4125 a Implementation Schedule

Implementation Schedule

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

Native American Housing Block Grant (NAHBG)

OMB Approval No.
(exp. )

See Instructions and Public Reporting Statement on back.
Submit a separate implementation schedule for each project category.
1. Name of Applicant (as shown in Item 5, Standard Form 424)

2. Application/Grant Number (to be assigned by HUD)

4. Name of Project (as shown on form HUD-4123A, item 4).

5. Effective Date (mm/dd/yyyy)

Original (First submission to HUD)
Date (mm/dd/yyyy)
Pre-Award Submission
Amendment (submitted after grant approval)

3.

Expected Completion Date (mm/dd/yyyy) Expected Closeout Date (mm/dd/yyyy)

6. Environmental Review Status (see instructions on back)

7. Tribal Fiscal Year (mm/dd/yyyy)

9. Schedule.
(List tasks such as environmental assessment, acquisition, etc.) Use Calendar Year (CY) quarters. Fill-in the CY below. See detailed instructions on back.

8. Task List

1st Qtr.

2nd Qtr.

CY _____
3rd Qtr.

4th Qtr.

5th Qtr.

6th Qtr.

CY _____
7th Qtr.

Date (mm/dd/yyyy)
(If exceeds 8th Q tr

8th Qtr.

10. Planned Drawdowns by Quarter
(Enter amounts non-cumulatively)

$

$

$

$

$

$

$

$

$Total

11. Cumulative Drawdown
(If more than one page, enter total on last page only)

$

$

$

$

$

$

$

$

$Total

Previous editions are obsolete

0.00

0.00
page

0.00
of

pages

0.00

0.00

0.00

0.00

0.00

0.00

form HUD-4125A

0.00

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. 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, Office of Information Technology, U.S. Department of Housing and Urban Development,
Washington, D.C. 20410-3600. 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.
This collection of information requires that each eligible applicant submit information to enable HUD to select the best projects for funding during the Recovery Act competition for the NAHBG Program.
The information will be used by HUD to determine whether applications meet minimum screening eligibility requirements and application submission requirements. Applicants provide general information
about the project which is preliminary to the review of the applicant’s response to the criteria for rating the application. The information is essential for HUD in monitoring grants to ensure that grantees
are making proper use of Federal dollars. Responses to the collection are required by Section 105 of the Department of Housing and Urban Development Reform Act (P.L. 101-235) as amended by
the Cranston-Gonzales National Affordable Housing Act of l990. The information requested does not lend itself to confidentiality.
Instructions for Item 6 Environmental Review Status: A HUD environmental review must be completed for any NAHASDA assisted activities not excluded from review under 24 CFR 50.19(c)
before a recipient may acquire, rehabilitate, convert, lease, repair or construct property, or commit HUD or local funds to be used in conjunction with such NAHASDA assisted activities with respect
to the property. An Indian tribe is not required to assume environmental review responsibilities. If an Indian tribe declines to assume the environmental review responsibilities, HUD will perform the
environmental review in accordance with 24 CFR part 50. 24 CFR 1000.20(a).
Applicants enter the environmental review status of the project in Item 6 from the following categories:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Exempt. As described in 24 CFR 58.34.
EIS Required. Finding that project may significantly affect environment or EIS automatically required 24 CFR 58.37.
Under Review. Review underway; findings not yet made.
Not Started. Review not yet begun.
Finding of No Significant Impact. Finding made that request for release of funds for project is not an action which may significantly affect the environment.
Certification. Environmental review completed; certification and request of funds being prepared for submission.
Categorically Excluded. As described in 24 CFR 58.35.
HUD Prepares EA. Indian tribe declines environmental review responsibilities; HUD prepares EA itself. 24 CFR 1000.20(a)
EA Prepared for HUD review. Indian tribe declines environmental review responsibilities; Indian tribe or TDHE prepares EA for HUD review and HUD assumes environmental review
responsibilities. 24 CFR 1000.20(c).

Instructions for Item 9 Schedule: Use Calendar Year (CY) quarters. Fill-in the CY below. If the project begins in May, for example, enter under "1st Qtr", A(April),
,
M(May), J(June). Indicate time period
required to complete each activity, e.g., acquisition, by entering "X" under the months it will begin and end. Draw a horizontal line f rom the first to the second "X". If the completion date will extend beyond
the 8th quarter, enter date in the far right column and attach an explanation.

Previous editions are obsolete

page

i

of

pages

form HUD-4125A