HUD 92910 Section 202 Demonstration Program for Elderly Housing fo

Section 202 Demonstration
Program for Elderly Housing
for Intergenerational Families

U.S. Department of Housing
and Urban Development

OMB Approval No. 2502-XXXX
(exp.XX/XX/XXXX)

Office of Housing
Federal Housing Commissioner

Public reporting burden for this collection of information is estimated to average 30 minutes 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 collect this information, and you are not required to complete this form, unless it
displays a currently valid OMB control number.
The Demonstration Program for Elderly Housing for Intergenerational Families was created by the Living Equitably: Grandparents
Aiding Children and Youth Act of 2003 or the “Legacy Act of 2003” (Pub. L. 108-186, title II, Dec. 16, 2003, 117 Stat. 2688). The
Department of Housing and Urban Development Appropriations Act, 2006 (Pub. L.109-115, approved Nov. 30, 2005) provides $4
million for a Demonstration Program for Elderly Intergenerational Families pursuant to section 203 of Public Law 108-186. The
Demonstration Program was created to provide assistance for intergenerational dwelling units for intergenerational families in
connection with the supportive housing program under section 202 of the Housing Act of 1959 (12 U.S.C. 1701q). The assistance
shall be provided only to private nonprofit owners of Section 202 projects for use only for expanding the supply of intergenerational
dwelling units. Not less than 2 and not more than 4 projects that are assisted under section 202 of the Housing Act of 1959 (12
U.S.C. 1701q) shall be selected for assistance based on the ability of the applicant to develop and operate intergenerational dwelling
units and national geographical diversity among the projects funded. Response to this information collection is necessary to
participate in the program. No assurance of confidentiality is provided.

Application for Intergenerational Housing Summary Information
HUD Project Number

1.

PRAC Number

Name(s), Address(es), Contact Person, and Telephone Number(s) of Applicant
Yes

1a. Applicant is a “grassroots” organization

No

2.

Minority Applicant Designation: A minority applicant is one in which at least 51 percent of the board
members are minority. Is this applicant a minority applicant?
Yes
No

3.

Location of Site (city & State)
3a. Will the project be located within the boundaries of a Federally-designated: (1) Empowerment
Zone, (2) Enterprise Community, (3) Urban Enhanced Enterprise Community, (4) Strategic Planning
Community, or (5) Renewal Community? (Contact local HUD Office for information on these
designated areas.)
Yes
No
If “Yes”, please indicate all numbers that apply.

4.

Congressional District

5. Census Tract

6.

Amount of Funds Requested $

7.

Project Rental Assistance Contract Amount Requested $

8.

Application Contains:

9.

Type of Construction:

Evidence of site control
New Construction
-1-

Identification of site
Rehabilitation

Acquisition
form HUD-92910 (12/2007)

U.S. Department of Housing
and Urban Development

Section 202 Demonstration
Program for Elderly Housing
for Intergenerational Families

OMB Approval No. 2502-XXXX
(exp.XX/XX/XXXX)

Office of Housing
Federal Housing Commissioner

10.

Year Built

11. Total No. of Units

12.

Number and Type of Units Proposed:

13.

Number of Buildings

14.

Type of Building(s):

15.

Number of Stories

17.

Check Utilities and services not included in the rent and to be paid directly by the tenant.
Electric

18.

Two Bedrooms

Row/Townhouse

Walk-up

Three Bedrooms

Elevator

Four Bedrooms

Semi-Detached

Detached

16. Number of Parking Spaces

Water

Heat

Gas

Off-site Facilities:
Public

At Site

Feet from Site

Water
Sewer
Paving
Gas
Electric
19.

Community Spaces to be included in Project

20.

Mixed-Finance or Mixed-Use Project for Additional Units

21.

No. of Additional Units

22. Unusual Site Features:
Erosion
High Water Table

None
Poor Drainage
Other

Yes

Cuts
Retaining Walls

-2-

No

Fill
Rock Foundations

form HUD-92910 (12/2007)

Section 202 Demonstration
Program for Elderly Housing
for Intergenerational Families

U.S. Department of Housing
and Urban Development

OMB Approval No. 2502-XXXX
(exp.XX/XX/XXXX)

Office of Housing
Federal Housing Commissioner

23.

(Check one box)
Consultant
Authorized Representative
Agent

Name, Address & Telephone Number

24.

Applicant’s Attorney (name, address & telephone number)

25.

By: (Signature of Applicant’s Authorized Representative)

Type in Name

Type in Title

Date (yyy/dd/mm)

-3-

form HUD-92910 (12/2007)