HUD 53001 Actual Modernization Cost Certificate

Actual Modernization
Cost Certificate

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

OMB Approval No. 2577-0157 (exp. 3/31/2010)

Comprehensive Improvement Assistance Program (CIAP)
Comprehensive Grant Program (CGP)

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.
HA Name:

Modernization Project Number:

The HA 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.

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

Signature of Executive Director & Date:

X

For HUD Use Only

The Cost Certificate is approved for audit:
Approved for Audit (Director, Office of Public Housing / ONAP Administrator)

Date:

X
The audited costs agree with the costs shown above:
Verified:
(Designated HUD Official)

Date:

X
Approved: (Director, Office of Public Housing / ONAP Administrator)

Date:

X
form HUD-53001 (10/96)
ref Handbooks 7485.1 &.3

Instructions for Preparation of Form HUD-53001
Actual Modernization Cost Certificate

Prepare 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 Comprehensive
Improvement Assistance Program (CIAP) or Comprehensive Grant Program (CGP).

Heading Instructions:
HA Name - Enter the name of the Housing Authority (HA).
Modernization Project Number - Enter the unique 13-digit Mod-

ernization Project Number for the grant for which this form is
being submitted. This number is the same number as on form
HUD-52825, CIAP Budget, or form HUD-52837, Annual Statement, for the same grant.

Line Instructions:
Line 1A, Original Funds Approved - For the identified grant,

enter the total Modernization funds originally approved by HUD
through a Modernization 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 HA. 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 HA 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 HA.

form HUD-53001 (10/96)
ref Handbooks 7485.1 &.3