5893 5893-RAD_Application

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Create New Application

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SECTION 1: PIC DEVELOPMENT NUMBER AND NAME

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Public reporting burden for this collection of information is estimated to average 30 minutes 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.
This collection of information is required to apply to the Rental Assistance Demonstration program as authorized by
the Consolidated and Further Continuing Appropriations Act of 2012 and subsequent appropriations. Requirements for
RAD were established in PIH 2012-32 and subsequent notices. The information will be used to determine program
eligibility and provide information necessary to make an initial award. There are no assurances of con dentiality.

Enter the PIC Development Number and Name.
Development Number

Name of Development

Conversion Manager

Public Housing Agency (PHA) Name

Project Name for Tracking Purposes

Enter the requested contact information that HUD will use for any questions about the application

PHA Contact Name

Title

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Telephone Number

Email

SECTION 2: BACKGROUND INFORMATION ON THE PHA AND THE PROJECT

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Has this property been approved for Section 18 Demolition or Disposition?

Is the property subject to a Capital Fund Financing Program (CFFP), Energy Performance Contract (EPC), or
repayment agreement?
CFFP

Other

EPC

Initial Conversion Plans
Identify which of these items are expected to occur as part of the conversion (check all applicable):
New Construction

Rehabilitation

Transfer of Assistance (TOA)

No Rehabilitation

Type of Conversion

For all conversions, a PHA must provide a RAD Information Notice to all residents prior to the resident meetings
to inform residents of projects proposed for conversion of their rights in connection with a proposed
conversion.
Date of RIN issuance

Error: The RIN must be issued before this Application is submitted
A PHA must provide any resident that may be displaced as a result of acquisition, rehabilitation, or demolition with a
General Information Notice (GIN) detailing potential rights under the Uniform Relocation Act. The GIN may be issued
simultaneous with the RIN, but no later than 30 days following the issuance of a CHAP.
Date of General Information Notice (GIN) issuance (if applicable)?

If awarded a CHAP, you must provide the GIN as soon as reasonable, but not later than 30 days from CHAP
issuance
Proposed Unit Bedroom Distribution Post RAD Conversion: Identify the bedroom distribution of units to be
included in your CHAP; entire should re ect the post-conversion property. (Applicants must attach a screen shot
from PIC of the AMPs' Development Pro le and Summary Information as evidence that the PHA currently has
this number of units under ACC).
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BEDROOM SIZE

Units
Converting

0-BR

1-BR

2-BR

3-BR

4-BR

5-BR

6-BR

Total
Units

0

0

0

0

0

0

0

0

*If units are converting from multiple PIC Development #s, complete the "Many-to-One" worksheet
Current Utility Allowances. Enter the utility allowances currently in e ect at the public housing project or
project(s). These amounts will be included in your CHAP award if your Application is approved. If there are
multiple sites covered by this application with di erent utility allowances, input a weighted average for the
purposes of the application (but note that the RAD Conversion Commitment and subsequent PBV or PBRA HAP
contract can accommodate di erent utility allowances for the same bedroom con guration):
0-BR

1-BR

2-BR

3-BR

4-BR

5-BR

6-BR

Current Public Housing
Utility Allowances

Check this box if the Utility Allowances shown above are weighted averages
Overview of Proposed Conversion. Provide a general description of the proposed conversion, including a
description of the existing site(s), the general scope of work (new construction, moderate rehab, minimal rehab),
whether units will be replaced on-site or o -site, major anticipated nancing sources, and any other information
that will help HUD to understand the conversion plan (i.e., anticipated use of FHA-insurance, 4% or 9% LITHC,
etc.). Additionally, if not all of the units at the AMP are included in the conversion provide a description of plans
for the remaining units in the AMP. It is acceptable and anticipated that conversion plans will change from what
is presented in this application.

SECTION 3: APPLICATION FEATURES AND/OR PRIORITY CATEGORIES
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Is this Application part of a new Portfolio Award request?

Is this Application a "many-to-one" request involving units from multiple AMPs?

Is this Application part of an existing (awarded) Portfolio award?

Was the public housing project developed through public housing mixed- nance?
Complete the next section to identify whether the application quali es for priority selection
Priority Categories
Applications are provided priority selection if they meet certain criteria for "high investment."

Is this property located in a designated Opportunity Zone



SECTION 4: REQUIRED ATTACHMENTS
The Following Must Be Attached as Part of Your Electronic Application:
Yes

Summary of Resident Comments and PHA Responses

Choose File No le chosen

Yes

PIC Development Pro le and Summary Screen Shot

Choose File No le chosen

No

Evidence of PHA to Administer PBV Contracts (on
PHA letterhead)

No

Mixed- nance A davit (available here) (mixednance-a davit.docx)

No

Portfolio Application (available here
(portfolioawardworksheet_9-13-19.xlsx))

No

Many-to-One Worksheet (Online worksheet below)

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SECTION 5: CERTIFICATION AND BOARD APPROVAL



Complete the elds below for the appropriate person within your organization. By submitting this application, the
signatory is certifying to the language below, including that he or she has obtained Board Approval for this application.
Print Name of Authorized Signator:

Print Title of authorized signator:

Date:

I hereby certify to the following: (1) that I have the requisite authority to execute this application on behalf of the
PHA; (2) that HUD can rely upon this certi cation in evaluating the Application, (3) that I acknowledge that I have
read and understand Notice PIH-2012-32 (HA) H-2017-03, REV-3 (the "Notice"), which describes the Rental
Assistance Demonstration (RAD) (the "Program"), and agree to comply with all requirements of the Program or
Notice; (4) that all materials submitted in association with the application are accurate, complete and not
misleading; (5) that, if selected for award, the owner will comply with the fair housing and civil rights
requirements at 24 CFR 5.105(a) (general requirements) and will a rmatively further fair housing; and (6) that
there are no debarments, suspensions, or Limited Denials of Participation in Federal programs lodged against
the applicant, PHA Executive Director, Board members, or a liates. Warning: HUD will prosecute false claims
and statements. Conviction may result in criminal and/or civil penalties (18 USC Sections 1001, 1010, 1012; 31
USC Sections 3729, 3802)

SUBMIT APPLICATION
Save for Later

Run Completeness Check

You cannot submit the application until all required items are completed.

Submit Application

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