HUD-4117 Appendices A-D

Corrections due by August 1

Appendix A1:
Conveyance Eligibility and Conveyance of Formula Current
Assisted Stock (FCAS) Units
Conveyance Regulation:
According to 24 CFR 1000.318,
"(a) Mutual Help and Turnkey III units shall no longer be considered Formula Current Assisted Stock
(FCAS) when the housing entity no longer has the legal right to own, operate, or maintain the units,
whether such right is lost by conveyances, demolition, or otherwise, provided that:
(1) Conveyance of each Mutual Help or Turnkey III unit occurs as soon as practicable after a unit
becomes eligible for conveyance by the terms of the Mutual Help and Occupancy Agreement
(MHOA); and
(2) The Indian tribe, tribally designated housing entity (TDHE), or Indian Housing Authority
actively enforce strict compliance by the homebuyer with the terms and conditions of the MHOA,
including the requirements for full and timely payment.
(b)(1) A Mutual Help or Turnkey III unit not conveyed after the unit becomes eligible for conveyance by
the terms of the MHOA may continue to be considered Formula Current Assisted Stock only if a legal
impediment prevented conveyance; the legal impediment continues to exist; the tribe, TDHE, or IHA has
taken all other steps necessary for conveyance and all that remains for conveyance is a resolution of the
legal impediment; and the tribe, TDHE, or IHA made the following reasonable efforts to overcome the
impediments:
(i) No later than four months after the unit becomes eligible for conveyance, the tribe, TDHE,
or IHA creates a written plan of action, which includes a description of specific legal
impediments as well as specific, ongoing, and appropriate actions for each applicable unit
that have been taken and will be taken to resolve the legal impediments within a 24-month
period; and
(ii) The tribe, TDHE, or IHA has carried out or is carrying out the written plan of action; and
(iii) The tribe, TDHE, or IHA has documented undertaking the plan of action.
(2) No Mutual Help or Turnkey III unit will be considered FCAS 24 months after the date the unit
became eligible for conveyance, unless the tribe, TDHE, or IHA provides evidence from a third
party, such as a court or state or federal government agency, documenting that a legal
impediment continues to prevent conveyance. FCAS units that have not been conveyed due to
legal impediments on December 22, 2016 shall be treated as having become eligible for
conveyance on December 22, 2016.”
The tribe/TDHE shall not include units that have been paid-off but not conveyed unless the
tribe/TDHE can demonstrate that the unit has not be conveyed for reasons beyond the tribe/TDHE’s
control.
The deadline for responding with changes to the data on the Formula Response Form is August 1. Any
changes reported after the August 1 deadline are not timely under §1000.315 and §1000.319.
Accordingly, no back funding will be provided based on changes reported after August 1.
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To maintain fairness to all tribes, if tribes receive funding for ineligible units, repayment will be
required.
On Table A1-1 below Report:
 All units that have been conveyed that did not have legal impediments preventing conveyance.
 All units that are conveyance eligible but not conveyed.
TABLE A1-1: Conveyed units and conveyance-eligible units that did not/do not have legal
impediments preventing conveyance
Project Number
Unit Number
Conveyance
Conveyance date
Eligibility date*

*The conveyance eligibility date is the date that the unit’s purchase price was paid-off, whether through lump sum payment, accrual in equity
accounts, self-amortization of the purchase price, or any combination of these. Because the MHOA has a self-amortizing purchase price,
pay-off necessarily occurs no later than the end of the term of the MHOA.

On Table A1-2 below Report:
 All units that are paid-off that have legal impediments preventing conveyance.
 All units that were previously removed as conveyance eligible that had legal impediments and
that have since conveyed.
 For each unit meeting the criteria in bullets 1 and 2 above, provide reasons that conveyance was
beyond the tribe’s control and steps the tribe has taken to resolve the problem. For further
information see PIH Notice 2017-15.
TABLE A1-2: Units that are eligible for conveyance with legal impediments preventing
conveyance
Project
Unit
Conveyance Conveyance Explanation of legal impediments
Number
Number
Eligibility
date
preventing timely conveyance**
date*

*The conveyance eligibility date is the date that the unit’s purchase price was paid-off, whether through lump sum payment, accrual in equity
accounts, self-amortization of the purchase price, or any combination of these. Because the MHOA has a self-amortizing purchase price,
pay-off necessarily occurs no later than the end of the term of the MHOA.
**Explanation of legal impediments preventing timely conveyance of each unit can be provided on supplemental pages if more space is
needed.

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Appendix A2:
Date of Full Availability (DOFA) of
Formula Current Assisted Stock (FCAS) Units
DOFA Regulation:
According to 24 CFR 1000.312 and 1000.314, FCAS "consists of housing units owned or
operated pursuant to an ACC. This includes all Low Rent, Mutual Help, and Turnkey III housing units
under management as of September 30, 1997, and all 1937 Act units in the development pipeline when
they become owned or operated by recipients and are under management as indicated in the Formula
Response Form."
Report:
 Low Rent, Mutual Help, and Turnkey III units funded under 1937 Housing Act
(i.e., units that were subject to an Annual Contributions Contract (ACC)).
Do Not Report:
 Units built with NAHASDA, HOME, or ICDBG funds.
 Units built with Bureau of Indian Affairs, State, or tribal funds.
 Units built over the number specified in the original ACC for Projects with DOFA after
October 1, 1997.
Please provide the information below for each new reported project DOFA. Please provide a
copy of the ACC for each reported project indicating the number and type of units allowed.
In accordance with §1000.319(c), a recipient will not be provided back-funding for any units that
the recipient failed to report on the Formula Response Form in a timely manner.
Project Number

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Number of Units

Type of Units

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DOFA

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Appendix A3:
Conversion of Formula Current Assisted Stock (FCAS) Units
Conversion Regulation:
According to 24 CFR 1000.316 (c), “ If units were converted before October 1, 1997, as
evidenced by an amended ACC, then those units will be counted for formula funding and eligibility
purposes as the type of unit to which they were converted. If units were converted on or after October 1,
1997, the following applies:
1. Units that converted after October 1, 1997 will be counted as the type of unit specified on the
original ACC in effect on September 30, 1997.
2. Whether or not it is the first conversion, a unit converted after October 1, 1997, will be considered
as the type converted to when determining continuing FCAS eligibility. A unit that is
converted to low-rent will be treated as a low-rent unit for purposes of determining continuing
FCAS eligibility. A unit that is converted to homeownership will be treated as a homeownership
unit for purposes of determining continuing FCAS eligibility.
3. The Indian tribe, TDHE, or IHA shall report conversions on the Formula Response Form.”
Report:
 Newly converted units.
Do Not Report:
 Units that have been previously reported as converted unless there has been a change.
Please provide the information below for each unit converted. Please provide a copy of the
Amended ACC for each unit converted prior to October 1, 1997.
Project
Number

Unit Number

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Unit Type as listed
on Formula
Response Form
(LR, MH, TKY III)

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Unit Type after
Conversion
(LR, MH, TKY III)

Date of
Conversion

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Appendix A4:
Demolimotion and Rebuilding of Formula Current Assisted Stock
(FCAS) Units
Demolition Regulation:
According to 24 CFR 1000.318(e), "A unit that is demolished pursuant to a planned demolition
may be considered eligible as a FCAS unit if, after demolition is completed, the unit is rebuilt within one
year. Demolition is completed when the site of the demolished unit is ready for rebuilding. If the unit
cannot be rebuilt within one year because of relative administrative capacities and other challenges
faced by the recipient, including but not limited to geographic distribution within the Indian area and
technical capacity, the Indian tribe, TDHE or IHA may request approval for a one-time, one-year
extension. Requests must be submitted in writing and include a justification for the request.”
Report:
 All demolished units when demolition is complete.
 All units that were rebuilt. If applicable, provide justification of why the units cannot be rebuilt
within one year of demolition.
Please note that requests for a one-time, one-year extension must be made within 24 months of
completed demolition.
Project
Number

Unit
Date
Number Demolition
Completed

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Date Unit
Rebuilt

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Explanation of why unit is not
rebuilt within one year of
demolition date

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Appendix A5:
All Other Corrections to Formula Current Assisted Stock (FCAS)
FCAS Correction Regulation:
According to 24 CFR 1000.312 and 1000.314, "Formula Current Assisted Stock (FCAS) consists
of housing units owned or operated pursuant to an ACC. This includes all Low Rent, Mutual Help, and
Turnkey III units under management as of September 30, 1997, and all 1937 Act units in the
development pipeline when they become owned or operated by recipients and are under management
as indicated in the Formula Response Form."
On Table A5-1 Report:
 Units not used as low-income housing dwelling units.
o Include units used for non-dwelling purposes.
o Include vacant units, unless they are being made available for occupancy through, for
example, active repair or rehabilitation, advertising, or processing from a wait list.
o Include units that are not occupied by a NAHASDA eligible family.
On Table A5-2 Report:
 Units previously removed based upon the project's DOFA that are still eligible for FCAS because
of a subsequent homebuyer.
On Table A5-3 Report:
 Differences between FCAS reported on the Formula Response Form and your Tribe’s records
that are not due to conveyances, Date of Full Availability and/or conversion.

Project Number

TABLE A5-1: Units not used as low-income dwelling units
Unit Number
Date unit was last
Reason for change
occupied by eligible
recipient

Project Number

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TABLE A5-2: Units with Subsequent Homebuyers
Unit Number
New Agreement
Term of the Agreement (in
Signed Date
years)

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Project Number

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TABLE A5-3: All other corrections to FCAS
Formula
Correct
Reason/Explanation for Change
Response
Number of
Form Unit
Units & Unit
Counts &
Type
Unit Type

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Appendix B1:
Request to Add Other Geographies to Formula Area Based on Formula
Area Definition
Formula Area Regulation:
According to 24 CFR 1000.302 Formula Area, (1) Formula areas are: (i) Reservations for federally
recognized Indian tribes, as defined by the U.S. Census; (ii) Trust lands; (iii) Department of the Interior NearReservation Service Areas; (iv) Former Indian Reservation Areas in Oklahoma Indian Areas, as defined by the
U.S. Census as Oklahoma Tribal Statistical Areas (OTSAs); (v) Congressionally Mandated Service Areas; (vi)
State Tribal Areas as defined by the U.S. Census as State Designated American Indian Statistical Areas
(SDAISAs); (vii) Tribal Designated Statistical Areas (TDSAs); (viii) California Tribal Jurisdictional Areas
established or reestablished by Federal court judgment; and (ix) Alaska formula areas described in paragraph
(4) of this definition.
Please show the boundaries of the area being requested on a map** and provide a copy of legal
documents (e.g., Federal Register Notice, publication of designation of Near-Reservation Service Area, Public
Law documents legislating Congressionally Mandated Service Areas) for each geographic area you want to
add to your Tribe’s Formula Area.
To request additional areas beyond those identified in the above list of nine, see Appendix B2.
**Maps are available from the US Census Bureau. https://www.census.gov/geo/maps-data/

Geographic Area
requested

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Category Requested
(i.e. reservation, OTSA,
SDAISAs, etc.)

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Legal Document
provided (description)

Map provided
(Yes or No)?

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Appendix B2:
Request to Add Other Geographies to Formula Area Based on
Provision of Substantial Housing Services
Substantial Housing Services Regulation:
According to 24 CFR 1000.302 Formula Area: (2)(i) For a geographic area not identified in paragraph
(1) of this definition, and for expansion or re-definition of a geographic area from the prior year, including those
identified in paragraph (1) of this definition, the Indian tribe must submit, on a form agreed to by HUD,
information about the geographic area it wishes to include in its Formula Area, including proof that the Indian
tribe, where applicable, has agreed to provide housing services pursuant to a Memorandum of Agreement
(MOA) with the tribal and public governing entity or entities of the area, or has attempted to establish such an
MOA; and is providing substantial housing services and will continue to expend or obligate funds for
substantial housing services as reflected in the form agreed to by HUD for this purpose.
According to §1000.302, Substantial Housing Services: (1) Affordable housing activities funded from
any source provided to American Indian and Alaska Native (AIAN) households with incomes 80 percent of the
median income as defined in the Native American Housing Assistance and Self-Determination Act (NAHASDA)
(25 U.S.C. 4103 (14)) or lower, equivalent to 100 percent or more of the increase in the IHBG formula
allocation that the Indian tribe would receive as a result of adding the proposed geography; or (2) Affordable
housing activities funded with IHBG funds provided to AIAN households with incomes 80 percent of the median
income as defined in NAHASDA or lower, equivalent to 51 percent or more of the Indian tribe’s current total
IHBG grant; and either: (i) 51 percent or more of the Indian tribe’s official enrollment resides within the
geographic area; or (ii) The Indian tribe’s official enrollment constitutes 51 percent or more of the total AIAN
persons within the geography. (3) HUD shall require that the Indian tribe annually provide written
verification…that the affordable housing activities it is providing meet the definition of substantial housing
services.
If you wish to request additional areas based on the above regulations, please provide a map showing
the boundaries if the area being requested**, an MOA or documentation of the Tribe’s efforts to secure one,
and fill in the two tables below for each area that you want to add to your Tribe’s Formula Area. In addition,
please provide a brief narrative describing each program and any income eligibility provisions that apply. Use a
separate table for each geographic area requested.
Add Other Geographies to Formula Area Based on Provision of Substantial Housing Services
Specific
Number of
Affordable
Program Income Source Year(s) Total Dollar Amount
Geographic
Tribal
Housing
Eligibility
of
of Program
Area
Members
Program/Program Provisions
Funds
Investment by Year
Requested
Living in
Purpose
(If multiple sources
Requested
of funding, please
Area
separate IHBG from
other)

Total dollar amount of program investment by year must appear in the Indian Housing Plan (IHP) and actual
accomplishments must appear in the Annual Performance Report (APR) separately for each area requested.
HUD will monitor Formula Area additions to ensure that the tribe continues investment at levels that are
consistent with the definition of Substantial Housing Services.
**Maps are available from the US Census Bureau at https://www.census.gov/geo/maps-data/
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Appendix C:
Enrollment in Overlapping Areas
Overlapping Area Regulation:
According to 24 CFR 1000.326, “(a) If an Indian tribe’s formula area overlaps with the formula area of
one or more other Indian tribes, the funds allocated to that Indian tribe for the geographic area in which the
formula areas overlap will be based on: (1) The Indian tribe’s proportional share of the population in the
overlapping geographic area; and (2) The Indian tribe’s commitment to serve that proportional share of the
population in such geographic area. (3) In cases where a State recognized tribe’s formula area overlaps with
the formula area of a Federally recognized Indian tribe, the Federally recognized Indian tribe receives the
allocation for the formula area up to its population cap, and the State recognized tribe receives the balance of
the overlapping area (if any) up to its population cap.
(b) Tribal membership in the geographic area (not to include dually enrolled tribal members) will be
based on data that all Indian tribes involved agree to use. Suggested data sources include tribal enrollment
lists, the U.S. Census, Indian Health Service User Data, and Bureau of Indian Affairs data. (c) If the Indian
tribes involved cannot agree on what data source to use, HUD will make the decision on what data will be used
to divide the funds between the Indian tribes by August 1*.”
Please provide the information below for each overlapping geographic area of your Tribe’s Formula
Area as listed in the Formula Response Form. This information will only be used if ALL tribes in the
overlapping area submit data.
Geographic Area Name

Tribal Enrollment

*Postmark or fax changes and corrections with appropriate supporting documentation to the IHBG Formula Customer Service Center by
August 1, 2020, for inclusion in the FY 2021 allocation. Please note that with respect to overlapping areas, while HUD requires requests for formula
changes to be submitted by August 1st , HUD may consider subsequent requests related to overlapping areas from tribes that have been directly
affected by changes resulting from requests submitted by another tribe or tribes in the overlapping area that were submitted prior to the August 1
deadline. Subsequent requests received in prior FYs may be carried into future FYs if processing of such requests is not finalized in the current FY.

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Appendix D:
Tribal Enrollment & Population Cap
Tribal Enrollment and Population Cap Regulation:
According to 24 CFR 1000.302, “(5) In some cases the population data for an Indian tribe within its Formula Area
is greater than its tribal enrollment. In general, to maintain fairness for all Indian tribes, the tribe’s population data will not
be allowed to exceed twice an Indian tribe’s enrolled population. However, an Indian tribe subject to this cap may receive
an allocation based on more than twice its total enrollment if it can show that it is providing housing assistance to
substantially more non-member Indians and Alaska Natives who are members of another federally recognized Indian tribe
than it is to members. For state-recognized Indian tribes, the population data and formula allocation shall be limited to their
Tribal Enrollment figures as determined under enrollment criteria in effect in 1996. (6) In cases where an Indian tribe is
seeking to receive an allocation more than twice its total enrollment, the tribal enrollment multiplier will be determined by
the total number of Indians and Alaska Natives the Indian tribe is providing housing assistance (on July 30 of the year
before funding is sought) divided by the number of members the Indian tribe is providing housing assistance. For
example, an Indian tribe which provides housing to 300 Indians and Alaska Natives, of whom 100 are members, would
then be able to receive an allocation for up to three times its tribal enrollment if the Indian and Alaska Native population in
the area is three or more times the tribal enrollment.”
Appendix D1: Corrections to and Certification of Tribal Enrollment:
If you wish to correct your Tribe’s enrollment, you must complete the appropriate certification below and
submit it to the IHBG Formula Customer Service Center by the correction deadline.
If there is a "*" next to "AIAN persons" in the Needs section of the Formula Response Form, your Tribe's data have
been "capped." Whether or not you wish to correct your Tribe’s enrollment, if the population data within your
Tribe’s Formula Area exceeds twice your Tribe’s enrollment (i.e., your Tribe is subject to the population cap
described above), you must complete the appropriate certification below and submit it to the IHBG Formula
Customer Service Center by the correction deadline.
Check and complete the applicable certification:
I certify, to the best of my knowledge, the Tribe’s enrollment number contained in this document is the most
accurate number available at the time of certification.**
I certify, to the best of my knowledge, the Tribe’s enrollment number contained in this document is inaccurate.
The Tribe’s most accurate enrollment number available at the time of the certification is:
.**

Signature of Tribal Representative authorized to make this certification
Print Name:
Title:

Date:

If the population data within your Tribe’s Formula Area exceeds twice your Tribe’s enrollment and you fail
to complete the above certification and submit it to the IHBG Formula Customer Service Center by the correction
deadline, you will be deemed to have certified the Tribe’s enrollment number contained in this document is the
most accurate number available at the time of certification, which will be the correction deadline.**
*Warning: Federal law provides that anyone who knowingly or willfully submits (or causes to submit) a document containing any false, fictitious, misleading, or
fraudulent statement/certification or entry may be criminally prosecuted and may incur civil administrative liability. Penalties upon conviction can include a fine and
imprisonment, as provided pursuant to applicable law, which includes, but is not limited to, 18 U.S.C. 1001, 1010, 1012; 13 U.S.C. 3729, 3802, 24 C.F.R. Parts 28
and 30, and 2 C.F.R. Parts 180 and 2424.
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Appendix D2: Corrections to Population Cap
According to the Native American Housing Assistance and Self-Determination Act Guidance 98-12, “A
tribe must demonstrate that it is serving substantially more non-member Indians and Alaska Natives who are
members of another federally recognized tribe than members. For Population Cap purposes, Housing
Assistance refers to grants or subsidies provided within the year before funding is sought to make housing
more affordable for low-income Indians and Alaska Natives who are member of Federally recognized Indian
tribes including but not limited to: HOME programs; energy assistance; home improvement assistance;
mortgage or downpayment assistance; homeless or emergency shelter assistance; and, programs similar to
the programs formerly known as Mutual Help, Low Rent, Turnkey 3, and Section 8.”
If you wish to adjust your Tribe’s population cap to a level greater than twice your Tribe’s enrollment,
please provide the information below and a brief narrative describing the programs.
A
Tribal
Enrollment

B
Total Number of
AIAN Persons
Served

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C
Total Number of
Tribal Members
Served

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D
Total Number of Members of
Other Federally Recognized
Tribes Served

Population
Factor
(C+D)/C
(submit if
Factor>2.0)

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