50075.2 Capital Fund Program - Five-Year Action Plan

Capital Fund Program—Five-Year Action Plan

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB No. 2577-0226
Expires 4/30/20011

Part I: Summary
PHA Name/Number
A.

B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.

Locality (City/County & State)

Development Number and
Name

Work Statement
for Year 1
FFY _______

Physical Improvements
Subtotal
Management Improvements
PHA-Wide Non-dwelling
Structures and Equipment
Administration
Other
Operations
Demolition
Development
Capital Fund Financing –
Debt Service
Total CFP Funds
Total Non-CFP Funds
Grand Total

Annual Statement

Work Statement for Year 2
FFY ________________

Original 5-Year Plan
Work Statement for Year 3
FFY ________________

Work Statement for Year 4
FFY ________________

Revision No:
Work Statement for Year 5
FFY _______________

____________________________________________________________________________________________________________________________________________________________________
Page 1 of 6
form HUD-50075.2 (4/2008)

Capital Fund Program—Five-Year Action Plan

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB No. 2577-0226
Expires 4/30/20011

Part I: Summary (Continuation)
PHA Name/Number
Development Number
and Name

Work
Statement for
Year 1
FFY _______

Locality (City/county & State)
Work Statement for Year 2
Work Statement for Year 3
FFY ________________
FFY ________________

Original 5-Year Plan
Revision No:
Work Statement for Year 4
Work Statement for Year 5
FFY ________________
FFY _______________

Annual
Statement

____________________________________________________________________________________________________________________________________________________________________
Page 2 of 6
form HUD-50075.2 (4/2008)

Capital Fund Program—Five-Year Action Plan

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB No. 2577-0226
Expires 4/30/20011

Part II: Supporting Pages – Physical Needs Work Statement(s)
Work
Statement for
Year 1 FFY
______

Work Statement for Year _____________
FFY ________________
Development Number/Name
Quantity
Estimated Cost
General Description of Major Work
Categories

Work Statement for Year: ____________
FFY ______________
Development Number/Name
Quantity
Estimated Cost
General Description of Major Work
Categories

See
Annual
Statement

Subtotal of Estimated Cost

$

Subtotal of Estimated Cost

$

____________________________________________________________________________________________________________________________________________________________________
Page 3 of 6
form HUD-50075.2 (4/2008)

Capital Fund Program—Five-Year Action Plan

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB No. 2577-0226
Expires 4/30/20011

Part II: Supporting Pages – Physical Needs Work Statement(s)
Work
Statement for
Year 1 FFY
______

Work Statement for Year _____________
FFY ________________
Development Number/Name
Quantity
General Description of Major Work Categories

Estimated Cost

Work Statement for Year: ____________
FFY ______________
Development Number/Name
Quantity
General Description of Major Work
Categories

Estimated Cost

See
Annual
Statement

Subtotal of Estimated Cost

$

Subtotal of Estimated Cost

$

____________________________________________________________________________________________________________________________________________________________________
Page 4 of 6
form HUD-50075.2 (4/2008)

Capital Fund Program—Five-Year Action Plan

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB No. 2577-0226
Expires 4/30/20011

Part III: Supporting Pages – Management Needs Work Statement(s)
Work
Statement for
Year 1 FFY
______
See
Annual
Statement

Work Statement for Year ______________
FFY ____________
Development Number/Name
General Description of Major Work Categories

Subtotal of Estimated Cost

Estimated Cost

$

Work Statement for Year: ____________
FFY _____________
Development Number/Name
General Description of Major Work Categories

Subtotal of Estimated Cost

Estimated Cost

$

____________________________________________________________________________________________________________________________________________________________________
Page 5 of 6
form HUD-50075.2 (4/2008)

Capital Fund Program—Five-Year Action Plan

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
OMB No. 2577-0226
Expires 4/30/20011

Part III: Supporting Pages – Management Needs Work Statement(s)
Work
Statement for
Year 1 FFY
______
See
Annual
Statement

Work Statement for Year ______________
FFY ____________
Development Number/Name
Estimated Cost
General Description of Major Work Categories

Subtotal of Estimated Cost

$

Work Statement for Year: ____________
FFY _____________
Development Number/Name
General Description of Major Work Categories

Subtotal of Estimated Cost

Estimated Cost

$

____________________________________________________________________________________________________________________________________________________________________
Page 6 of 6
form HUD-50075.2 (4/2008)