Change Worksheet

Distribution of State CDBG Funds

Timeliness Compliance Report Instructions

1. State: State name or abbreviation

2. FY: Fiscal year of the federal appropriation that funds the grant.

3. Grant #: Program grant number e.g. B-11-DC-##0001 where “B” indicates the CDBG program, “11” is the fiscal year, “DC” indicates the allocation for states’ use in nonentitlement areas, “##” is a code identification number for the state, and “0001” is the number of the grant.

4. Date Signed by State: Date the grant agreement was signed by the state. This date marks the beginning of the 15-month period for timely distribution.

5. Timeliness Compliance Date: This is the date 15 months after the date the grant agreement was signed by the state.

6. Grant Amount: The amount of the state’s allocation of CDBG funds for this grant.

7. Admin Deduction: The state may use $100,000 plus up to 3% of the grant for state administration and must match the percentage allowance dollar for dollar. This line shows the actual amount claimed for state administration.

8. TA Deduction: The state may use up to 3% of the grant for technical assistance to local governments, no state match is required. This line shows the actual amount claimed for technical assistance.

9. Total Admin/TA Deduction: This is the total of the previous 2 lines. Note that the percentage allowance for State Administration and for Technical Assistance is a combined allowance for both functions, not a separate allowance for each. The state decides how to allocate the total 3% allowance. The total entered on this line may not exceed $100,000 plus 3% of the grant.

10. Expected Distribution: This equals the Grant Amount less the Total Admin/TA deduction claimed by the state. This is the amount of the annual allocation expected to be available for distribution to its local governments.

11. Adjustments: The state my make certain additional adjustments in the amount of funds it distributes to local governments from its annual allocation. These may include Section 108 loan guarantee repayments and/or a 3% allowance for state administration and technical assistance associated with program income retained by units of local government. Any adjustments claimed on this line must be supported by an attached explanation justifying the adjustment in detail.

12. Available Distribution: This equals the Expected Distribution less Adjustments claimed on the previous line. This is the amount of the annual allocation required to be distributed to the state’s local governments.

13. Amount Obligated & Anncd (at 15 months): This is the amount which the state has actually obligated and announced to its units of general local government as of the 15-month timeliness target date. To be compliant, it should equal the amount of the “Available Distribution” on the previous line. This amount should include only awards from the original grant allocation. Do not include awards from program income or recaptured funds.

14. % Obligated & Anncd (at 15 months): This is the percentage of the “Amount Obligated and Anncd” divided by the “Adjusted Grant Amount”. To be compliant, this entry should equal 100%.

Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The purpose of the data is to safeguard HUD form 40108. While the provision of the SSN is voluntary, HUD uses it as a unique identifier for safeguarding HUD form 40108. This information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law.

HUD Form 40108