HUD-52800 HOPE VI Revitalization Application Checklist

HOPE VI Revitalization
Application Checklist

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

OMB Approval No. 25770208
(exp. 09/30/2014)

The public reporting burden for this collection of information for the HOPE VI Revitalization Program is
estimated to average fifteen minutes, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information and preparing the application package for submission to HUD.
Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions to reduce this burden, to the Reports Management Officer, Paperwork Reduction
Project, to the Office of Information Technology, US. Department of Housing and Urban Development,
Washington, DC 20410-3600. When providing comments, please refer to OMB Approval No. 25770208. HUD may not conduct and sponsor, and a person is not required to respond to, a collection of
information unless the collection displays a valid control number.
The information submitted in response to the Notice of Funding Availability for the HOPE VI Program is
subject to the disclosure requirements of the Department of Housing and Urban Development Reform Act
of 1989 (Public Law 101-235, approved December 15, 1989, 42 U.S.C. 3545).

REVITALIZATION APPLICATION CHECKLIST/TABLE OF CONTENTS

NARRATIVE EXHIBITS
Exhibit A:
SUMMARY INFORMATION
A.1
Executive Summary
A.2
Physical Plan
A.3
Hazard Reduction
A.4
Demolition
A.5
Disposition
A.6
Site Improvements
A.7
Site Conditions
A.8
Separability
A.9
Proximity
Exhibit B:
CAPACITY
B.1
Capacity of Development Team
B.2
Capacity of Applicant
B.3
Capacity of Existing HOPE VI Revitalization Grantees – Expenditures
B.4
Capacity of Existing HOPE VI Revitalization Grantees – Timeliness
B.5
CSS Program Capacity
B.6
Property Management Capacity
Exhibit C:
NEED
C.1
Severe Physical Distress of the PH Project
C.2
Severe Distress of the Surrounding Neighborhood
C.3
Need for HOPE VI Funding
C.4
Sites Previously Funded
C.5
Need for Affordable Accessible Housing in the Community

Page Number

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form HUD-52800 (12/2003)

Exhibit D:
RESIDENT AND COMMUNITY INVOLVEMENT
D.1
Resident and Community Involvement
Exhibit E:
COMMUNITY AND SUPPORTIVE SERVICES
E.1
Case Management
E.2
Needs Assessment and Results
E.3
Overall CSS Program
E.4
Transition to Housing Self-Sufficiency
E.5
Health Initiatives
E.6
Workforce Partnerships, Green Jobs and Green Jobs Training
E.7
Endowment Trust
Exhibit F:
EARLY CHILDHOOD EDUCATION
F.1
Needs Assessment
F.2
Existing Neighborhood Strengths – ECE
F.3
Quality and Results Orientation – ECE - Pre-Revitalization/Relocation
F.4
Quality and Results Orientation – ECE - Post Revitalization
Exhibit G:
RELOCATION
G.1
Housing Choice Voucher Needs
G.2
Relocation Plan
Exhibit H:
FAIR HOUSING AND EQUAL OPPORTUNITY
H.1
Site Selection (Site and Neighborhood Standards)
H.2
Accessibility
H.3
Universal Design
H.4
Fair Housing
H.5
Section 3
Exhibit I:
MIXED-INCOME COMMUNITIES
I.1
Public Housing Replacement Requirement
I.2
Project-Based Affordable Housing
I.3
Off-Site Housing Units
I.4
Low-Income Housing Tax Credit Units
I.5
Market Rate Housing Units
Exhibit J:
SOUNDNESS OF APPROACH
J.1
Appropriateness of Proposal
J.2
Appropriateness and Feasibility of the RP
J.3
Neighborhood Strengths, Impact and Sustainability of RP
J.5
Project Readiness
J.6
Program Schedule Certifying Statement
J.7
Design
J.8
Green Development and Energy Efficiency Strategies
J.9
Broadband Internet Access
J.10
Evaluation

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ATTACHMENTS
1:
2:
3:
4.
5:
6:
7:
8:

Application Data Form: Cover Sheet
Application Data Form: Existing Units, Occupancy, Vacancy
Appl. Data Form: Relocation, Income, & Non-Dwelling Structures
Application Data Form: Proposed Unit Mix Post-Revitalization
Application Data Form: Units, Accessibility, Concentration
Application Data Form: Self-Sufficiency
Application Data Form: Sources and Uses
HOPE VI Budget Form

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form HUD-52800 (12/2003)

9: TDC/Grant Limitations Worksheet
10: Extraordinary Site Costs Certification
11: City Map
12: Assurances for a HOPE VI Application
13: Preliminary Market Assessment Letter
14: Certification of Severe Physical Distress
15: Photographs of the Severely Distressed Housing
16: Neighborhood Conditions
17: Land Use Certification or Documentation
18: Documentation of Site Control for Off-Site Public Housing
19: Physical Development Resources
20: CSS Resources
21: Anticipatory Resources
22: Collateral Resources
23: Sites Previously Funded
24: PHA or MTW Plan
25: Evaluation Commitment Letter(s)
26: Current Site Plan
27: Photographs of Architecture in the Surrounding Community
28: Conceptual Site Plan
29: Conceptual Building Elevations
30: HOPE VI Revitalization Application Certifications (4pg. Form)
31: Capital Fund Financing Program Threshold
32: Documentation for Workforce Partnerships, Green Jobs and Green Training
33: Documentation for Early Childhood Education
34: Documentation for Green Development and Energy Efficiency Strategies

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Standard Forms and Certifications
35. Application for Federal Assistance (SF-424)
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36. Disclosure of Lobbying Activities (SF-LLL)
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37. Applicant/Recipient Disclosure/Update Report (form HUD-2880)
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38. Program Outcome Logic Model (form HUD-96010)
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39. Funding Application for Housing Choice Voucher Assistance prepared in accordance with Notice
PIH 2005-15, including, Section 8 Tenant-Based Assistance Rental Certificate Program, Rental Voucher
Program, form HUD-52515
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40. If applicable, Section 3 Annual Summary Report (Form HUD 60002
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41. Form HUD-96011, Third Party Documentation Facsimile Transmittal (Facsimile Transmittal Form
on Grants.gov), if applicable.

form HUD-52800 (12/2003)