50077-SL_2021_ CLEAN

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Certification by State or Local	U. S Department of Housing and Urban Development
Official of PHA Plans Consistency 	Office of Public and Indian Housing
with the Consolidated Plan or                                                                    OMB No. 2577-0226
State Consolidated Plan	Expires 3/31/2024
(All PHAs)	
Certification by State or Local Official of PHA Plans 
Consistency with the Consolidated Plan or State Consolidated Plan
I, ______________________________, the _____________________________________
                         Official’s Name                                                    Official’s Title

certify that the 5-Year PHA Plan for fiscal years ______ and/or Annual PHA Plan for fiscal year _______ of the ____________________________________________ is consistent with the
                                                                                            PHA Name

Consolidated Plan or State Consolidated Plan including the Analysis of Impediments (AI) to Fair Housing Choice or Assessment of Fair Housing (AFH) as applicable to the





 ______________________________________________________________________________
Local Jurisdiction Name

pursuant to 24 CFR Part 91 and 24 CFR §§ 903.7(o)(3) and 903.15.

Provide a description of how the PHA Plan’s contents are consistent with the Consolidated Plan or State Consolidated Plan.




I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning:  HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.  (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
						
Name of Authorized Official:				                 Title:




Signature:						                 Date:


The United States Department of Housing and Urban Development is authorized to solicit the information requested in this form by virtue of Title 12, U.S. Code, Section 1701 et seq., and regulations promulgated thereunder at Title 12, Code of Federal Regulations.  Responses to the collection of information are required to obtain a benefit or to retain a benefit.  The information requested does not lend itself to confidentiality.  This information is collected to ensure consistency with the consolidated plan or state consolidated plan.

Public reporting burden for this information collection is estimated to average 0.16 hours per year 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. HUD may not collect this information, and respondents are not required to complete this form, unless it displays a currently valid OMB Control Number.