Form HUD Form 40151 HUD Form 40151 Attachment B State CDBG Program Grant Close-out Certific

U.S. Department of Housing and Urban Development
Community Planning and Development
OMB Approval No. 2506-0193 (exp 1/31/2015)

Attachment: B
State CDBG Program Grant Close-out
Certification
Grantee Name: ________________________________
State CDBG Program

(Insert) Grant Year
Grant Number
Grant Amount
Authorized
Cumulative Grant
Funds Disbursed
Balance of Grant
Funds Remaining to
be Recaptured

Certification
The CPD Field Office in _____________________________ has received and reviewed
the financial status information and hereby confirms that all of the conditions for close-out have
been met.
________________________________________________
Name of CPD Field Office Director (Print)
________________________________________________
Signature of CPD Field Office Director
________________________________________________
Date

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HUD Form 40151 (1/2012)