Assisted Living Conversion Program (ALCP) and Emergency Capital Repair Program (ECRP)

U.S. Department of Housing
and Urban Development

Certification of Consistency
with the Consolidated Plan

I certify that the proposed activities/projects in the application are consistent with the jurisdiction’s current, approved Consolidated Plan.
(Type or clearly print the following information:)
Applicant Name: ___________________________________________________________________

Project Name: ___________________________________________________________________

Location of the Project:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Name of the Federal
Program to which the
applicant is applying:

___________________________________________________________________

Name of
Certifying Jurisdiction: ___________________________________________________________________
Certifying Official
of the Jurisdiction
Name:

___________________________________________________________________

Title:

___________________________________________________________________

Signature: ___________________________________________________________________

Date: _____________________________________

Page 1 of 1

form HUD-2991 (3/98)