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. Key Personnel

2. Partners

1. 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

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

Description of Commitment

Proposed Activities to be Conducted by Partner

Resource and leveraged resource commitment ($ value for services)

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:      

Factor 2 – Need and Extent of the Problem

Housing Costs	Economic Opportunity
Environmental Quality	Fresh Food Access
Transportation Access	Healthy Communities
Socioeconomic Inequity

1. Housing Costs

1. Median Regional Housing Costs Relative to Household Income

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

YEAR

median monthly regional

rental

prices

Median monthly regional household income

ratio: median monthly housing cost/income

Location

regional housing and transportation cost

regional income level

households spending more than 45% of Income

1990

     

     

     

Region-wide

     

     

     

2000

     

     

     

Community 1

     

     

     

2008

     

     

     

Community 2

     

     

     

     

     

     

Community 3

     

     

     

Source:

http://www.hud.gov/sustainability

Source:

http://htaindex.cnt.org/

Date Documented:      

Date Documented:      

2. Environmental Quality

2.1 Urbanized Land per Capita

2.2 Total Miles of Distribution of Water Infrastructure per Population Served

YEAR

urbanized land

(acres)

population of region

urbanized land per capita

year

miles of distribution of water infrastructure

population of region

water distribution service population

miles of water distribution infrastructure per 1000

1990

     

     

1990

     

     

     

2000

     

     

2000

     

     

     

     

     

2008

     

     

     

Source:

http://www.hud.gov/sustainability

Source:

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

Date Documented:      

Date Documented:      

3. Transportation Access

1. Vehicle Miles Traveled per Capita

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

Year

total road mileage (all modes)

vehicle miles traveled

vehicle miles traveled per capita

Years

Automobile

Transit

Walking

Bicycling

trips

% of total

trips

% of total

trips

% of total

trips

% of total

1990

     

     

     

2000

     

     

     

1990

     

     

     

     

     

     

     

     

2009

     

     

     

2000

     

     

     

     

     

     

     

     

2008

     

     

     

     

     

     

     

     

Source:

http://www.hud.gov/sustainability

Source:

http://www.hud.gov/sustainability

Date Documented:      

Date Documented:      

4. 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

     

     

     

     

4.2 School Lunch Eligibility

County Name

2009 School Lunch Eligibility (pct.)

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
Note: include a regional figure if the data is available. if raw numbers of eligible students are available by county, please include them as well.

Date Documented:      

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. List specific locations (e.g. company HQ) rather than a regionally dispersed employers (e.g. school district))
employment center (name / SIC designation)		# of employees	number of housing units within 2 miles of the employment center	percentage of housing near employment center that is subsidized
1	     	     	     	     
2	     	     	     	     
3	     	     	     	     
4	     	     	     	     
5	     	     	     	     
Source: Local Economic Development Departments, Offices of Housing.
TOTAL REGIONAL WORKFORCE:     			Date Documented:     

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:      

Healthy Communities

7.1 Prevalence of Preventable Disease

County:      

Race and Ethnicity

White

American Indian or Alaska Native

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

Asian

Two or More Races

Indicator

Incidence Per 1000

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:      

County:      

Race and Ethnicity

White

American Indian or Alaska Native

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

Asian

Two or More Races

Indicator

Incidence Per 1000

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

Date Documented:      

County:      

Race and Ethnicity

White

American Indian or Alaska Native

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

Asian

Two or More Races

Indicator

Incidence Per 1000

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

Date Documented:      

County:      
Race and Ethnicity	White	American Indian or Alaska Native	Black or African American	Hispanic or Latino	Native Hawaiian or Other Pacific Islander	Asian	Two or More Races
Indicator	Incidence Per 1000	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
Date Documented:      
County:      
Race and Ethnicity	White	American Indian or Alaska Native	Black or African American	Hispanic or Latino	Native Hawaiian or Other Pacific Islander	Asian	Two or More Races
Indicator	Incidence Per 1000	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
Date Documented:      
County:      
Race and Ethnicity	White	American Indian or Alaska Native	Black or African American	Hispanic or Latino	Native Hawaiian or Other Pacific Islander	Asian	Two or More Races
Indicator	Incidence Per 1000	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
Date Documented:      

Factor 4 – Leveraging Resources
Name and contact information of the organization or entity that will partner with applicant			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
Name:      			     	     	     		     
Type of Organization      
Partner Receiving Award Grant Funds:	Yes No
Address:      
City:      
State:      
Zip Code:      
Phone Number:      
Fax Number:      
Email:      
Name:      			     	     		     	     
Type of Organization      
Partner Receiving Award Grant Funds:		Yes No
Address:      
City:      
State:      
Zip Code:      
Phone Number:      
Fax Number:      
Email:      
Name:      			     	     		     	     
Type of Organization      
Partner Receiving Award Grant Funds:		Yes No
Address:      
City:      
State:      
Zip Code:      
Phone Number:      
Fax Number:      
Email:      
Name:      			     	     		     	     
Type of Organization      
Partner Receiving Award Grant Funds:		Yes No
Address:      
City:      
State:      
Zip Code:      
Phone Number:      
Fax Number:      
Email:      
Name:      			     	     		     	     
Type of Organization      
Partner Receiving Award Grant Funds:		Yes No
Address:      
City:      
State:      
Zip Code:      
Phone Number:      
Fax Number:      
Email:      
Name:      			     	     		     	     
Type of Organization      
Partner Receiving Award Grant Funds:		Yes No
Address:      
City:      
State:      
Zip Code:      
Phone Number:      
Fax Number:      
Email:      
			Total Amount	     	     		     

Factor 5 – Achieving Results and Program Evaluation
Regional planning issue to be addressed	Long-term outcome desired	Livability Principle(s) addressed	Applicable Activity in the Regional Plan for Sustainable Development	Anticipated Progress and Forms of Measurement
				6 months	12 months	24 months	36 months
Disconnection between low- and moderate-income workforce to employment options (NOTE: this is a sample – if this outcome is pertinent to your application, please include it below.)	Increased proportion of low- and very-low income households within to  transit commute of major employment centers (sample)	Providing More Transportation Choices; Increasing Economic Competitiveness	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. Measure: letters of commitment from participating agencies (sample)	Working group convenes and completes 4-month charge to develop agreements to incorporate into the RPSD. Measure: meeting summaries; strategic plan outline, appropriate research (sample)	Draft plan submitted to leadership Team for review and incorporation into the RPSD; review process commenced. Measure: draft plan, summary of public plan reviews, analysis of comments (sample)	Draft transportation plan, ratified as component of RSPD. Measure: RPSD, coverage of plan adaption, survey of implementing agencies to ascertain their respective operating plans (sample)
	Increased proportion of low- and very-low income households within to  transit commute of major employment centers
     	Creation of shared elements in regional transportation, housing, water, and air quality plans tied to local comprehensive land use.	     	     	     	     	     	     
     	Reduced social land economic disparities for the low-income and communities of color within the target region.	     	     	     	     	     	     
     	Decrease in per capita VMT and transportation-related emissions for the region.	     	     	     	     	     	     
     	Decrease in combined housing and transportation costs per household.	     	     	     	     	     	     
     	Increased participation and decision-making in developing and implementing a long range vision for the region by populations traditionally marginalized in public planning processes.	     	     	     	     	     	     
     	Increased proportion of low-and very-low income households within to transit commute or major employment centers.	     	     	     	     	     	     

HUD Form 2010 (6-2010)