Public reporting burden for this collection of information is estimated to average 0.6 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.This agency.
may not conduct or sponsor this collection of information,and a person is not required to respond to questions about this requirement,unless the collection request
displays a valid OMB control number.
Part I. Program Description and Request for Release of Funds (to be completed by Responsible Entity)
7 Program Titles) 2 HUD/State identification Number 3 Recipient Identification Number:
(optional)
:........................
4.OMB Catalog Nets): 5.Name&Address of Responsible Entity:
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6 For information about this request,Contact 7.N in &Address of Recipient.(d different from reapers ble entitxx
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8 HUD or State Agency&Office Unit to Receive Request
The recipient(s)of assistance under the program(s)listed above requests the release of funds and removal of erwironmental grant conditions
governing the use of the assistance for the following:
rogram Activity/Project Name 10 Locafion (street,address city,county,&state)
PdJ l u + o 3 f tlWi#t ,J3I d Ave.
7 S' '77 #t}1� rea i...s.
11.Program Activity/Project Description:
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formHUD- 015.15 2/98 r 7 ( )
Part 2. Environmental Certification (to be completed by responsible entity)
With reference to the above Program Activity(ies)/Project(s),I,the undersigned officer of the responsible entity,certify that:
1`The responsible entity has assumed responsibility for and complied with,or will continue to comply with, the National Environmental policy
Act of 1969, as amended; the environmental procedures, permit requirements and statutory obligations of the laws cited in 24 CFR 58.5 and
24 CFR 58.6;and the applicable State and Local laws.
2. After considering the type and degree of environmental effects identified by the environmental review completed for the proposed project
described in Part 1 of this request, I have found that the project aI did �( !did not require the preparation and dissemination of an
of an environmental impact statement.
3. The responsible entity has disseminated and/or published in the manner prescribed by 24 CFR 58.43 and 58.60 a notice to the public in
accordance with 24 CFR 58.70 and as evidenced by the attached copy(copies) or provide evidence of posting and mailing procedure.
4. The dates for all statutory and regulatory time periods for review, comment or other action are in compliance with procedures and
requirements of 24 CFR Part 58.
5. In accordance with 24 CFR Part 58.71(b) the responsible entity will advise the recipient (if different from the responsible entity) of any
special environmental conditions that must be adhered to in carrying out the project-
As the duly designated certifying official of the responsible entity,I also certify that:
6. I am authorized to and do consent to assume the status of federal official under the National Environmental Policy Act of 1969 and each
provision of law designated in the 24 CFR Part 58.5 and 24 CFR Part 58.6 list of NEPA-related authorities insofar as the provisions of these
laws apply to the HUD responsibilities for environmental review, decisionmaking and actions that have been assumed by the responsible
entity.
7. I am authorized to and do accept, on behalf of the recipient personally, the jurisdiction of the federal courts for the enforcement of all these
responsibilities,in my capacity as certifying officer of the responsible entity.
Signature of Certifying Officer of the Responsible Entity: Title of CentiTym r aSC��
le
✓�ti� `/�'W'Y'/'^ Date Signed
X
Address of Certifying Officer:
A W xx-
Part 3. To be completed when the Recipient Is not the Responsible Entity
The recipient agrees to abide by the special conditions,procedures and requirements of the environmental review and to advise the responsible
entity of any proposed change in the scope of the project or any change in environmental conditions in accordance with 24 CFR 58.71(b).
Signature of Authorized Officer of the Recipient: Title of Authorized Officer:
Date Signed
Warning:HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties(18 USC 1001,1010, 1012;31 USC 3729,3802).
form HUD-7015.15.(2/98)
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Attachments
Use this section to provide any additional attachments referenced in the Plans.
Attachments
I. Capital Fund Program Annual Statement
H. Capital Fund 5-Year Action Plan
M. Public Housing Admissions and Occupancy Policy
FY 2000 Annual Plan Page 45
HUD 50075
OMB Approval No:2577-0226
Expires:03/31/2002
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Annual Statement
Capital Fund Program (CFP) Part H: Supporting Table
Development General Description of Major Work Development Total
Number/Name Categories Account Estimated
HA-Wide Activities Number Cost
10-3 Fees&Costs-Advertising 1430 500
10-3 Site Imrpovement-replace gas/water lines 1450 35,000
10-3 Dwelling Structure-Continue Unit 1460 131,466
Renovation on units 30+years old
10-2 Dwelling Structure-gutter replacement 1460 5,000
&deck painting
HA-Wide Wages&Benefits Mod Coord. &ED 1410 8,000
HA-Wide Relocation Costs 1495.1 1,000
HA-Wide Management Improvements-Training 1408 2,000
in Capital Fund Program
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Annual Statement
Capital Fund Program (CFP) Part III: Implementation Schedule
Development All Funds Obligated All Funds Expended
Number/Name (Quarter Ending Date) (Quarter Ending Date)
HA-Wide Activities
HA-Wide 12/2001 3/2002
10-3 12/2001 3/2002
10-2 6/2001 9/2001
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PHA Plan
Table Library
Component 7
Capital Fund Program Annual Statement
Parts I, II,and II
Annual Statement
Capital Fund Program (CFP) Part I: Summary
Capital Fund Grant Number FFY of Grant Approval: 9/( 2000)
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® Original Annual Statement
Line No. Summary by Development Account Total Estimated
Cost
1 Total Non-CGP Funds
2 1406 Operations
3 1408 Management Improvements 2,000
4 1410 Administration 8,000
5 1411 Audit
6 1415 Liquidated Damages
7 1430 Fees and Costs 500
8 1440 Site Acquisition
9 1450 Site Improvement 35,000
10 1460 Dwelling Structures 136,466
11 1465.1 Dwelling E ui ment-Nonex endable
12 1.470 Nondwelling Structures
13 1475 Nondwelling Equipment
14 1485 Demolition
15 1490 Replacement Reserve
16 1492 Moving to Work Demonstration
17 1495.1 Relocation Costs 1,000
18 1498 Mod Used for Development
19 1502 Contingency
20 Amount of Annual Grant Sum of lines 2-19 182,966
21 Amount of line 20 Related to LBP Activities
22 Amount of line 20 Related to Section 504 Com liance
23 1 Amount of line 20 Related to Security
24 Amount of line 20 Related to Energy Conservation
Measures
Table Library
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