HUD-50164 Unexploded Ordinance Hazards Disclosure-Waikoloa Maneuve

OMB Control #: 2577-0169

Exp. Date: XXXX, XX, XXXX

Unexploded Ordnance Hazards Disclosure – Waikoloa Maneuver Area (WMA)

Over the past two centuries, the Department of Defense (DOD) has used land throughout the country as military training and weapons testing grounds. As training and testing needs changed, DOD obtained property or returned it to private or public uses. Today, the U.S Army Corps of Engineers (USACE) has primary responsibility for cleanup of these Formerly Used Defense Sites (FUDS). In many locations, live ammunition was used and the removal of superficial and subsurface unexploded ordnance and munitions and explosives of concern (UXO/MEC) is incomplete. Together with the USACE, local city, county, and state government agencies have the primary responsibility to ensure adequate regulatory controls exist to protect human health and safety.

Living in a FUDS area can pose serious health hazards if not managed properly. HUD’s concern for resident safety at UXO/MEC sites is paramount. If a lessee believes his or her civil rights have been violated, including in relation to environmental conditions, contact the San Francisco Office of Fair Housing and Equal Opportunity (FHEO). In the case of the Waikoloa Maneuver Area FUDS, until remediation is complete, and the local regulatory agency issues the appropriate site closure document(s), the head of households/lessees of all Public Housing and Housing Choice Voucher programs must complete this acknowledgement form annually.

Agency:

Participant:

Project:

Unit Address:

LESSOR’S DISCLOSURE

1. Presence of unexploded ordnance hazards exist (check one below):

• Known unexploded ordnance hazards are present. Details are:

2. Records and reports available to the Lessor (check one below):

• Lessor has provided Lessee with all available records, informational materials and reports pertaining to unexploded ordnance hazards (list documents below).

Head of Household’s/Lessee’s Acknowledgment (Initial)

Head of Household/Lessee has received copies of all information listed above.

ACKNOWLEDGEMENT AND ACCEPTANCE

The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate.

Lessor: Signature, name and date

Head of Household/Lessee: Signature, name and date

Form HUD-50164