Assisted Living Conversion Program (ALCP) and Emergency Capital Repair Program (ECRP)

Certification of Consistenc\
with the Consolidated Plan

U.S. Department of Housing
and Urban Development

Exempt from OMB approval requirements under
5 CFR 1320.3(h). Form is a certification only.

I certify that the proposed activities/projects in the application are consistent with the jurisdiction’s current, approved Consolidated Plan.
(Type or clearly print the following information:)
Applicant Name:

___________________________________________________________________

Project Name:

___________________________________________________________________

Location of the Project:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Name of the Federal
Program to which the
applicant is applying:

___________________________________________________________________

Name of
Certifying Jurisdiction:

___________________________________________________________________

Certifying Official
of the Jurisdiction
Name: ___________________________________________________________________

Title: ___________________________________________________________________

Signature: ___________________________________________________________________
Date: _____________________________________

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form HUD-2991 (3/98)