+-----------+----------+---------------------+---+---+------------------+
| **Guide   |          |                     |   |   |                  |
| for       |          |                     |   |   |                  |
| Review of |          |                     |   |   |                  |
| R         |          |                     |   |   |                  |
| elocation |          |                     |   |   |                  |
| of        |          |                     |   |   |                  |
| Resi      |          |                     |   |   |                  |
| dential** |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
| **        |          |                     |   |   |                  |
| Displaced |          |                     |   |   |                  |
| Person    |          |                     |   |   |                  |
| \--       |          |                     |   |   |                  |
| I         |          |                     |   |   |                  |
| ndividual |          |                     |   |   |                  |
| Case      |          |                     |   |   |                  |
| File**    |          |                     |   |   |                  |
+-----------+----------+---------------------+---+---+------------------+
| **Name of |          |                     |   |   |                  |
| Program   |          |                     |   |   |                  |
| Parti     |          |                     |   |   |                  |
| cipant:** |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
+-----------+----------+---------------------+---+---+------------------+
| **Staff   |          |                     |   |   |                  |
| Con       |          |                     |   |   |                  |
| sulted:** |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
| **     ** |          |                     |   |   |                  |
+-----------+----------+---------------------+---+---+------------------+
| **Project |          | **Funding Source:\  |   | * |                  |
| Name and  |          |      **             |   | * |                  |
| Number:   |          |                     |   | L |                  |
|      **   |          |                     |   | o |                  |
|           |          |                     |   | c |                  |
|           |          |                     |   | a |                  |
|           |          |                     |   | t |                  |
|           |          |                     |   | i |                  |
|           |          |                     |   | o |                  |
|           |          |                     |   | n |                  |
|           |          |                     |   | : |                  |
|           |          |                     |   | \ |                  |
|           |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
|           |          |                     |   |   |                  |
|           |          |                     |   | * |                  |
|           |          |                     |   | * |                  |
+-----------+----------+---------------------+---+---+------------------+
| **Name(s) |          |                     | * |   |                  |
| of        |          |                     | * |   |                  |
| Revi      |          |                     | D |   |                  |
| ewer(s)** |          |                     | a |   |                  |
|           |          |                     | t |   |                  |
|           |          |                     | e |   |                  |
|           |          |                     | * |   |                  |
|           |          |                     | * |   |                  |
+-----------+----------+---------------------+---+---+------------------+

**NOTE:** All questions that address requirements contain the citation
for the source of the requirement (statute, regulation, NOFA, or grant
agreement). If the requirement is not met, HUD must make a finding of
noncompliance. All other questions (questions that do not contain the
citation for the requirement) do not address requirements, but are
included to assist the reviewer in understanding the participant\'s
program more fully and/or to identify issues that, if not properly
addressed, could result in deficient performance. Negative conclusions
to these questions may result in a \"concern\" being raised, but not a
\"**finding**.\"

**[Instructions]{.underline}:** This Exhibit is designed to monitor
compliance with statutory and regulatory requirements governing
displacement, relocation and the provision of assistance to certain
residential occupants who are displaced under HUD-assisted projects.
(**NOTE:** For review of individual case files for persons temporarily
relocated, use Exhibit 25-5.\] Generally, the displacement sample shall
include completed cases in which payments have been made. However, if
necessary to provide a representative sample, other cases may be
included. The sample should provide a basis to determine not only
whether payments were computed properly and made promptly, but also
whether displaced persons received the full range of relocation payments
and services to which they were entitled. Cases in which an appeal has
been filed or the program participant has determined that a person is
ineligible for relocation assistance shall be given a high priority.
Following the guidance on the selection of projects to review in the
introduction to this Chapter, the sample of cases should include
residential tenants and owners, with particular emphasis on lower-income
tenants.

**[Questions]{.underline}:**

1\. Client Information

+-----------------------------------------------------------------------+
| Provide the following client information:                             |
+-----------------------------------------------------------------------+
| Name(s) of Person(s) Displaced:                                       |
|      \_\_\_\_\_\_\_\                                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Telephone Number(s):                                                  |
|      \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Address From Which Displaced:                                         |
|      \_\_\_\_\_\_\_\_\                                                |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\                                                           |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Address of Replacement Property:                                      |
|      \_\_\_\_\_\_\                                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\                                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Date of Initial Occupancy:                                            |
|      \_\_\_\_\_\_\_\_\_\_\_\_\                                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Date Final Move Completed:                                            |
|      \_\_\_\_\_\_\_\_\_\_\                                            |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+
| **Describe Basis for Conclusion:**                                    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

2\.

+-----------------------------------------------------------------------+
| a\. **Occupant Characteristics**                                      |
|                                                                       |
| > Check As Appropriate: Check One:                                    |
| >                                                                     |
| > Owner Family                                                        |
| >                                                                     |
| > Tenant Individual                                                   |
+-----------------------------------------------------------------------+
| b\. **Household Composition** (indicate number)                       |
|                                                                       |
| > Adults (lawfully present in U.S.) [     ]{.underline}               |
| >                                                                     |
| > Adults (not lawfully present in U.S.) [     ]{.underline}           |
| >                                                                     |
| > Children (under 18 & lawfully present in U.S.) [     ]{.underline}  |
| >                                                                     |
| > Children (under 18 & not lawfully present in U.S.)                  |
| > [     ]{.underline}                                                 |
| >                                                                     |
| > **Total** \_\_\_\_\_\_                                              |
+-----------------------------------------------------------------------+
| c\. **Head of Household**                                             |
|                                                                       |
| > Check One: Check One: Check One:                                    |
| >                                                                     |
| > Male Under 65 Lawfully present in U.S.                              |
| >                                                                     |
| > Female 65 and Over Not lawfully present in U.S.                     |
+-----------------------------------------------------------------------+
| d\. **Racial/Ethnic Data**                                            |
|                                                                       |
| (Check one or more, if applicable)                                    |
|                                                                       |
| Alaskan Native or American Indian                                     |
|                                                                       |
| Asian                                                                 |
|                                                                       |
| Black/African American                                                |
|                                                                       |
| Hispanic/Latino                                                       |
|                                                                       |
| Native Hawaiian/Other Pacific Islander                                |
|                                                                       |
| White                                                                 |
|                                                                       |
| American Indian/Alaskan Native and White                              |
|                                                                       |
| Asian and White                                                       |
|                                                                       |
| Black/African American and White                                      |
|                                                                       |
| American Indian/Alaskan Native and Black/African American             |
|                                                                       |
| Other Multi-racial                                                    |
+-----------------------------------------------------------------------+
| **Describe Basis for Conclusion:**                                    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

3\.

+------------------------------------------------------------+---------+
| Is there evidence that the displaced person was            |         |
| interviewed to determine his/her relocation needs and      |         |
| preferences and to explain his/her rights and options? (If |         |
| yes, include date of interview in response below.)         |         |
|                                                            |         |
| \[49 CFR 24.205(c)(2)(ii)\]                                |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

4\.

+----------------------------------------------------------+---+---------+
| a\. Is the displaced person's average monthly gross      |   |         |
| household income "low-                                   |   |         |
|                                                          |   |         |
| income" as classified by HUD's Annual Survey of Income   |   |         |
| Limits for the                                           |   |         |
|                                                          |   |         |
| Public Housing and Section 8 programs?                   |   |         |
+----------------------------------------------------------+---+---------+
| b\. If the answer to "a" above is "yes," was the         |   |         |
| person's replacement                                     |   |         |
|                                                          |   |         |
| housing payment calculated using the lesser of the       |   |         |
| following (check one                                     |   |         |
|                                                          |   |         |
| and complete):                                           |   |         |
|                                                          |   |         |
| 30% of average monthly gross household                   |   |         |
|                                                          |   |         |
| income \$[     ]{.underline}\_\_\_\_\_\_\_\_\_\_\_       |   |         |
|                                                          |   |         |
| Average monthly cost for rent and utilities at the       |   |         |
| displacement                                             |   |         |
|                                                          |   |         |
| dwelling for a reasonable period prior to displacement   |   |         |
|                                                          |   |         |
| \$[     ]{.underline}\_\_\_\_\_\_\_\_\_                  |   |         |
|                                                          |   |         |
| \[49 CFR 24.402(b)(2)(ii)\]                              |   |         |
+----------------------------------------------------------+---+---------+
| **Describe Basis for Conclusion:**                       |   |         |
+----------------------------------------------------------+---+---------+
|                                                          |   |         |
+----------------------------------------------------------+---+---------+

5\.

+------------------------------------------------------------+---------+
| Does the file contain a written General Information Notice |         |
| (GIN)? (If yes, include the date of the GIN in response    |         |
| below.)                                                    |         |
|                                                            |         |
| \[49 CFR 24.9 and 49 CFR 24.203(a)\]                       |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

6\.

+----------------------------------------------------------+-----------+
| If the answer to 5 above is "yes," did the General       |           |
| Information Notice:                                      |           |
+----------------------------------------------------------+-----------+
| a\. Include a description of the program participant's   |           |
| relocation program?                                      |           |
|                                                          |           |
| \[49 CFR 24.203(a)\]                                     |           |
+----------------------------------------------------------+-----------+
| b\. Inform the person that he/she may be displaced for   |           |
| the project and                                          |           |
|                                                          |           |
| generally describe the relocation payment(s) for which   |           |
| he/she may be                                            |           |
|                                                          |           |
| eligible?                                                |           |
|                                                          |           |
| \[49 CFR 24.203(a)(1)\]                                  |           |
+----------------------------------------------------------+-----------+
| c\. Inform the person that he/she will be given          |           |
| reasonable relocation                                    |           |
|                                                          |           |
| advisory services, including referrals to replacement    |           |
| properties, help                                         |           |
|                                                          |           |
| in filing payment claims, and other necessary assistance |           |
| to help the                                              |           |
|                                                          |           |
| person successfully relocate?                            |           |
|                                                          |           |
| \[49 CFR 24.203(a)(2)\]                                  |           |
+----------------------------------------------------------+-----------+
| d\. Inform the person that he/she will not be required   |           |
| to move without at                                       |           |
|                                                          |           |
| least 90 days advance written notice and that he/she     |           |
| cannot be required                                       |           |
|                                                          |           |
| to move permanently unless at least one comparable       |           |
| replacement                                              |           |
|                                                          |           |
| dwelling has been made available?                        |           |
|                                                          |           |
| \[49 CFR 24.203(a)(3)\]                                  |           |
+----------------------------------------------------------+-----------+
| e\. Inform the person that any person who is an alien    |           |
| not lawfully present                                     |           |
|                                                          |           |
| in the United States is ineligible for relocation        |           |
| advisory services and                                    |           |
|                                                          |           |
| relocation payments, unless such ineligibility would     |           |
| result in                                                |           |
|                                                          |           |
| exceptional and extremely unusual hardship to a          |           |
| qualifying spouse,                                       |           |
|                                                          |           |
| parent, or child?                                        |           |
|                                                          |           |
| \[49 CFR 24.203(a)(4)\]                                  |           |
+----------------------------------------------------------+-----------+
| f\. Describe the person's rights to appeal the program   |           |
| participant's deter-                                     |           |
|                                                          |           |
| mination as to his/her application for assistance?       |           |
|                                                          |           |
| \[49 CFR 24.203(a)(5)\]                                  |           |
+----------------------------------------------------------+-----------+
| g\. Include the pertinent HUD information booklet(s) or  |           |
| the equivalent?                                          |           |
+----------------------------------------------------------+-----------+
| **Describe Basis for Conclusion:**                       |           |
+----------------------------------------------------------+-----------+
|                                                          |           |
+----------------------------------------------------------+-----------+

7\.

+------------------------------------------------------------+---------+
| Does the file contain a Notice of Eligibility for          |         |
| Relocation Assistance? (If yes, include date of Notice of  |         |
| Eligibility in response below.)                            |         |
|                                                            |         |
| \[49 CFR 24.9 and 49 CFR 24.203(b)\]                       |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

8\.

+----------------------------------------------------------+-----------+
| If the answer to question 7 above is "yes," does the     |           |
| Notice of Eligibility:                                   |           |
+----------------------------------------------------------+-----------+
| a\. Inform the person of his/her eligibility for         |           |
| relocation assistance effective                          |           |
|                                                          |           |
| on the date of the initiation of negotiations?           |           |
+----------------------------------------------------------+-----------+
| b\. If the answer to question 7 above is "yes," does the |           |
| Notice of Eligibility                                    |           |
|                                                          |           |
| adequately describe the assistance, the estimated amount |           |
| of assistance                                            |           |
|                                                          |           |
| and the procedures for obtaining the assistance?         |           |
+----------------------------------------------------------+-----------+
| c\. If the answer to question 7 above is "yes," does the |           |
| Notice of Eligibility                                    |           |
|                                                          |           |
| identify the specific comparable replacement dwelling    |           |
| and the rent/utility                                     |           |
|                                                          |           |
| costs used for establishing the upper limit of the       |           |
| replacement housing                                      |           |
|                                                          |           |
| payment? (Include, in response below, the cost of        |           |
| comparable                                               |           |
|                                                          |           |
| replacement dwelling monthly rent/utility costs or       |           |
| proposed sale price                                      |           |
|                                                          |           |
| used to establish replacement housing payment.)          |           |
+----------------------------------------------------------+-----------+
| d\. If the answer to question 7 is "yes," did the Notice |           |
| of Eligibility correctly                                 |           |
|                                                          |           |
| explain to the person the moving expense choices that    |           |
| were available?                                          |           |
+----------------------------------------------------------+-----------+
| **Describe Basis for Conclusion:**                       |           |
+----------------------------------------------------------+-----------+
|                                                          |           |
+----------------------------------------------------------+-----------+

9\.

+-----------------------------------------------------------------------+
| How many referrals were made to comparable replacement dwellings?     |
|                                                                       |
| \[49 CFR 24.204 and 49 CFR 24.403(a)(1)\]                             |
+-----------------------------------------------------------------------+
| **Describe Basis for Conclusion:**                                    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

10\.

+------------------------------------------------------------+---------+
| Was a 90-day notice issued? (If yes, include date of       |         |
| 90-day notice in response below.)                          |         |
|                                                            |         |
| \[49 CFR 24.203(c)(1)\]                                    |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

11\.

+----------------------------------------------------------+-----------+
| If the 90-day notice did not state a specific day as the |           |
| earliest date by which the occupant would be required to |           |
| move, was a 30-day vacate notice issued? (If yes,        |           |
| include date of 30-day notice in response below.)        |           |
|                                                          |           |
| \[49 CFR 24.203(c)(3)\]                                  |           |
+----------------------------------------------------------+-----------+
| **Describe Basis for Conclusion:**                       |           |
+----------------------------------------------------------+-----------+
|                                                          |           |
+----------------------------------------------------------+-----------+

12\.

+------------------------------------------------------------+---------+
| Does the file contain evidence that advisory services were |         |
| provided in accordance with 49 CFR 24.205(c)?              |         |
|                                                            |         |
| \[49 CFR 24.9\]                                            |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

13\.

+------------------------------------------------------------+---------+
| Does the file contain evidence that the displaced person   |         |
| received a payment for moving and related expenses? (If    |         |
| yes, include date of final payment in response below.)     |         |
|                                                            |         |
| \[49 CFR 24.9\]                                            |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

14\.

+------------------------------------------------------------+---------+
| If the answer to question 13 above is "yes":               |         |
+------------------------------------------------------------+---------+
| a\. What type of moving and related expenses payment was   |         |
| made:                                                      |         |
|                                                            |         |
| Actual Expenses? Fixed Payment? Self-Move (may be          |         |
| combination)                                               |         |
|                                                            |         |
| \[49 CFR 24.301\] \[49 CFR 24.302\] \[49 CFR               |         |
| 24.301(b)(2)\]                                             |         |
+------------------------------------------------------------+---------+
| b\. What was the amount of payment for moving and related  |         |
| expenses? [     ]{.underline}                              |         |
+------------------------------------------------------------+---------+
| c\. What was the date of final payment?                    |         |
| [     ]{.underline}                                        |         |
+------------------------------------------------------------+---------+
| d\. Was the computation correct?                           |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

15\.

+------------------------------------------------------------+---------+
| Does the file contain evidence that, before making a       |         |
| replacement housing payment or releasing the initial       |         |
| payment from escrow, the following units were inspected to |         |
| determine they were decent, safe and sanitary:             |         |
|                                                            |         |
| \[49 CFR 24.205(c)(2)(ii)(C) and 49 CFR 24.403(b)\]        |         |
+------------------------------------------------------------+---------+
| a\. Comparable replacement unit (prior to referral)?       |         |
| [     ]{.underline}                                        |         |
+------------------------------------------------------------+---------+
| b\. Actual replacement unit? [     ]{.underline}           |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

16\.

+------------------------------------------------------------+---------+
| Does the file contain evidence that the displaced person   |         |
| received a replacement housing payment?                    |         |
|                                                            |         |
| \[49 CFR 24.9 and 49 CFR 24.401-24.404, as applicable\]    |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

17\.

+------------------------------------------------------------+---------+
| If the answer to question 16 above is "yes":               |         |
+------------------------------------------------------------+---------+
| a\. What date was the Replacement Housing Payment Claim    |         |
| Filed? [     ]{.underline}                                 |         |
+------------------------------------------------------------+---------+
| b\. What was the amount claimed? [     ]{.underline}       |         |
+------------------------------------------------------------+---------+
| c\. What date was the claim paid? [     ]{.underline}      |         |
+------------------------------------------------------------+---------+
| d\. What was the amount paid? [     ]{.underline}          |         |
+------------------------------------------------------------+---------+
| e\. Was the replacement housing payment accurate?          |         |
| (Complete Attachment I                                     |         |
|                                                            |         |
| Worksheet to respond to this question or attach copy of    |         |
| claim form.)                                               |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

18\.

+----------------------------------------------------------+-----------+
| Were the following Notices personally served or sent     |           |
| registered or certified mail, return receipt requested:  |           |
|                                                          |           |
| \[49 CFR 24.5\]                                          |           |
+----------------------------------------------------------+-----------+
| a\. General Information Notice? [     ]{.underline}      |           |
+----------------------------------------------------------+-----------+
| b\. Notice of Eligibility? [     ]{.underline}           |           |
+----------------------------------------------------------+-----------+
| c\. 90-Day Notice (as applicable)? [     ]{.underline}   |           |
+----------------------------------------------------------+-----------+
| d\. 30-Day Notice to Vacate? [     ]{.underline}         |           |
+----------------------------------------------------------+-----------+
| **Describe Basis for Conclusion:**                       |           |
+----------------------------------------------------------+-----------+
|                                                          |           |
+----------------------------------------------------------+-----------+

19\.

+------------------------------------------------------------+---------+
| a\. Was the displaced person advised of his/her rights     |         |
| under the Fair Housing                                     |         |
|                                                            |         |
| Act?                                                       |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

+------------------------------------------------------------+---------+
| b\. If the comparable replacement dwelling to be provided  |         |
| to a displaced person                                      |         |
|                                                            |         |
| who is a minority was located in an area of minority       |         |
| concentration, was the                                     |         |
|                                                            |         |
| displaced person also given referrals to comparable not    |         |
| located in such                                            |         |
|                                                            |         |
| area?                                                      |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

  ------------------------------------------------------------- ---------
  c\. Did the reviewer learn of any other issues that may be of 
  interest to FHEO?                                             

  **Describe Basis for Conclusion:**                            

                                                                
  ------------------------------------------------------------- ---------

20\.

+------------------------------------------------------------+---------+
| If a written appeal or complaint was filed by the          |         |
| displaced person, did the program participant promptly     |         |
| review the appeal in accordance with the requirements of   |         |
| 49 CFR Part 24 and/or 24 CFR 42.390? (If yes, describe     |         |
| issue raised and program participant's conclusion.)        |         |
|                                                            |         |
| \[49 CFR 24.10\]                                           |         |
+------------------------------------------------------------+---------+
| **Describe Basis for Conclusion:**                         |         |
+------------------------------------------------------------+---------+
|                                                            |         |
+------------------------------------------------------------+---------+

+-----------------------------------+-----------------------------------+
| **Attachment I: Worksheet for     |                                   |
| Replacement Housing Payment**     |                                   |
+-----------------------------------+-----------------------------------+
| **Name of Program Participant:\   | **Project Name/Number:     **     |
|      **                           |                                   |
|                                   | **Location:     **                |
+-----------------------------------+-----------------------------------+
| **Name of Reviewer:     **        | **Date Form Completed:     **     |
+-----------------------------------+-----------------------------------+

**[Instructions]{.underline}:** Complete this worksheet to answer
question 17.e of this Exhibit. "CRD" means "Comparable Replacement
Dwelling" and "MRU" stands for "Monthly Rent Plus Utilities."

**[A. Uniform Relocation Act]{.underline}**

+----------------------+------------------------+----------------------+
| **180-Day Homeowner  | **Rental Assistance    | **Downpayment        |
| Payment**            | Payment**              | Assistance**         |
+----------------------+------------------------+----------------------+
| 1\. Cost of          | 1\. MRU of replacement | 1\. MRU of CRD:      |
| replacement dwelling | dwelling               | \$[     ]{.underl    |
|                      |                        | ine}\_\_\_\_\_\_\_\_ |
| or CRD, whichever is | or CRD, whichever is   | \_\_\_\_\_\_\_\_\_\_ |
| less:                | less:                  |                      |
| \$[     ]{.un        | \$[     ]              | 2\. MRU of           |
| derline}\_\_\_\_\_\_ | {.underline}\_\_\_\_\_ | Displacement         |
| \_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_ | Dwelling             |
|                      |                        |                      |
| 2\. Cost of          | 2\. MRU of             | (For low-income      |
| displacement         | displacement dwelling  | enter MRU of         |
| dwelling:            | (For low-income enter  | displacement         |
| \$[     ]{.un        | MRU of displacement    | dwelling or 30% of   |
| derline}\_\_\_\_\_\_ | dwelling or 30% of     | income, whichever is |
| \_\_\_\_\_\_\_\_\_\_ | income, whichever is   | less):               |
|                      | less):                 | \$[     ]{.underl    |
| 3\. Price            | \$[     ]{.un          | ine}\_\_\_\_\_\_\_\_ |
| Differential         | derline}\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_ |
| (Subtract Line 2     | \_\_\_\_\_\_\_\_\_\_\_ |                      |
| from Line 1):        |                        | 3\. Monthly need     |
|                      | 3\. Monthly Need       | (subtract line 2     |
| \$[     ]{.un        | (subtract line 2 from  | from line 1):        |
| derline}\_\_\_\_\_\_ | line 1):               |                      |
| \_\_\_\_\_\_\_\_\_\_ |                        | \$[     ]{.underl    |
|                      | \$[     ]{.unde        | ine}\_\_\_\_\_\_\_\_ |
| 4\. Mortgage         | rline}\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_ |
| Interest             | \_\_\_\_\_\_\_\_\_\_\_ |                      |
| Differential:        |                        | 4\. Line 3 x 42:     |
| \$[     ]{.un        | 4\. Line 3 x 42:       | \$[     ]{.underlin  |
| derline}\_\_\_\_\_\_ | \$[     ]{.unde        | e}\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_ | rline}\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_ |
|                      | \_\_\_\_\_\_\_\_\_\_\_ |                      |
| 5\. Add lines 3 + 4: |                        |                      |
| \$[     ]{.un        |                        |                      |
| derline}\_\_\_\_\_\_ |                        |                      |
| \_\_\_\_\_\_\_\_\_\_ |                        |                      |
+----------------------+------------------------+----------------------+

**[B. Section 104(d)]{.underline}**

+--------------------------+--------------------+----------------------+
| **Sec. 8 Housing Choice  | **Section 8        | **Purchase           |
| Voucher and/or Cash      | Housing Choice     | Assistance**         |
| Assistance Provided**    | Voucher Accepted** |                      |
+--------------------------+--------------------+----------------------+
| 1\. MRU of replacement   | 1\. Security       | 1\. MRU of CRD:      |
| dwelling,                | Deposit:           | \                    |
|                          | \$[     ]{.        | $[     ]{.underline} |
| or CRD, whichever is     | underline}\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_ |
| less:                    | \_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_ |
| \$[     ]{.              |                    |                      |
| underline}\_\_\_\_\_\_\_ | 2\. Reimbursement  | 2\. TTP:             |
| \_\_\_\_\_\_\_\_\_\_\_\_ | for credit         | \$[     ]{.un        |
|                          |                    | derline}\_\_\_\_\_\_ |
| 2\. Voucher subsidy (if  | check:\$[          | \_\_\_\_\_\_\_\_\_\_ |
| none enter "0"):         |      ]{.underline} |                      |
| \$[     ]{.un            | \_\_\_\_\_\_\_\_\_ | 3\. Monthly need     |
| derline}\_\_\_\_\_\_\_\_ |                    | (subtract line 2     |
| \_\_\_\_\_\_\_\_\_\_\_\_ | 3\. Gap/monthly    | from line 1):        |
|                          | need:\*            | \$[     ]{.underl    |
| 3\. Out-of-pocket cost   | \$[     ]{.unde    | ine}\_\_\_\_\_\_\_\_ |
| (subtract line 2 from    | rline}\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_ |
| line 1):                 | \_\_\_\_\_\_\_\_\_ |                      |
| \$[     ]{.underline}\_  |                    | 4\. Capitalized      |
| \_\_\_\_\_\_\_\_\_\_\_\_ | 4\. Line 3 x 60:   | value of 60 monthly  |
|                          | \$[     ]{.underl  | installments of      |
| 4\. Total Tenant Payment | ine}\_\_\_\_\_\_\_ | amount on line 3:    |
| (TTP):                   |                    | \$[     ]{.underl    |
|                          | 5\. Add lines      | ine}\_\_\_\_\_\_\_\_ |
| \$[                      | 1+2 + 4:           | \_\_\_\_\_\_\_\_\_\_ |
|  ]{.underline}\_\_\_\_\_ | \                  |                      |
| \_\_\_\_\_\_\_\_\_\_\_\_ | $[     ]{.underlin | 5\. Reimbursement    |
|                          | e}\_\_\_\_\_\_\_\_ | for credit           |
| 5\. Monthly need         | \_\_\_\_\_\_\_\_\_ |                      |
| (subtract line 4 from    |                    | check:               |
| line 3. If less than     | **\* NOTE**: If    | \$[     ]{.underlin  |
| "0," skip line 6):       | tenant was         | e}\_\_\_\_\_\_\_\_\_ |
|                          | referred to a      |                      |
| \$[     ]{.underlin      | comparable unit    | 6 6. Add lines 4 +5: |
| e}\_\_\_\_\_\_\_\_\_\_\_ | for which the MRU  | \$[     ]{.          |
| \_\_\_\_\_\_\_\_\_\_\_\_ | exceeds the        | underline}\_\_\_\_\_ |
|                          | subsidy amount     | \_\_\_\_\_\_\_\_\_\_ |
| 6\. Line 3 x 60:         | plus TTP, a cash   |                      |
| \$[     ]{.underline}    | rental assistance  |                      |
| \_\_\_\_\_\_\_\_\_\_\_\_ | payment must be    |                      |
|                          | made. Such cash    |                      |
| 7\. Security Deposit:    | rental assistance  |                      |
| \$[     ]{.underl        | payment must be    |                      |
| ine}\_\_\_\_\_\_\_\_\_\_ | made in            |                      |
|                          | installments.      |                      |
| 8\. Reimbursement for    |                    |                      |
| credit                   |                    |                      |
|                          |                    |                      |
| check:                   |                    |                      |
| \$[     ]{.un            |                    |                      |
| derline}\_\_\_\_\_\_\_\_ |                    |                      |
| \_\_\_\_\_\_\_\_\_\_\_\_ |                    |                      |
|                          |                    |                      |
| 9\. Add lines 6 + 7 + 8: |                    |                      |
| \$[     ]{.              |                    |                      |
| underline}\_\_\_\_\_\_\_ |                    |                      |
+--------------------------+--------------------+----------------------+