HUD-40110-B HOPWA Competitive Application & Renewal of Permanent Sup

Housing Opportunities for Persons with AIDS (HOPWA) Program: Comeptitive Grant Application; Annual Progress Report (APR) for (Competitive Grantees); Consolidated Annual Performance

HUD-40110-b_2506-0133_v. 06-2020

Housing Opportunities for Persons with AIDS (HOPWA) Program: Comeptitive Grant Application; Annual Progress Report (APR) for (Competitive Grantees); Consolidated Annual Performance...

OMB: 2506-0133

Document [docx]
Download: docx | pdf


OMB Approval No. 2506-0133

exp. XX/XX/XXXX



Shape1

HOPWA

Competitive Application &

Renewal of Permanent Supportive Housing Project

Budget Summary



U.S. Department of Housing and Urban Development

Office of Community Planning and Development

Office of HIV/AIDS Housing

Shape2




The information collection requirements pertain to grant application submission requirements which will be used to rate applications, determine eligibility, and establish grant amounts. Selections of applications for funding under the HOPWA Program are based on the criteria established in the published Notice of Funding Availability (NOFA) for new competitions or annual HOPWA renewal notice for grantees seeking renewal funding for eligible permanent supportive housing projects. HUD’s information collection requirements are supported by 42 U.S.C. § 12903(d) and HUD’s regulations at 24 CFR § 574.240.


The public reporting burden for the collection of information for a HOPWA Renewal Application (including this form, narratives, and other requirements listed in the renewal notice) is estimated at 15 hours. The public reporting burden for the collection of information for a new HOPWA Competitive Application (including this form, narratives, and other requirements listed in the applicable NOFA) is estimated at 45 hours. The information collected on this form is required to obtain a benefit. This agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless that collection displays a currently valid OMB control number. While confidentiality is not assured, HUD generally only releases this information as required or permitted by law. OMB Approval No. 2506-0133 (Expiration Date: XX/XX/XXXX)


WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802)




Application Budget Summary (all applicants)


Applicant Name


     

Number of Project Sponsors

     

Plan dates for grant agreement and activities

     

(mo./yr.)


A.

Eligible Activity

HOPWA Request

Leveraged Funds


 

A. Year 1

B. Year 2

C. Year 3

D. Total

Facility Development (new applications only)

1. Acquisition

     

     

     

     

     

2. Rehabilitation, Repair & Conversion

     

     

     

     

     

3. New Construction (for Community Residences and SRO dwellings only)

     

     

     

     

     

Facility Operations

4. Operating Costs for Housing Facility

     

     

     

     

     

5. Leasing

     

     

     

     

     

TBRA

6. Tenant-based Rental Assistance

     

     

     

     

     

STRMU

7. Short-term Rent, Mortgage, & Utility Payments to Prevent Homelessness

     

     

     

     

     

Support

Services

8. Supportive Services

     

     

     

     

     


Other Program Expenses

9. Housing Information Services

     

     

     

     

     

10. Permanent Housing Placement

     

     

     

     

     

11. Resource Identification to Establish, Coordinate & Develop Housing Assistance

     

     

     

     

     

12. Other Housing Activity (Approved by HUD)


     

     

     

     

     

 

13. Total Program Costs:

(total of lines 1-12)

 

     

 



Administrative Expenses

14. Grantee’s Administrative




     


15. Project Sponsor’s Administrative Costs




     


 

 




 


 

16. Total HOPWA Request

(total of lines 13-15)




     




Detailed Project Budget & Housing Outputs (each organization)


Name of organization:

     

Type:

Grantee: ; Project Sponsor:

If applicable:

Faith based:

Grassroots:


B.


Eligible Activity

HOPWA Request

 

Yr. 1

Yr. 2

Yr. 3

Totals:

Facility Development

(new applications only)

1. Acquisition Description:      

Budget

     

     

     

     

# of Units

     

     

     

     

2. Rehabilitation/Repair/Conversion Description:      

Budget

     

     

     

     

# of Units

     

     

     

     

3. New Construction (Community Residences & SRO dwellings only) Description:      

Budget

     

     

     

     

# of Units

     

     

     

     

Type of Facility:

Short-term shelter ; Transitional housing ; Community residence ; SRO dwelling ; or other permanent supportive housing

Facility Operations

4. Operating Costs for Housing Facility

Description:      

Budget

     

     

     

     

# of Units

     

     

     

     

5. Leasing

Description:      

Budget

     

     

     

     

# of Units

     

     

     

     

TBRA

6. Tenant-Based Rental Assistance Payments Description:      

Budget

     

     

     

     

# of Households

     

     

     

     

STRMU

7. Short-Term Rent, Mortgage & Utility Payments to Prevent Homelessness

Description:      

Budget

     

     

     

     

# of Households

     

     

     

     

Support Services

8. Supportive Services Costs

Description:      

Budget

     

     

     

     

# of Households

     

     

     

     

Other Program Expenses

9. Housing Information Services

Description:      

Budget

     

     

     

     

# of Households

     

     

     

     

10. Permanent Housing Placement Services Description:      

Budget

     

     

     

     

# of Households

     

     

     

     

11. Resource Identification to Establish, Coordinate, & Develop Housing Assistance

Description:      

Budget





12. Other Housing

Activity (Approved by HUD)

Description:      

Budget

     

     

     

     

# of Units

     

     

     

     

 

Administrative Expenses

13. Grantee's Administrative Costs

Description:      

Budget

     

     

     

     

14. Project Sponsor's Administrative Costs Description:      

Budget

     

     

     

     




15. Total HOPWA Request for this Organization






     


Note: Activity/Service delivery costs such as salary and overhead costs directly relating to carrying out a particular eligible activity in a budget line item should be represented in the funding amount requested for that particular budget line item.

15

Insert application package page number ____ Form HUD-40110-B (Expiration Date XX/XX/XXXX)


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2021-01-14

© 2024 OMB.report | Privacy Policy