HUD-53001 Actual Modernization Cost Certificate

Actual Modernization Cost Certificate

U.S. Department of Housing and Urban Development Office of Public and Indian Housing Office of Public and Indian Housing

OMB Approval No. 2577-0157 (exp. 01/31/2014)

Capital Fund Program (CFP)

Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Management Officer, Paperwork Reduction Project (2577-0044 and 0157), Office of Information Technology, U.S. Department of Housing and Urban Development, Washington, D.C.20410-3600. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.

Do not send this form to the above address.

This collection of information requires that each Housing Authority (HA) submit information to enable HUD to initiate the fiscal closeout process. The information will be used by HUD to determine whether the modernization grant is ready to be audited and closed out. The information is essential for audit verification and fiscal close out. Responses to the collection are required by regulation. The information requested does not lend itself to confidentiality.

PHA Name:

Modernization Project Number:

The PHA hereby certifies to the Department of Housing and Urban Development as follows:

1. That the total amount of Modernization Cost (herein called the “Actual Modernization Cost”) of the Modernization Grant, is as shown below:

A. Funds Approved	$
B. Funds Disbursed	$
C. Funds Expended (Actual Modernization Cost)	$
D. Amount to be Recaptured (A–C)	$
E. Excess of Funds Disbursed (B-C)	$

2. That all modernization work in connection with the Modernization Grant has been completed;

3. That the entire Actual Modernization Cost or liabilities therefor incurred by the PHA have been fully paid;

4. That there are no undischarged mechanics', laborers', contractors', or material-men's liens against such modernization work on file in any public office where the same should be filed in order to be valid against such modernization work;

5. That the time in which such liens could be filed has expired; and

6. That for any years in which the grantee is subject to the audit requirements of the Single Audit Act, 31 U.S.C. § 7501 et seq., as amended, the grantee has or will perform an audit in compliance with said requirements.

7. Please mark one:

A. This grant will be included in the PHA’s next fiscal year audit per the requirements of the Single Audit Act.

 B. This grant will not be included in the PHA’s next fiscal year audit per the requirements of the Single Audit Act.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Name & Title of Authorized Signatory (type or print clearly):
Signature of Executive Director (or Authorized Designee): X	Date:

For HUD Use Only

The Cost Certificate is approved for audit (if box 7A is marked):

Approved for Audit (Director, Office of Public Housing) X

Date:

The costs shown above agree with HUD verified costs (if box 7A or 7B is marked):

Approved: (Director, Office of Public Housing) X

Date:

Instructions for Preparation of Form HUD-53001

Actual Modernization Cost Certificate

P repare and submit to the HUD Field Office an original and one copy of form HUD-53001 for each terminated or com­pleted modernization program under the Capital Fund Program (CFP). Heading Instructions: PHA Name - Enter the name of the Public Housing Authority (PHA). Modernization Project Number - Enter the unique 13-digit Mod­ernization Project Number for the grant for which this form is being submitted. This number is the same number as on form HUD-52840-A, ACC Amendment to form HUD-53012, or form HUD-50075.1, Annual State­ment, for the same grant.

Line Instructions: Line 1A, Funds Approved - For the identified grant, enter the total Modernization funds currently approved by HUD through a Modernization ACC Amendment to the Consolidated Annual Contributions Contract(s). Line 1B, Funds Disbursed - For the identified grant, enter the total funds disbursed by HUD. This amount may never exceed the amount on line 1A. Line 1C, Funds Expended - For the identified grant, enter the total funds expended (total cash disbursed) by the PHA. This amount may never exceed the amount on line 1A. Line 1D, Amount To Be Recaptured (A minus C) - For the identified grant, enter the amount to be recaptured by subtract­ing line 1C from line 1A. Line 1E, Excess of Funds Disbursed (B minus C) - For the identified grant, enter the excess of funds disbursed by sub­tracting line 1C from line 1B; this is the amount to be remitted by the PHA to HUD. If line 1C is greater than line 1B, enter the figure in brackets; this is the amount of funds owed by HUD to the PHA.

form HUD-53001 (10/96)

ref Handbooks 7485.1 &.3