HUD Form 40175 Attachment B Community Development Block Grant - (CDBG)

Closeout Instructions for Community Development Block Grant Programs (CDBG)

Entitlement Closeout Certification (2) 40175

Closeout Instructions for Community Development Block Grant Programs (CDBG)

OMB: 2506-0193

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U.S. Department of Housing and Urban Development

Community Planning and Development


Community Development Block Grant – (CDBG) Entitlement Program

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Attachment B

Grantee Closeout Certification



Grantee Name:



Grant Number:



The Grantee hereby certifies that: (1) the grant as described in the approved application has been performed in accordance with the terms and conditions of the executed Grant Agreement and that there are no known outstanding programmatic or financial issues; and (2) all data provided below fairly reflects costs and sources of funds of the CDBG grant and are taken from HUD-approved reports and other project-related documents.


1. Grant amount $ ___________

2. Cumulative grant funds disbursed $ ___________

(Grantee should draw down amounts for any final audit costs

or unsettled third-party claims. Any such amounts not subsequently disbursed

must be immediately reimbursed to HUD.)


3 Previously-recaptured grant funds $ ___________

4. Balance of grant funds. $ ___________

(These funds will be recaptured by HUD.)



______________________________________ _________________________________

Grantee Authorized Representative’s Signature CPD Division Director’s Signature


____________________________________ ________________________________

Typed Name of Signatory Typed Name of Signatory


____________________________________ _________________________________

Title Title

____________________________________ _________________________________

Date Date


The above signature by HUD signifies approval of grant closeout.


Note: Any false statements knowingly or deliberately made are subject to civil or criminal penalties under Section 1001 of Title 18 of the U.S. Code.

HUD Form 40175

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCommunity Development Block Grant Programs Closeout Instructions
AuthorPreferred User
File Modified0000-00-00
File Created2021-11-20

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