Form HUD 40108 HUD 40108 Timely Distribution of Funds by State

Timely Distribution of Funds by States 24 CFR 570.494(b)(1)

U.S. Department of Housing and Urban Development Office of Community Planning and Development State Community Development Block Grant Program

OMB No: 2506-0085 exp. (XX/XX/XX)

This form is for use by State grantees of the Community Development Block Grant program in order to demonstrate compliance with timely distribution requirements pursuant to 24 CFR 570.494(b)(1).

1. Name of State Grantee (as shown in item 5 of Standard Form 424)	3. Fiscal Year (Fiscal year of the grant funds)
2. Grantee’s Complete Address (as shown in item 5 of Standard Form 424)	4. Grant Number (Format “B-##-DC-##0001”)
	5. Date Signed by State (Date grant agreement, HUD 7082, was signed by the state)
6. Compliance Date (Line 5 plus 15 months.)	7. State CDBG Grant Amount (Excluding program income and prior year grants).
ADJUSTMENTS	12. Expected Distribution (Line 7 minus Line 11)
8. Administrative Cost Allowance 24 CFR 570.489(a)
9. Technical Assistance Allowance 24 CFR 570.489(a)	13. Total Awards to Units of General Local Government (Must equal Total Awards in REQUIRED table on page 2.)
10. Section 108 Loan Allowance 24 CFR 570.705(c)
11. Total Adjustments (Sum of Lines 8, 9 and 10)	14. Percent Awarded (Line 13 divided by Line 12 multiplied by 100%.)
15. Date of Last Award (Most recent award from REQUIRED table on page 2)
By signing this form, I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001).
Authorized Representative
First Name		Prefix
Middle Name		Suffix
Last Name		Telephone Number
Title		Email
Signature of Authorized Representative			Date Signed

REQUIRED Listing of Local Awards from Fiscal Year Grant
Award Recipient (Unit of General Local Government)	Award Amount* ($)	Date of Award** (mm/dd/yy)	Award Number (Optional)
Attach Additional Pages as Necessary
TOTAL AWARDS:

* Award Amount is the amount of funds received by the unit of general local government from the State CDBG grant being reported. Exclude amounts awarded to the unit of general local government from prior year grants or from program income. Timely distribution of recaptured funds from prior year grants and program income is addressed separately (see 24 CFR 570.494(b)(2)).

** Date of Award is the date the award was “obligated and announced” pursuant to 24 CFR 570.494(b)(1). “Obligated and announced” may include the date on which a state officially announces the selection and award of grants to its units of general local government by means of any official letter, press release, news media announcement, public notice, or official notice of award that the state may use to notify its localities and citizens that a grant has been awarded.

Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The purpose of the data is to safeguard HUD form 40108.

The public reporting burden for the collection of information is estimated to average 2.6 hours per response. Response to this form is mandatory for all State CDBG Grantees. 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 valid OMB control number.

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