HUD Form 2010 Rating Factor

U.S. Department of Housing and Urban Development
Office of Sustainable Housing and Communities

Rating Factor – Form

OMB Approval Number: 2501-0024
Expiration Date: 12/31/2010

Factor I – Capacity of the Applicant and Relevant Organizational Experience
1.
2.
1.

Key Personnel
Partners
Key Personnel

Name and Position Title (please include the organization position
titles in addition to those shown)

Percent of Time
Proposed for this
Grant

Percent of Time to be
spent on other HUD grants

Percent of time to be spent
on other activities

Description of
Commitment

Proposed Activities to be
Conducted by Partner

Resource and leveraged
resource commitment ($
value for services)

1.1 Overall Project Director
Name:
Organization Position Title:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
1.2 Day-to-Day Program Manager
Name:
Organization Position Title:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
1.3 Other
Name:
Organization Position Title:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
2.
Partners
Name and contact information

Name:
Organization Position Title:
Sub-recipient:
Yes
No
Address:
Phone Number:
Email:
Name:
Organization Position Title:
Sub-recipient:
Yes
No
Address:
Phone Number:
Email:
Name:
Organization Position Title:
Sub-recipient:
Yes
No
Address:
Phone Number:
Email:
Name:
Organization Position Title:
Sub-recipient:
Yes
No
Address:
Phone Number:
Email:

HUD Form 2010 (6-2010)

U.S. Department of Housing and Urban Development
Office of Sustainable Housing and Communities

Rating Factor – Form

OMB Approval Number: 2501-0024
Expiration Date: 12/31/2010

Factor 2 – Need and Extent of the Problem
1.
2.
3.
4.
1.

Housing Costs
Environmental Quality
Transportation Access
Socioeconomic Inequity

5.
6.
7.

Economic Opportunity
Fresh Food Access
Healthy Communities

Housing Costs

1.1

Median Regional Housing Prices Relative to Household
Income
median
regional
rental
prices

YEAR

median
regional
household
income

1.2 Proportion of Regional Population Paying More than 45% of Income to
Combined Housing and Transportation Costs

rent to income
ratio

median
housing to
income
ratio

Location

1990

Region-wide

2000

Community 1

2008

Community 2

regional housing
and transportation
cost

regional
income level

households
spending
more than
45% of
Income

Community 3
http://www.hud.gov/sustainability

Source:

Source:

2.

http://htaindex.cnt.org/

Field Code Changed

Date Documented:

Date Documented:

Environmental Quality

2.1 Urbanized Land per Capita
YEAR

urbanized
land
(acres)

2.2 Total Miles of Distribution of Water Infrastructure per Population Served
population
of region

urbanized
land per
capita

year

1990
2000

population of
region

miles of
distribution of
water
infrastructure

water
distribution
service
population

miles of
water
distribution
infrastructure
per 1000

1990
2000
2008

Source:

http://www.hud.gov/sustainability

Source:

Date Documented:
3.
3.1
Year

Public Utilities; http://www.hud.gov/sustainability

Field Code Changed

Date Documented:

Field Code Changed

Transportation Access
3.2

Vehicle Miles Traveled per Capita
total road
mileage (all
modes)

vehicle
miles
traveled

vehicle miles
traveled per
capita

Portion of Regional Trips:
Automobile, Transit, Walking, and Bicycling
Automobile
Transit
Walking

Bicycling

Years
trips

% of
total

1990
2000

1990

2009

2000

trips

% of
total

trips

% of
total

trips

% of
total

2008

http://www.hud.gov/sustainability

Source:

Date Documented:

4.

Source:

http://www.hud.gov/sustainability

Field Code Changed
Field Code Changed

Date Documented:

Socioeconomic Inequity

4.1 Segregation by County
County Name

2009 Black/White
Dissimilarity Index

2009 Asian/White
Dissimilarity Index

2009 Hispanic/White
Dissimilarity Index

1
2
3
4
5

HUD Form 2010 (6-2010)

U.S. Department of Housing and Urban Development
Office of Sustainable Housing and Communities

Rating Factor – Form

OMB Approval Number: 2501-0024
Expiration Date: 12/31/2010

4.2 School Lunch Eligibility
County Name

2009 School Lunch Eligibility

1
2
3
4
5
Source: http://www.s4.brown.edu/cen2000/SchoolPop/SPDownload.html; http://www.nces.ed.gov/ ; instructions at http://www.hud.gov/sustainability
Date Documented:

5.

Economic Opportunity

5.1 Availability of Subsidized Affordable Housing near Employment Centers
(Note: please list the five largest employers and the housing conditions related to it)
employment center (name / SIC
designation)
1

# of employees

number of housing units within 2 miles of
the employment center

% of housing near employment center that is
subsidized

2
3
4
5
Source: Local Economic Development Departments, Offices
of Housing.
Date Documented:

6.

Fresh Food Access

6.1 Proximity of Full-Service Grocery Stores for Low-Income and Auto-Dependent Households
% households with no
car and > 1 mile to
grocery store

% low-income people
living > 1 mi to grocery
store

Regional Average
County 1
County 2
County 3
County 4
County 5
Source : http://www.ers.usda.gov/foodatlas/
Date Documented:

7.

Healthy Communities

7.1 Prevalence of Preventable Disease
County:
Race:
Indicator

White

Native
American

African American

Hispanic

Asian American/
Pacific Islander

Other

Incidence
Per 1000

Incidence
Per 1000

Incidence
Per 1000

Incidence
Per 1000

Incidence
Per 1000

Incidence
Per 1000

Asthma hospitalization
Childhood Obesity
Diabetes
Heart Disease
Lead Poisoning
Low birth weight

Source : County and State Health Departments also http://www.communityhealth.hhs.gov
Date Documented:

HUD Form 2010 (6-2010)

Field Code Changed

U.S. Department of Housing and Urban Development
Office of Sustainable Housing and Communities

Rating Factor – Form

OMB Approval Number: 2501-0024
Expiration Date: 12/31/2010

County:
Race:

White
Indicator

Native
American

Incidence
Per 1000

Incidence
Per 1000

African American
Incidence
Per 1000

Hispanic
Incidence
Per 1000

Asian American/
Pacific Islander

Other

Incidence
Per 1000

Incidence
Per 1000

Asthma hospitalization
Childhood Obesity
Diabetes
Heart Disease
Lead Poisoning
Low birth weight

Source : County and State Health Departments
Date Documented:
County:
Race:
Indicator

White

Native
American

Incidence
Per 1000

Incidence
Per 1000

African American
Incidence
Per 1000

Hispanic
Incidence
Per 1000

Asian American/
Pacific Islander

Other

Incidence
Per 1000

Incidence
Per 1000

Asthma hospitalization
Childhood Obesity
Diabetes
Heart Disease
Lead Poisoning
Low birth weight

Source : County and State Health Departments
Date Documented:
County:
Race:
Indicator

White

Native
American

Incidence
Per 1000

Incidence
Per 1000

African American
Incidence
Per 1000

Hispanic
Incidence
Per 1000

Asian American/
Pacific Islander
Incidence
Per 1000

Other
Incidence
Per 1000

Asthma hospitalization
Childhood Obesity
Diabetes
Heart Disease
Lead Poisoning
Low birth weight

Source : County and State Health Departments
Date Documented:

HUD Form 2010 (6-2010)

U.S. Department of Housing and Urban Development
Office of Sustainable Housing and Communities

Rating Factor – Form

OMB Approval Number: 2501-0024
Expiration Date: 12/31/2010

Factor 4 – Leveraging Resources
Name and contact information of the organization or entity that
will partner with applicant

Name:
Type of Organization
Partner Receiving Award Grant Funds:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
Name:
Type of Organization
Partner Receiving Award Grant Funds:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
Name:
Type of Organization
Partner Receiving Award Grant Funds:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
Name:
Type of Organization
Partner Receiving Award Grant Funds:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
Name:
Type of Organization
Partner Receiving Award Grant Funds:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:
Name:
Type of Organization
Partner Receiving Award Grant Funds:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email:

Yes

Work To Be
Accomplished In
Support of the
Program

Value of In-Kind or
Cash Match
Contribution*

Additional
Leveraged Funds
Contribution

Total of Match and
Leveraged
Contributions

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Total Amount
HUD Form 2010 (6-2010)

U.S. Department of Housing and Urban Development
Office of Sustainable Housing and Communities

Rating Factor – Form

OMB Approval Number: 2501-0024
Expiration Date: 12/31/2010

Factor 5 – Achieving Results and Program Evaluation
Regional planning
issue to be
addressed
Disconnection
between low- and
moderate-income
workforce to
employment
options (sample)

Long-term outcome
desired
a. Increased proportion of
low- and very-low
income households within
to transit commute of
major employment
centers (sample)

Livability
Principle(s)
addressed
Providing More
Transportation
Choices; Increasing
Economic
Competitiveness

HUD goals
addressed
Strengthen
Communities.
(2) Enhance
sustainability of
communities by
expanding
economic
opportunities.

Applicable
Activity in the
Regional Plan for
Sustainable
Development

Anticipated 6month progress

Measure of
progress

Anticipated 12month progress

Measure of
progress

Anticipated 24month progress

Measure of
progress

Workforce
Transportation
2020 plan that
cements agreements
between major
employers and
regional transit
agency (sample)

Identify potential
long term
employers willing
to participate in
program; secure
participation of
transit agency
(sample)

Letters of
commitment from
participating
agencies

Convene working
group that has 4month charge to
develop
agreements to
incorporate into
the RPSD (sample)

Summaries of
meetings;
strategic plan
outline

Draft plan
submitted to
leadership Team
for review and
incorporation into
the RPSD – review
process
commenced
(sample)

Draft plan,
ratification by
RPSD

b. Creation of shared
elements in regional
transportation, housing,
water, and air quality
plans tied to local
comprehensive land use.
c. Reduced social land
economic disparities for
the low-income and
communities of color
within the target region.
d. Decrease in per capita
VMT and transportationrelated emissions for the
region.
e. Decrease in combined
housing and
transportation costs per
household.
f. Increased participation
and decision-making in
developing and
implementing a long
range vision for the
region by populations
traditionally
marginalized in public
planning processes.

g. Increased proportion of
low-and very-low
income households within
to transit commute or
major employment
centers.

HUD Form 2010 (6-2010)