| Instructions for Choice Neighborhoods Planning Grant Budget Form |
| 1. Part I |
| A. Fill in "Grantee Name", "Grant Number", "Site Name"and "Budget Revision #" above the table. |
| B. Cells in lines 1-6 of the table autopopulate with information from Part II; Line 7 autopopulates with information from Part III. |
| 2. Part II |
| Refer to the "Choice Neighborhoods Planning Grant Budget Guidance" posted to the program website at www.hud.gov/cn for information about how to classify each activity. |
| A. Under each BLI list each activity/contract separately. Provide enough detail for your grant management team to understand each activity. |
| B. "Current Overall Choice Neighborhoods Planning Grant Budget" (Column 3) is the amount previously approved by HUD for each activity. If this is Budget Revision #1, enter the budget as proposed in your original grant application. |
| C. "Requested Change in Overall Choice Neighborhoods Planning Grant Budget" (Column 4) is the amount by which you are changing from the previously approved amount for each activity. |
| D. "Requested Change in Disbursed Funds (Realignment)" (Column 5) is used if funds were erroneously drawn from LOCCS from the wrong BLI. HUD will use this information to 'realign' the LOCCS draw information. |
| E. "Current Authorized Amount" (Column 6) is the amount of funding currently availble for draw down (i.e. has been 'spread') in LOCCS for each activity. |
| F. "Requested Change in Amount Authorized for Expenditure (Change in Spread)" (Column 7) is the amount by which you are changing the funding available in LOCCS for each activity. |
| G. All other cells have formulas and will autopopulate based on your entry in columns 3-7. |
| 3. Part III |
| A. List on this spreadsheet any Non-Choice Neighborhoods funds (e.g., from match/leverage funds) that will be used to pay for costs associated with the Planning Grant effort that are not paid for by the Choice Neighborhoods grant funds. |
| - This form must include cash match and leverage. You may also include in-kind leverage. If including both, you must clearly label each source of leverage as "cash" or "in-kind." |
| 4. LOCCS form |
| A. Enter your Grant Management Team Coordinator's name. |
| B. "Current LOCCS Expenditures" is the amount of funds you have drawn from LOCCS for each BLI. |
| C. All other cells have formulas and will autopopulate. |
| 5. Complete the form |
| A. Review budget totals to make sure budgeted amounts equal the grant amount. |
| B. Print Parts I, II, and III. |
| C. Authorized Executive Officer signs and dates form on Part I. |
| D. Submit completed workbook and signed form to your grant management team. You may submit the signed budget form either via email with a pdf or via mail with a hard copy. In either case, please also email the Excel workbook to your Team Coordinator. |
| Choice Neighborhoods Planning Grant Budget | OMB Approval No. 2577-0269 (exp. TBD) |
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| Public Reporting Burden for this collection of information is estimated to average one hour 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 information is necessary to provide details on the funds requested by applicants/grantees. The form displays the amount requested, broken down by budget line item, with each use explained on Part II. Any Non-Choice Neighborhoods funds needed in association with the Planning Grant effort must be explained on Part III. The requested information will be reviewed by HUD to determine if the amount requested is reasonable and whether the required percentages of capital and supportive services funds are met. Responses to the collection are required by the appropriation under which the Choice Neighborhoods Planning grant was funded. The information collected does not lend itself to confidentiality. HUD may not conduct or sponsor, and a person is not required to respond to collection of information unless it displays a currently valid OMB control number. | ||||||
| Part I: Summary | ||||||
| Grantee Name: | Choice Neighborhoods Planning Grant Number: | |||||
| Site Name: | Budget Revision Number: | |||||
| Line No. | Summary by Budget Line Item | New Overall Choice Neighborhoods Planning Grant Budget | Previous LOCCS Authorized Amount of Funds |
Changes in LOCCS Authorization in this Revision | New Total Authorized Amount of Funds in LOCCS |
|
| 1 | 1408 | Management Improvements/ Capacity Building |
$- | $- | $- | $- |
| 2 | 1410 | Administration | $- | $- | $- | $- |
| 3 | 1430 | Fees and Costs | $- | $- | $- | $- |
| 4 | Total Funds Authorization ( Sum Of Lines 1-3) | $- | $- | $- | ||
| 5 | U2000 | Funds held in Reserve | $- | $- | ||
| 6 | Amount of Planning Grant ( Sum Of Lines 1-3) | $- | $- | $- | ||
| 7 | Non-CN | Total Non-CN Funds | $- | |||
| Signature of Lead Applicant/Grantee Executive Officer | Signature of Authorized HUD Official | |||||
| I/We, the undersigned, certify under penalty of perjury that the information provided on this form is true, accurate and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802). | ||||||
| X | Date | Date | ||||
| HUD Form 53421 (02/2012) | ||||||
| Part II: Supporting Pages for Revision to Overall Budget, Expenditure Allocation and/or Authorized Spending Amount | |||||||||||
| 0 | Grant Number | Budget Revision Number | |||||||||
| 0 | 0 | 0 | |||||||||
| Budget Line Item Number | Description of Proposed/Approved Action Use of Additional Authorized Funds |
Current Overall Choice Neighborhoods Planning Grant Budget | Requested Change in Overall Choice Neighborhoods Planning Grant Budget | Requested Change in Disbursed Funds (Realignment) | Current Authorized Amount (Current Spread) |
Requested Change in Amount Authorized for Expenditure (Change in Spread) | Total Funds to be Authorized for Expenditure (New Spread) |
New Budget Total | Difference between total budget and total spread | ||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ||||
| 1408 | MANAGEMENT IMPROVEMENTS / CAPACITY BUILDING | ||||||||||
| $- | $- | $- | |||||||||
| $- | $- | $- | |||||||||
| $- | $- | $- | |||||||||
| $- | $- | $- | |||||||||
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| $- | $- | $- | |||||||||
| $- | $- | $- | |||||||||
| Total Changes | $- | $- | $- | ||||||||
| Previous Approved Totals | $- | $- | |||||||||
| NEW TOTALS | $- | $- | $- | ||||||||
| BLI Percentage of Overall Budget | % | % | % | ||||||||
| 1410 | ADMINISTRATION | ||||||||||
| $- | $- | $- | |||||||||
| $- | $- | $- | |||||||||
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| $- | $- | $- | |||||||||
| Total Changes | $- | $- | $- | ||||||||
| Previous Approved Totals | $- | $- | |||||||||
| NEW TOTALS | $- | $- | $- | ||||||||
| BLI Percentage of Overall Budget | % | % | % | ||||||||
| 1430 | FEES AND COSTS | ||||||||||
| $- | $- | $- | |||||||||
| $- | $- | $- | |||||||||
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| Total Changes | $- | $- | $- | ||||||||
| Previous Approved Totals | $- | $- | |||||||||
| NEW TOTALS | $- | $- | $- | ||||||||
| BLI Percentage of Overall Budget | % | % | % | ||||||||
| Overall Totals | $- | $- | $- | $- | $- | $- | $- | ||||
| Part III: Match, Leverage and other Non-Choice Neighborhoods Funds | ||
| Source | Dollar Amount | Activity/Costs for which Non-Choice Neighborhoods Funds will be used |
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| TOTAL | $- |
| Memorandum For: OPHI LOCCS Administrator | |||||||||||
| From: | [enter HUD Team Coordinator Name] | ||||||||||
| Re: Choice Neighborhoods Grant #: | 0 | ||||||||||
| Grantee: | 0 | ||||||||||
| Budget Revision #: | 0 | ||||||||||
| Please make the following changes in LOCCS for the subject grant. | |||||||||||
| OVERALL CN BUDGET | REALIGNMENT OF EXPENDITURES | CHANGE IN SPREAD | |||||||||
| BLI | Current Overall CN Budget | Increase/ Decrease | Revised Overall CN Budget | BLI | Current LOCCS Expenditures | Increase/ Decrease | Revised LOCCS Expenditures | BLI | Current Spread | Increase/ Decrease | Revised Spread |
| 1408 | $- | $- | $- | 1408 | $- | $0.00 | 1408 | $- | $- | $- | |
| 1410 | $- | $- | $- | 1410 | $- | $0.00 | 1410 | $- | $- | $- | |
| 1430 | $- | $- | $- | 1430 | $- | $0.00 | 1430 | $- | $- | $- | |
| BLI Totals | $- | $- | $- | BLI Totals | $0.00 | $0.00 | $0.00 | BLI Totals | $- | $- | $- |
| U2000 | $- | $- | $- | ||||||||
| Choice Neighborhoods Director | |||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |