Application for Healthy Homes and Lead Hazard Control Program Grants

OMB Approval No. 2506-0112 (Exp. 3/31/2010)

U.S. Department of Housing
and Urban Development

Certification of Consistency
with the Consolidated Plan

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)