HUD 96015 Leveraging Resources

Healthy Homes and
Lead Hazard Programs

U.S. Department of Housing
and Urban Development

OMB Approval No. 2539-0015
(expires 11/30/2008)

Office of Lead Hazard Control
Factor 4

Leveraging Resources

Name Of The Organization Or Entity That Will
Contribute Match Or Leveraged Funds And If The
Organization Will Be a Subgrantee/Subrecipient

Work To Be
Accomplished In
Support Of The
Program.

Value Of In-Kind
Or Cash Match
Contribution*

Additional
Leveraged Funds
Contribution

Total
Of Match And
Leveraged
Contributions

Name:
Type of Organization:
Subgrantee/Subrecipient:

Yes

No

$0.00

Yes

No

$0.00

Yes

No

$0.00

Yes

No

$0.00

Yes

No

$0.00

Yes

No

$0.00

Yes

No

$0.00

Yes

No

$0.00

Yes

No

Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:
Name:
Type of Organization:
Subgrantee/Subrecipient:

$0.00
Total Amount

$

0.00 $

0.00 $

0

Name of the organization or entity that will contribute match or leveraged funds and if they are to be a subgrantee/subrecipient: Self
explanatory.
Work to be accomplished in support of the program: The type of activities that will be accomplished in support of the program (i.e.
outreach, training, risk Assessments/paint Inspections, relocation, etc.)
Value of In-kind or Cash Match Contribution: As required by statute or appropriation.
Additional Leveraged Funds Contribution: Additional funds above the match contribution required by statute or appropriation
Total of Match and Leveraged Contributions: The total of an applicant’s In-kind or Cash Match Contribution and any additional Leveraged
Funds Contribution

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form HUD-96015
(2/2005)