HUD 53233 Choice Neighborhoods Implementation Grants Application I

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Overview

Applicant Info
Housing Project Info

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Sheet 1: Applicant Info

Choice Neighborhoods	U.S. Department of Housing								OMB Approval No. 2577-0269
IMPLEMENTATION GRANTS	and Urban Development								(exp. 2/28/2011)
Key Eligibility Data Form	Office of Public and Indian Housing
CHOICE NEIGHBORHOODS IMPLEMENTATION GRANTS APPLICATION INFORMATION
ELIGIBLE APPLICANT
You must provide the following information for the Lead Applicant and, if applicable, the Co-Applicant
Lead Applicant:
Type of Eligible Applicant		Public Housing Agency					Local Government
(check one)		PHA Code:
		Nonprofit					For profit developer applying jointly with a public entity
Mailing Address:
Executive Officer Name & Title:
Telephone:			Fax:				Email:
Primary Contact Name & Title:
Telephone:			Fax:				Email:
Co-Applicant (if any):
Type of Eligible Applicant		Public Housing Agency					Local Government
(check one)		PHA Code:
		Nonprofit					For profit developer applying jointly with a public entity
Mailing Address:
Executive Officer Name & Title:
Telephone:			Fax:				Email:
Primary Contact Name & Title:
Telephone:			Fax:				Email:
PRINCIPAL TEAM MEMBERS
Housing Implementation Entity:
Mailing Address:
Executive Officer Name & Title:
Telephone:			Fax:				Email:
People Implementation Entity:
Mailing Address:
Executive Officer Name & Title:
Telephone:			Fax:				Email:
Education Implementation Entity:
Mailing Address:
Executive Officer Name & Title:
Telephone:			Fax:				Email:
Neighborhood Implementation Entity:
Mailing Address:
Executive Officer Name & Title:
Telephone:			Fax:				Email:
								HUD Form 53233 (3/2011)

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Sheet 2: Housing Project Info

CHOICE NEIGHBORHOODS- Key Eligibility Data Form
ELIGIBLE TARGET HOUSING
Your application must focus on severely distressed public and/or HUD-assisted housing. See section I.C for defintions of "public housing," "assisted housing," and "severely distressed housing."
Provide the following information for each target housing project. List each site separately.
Project #1
Project Name:
Type of Eligible Housing
(check one)			Public Housing (section 9)			section 811
			Project-based section 8			section 221(d)(3)
			section 202			section 236
	If Public Housing		PIC AMP Number:
			"old" Project Number:
	If Assisted Housing		Contract Number:
			REMS Number:
			If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)
Unit Information as of Application Date
			Total Number of Units in Project					Number Occupied
			Number of Public and/or Assisted Units in Project					Number Vacant
Project #2 (if applicable)
Project Name:
Type of Eligible Housing
(check one)			Public Housing (section 9)			section 811
			Project-based section 8			section 221(d)(3)
			section 202			section 236
	If Public Housing		PIC AMP Number:
			"old" Project Number:
	If Assisted Housing		Contract Number:
			REMS Number:
			If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)
Unit Information as of Application Date
			Total Number of Units in Project					Number Occupied
			Number of Public and/or Assisted Units in Project					Number Vacant
Project #3 (if aplicable)
Project Name:
Type of Eligible Housing
(check one)			Public Housing (section 9)			section 811
			Project-based section 8			section 221(d)(3)
			section 202			section 236
	If Public Housing		PIC AMP Number:
			"old" Project Number:
	If Assisted Housing		Contract Number:
			REMS Number:
			If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)
Unit Information as of Application Date
			Total Number of Units in Project					Number Occupied
			Number of Public and/or Assisted Units in Project					Number Vacant
Project #4 (if applicable)
Project Name:
Type of Eligible Housing
(check one)			Public Housing (section 9)			section 811
			Project-based section 8			section 221(d)(3)
			section 202			section 236
	If Public Housing		PIC AMP Number:
			"old" Project Number:
	If Assisted Housing		Contract Number:
			REMS Number:
			If FHA Insured, FHA #:
Physical Street Address
(include city, state and ZIP)
Unit Information as of Application Date
			Total Number of Units in Project					Number Occupied
			Number of Public and/or Assisted Units in Project					Number Vacant