HUD-92015-CA Application for Capital Advance Summary Information

Supportive Housing for the Elderly Section 202
Application for Capital Advance Summary Information

U.S. Department of Housing and Urban Development

OMB Approval No. 2502-0267

(exp. xx/xx/xxxx)

Office of Housing

Federal Housing Commissioner

Public reporting burden for this collection of information is estimated to average 1 hour 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. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

HUD

202 Project Number

PRAC Number

Use Only

1. Sponsor's Name(s), Address(es) & Telephone Number (s)

2. Minority Sponsor Designation. A minority sponsor is one in which at least 51 percent of the board members are minority.

Is this sponsor a minority applicant?

Yes

No

If "Yes," place the numeric code as shown below in this box

Codes: 2 - Black; 3 - Native American; 4 - Hispanic;
5 - Asian Pacific; 6 - Asian Indian

1a. Sponsor is a "grassroots" organization

Yes

No

3a. Address of Site

Yes

No

If "Yes," please place the appropriate number as shown above in this box

4a. Congressional District

5. Type of Area

Metropolitan

Non-metropolitan

6. Capital Advance Amount Requested

7. Project Rental Assistance Contract Amount Requested

4b. Census Tract

$

$

8. Total No. of

202 Units

8a. Number & Type of Resident Units Proposed

Efficiency

One bedroom

8b. Resident Manager's Unit (check appropriate type)

Efficiency

One bedroom

Two bedroom

9. Number of Buildings

10. Type of Project

Year Built (yyyy)

New Construction

Rehabilitation

Acquisition

11. Type of Building(s)

Row/Townhouse

Walk-up

Elevator

12. Number of Stories

13. Number of Parking Spaces

14. Check utilities and services not included in the rent and to be paid directly by the tenant.

Electric

Water

Heat

Gas

15. Off-Site Facilities

Public At Site

Feet from Site

Water

Sewer

Paving

Gas

Electric

16a. Community Spaces to be included in Project

16b. Mixed-Finance or Mixed-Use Project For Additional Units

Yes

No

No. of Additional Units

17. Unusual Site Features

None

Poor Drainage

Cuts

Retaining Walls

Fill

Rock Foundations

Erosion

High Water Table

Other (specify)

18. Mark one box

Name, Address & Telephone Number

Consultant

Agent

Authorized

Representative

19. If Sponsor is applying for more than one HUD program from the SuperNOFA, indicate which application(s) contain the forms with original signatures.

Date (mm/dd/yyyy)

Previous editions are obsolete

form HUD-92015-CA (02/2014) ref: Handbook 4571.3 Rev-1

Program Name

Form

2

0. Sponsor's Attorney (name, address & telephone number)

By (Signature of Sponsor's Authorized Representative)

Type in Title

Type in Name

Semi-detached

Detached