Form HUD 4150 HUD 4150 Verification of State CDBG Program Grant Closed-Out

U.S. Department of Housing and Urban Development
Community Planning and Development
OMB Approval No. 2506-0193 (exp 1/31/2015)

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)

Year

Grantee Name (State)

Grant Amount

Verification of
Zero Balance
Date
(Headquarters)

Certification
_______________________________________________
Name of CPD Field Office Director (Print)
________________________________________________           __________________________
Signature of CPD Field Office Director                                        Date
Page 1
HUD Form 40150 (1/2012)