Appendices

U

.S. Department of Housing and Urban Development

Community Planning and Development

Appendices

Appendix 1. State CDBG Program Grant

Appendix 2. Community Development Block Grant-Recovery Program

Appendix 3. Disaster Recovery Grants

Appendix 4. Federal Financial Report Standard Form 425

Appendix 1

State Community Development Block Grant

Attachment: A

Verification of State CDBG Program Grants

Closed-out

CPD Field Office staff should provide the State CDBG program grant information that will enable the State and Small Cities Division to verify its status based on commitment and obligation amounts in LOCCS. The CPD Director’s signature certifies that the information is accurate. Headquarters will verify the status of the State CDBG program grants and enter the closeout dates in the appropriate column of the Table.

Grant Information			Date Closed (Field Office)	Verification of Zero Balance Date (Headquarters)
Year	Grantee Name (State)	Grant Amount

Certification

_______________________________________________

Name of CPD Field Office Director (Print)

________________________________________________

Signature of CPD Field Office Director

________________________________________________

Date

Attachment: B

State CDBG Program Grant Close-out

Certification

Grantee Name: ________________________________

	State CDBG Program
(Insert) Grant Year
Grant Number
Grant Amount Authorized
Cumulative Grant Funds Disbursed
Balance of Grant Funds Remaining to be Recaptured

Certification

The CPD Field Office in _____________________________ has received and reviewed the financial status information and hereby confirms that all of the conditions for close-out have been met.

________________________________________________

Name of CPD Field Office Director (Print)

________________________________________________

Signature of CPD Field Office Director

________________________________________________

Date

Attachment: C

Closeout Agreement Between the State of __________________________ and HUD

State CDBG Program Grant Number: ______________________

THIS AGREEMENT entered into by and between the (insert State) (hereinafter referred to as the “Grantee”) and the Secretary of Housing and Urban Development (hereinafter referred to as “HUD”).

WITNESSETH:

WHEREAS, the Grantee was awarded a grant in the amount of (insert amount) under Title I of the Housing and Community Development Act of 1974, as amended (hereinafter called “Grant”).

WHEREAS, the Grant has been completed and the parties hereto desire to effectuate a final settlement.

WHEREAS, the Grantee has incurred Grant costs subsequent to its most recent audit, if applicable.

WHEREAS, the Grantee desires to close out the Grant prior to the submission of a final audit, if applicable.

NOW THEREFORE, in consideration of the mutual covenants, promises and representations contained herein, the parties hereto agree as follows:

Grantee represents that all Grants have been disbursed.

The Grantee agrees as follows:

To secure an audit in accordance with OMB Circular A-133;

To remit to HUD the amount of any cost disallowed by a subsequent audit and or HUD monitoring sustained by HUD;

To use program income received subsequent to the closeout in accordance with CDBG requirements and the Method of Distribution that covers the program income received after closeout; and

To submit to HUD a Federal Financial Report using either Standard Form 425 or in acceptable format for any change to Grant costs as a result of the completion and resolution of the final audit.

THIS AGREEMENT is hereby executed and delivered by the parties hereto on the dates set forth below their respective signatures.

_______________________________________________ Date: _____________________

(Signature of CPD Field Office Director)

_______________________________________________

Name of Field Office

_______________________________________________ Date: _____________________

(Signature of State CDBG Program Director)

_______________________________________________

Name of State

Attachment: D

State CDBG Closeout Checklist

For the purposes of expediting the grant closeout process, HUD asks applicants to submit the following checklist.

Grantee Name ___________________________ Official Contact Name _____________________ Email Address ___________________________ Telephone Number _______________________

Grant Number ___________________________ DUNS Number __________________________ Fax Number_____________________________

1. Criteria for Closeout

1. Regarding the grant to be closed out, the State disbursed all funds to UGLGs as stipulated in the MOD

Yes No if no, explain:

2. Pursuant to statutory requirements of the HCDA of 1974 (as amended), the State

1. Carried out all of its certifications

Yes No if no, explain:

2. Ensured that all CDBG-funded activities were eligible and met a national objective

Yes No if no, explain:

3. Monitored UGLGs to determine whether applicable performance criteria were met

Yes No if no, explain:

3. As part of the financial review, the state confirmed that:

1. 15% public services cap was not exceeded

Yes No if no, explain:

2. 20% planning and administration cap was not exceeded

Yes No if no, explain:

3. Administrative costs and technical assistance do not exceed the 3% combined threshold for CDBG funds received after January 23, 2004 (or regulatory amounts for grants received before January 23, 2004)

Yes No if no, explain:

4. The state has met the required match for administration

Yes No if no, explain:

4. With regard to audits and monitoring of the State CDBG program

1. No audit findings are outstanding

Yes No if no, explain:

2. No monitoring findings are outstanding

Yes No if no, explain:

2. Closeout Actions

1. Verify Grants closed out to reconcile records and provide accurate information on the status of State CDBG funds

1. Reviewed grants to be closed out to ascertain that conditions for closeout are met

Yes No if no, explain:

2. Provided financial information about grant to be closed out to the CPD Field Office

Yes No if no, explain:

Grantee

By: ________________________________ _____________

Authorized Representative’s Signature Date

Appendix 2

Community Development Block Grant –Recovery

Attachment: A

LETTERHEAD

Date _______________

Dear _______________:

SUBJECT: Entitlement Grant Closeout and Recapture of Unspent Grant Funds Community Development Block Grant – Recovery

Grant Number: xxxxxxxxx

It appears that the activities are completed and funds have been drawn down and the grant is ready for closeout. In accordance with the U.S. Department of Housing and Urban Development CDBG Closeout Procedures regulation at 24 CFR 570.509 (b) (3), any unspent funds remaining in the account of an expired grant period are to be recaptured. Our records indicate that your CDBG-R grant has a remaining balance of ____________.

Program income generated from the use of CDBG-R funds will be treated as program income of the regular CDBG program, not as program income of the CDBG-R program. In order to proceed with this grant closeout and recapture of the remaining funds, the following documentation should be submitted by the grantee.

• Final Report (if not already submitted)

• Federal Financial Report Form 425 (if not already submitted)

• A completed copy of the enclosed “CDBG-R Grantee Closeout Certification” signed by the grantee’s authorized representative

• A completed copy of “CDBG-R Closeout Checklist” signed by the grantee’s authorized representative

The Grantee Closeout Certification has been completed for your review, and your signature confirms the accuracy of the information. HUD retains the right to monitor and follow-up on monitoring and audit findings. In addition, the Department may recover disallowed costs for ineligible activities or to take other appropriate actions identified at 24 CFR 570.910, if HUD determines that the information provided by the grantee was false, erroneous or did not meet statutory or regulatory requirements. Once HUD has approved the certification, an executed copy will be returned to you as evidence that the grant has been closed out.

Please return the signed certification and the other listed documents to our Office within 15 days of the date of this letter. If you have any questions, please contact the CPD Representative.

Sincerely,

CPD Director

Enclosure

Attachment: B

LETTERHEAD

Date _______________

Dear _______________:

SUBJECT: Grant Closeout and Recapture of Unspent Grant Funds State Community Development Block Grant – Recovery

Grant Number: xxxxxxxxx

It appears that the activities are completed and funds have been drawn down and the grant is ready for closeout. In accordance with the U.S. Department of Housing and Urban Development CDBG Closeout Procedures for States, any unspent funds remaining in the account of an expired grant period are to be recaptured. Our records indicate that your CDBG-R grant has a remaining balance of ____________.

Program income generated from the use of CDBG-R funds will be treated as program income of the regular CDBG program, not as program income of the CDBG-R program. In order to proceed with this grant closeout and recapture of the remaining funds, the following documentation should be submitted by the grantee.

• Final Report (if not already submitted)

• Federal Financial Report Form 425 (recommended but not required)

• A completed copy of the enclosed “CDBG-R Grantee Closeout Certification” signed by the state’s authorized representative

• A completed copy of “CDBG-R Closeout Checklist” signed by the state’s authorized representative

The Grantee Closeout Certification has been completed for your review, and your signature confirms the accuracy of the information. HUD retains the right to monitor and follow-up on monitoring and audit findings. In addition, the Department may recover disallowed costs for ineligible activities or to take other appropriate actions identified at 24 CFR 570.496, if HUD determines that the information provided by the grantee was false, erroneous or did not meet statutory or regulatory requirements. Once HUD has approved the certification, an executed copy will be returned to you as evidence that the grant has been closed out.

Please return the signed certification and the other listed documents to our Office within 15 days of the date of this letter. If you have any questions, please contact the CPD Representative.

Sincerely,

CPD Director

Enclosure

Attachment: C

Community Development Block Grant – Recovery (CDBG-R) Program

Grantee Closeout Certification

Grantee Name:

Grant Number:

The Grantee hereby certifies that: (1) the grant as described in the approved application has been performed in accordance with the terms and conditions of the executed Grant Agreement and applicable CDBG-R Grant Award and that there are no known outstanding programmatic or financial issues; and (2) all data provided below fairly reflects costs and sources of funds of the CDBG-R grant and are taken from HUD-approved reports and other project-related documents.

1. Grant amount authorized. $ ___________

2. Cumulative grant funds disbursed. $ ___________

(Grantee should draw down amounts for any final audit costs

or unsettled third party claims. Any such amounts not subsequently disbursed

must be immediately reimbursed to HUD.)

3. Grant funds recaptured previously $ ___________

4. Balance of grant funds to be recaptured. $ ___________

(These funds will be recaptured by HUD in order for the funds to be returned to the U.S. Treasury.)

_____________________________________________ _________________________________

Grantee Authorized Representative’s Signature and Date CPD Division Director Signature and Date

____________________________________ ________________________________

Typed Name of Signatory Typed Name of Signatory

____________________________________ _________________________________

Title Title

The above signature by HUD signifies approval of grant closeout.

Attachment: D

CDBG-R Closeout Checklist

For the purposes of expediting the grant closeout process, HUD asks applicants to submit the following checklist.

Grantee Name _____________________________ Official Contact Person_________________________ Email Address ________________________________ DUNS NUMBER__________________________

Grant Number _________________________ Telephone Number ____________________ Fax Number___________________________

1. Program Income

• Is there any program income on-hand at the time the close out agreement is signed? Yes No If yes, explain:

2. CDBG-R Activities

• Are any of the activities ineligible under the Recovery Act, including swimming pools, golf courses, zoos, aquariums, and casinos or other gambling establishments? Yes No If yes, explain:

• Are any of the activities ineligible under the regular CDBG program or do any of the activities provide insufficient public benefit per 24 CFR 570.209(b)(3) or 24 CFR 570.482(f)(4)?

Yes No If, no explain:

• Do any activities contradict with any of the provisions in President Obama’s Ensuring Responsible Spending of Recovery Act Funds Memo, including the section on Avoiding Funding of Imprudent Projects? Yes No If no, explain:

• Any unused grant funds cancelled by HUD? Yes No If yes, explain:

3. Draw Downs

• Evidence that no more than 10% of the grant amount was spent on administration and planning?

Yes No If no, explain:

• Evidence that no more than 15% of the grant amount was spent on public services? Yes No If no, explain:

• Evidence that at least 70% of the grant amount principally benefitted persons of low- and moderate- income? Yes No If no, explain:

• Did grantee commingle regular CDBG and CDBG-R funds? Yes No If yes, explain:

• If applicable, did the activities identified meet the public benefit standard underwriting guidelines as described in 24 CFR 570.209 (a)-for entitlements grantees and 24 CFR 570.482(e) for states

Yes No If no, explain:

4. Activity Eligibility and Meet a National Objective

• Are all activities eligible and does each activity meets a national objective? Yes No If no, explain

5. Audits

• Did the grantee have any open audits prior to CDBG-R allocation? Yes No, if yes explain

• Did the grantee make reviews and audits of subrecipients and/or state recipients? Yes No, if no explain

6. Monitoring

• Does the grantee have any open monitoring findings? Yes No, if yes explain

7. Reporting Systems

• Are all quarterly reports current and accurate in Federal Reporting? Yes No, if no explain

• Did grantee report on the number of jobs created or retained for each activity carried out? Yes No, if no explain

• Did the grantee report on the name, location, and contact information for the entity that carried out each activity? Yes No, if no explain

• Does the RAMPS data system indicate that the environmental review is complete? Yes No, if no explain

• Did the grantee indicate that the grant is complete in Federal Reporting? Yes No, if no explain

8. Certifications

• Did the grantee adhere to all certifications regarding the applicable provisions of the CDBG-R Notice?

For example, Buy American provisions, Affirmatively Furthering Fair Housing, Section 3, Lead-based paint procedures. Yes No, if no explain

GRANTEE

By: ________________________________ _____________

Grantee Authorized Representative’s Signature Date

Attachment: E

GRANT CLOSEOUT AGREEMENT

For

Entitlement Community Development Block Grant-Recovery Program

Between

U.S. Department of Housing & Urban Development

(Address)

AND

Name and address of Grantee

This agreement sets forth the terms and conditions associated with the closeout of HUD CDBG-R Grant (Number) dated (date of grant approval), and any applicable amendments. The (name of grantee) certifies that, to the best of its knowledge:

• All activities as authorized by this grant and any applicable amendments have been completed as described in the grantee’s final performance report dated (date of final report).

• During the administration of this award, no fraud, waste or mismanagement has occurred in carrying out the approved activities.

• All grant-financed costs associated with these activities have been incurred.

• Proper provisions have been made for the payment of all unpaid costs and unsettled third-party claims.

• The Department of Housing and Urban Development is under no obligation to make any payment to the (name of grantee) in excess of the amount identified in the grant agreement.

• Statements and amounts set forth in the Federal Financial Report (SF-425) are true and accurate as of this date.

Further, the (name of grantee) hereby acknowledges the remaining obligation(s) under the terms of the grant agreement and agrees as follows:

• All records and documents pertaining to this grant will be maintained for a period of 4 years after execution of this closeout agreement or the period required by other applicable laws and regulations related to affirmatively furthering fair housing-24 CFR 570.506 (g)(1), Lead-Based Paint-Poisoning Prevention Act-24 CFR 570.608, Architectural Barriers Act and Americans with Disabilities Act—24 CFR 570.614, and the Uniform Relocation Act – 24 CFR 570.606.

Insert as Applicable

• Any real property within the (name of grantee)’s control which was acquired or improved in whole or part using CDBG funds in excess of $25,000 is governed by the principles described in 24 CFR 570.505.

• If any rehabilitated property falls within a flood plain, flood insurance coverage must be maintained for the mandatory period for affected property owners.

• Identify any closeout costs or contingent liabilities subject to payment after the closeout agreement is signed.

• Submit to HUD a Federal Financial Report using Standard Form 425 upon the completion of the final audit and resolution of any finding.

• A total of $ (amount) in grant funds has been previously cancelled and returned to the Department on (date) OR A total of $ (amount) in grant funds will be recaptured by HUD upon execution of this closeout agreement. (Optional)

HUD maintains the right to conduct future monitoring of this grant, either on site or by review of information or copies of documents requested from the (name of grantee). The (name of grantee) acknowledges that a finding of non-compliance resulting from such a review and failure to take appropriate corrective action satisfactory to HUD may be taken into account by HUD as evidence of unsatisfactory performance, in consideration of future grant awards. Further the (name of grantee) may be required to repay HUD any disallowed costs based on the results of a future audit or monitoring finding.

For the (name of grantee),

__________________________________ ________________________

Name /Title of Authorized Official/Title Date

__________________________________

Signature

For the Department of Housing and Urban Development:

__________________________________ ________________________

Typed name of CPD Director Date

__________________________________

Signature

Attachment F

GRANT CLOSEOUT AGREEMENT

For

State Community Development Block Grant-Recovery Program

Between

U.S. Department of Housing & Urban Development

(Address)

AND

Name and address of the State

This agreement sets forth the terms for final disposition and conditions associated with the closeout of HUD State CDBG-R Grant (Number) dated (date of grant approval), and any applicable amendments. The (name of state) certifies that to the best of its knowledge:

• All activities as authorized by this grant and any applicable amendments have been completed as described in the grantee’s final performance report dated (date of final report).

• During the administration of this award, no fraud, waste or mismanagement has occurred in carrying out the approved activities.

• All grant-financed costs associated with these activities have been incurred.

• Proper provisions have been made for the payment of all unpaid costs and unsettled third-party claims.

• The Department of Housing and Urban Development is under no obligation to make any payment to the (name of grantee) in excess of the amount identified in the grant agreement.

Further, the (name of grantee) hereby acknowledges the remaining obligation(s) under the terms of the grant agreement and agrees as follows:

• All records and documents pertaining to this grant will be maintained for a period of 3 years after execution of this close-out agreement or the period required by other applicable laws and regulations related to affirmatively furthering fair housing, Lead-Based Paint Poisoning Prevention Act, Architectural Barriers Act and Americans with Disabilities Act.

Insert as Applicable

• Any real property within a State recipient’s control which was acquired or improved in whole or part using CDBG funds in excess of $100,000 is governed by the principles described in 24 CFR 570.489 (j).

• If any rehabilitated property falls within a flood plain, flood insurance coverage must be maintained for the mandatory period for affected property owners.

• Identify any closeout costs or contingent liabilities subject to payment after the closeout agreement is signed.

• Submit to HUD a Federal Financial Report using Standard Form 425 or other state form, as a result of the completion of the final audit and resolution of any findings.

• A total of $ (amount) in grant funds has been previously cancelled and returned to the Department on (date) OR A total of $ (amount) in grant funds will be recaptured by HUD upon execution of this closeout agreement. (Optional)

HUD maintains the right to conduct future monitoring of this grant, either on site or by review of information or copies of documents requested from the (name of grantee). The (name of grantee) acknowledges that a finding of non-compliance resulting from such a review and failure to take appropriate corrective action satisfactory to HUD may be taken into account by HUD as evidence of unsatisfactory performance in consideration of future grant awards. Further, the (name of grantee) may be required to repay HUD any disallowed costs based on the results of a future audit or HUD monitoring finding.

For the (name of State),

__________________________________ ________________________

Name /Title of Authorized Official/Title Date

__________________________________

Signature

For the Department of Housing and Urban Development:

__________________________________ ________________________

Type name of CPD Director Date

__________________________________

Signature

Attachment G

Appendix 3

Disaster Recovery Grants

G

Attachment A

rant Closeout Review/Checklist

Date Open: Date closed:

GRANTEE: GRANT #:

Grant Amount:

Method of Distribution:

STATUS OF FUNDS:

Budgeted Expended

Total Budget per Grant Agreement __________ _________

Program Administration __________ _________

Program Income (if applicable) __________ _________

Total Unliquidated obligations: __________ _________

Required Targets

Specified Limit or Minimum

Minimum Overall benefit%:_____________ Actual _________

Limit on Public services: _____________ Actual _________

Limit on Admin/Planning:______________ Actual _________

Limit on Grantee Admin: _________________ Actual _________

SUBMISSION OF QUARTERLY PROGRESS REPORTS:

Has the grantee submitted the final and complete QPR in DRGR? ____ Yes ____ No

Is the final QPR accurate, complete, and consistent with LOCCS, the Action Plan, and/or approved Action Plan amendments? ____ Yes ____ No

STATUS OF MONITORING:

Date of last monitoring visit: ____________________________________

Were there any findings?
____Yes _____No

Have all issued findings been cleared? _____Yes ___No

If applicable, what is the status of the A-133 Audit?

_____________________________________________________________________________
_____________________________________________________________________________

_____________________________________________________________________________

________________________________________ _________________

Grantee Authorized Representative’s Signature Date

RECOMMENDATION

The Grant is ready to close_______ Not ready to close______ (explain if not ready to close)

Action recommended:

Prepare and complete the closeout package. Write a standard letter to grantee regarding specific issues or concerns related to the acceptability/completeness of the QPR, forms or portions thereof that need to be submitted, or open findings that need to be addressed prior to completion of grant closeout.

______________________­­­___ __________________

CPD Director Date

C

1. Attachment B

LOSEOUT CERTIFICATION

Grant # _______________________________________

To the best of my knowledge, all activities undertaken, or to be undertaken, with funds provided under this agreement have been carried out, or will be carried out, in accordance with the award agreement; that any fraud, waste, or mismanagement that may have occurred in the administration of this award has been adequately addressed in accordance with the recommendations and concurrence of the HUD Office of the Inspector General; that proper provision has been made for the payment of all unpaid costs and unsettled third-party claims; that the Department of Housing and Urban Development is under no obligation to make any payment to the awardees in excess of the amount identified in the grant agreement; and that every statement and amount set forth in the final quarterly, financial summary and federal cash transaction reports is true and accurate as of this date.

I certify that all program income on hand at the time of closeout shall continue to be used in accordance with the eligibility requirements in Title 1 of the Housing and Community Development Act of 1974, as amended, [insert “24 CFR Part 570 subpart C” for Entitlement communities or “24 CFR Part 570 subpart I” for states], the applicable Federal Register Notices, and all other applicable authorities including the grant agreement until it is expended. I further certify that income received after closeout shall not be governed by the provisions of this part, except that, 1) if at the time of closeout the recipient has another ongoing CDBG grant received directly from HUD, funds received after closeout shall be treated as program income of the ongoing grant program; or 2) if the recipient does not have another ongoing grant received directly from HUD at the time of closeout, income received after closeout from the disposition of real property or from loans outstanding at the time of closeout shall not be governed by the provisions of this part, except that such income shall be used for activities that meet one of the national objectives in 570.208 (for Entitlement communities) and the eligibility requirements described in section 105 of the Housing and Community Development Act.

Real property acquired with grant funds or program income is listed in the quarterly reports or as an attachment to this certification. At this time, program income received throughout the term of the grant amounts to $__________ and program income on hand amounts to $___________. Accounting records will be kept on the use of these funds and any additional program income.

I understand that HUD may monitor compliance with the terms of this agreement at any time. Financial records, supporting documents, statistical records and all other records pertinent to this grant shall be retained for a period of 4 years from the date of submission of the final expenditure report. (Exceptions to this requirement for Entitlement communities are listed at 2 CFR Part 215.)

Name /Title of Authorized Official _________________________________

Signature Date_________

Note: Any false statements knowingly or deliberately made are subject to civil or criminal penalties under Section 1001 of Title 18 of the U.S. Code.

E

Attachment C

XAMPLE OF LETTER TO BE ATTACHED TO FINANCIAL REPORT

SUBJECT: Financial Report

Statement of Grant Costs

The Community Planning and Development Office received and reviewed the Financial Report submitted by the State of (Insert Name of State) for (Insert Grant Number). Our review of the Report and other documents related to the grant agreement indicates that the grant document balances are as follows:

Description $ Amount

1. Grant applied to Program Costs __________________________________

2. *Estimated amount for Unsettled __________________________________

Third Party Claims

3. Subtotal (sum of line 1 and 2) __________________________________

4. Grant Amount per Grant Agreement __________________________________

5. Unused Grant to be Recaptured __________________________________

(Line 4 minus line 3)

6. Grant Funds Received ___________________________________

7. Balance of Grant Payable ____________________________________

(Line 3 minus line 6)

*Note: The Grantee should draw down amounts for unsettled third party claims. Any such amounts not subsequently disbursed by the grantee or subgrantee, must comply with procedures to minimize the time elapsing between the transfers of the funds and/or shall be immediately reimbursed to HUD.

The Financial Report is hereby approved. Because the amount on line 5 is zero, no adjustment to the Line of Credit is required at this time. Or, I authorize cancellation of the unused contract commitment and related funds reservations and obligations of $ _________________, less $____________________ previously authorized for cancellation.

Date: ____________

_____________________ _____________________

Name/Title of Authorized Signature of Authorized

HUD Program Official HUD Official

_____________________ ___________________

Name/Title of Authorized Signature of Authorized

HUD Accounting Official HUD Accounting Official

Attachment C

GRANT CLOSEOUT AGREEMENT

F

Attachment D

or

Community Development Block Grant Disaster Recovery Program

Between

U.S. Department of Housing & Urban Development

(Address)

AND

Name and address of the Grantee

This agreement sets forth the terms for final disposition and conditions associated with the closeout of HUD CDBG Disaster Recovery Grant (Number) dated (date of grant approval), and any applicable amendments and waivers. The (name of grantee) certifies that to the best of its knowledge:

• All activities as authorized by this grant and any applicable amendments, Notices, alternative requirements, and waivers have been completed as described in the grantee’s final performance report dated (date of final report).

• Any fraud, waste, or mismanagement that may have occurred in the administration of this award has been adequately addressed in accordance with the recommendations and concurrence of the HUD Office of the Inspector General, or the Office of Community Planning and Development.

• All grant-financed costs associated with these activities have been incurred.

• Proper provisions have been made for the payment of all unpaid costs and unsettled third-party claims.

• The Department of Housing and Urban Development is under no obligation to make any payment to the (name of grantee) in excess of the amount identified in the grant agreement.

Further, the (name of grantee) hereby acknowledges the remaining obligation(s) under the terms of the grant agreement and agrees as follows:

• States: All records and documents pertaining to this grant will be maintained for a period of 3 years after execution of this close-out agreement or the period required by other applicable laws and regulations related to affirmatively furthering fair housing, Section 3 of the Housing and Community Development Act of 1968 (24 CFR part 135), Lead-Based Paint Poisoning Prevention Act, Architectural Barriers Act, Assistance and Real Property Acquisition Policies Act of 1970, and Americans with Disabilities Act-- 24 CFR 570.487 and the Uniform Relocation Act—24 CFR 570.488.

• Entitlement Communities: All records and documents pertaining to this grant will be maintained for a period of 4 years after execution of this closeout agreement or the period required by other applicable laws and regulations related to affirmatively furthering fair housing-24 CFR 570.506 (g)(1), Section 3 of the Housing and Community Development Act of 1968 (24 CFR part 135)Lead-Based Paint-Poisoning Prevention Act-24 CFR 570.608, Architectural Barriers Act and Americans with Disabilities Act—24 CFR 570.614, and the Assistance and Real Property Acquisition Policies Act of 1970-24 CFR 570.606.

Insert as Applicable

• States: Any real property within the (name of grantee)’s or State grantee’s control which was acquired or improved in whole or part using CDBG funds in excess of $100,000 is governed by the principles described in 24 CFR 570.489(j).

• Entitlement Communities: Any real property within the (name of grantee)’s control which was acquired or improved in whole or part using CDBG funds in excess of $25,000 is governed by the principles described in 24 CFR 570.505.

• Entitlement Communities: If any rehabilitated property falls within a flood plain, flood insurance coverage must be maintained for the mandatory period for affected property owners described in 24 CFR 570.605.

• Identify any closeout costs or contingent liabilities subject to payment after the closeout agreement is signed.

• Submit to HUD a Federal Financial Report using Standard Form 425 (if necessary) or other state form, as a result of the completion of the final audit and resolution of any findings.

• A total of $ (amount) in grant funds has been previously cancelled and returned to the Department on (date) OR A total of $ (amount) in grant funds will be recaptured by HUD upon execution of this closeout agreement. (Optional)

HUD maintains the right to conduct future monitoring of this grant, either on site or by review of information or copies of documents requested from the (name of grantee). The (name of grantee) acknowledges that a finding of non-compliance resulting from such a review and failure to take appropriate corrective action satisfactory to HUD may be taken into account by HUD as evidence of unsatisfactory performance in consideration of future grant awards. Further, the (name of grantee) may be required to repay HUD any disallowed costs based on the results of a future audit or HUD monitoring.

For the (name of grantee),

__________________________________ ________________________

Name /Title of Authorized Official/Title Date

For the Department of Housing and Urban Development:

_________________________________ ________________________

Type name of CPD Director Date

Appendix 4

Federal Financial Report - Standard Form 425

Page 34

CPD Notice-11-142 Grant Close-Out Procedures