U.S. Department of Housing and Urban Development

H O U S I N G

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Special Attention of: Notice H 92-40 (HUD)

All Regional Administrators, Issued: 4/29/92

Directors, Office of Regional Expires: 4/30/93

Housing, Field Office Managers,

Directors, Housing Management and Cross References:

Housing Development Divisions,

(Category A and B Offices) Handbooks 4350.1, 4640.1

4350.3

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Subject: Processing of Applications for Service coordinators in

Section 202 Housing and Monitoring of Approved

Applications

I. GENERAL: This Notice supersedes HUD Notice H-91-42 which

allowed the funding of service coordinators in Section 202/8

projects for the elderly and disabled which had principally

frail residents; Notice H-91-42 was canceled on January 22,

1992 by HUD Notice H-92-6.

Service coordinators became a specifically allowed expense

under Section 808 of the National Affordable Housing Act

(P.L. 101-625). Funds were appropriated for service

coordinators under the Department of Veterans Affairs, HUD

and Independent Agencies Appropriations Act, 1992 (the Act),

(P.L. 102-139). This Notice provides guidance for the usage

of these funds.

II\. PURPOSE: This Notice restates general HUD policy and

background information regarding service coordinators and

allows the hiring of one in all Section 202 and 202/8

housing projects for the elderly and disabled which meet

stated criteria. It also transmits the FY 1992 allocation

of funds appropriated for service coordinators under the Act

to HUD Regional offices and the requirements under which

projects may apply for both the position, and the funds, if

needed. Finally, it provides instructions to the HUD

Regional and field offices on the review, approval and

selection process.

A Notice of Funds Availability (NOFA) for the funding of

service coordinators will be published shortly. Eligible

projects needing funds will be selected by lotteries within

regions. Residual regional allocations will be combined and

additional selections will be made from among eligible

applicants by a national lottery; eligible projects may also

apply to utilize residual receipts, if available.

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HMAH : Distribution:
W-3-1,W-2(H),W-3(H)(FHEO)(ZAS)(OGC)(PD&R),W-4(H),R-1,

R-2,R-3,R-3-1(H)(RC),R-3-2,R-3-3,R-6,R-6-1,R-7,R-7-1,

R-7-2,R-8,R-8-1

Previous Editions Are Obsolete HUD 21B(3-80)

GPO 871 902

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A service coordinator is a social service staff person hired

by the project owner/management company. The coordinator is

responsible for assuring that the elderly, especially those

who are frail and disabled, residents of the project are

linked to the supportive services they need to continue

living independently in that project. However, it must be

understood that HUD assumes that some projects have

coordinators, or the management/ownership have made

arrangements for service coordination and/or case management

through third party agencies.

Under this Notice, a coordinator may be funded from residual

receipts or funds appropriated under the Act. The

requirement that a project for the elderly and disabled

contain a majority of principally frail residents has been

changed: Now, only 25 percent of the residents of a project

(or group of two projects) must be frail or \"at risk\".

Other requirements are noted below. Project and field

office reporting procedures have been modified. Field

Office staff must make a copy of this Notice available to

all sponsors/borrowers/owners, upon request. The project

application, file keeping and reporting process, as

modified, is approved per OMB Number 2502-0447.

III\. PROJECTS UNDER THE CONGREGATE HOUSING SERVICES PROGRAM

(CHSP): PROJECTS FUNDED UNDER THE CHSP ARE NOT ELIGIBLE FOR

A SERVICE COORDINATOR UNDER THE PROVISIONS OF THIS NOTICE.

IV\. UTILIZATION OF SECTION 8 FUNDS FOR SUPPORTIVE SERVICES:

THIS NOTICE DOES NOT IMPLEMENT THE PORTION OF SECTION 808 OF

THE NATIONAL AFFORDABLE HOUSING ACT WHICH ALLOWS HUD TO

UTILIZE SECTION 8 FUNDS TO PAY FOR 15 PERCENT OF THE COSTS

OF SUPPORTIVE SERVICES OF FRAIL ELDERLY PERSONS OR

NON-ELDERLY DISABLED PERSONS IN SECTION 202 PROJECTS FOR THE

ELDERLY AND DISABLED. FIELD OFFICES MAY NOT APPROVE SUCH

REQUESTS FROM PROJECT BORROWERS/OWNERS.

V. BACKGROUND: In HUD\'s view, the intent of Section 808 of

NAHA is to serve primarily those projects which serve both

the elderly and people with disabilities, though, projects

serving primarily the non-elderly disabled may qualify.

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Federally-assisted projects for the elderly have been

experiencing aging in place among their residents. The

initial populations have become significantly older and

frail, and the average age of new tenants moving into

projects has increased to the point that anecdotal

information on the average age of residents at rent-up

indicates that it may be in the early to late 70\'s. The

1988 National Survey of Section 202 indicated that for new

residents admitted between 1985-1988 83 percent are over 66

years of age and 70 percent are over 70 years of age.

Additionally, there are some non-elderly disabled, such as

the physically disabled, who reside in Section 202 projects

for the elderly and may also need effective supportive

services in order to remain in an independent living

environment. This increase in age and frailty and service

needs of both long-time residents and new tenants puts

increasing pressure on management to deal with the

supportive service needs of those individuals to enable them

to remain in their apartments as long as possible.

Project management has developed many methods to attempt to

meet the resultant need for services. In some cases,

cooperative agreements have been developed by the project

with local service organizations to provide volunteer staff

and/or services. In most cases, the question has not been

formally addressed to, or formally acted upon by HUD, so the

project manager has been the person to whom the residents

turn for help with their supportive service needs.

What is clear, however, is that housing managers in projects

serving primarily the elderly and disabled, generally, do

not have the training and skills necessary to deal both with

an increasingly frail elderly population and the non-elderly

disabled who need support services. Those serving primarily

the non-elderly disabled, also may not have such skills;

however, extensive additional supports may exist for many of

the projects which do serve the non-elderly disabled

population.

While the training of managers in frailty, aging in place

and the coordination of supportive services is necessary,

and a critical component of a successful management team

approach to dealing with the frail elderly and the non-elderly

disabled in these projects, housing managers do not

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generally have the time available to function as \"social

services\" staff on a regular, ongoing basis.

Thus, the service coordinator (the individual who does

casework with the frail elderly and non-elderly disabled,

residents in need of support, refers them for assessment,

links them with service providers in the community and

monitors the provision of the services) is the missing and

necessary link to improving the quality of life for both the

frail and non-elderly disabled residents of HUD-assisted

housing built for the elderly and disabled under Section 202

only. This individual is a key support to, and part of, the

management team of a project. He/she works closely with

management to ensure that the individual (and the family) is

assisted in getting the services necessary to continue

residency in that project, or, if necessary, to assist with

the decision to move to a higher level of care.

This necessary link may be already in place in many projects

serving primarily the non-elderly disabled, though it is

not usually called a service coordinator. In these

projects, the residents are assigned to, or are working

with, a case manager(s), who may be an employee of

state/local government a private, non-profit agency, or,

sometimes, the management company/owner/sponsor. This

individual(s) is responsible for assuring that the resident

receives the social and/or medical services needed to remain

in the group home or independent living complex.

VI\. SERVICE COORDINATION:

A. General: Service coordination is a general term which

covers a multiplicity of functions. Primarily, it

refers to the activity of linking a person to the

supportive service or medical services that the

individual needs which are provided by private

practitioners or agencies in the general community.

Additionally, the term may cover case management, both

formal or informal, in which the individual (or

individuals) providing the service coordination is/are

responsible for decisions about the way resources are

allocated to an individual on the basis of that

person\'s needs, assessment of service needs for that

individual and the determinant of eligibility for

public services.

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B. Who Does Services Coordination: Services coordination

may be performed by:

\- a staff person hired by the project or shared

between projects and located on-site(s);

\- a staff person hired by the project or shared

between projects and located off-site(s);

\- a staff person hired by a third party agency, and

contracted to the project(s) on-site(s);

\- a staff person hired by a third party agency, and

contracted to one or more projects, but based

off-site; and,

\- a staff person hired by a third party agency, who

provides case management and services coordination

for a project resident in concert with the

distribution of that agency\'s or another agency\'s

funding.

There are significant numbers of section 202 and 202/8

projects in the HUD inventory which currently utilize

service coordination. These may typically be in:

\- some older section 202 projects in which a

coordinator may have been approved using

non-section 8 operating funds; or,

\- projects generally under 40 units serving

primarily the non-elderly disabled, which either

had to provide such arrangements as part of the

initial funding agreement with HUD, or have

otherwise made such arrangements and have them in

place.

C. Indications of Service Coordination: The following may

be indicators of existing coordination

arrangements:

\- SSI and/or Medicaid payments going directly to the

projects management for rent and service costs;

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\- the coordination of the services (and possibly

their payment) through the management or

management agent of the project;

\- placement of third party staff persons on the

premises without charge to the current HUD budget

of the project; and,

\- any combination of the above.

These arrangements may be with case managers, social

workers, or service coordinators, either with the

owner/borrower\'s management company or a state/local

government agency, in which the major functions of a

service coordinator as stated below are currently in

place, and the residents are being served.

Please remember that not all projects for the non-elderly

disabled have a service coordinator in place or

are able to provide this type of service for their

residents. Therefore, each application must be

carefully and individually evaluated to determine

whether it may qualify for funding under this program,

regardless of the population served.

If service coordination is currently in-place and paid

for by resources other than HUD, the costs shall NOT be

shifted to HUD.

D. Functions of a Service Coordinator Hired Under the

Auspices of this Notice: The service coordinator

normally reports to the project administrator/executive

director/director of management in a management

company. If there are \"aides\" in that project, they

will work under the direction of that coordinator.

The major functions of the service coordinator are:

1\. Provides general case management (including

intake) and referral services to all residents

needing such assistance.

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May provide formal case management (i.e.,

evaluation of health, psychological and social

needs, the development of an individually tailored

case plan for services and a periodic thorough

reassessment of the resident\'s situation and

needs) for a resident when such service is not

available through the general community. (If

necessary, this will probably be primarily in

rural areas.)

2\. Establishes linkages with all agencies and service

providers in the community; shops around to

determine/develop the best \"deals\" in service

pricing to assure individualized, flexible and

creative services for the involved resident(s).

3\. Sets up a directory of providers for use by both

project staff and residents. Refers and links the

residents of the project to service providers in

the general community; these are: E.g., case

management, personal assistance, homemaker,

meals-on-wheels, transportation, counseling,

occasional visiting nurse, preventive health

screening/wellness, legal or other advocacy.

NOTE: There may be times when there will be

difficulty in linking up residents with

a community assessment agency in a

timely manner. Therefore, the project

may want to consider setting up a

Professional Assessment Committee (PAC)

to work with the Service coordinator to

perform initial assessments.

A PAC would be composed of at least

three members, at least one of which is

a qualified medical professional, with

all members professionally competent to

assess frailty and functional

independence.

For projects wanting to consider setting

up a PAC, see the guidance given in HUD

Handbook 4640.1, Chapter 1, Paragraph

I.D, Pages 1-8 to 1-12, Section

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802(e)(3) of the National Affordable

Housing Act, or the Guidelines for the

HOPE for Elderly Independence Program

published in the Federal Register,

FR-2959, on February 4, 1991.

Use of a PAC under the provisions of

this Notice may be modeled after any of

the above. However, a PAC member may

NOT be paid for his/her services with

HUD funds.

4\. Educates residents on service availability,

application procedures, client rights, etc.

5\. May develop case plans in coordination with

assessment services in the community, or the PAC.

6\. Monitors the ongoing provision of services from

community agencies and keeps the case management

and provider agency current with the progress of

the individual.

7\. May set up volunteer support programs with service

organizations in the community.

8\. Helps the residents build informal support

networks with other residents, family and friends.

9\. May educate other staff on the management team on

issues related to aging in place and services

coordination, to help them to better work with and

assist the residents.

THE SERVICE COORDINATOR CANNOT BE ASSIGNED

RESPONSIBILITY AS THE PROJECT\'S RECREATIONAL OR

ACTIVITIES DIRECTOR, PROVIDE SUPPORT SERVICES DIRECTLY,

OR ASSIST WITH OTHER ADMINISTRATIVE WORK NORMALLY

ASSOCIATED WITH THE PROJECT(S) UTILIZING FUNDS UNDER

THE ACT. HOWEVER, A PROJECT MAY PROPOSE TO INCREASE

THE TIME OF A PART-TIME COORDINATOR FOR OTHER DUTIES IN

THE PROJECT, SUBJECT TO THE PROCEDURES STATED IN

HANDBOOK 4350.1, CHAPTER 7, \"PROCESSING BUDGETED RENT

INCREASE.\"

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VII\. FRAILTY CONSIDERATIONS: While a service coordinator may

serve any resident of a project who needs assistance,

priority is given to those who are frail or \"at-risk\".

Frailty is defined as being deficient in at least three

Activities of Daily Living (ADL), as defined below. A

person who is \"at-risk\" will be deficient in at least one

ADL, but not three or more.

The MINIMUM requirements necessary to qualify for an ADL

deficiency are as follows:

A. EATING: May need assistance with cooking, preparing or

serving food, but must be able to feed self;

B. BATHING: May need assistance in getting

in and out of the shower or tub, but must be able to

wash self;

C. GROOMING: May need assistance in washing hair, but must

be able to take care of personal appearance;

D DRESSING: must be able to dress self, but may need

occasional assistance.

E. HOME MANAGEMENT ACTIVITIES: May need assistance in

doing housework or laundry or getting to and from one

location to another, for activities such as going to

the doctor or shopping, but must be mobile. The

mobility requirement does not exclude persons in

wheelchairs or those requiring mobility devices.

Each of the ADLs noted above includes a requirement that a

person must be able to perform at a specified minimum level

(e.g., to satisfy the eating ADL, the person must be able to

feed him/herself). The determination of whether a person

meets this minimal level of performance must include

consideration of those services being performed by a

persons\'s spouse, relatives or other attendants to be

provided by the individual.

For example, if a person requires assistance with cooking,

preparing or serving food plus assistance in feeding him/

herself, the individual meets the minimum performance level

and thus satisfy the eating ADL if a spouse, relative or

attendant provides assistance with feeding the person.

Should such assistance become unavailable at any time, the

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owner is not obligated at any time to provide individualized

services beyond those offered to the resident population in

general.

The ADL analysis is NOT used for a determination of

eligibility for occupancy. Rather, it is relevant only to

determine how a person should to be counted among those

deemed frail or \"at-risk\" by the project, in order for it to

be considered among those eligible for a service coordinator

under the auspices of this Notice.

HUD DOES NOT REQUIRE PROJECT MANAGEMENT TO ASSESS RESIDENTS

AS A CONDITION FOR RECEIVING APPROVAL FOR HIRING A SERVICE

COORDINATOR. Rather, the borrower/owner, in the application

to HUD, must provide documentation that at least 25 percent

of the residents of the project meet the stated definition

of frailty (this is defined further in section II.B(3)(b) of

the NOFA).

VIII.BASIC OUALIFICATIONS OF A SERVICE COORDINATOR: The minimum

qualifications are as follows:

A. A Bachelor of Social Work or degree in Gerontology,

Psychology or Counseling is preferable; a college

degree is fully acceptable. Supervisory experience may

be necessary in some team situations in which a

professional supervises a number of non-professional or

paraprofessional \"aides\". Some projects may prefer to

utilize a person with a MSW (Master of Social Work) in

this capacity, but such is explicitly not required (see

\"NOTE\" under section VIII.D, below).

NOTE: Individuals without a degree, but with

appropriate work experience (such as a highly

energetic and/or knowledgeable and talented

\"people person\" or a person with special

skills such as sign language/interpretation

skills) may be hired as a service

coordinator. Such situations should NOT be

rejected out of hand.

B. 2-3 years experience in social service delivery with

senior citizens and non-elderly disabled. some

supervisory or management experience may be desirable.

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C. Demonstrated working knowledge of supportive services

and other resources for senior citizens and non-elderly

disabled, in the jurisdiction where the project lies.

D. Ability to advocate, organize, problem-solve and

provide results for the elderly and disabled served.

NOTE: In situations where the management of a

building(s) wants to create a services \"team\"

in which a service coordinator supervises one

or more \"aides\" (non-professional persons),

the coordinator should have appropriate

professional staff experience AND prior

supervisory or management experience.

ALSO, ANY \"AIDES\" ABOVE AND BEYOND THE SINGLE

COORDINATOR ALLOWED FOR THE PROJECT MUST BE

VOLUNTEERS OR PAID FOR WITH RESOURCES OTHER

THAN HUD FUNDS.

It is desirable, but certainly not required

for \"aides\" to have a college degree; they

should, however, have appropriate experience

in working with the elderly and/or disabled.

Another option for management in structuring

an \"aide\" situation is to set up an

internship or work study program with local

colleges and universities to assist in

carrying out some of the functions noted

under Section III above, or to provide

planning guidance to staff or provide program

evaluation/ assessment functions.

IX\. STAFFING CONSIDERATIONS

A. Contracting Out

The service coordinator may be a contracted out by the

owner(s)/borrower(s) if the contract is with a single

individual or with a third party agency in which that

agency commits the time of a single individual to do

the necessary work.

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B. Projects Sharing a Coordinator

Two Section 202 projects for the elderly and disabled

in the same immediate geographic area may combine

efforts to hire one part-time or full-time service

coordinator, as long as the combined number of units in

the group of projects is 75 or more.

C. Staffing Guidelines

Under normal circumstances, a full-time service

coordinator should be able to serve at least 60 frail

elderly and non-elderly disabled.

Thus, the determination of whether or not a service

coordinator is full time or not should be directly

related to the number of people in the project who are

frail or at-risk.

The requirement that 25 percent of the residents must

be frail or at risk means that in a 75 unit project, at

least 19 residents are frail or at risk, with the rest

in varying stages of health, but not deficient in one

or more ADLs.

Example 1: In a 75 unit project, 20 residents are

frail, 15-20 others are deficient in at

least one ADL, and the remaining 35-40

generally healthy. This project could

probably justify at least a 1/2 time

service coordinator.

Example 2: In a 110 unit project, 40 residents are

frail, 40 others are deficient in at

least one ADL with the remainder

generally healthy. This project could

probably justify a full-time

coordinator.

Example 3: Two projects of 30 and 51 units in the

same, immediate, geographic area (81

units, total) join forces. Among them,

they have 10 frail residents, 11 others

that are deficient in at least one ADL,

with the remaining 60 generally healthy.

This project group could justify a one

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-third to one-half time coordinator to

share time on-site between both

projects.

Example 4: In a 80 unit project there are no frail

individuals, but about 40 who are at

risk, with the rest generally healthy.

This project could probably justify a

half-time coordinator.

D. Coordinators in Projects Which are Physically Joined

There are cases in which a Section 202 or 202/8 project

is physically connected to, e.g., a Section 221(d) or a

Section 236 project. In such cases, the coordinator

may only serve the residents of the Section 202 subject

to the cited examples above, unless the time of the

service coordinator serving the other building is paid

for by resources other than HUD. HUD funding for the

service coordinator under the auspices of this Notice

is NOT permitted for the building which is not a

section 202 or 202/8 project.

X. ALLOCATION OF FUNDS:

A. Fiscal Year 1992 Service Coordinator Fund Assignments

The formula for the use of funds appropriated under the

Act, below, does not include any dollars from residual

receipts. Use of residual receipts will be

project-specific, and, thus, is not calculated in the

allocation formula.

B. Allocation Amounts

The funds for service coordinators appropriated under

the Act are subject to the requirements of Section

213(d) of the Housing and Community development Act of

1974\. The formula below was developed to allocate

these funds among the HUD Regions. The amount of funds

assigned to each Regional office was determined as

follows:

1\. There are 1,201 projects of 75 units or larger,

containing 149,770 units.

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2\. Each field office has an identified number of

Section 202 projects for the elderly and disabled

of at least 75 units and up.

3\. The number of units in each Region were converted

to a percentage of the total units of the 75 unit

and over project category.

While this method does not consider the number of

multi-project applications submitted, HUD assumed

that applications submitted this year will be

relative to the number of projects in the Regions.

4\. There are \$15,504,746 in Section 8 funds

designated for service coordinator under the Act.

5\. Each Region\'s section 202 units for the elderly

and disabled in projects of 75 units or more are a

percentage of the total section 202 units for the

elderly and disabled of 75 units or more in the

inventory. That Region\'s percentage of units was

utilized to determine the percentage of dollars

assigned.

C. Fund Assignments

Following are the service coordinator fund assignments

to the Regions:

FY 1992 FUNDS FOR SERVICE COORDINATORS

Region Projects Units Dollars Percentage

Region I: 66 7,776 \$775,237 5

Region II: 150 19,341 \$2,015,617 13

Region III 156 19,459 \$2,015,617 13

Region IV: 240 30,533 \$3,100,949 20

Region V: 230 29,156 \$3,023,426 19.5

Region VI 104 12,607 \$1,317,903 8.5

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Region VII 64 7,377 \$775,237 5

Region VIII 27 3,199 \$310,095 2

Region IX: 139 17,208 \$1,860,570 12

Region X: 25 3,114 \$310,095 2

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Totals: 1,201 149,770 \$15,504,746 100 percent

The issuance of the Regional Fund and Contract

Authority Assignment (HUD-185.1) and the subsequent

sub-assignment by the Region to specific field offices

will be made at the time the coordinator selections are

announced (see Paragraph XII, following).

XI\. APPLICATION DISTRIBUTION AND REVIEW PROCESS: The following

is the process that the field offices and Regions will use

to give out applications to those requesting them, identify

applicants which meet all appropriate criteria, and report

to Headquarters on those projects which are eligible to use

residual receipts or be included in the lotteries.

NOTE: A lottery will ONLY be used for projects needing

funds available under the ACT. Projects

requesting to utilize residual,receipts (without

using funds under the Act) may be approved

directly by the field office, if otherwise

eligible.

A. Application Processing/Distribution of this Notice

After the service coordinator NOFA is published in the

Federal Register, project borrowers/owners/management

agents will be contacting the field offices for

application materials, which are included with this

Notice.

In addition to the NOFA, the following items in this

Notice are necessary for the preparation and submission

of an application from an eligible applicant (field

office staff should review application requirements in

section II of the NOFA).

1\. Appendix 1, Applicant Checklist

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2\. Appendix 12, SF-424 (projects requesting funds

under the Act ONLY).

3\. Appendix 13, Drug-free Workplace Form

4\. Appendix 14, Lobbying Certification Form

5\. Appendix 15, SF-LLL (if appropriate for that

project)

6\. Appendix 16, HUD-2880, Applicant/Recipient

Disclosure/Update Report

7\. Appendix 17, Certification regarding transfer of

service coordination costs to HUD

8\. Appendix 18, Data collection and reporting

certification

9\. Appendix 19, Civil Rights Certification

10\. Appendix 20, Certification for HUD-approved

budget.

11\. Appendix, 21, Certification for separate residual

receipts account.

HUD expects that applicants will use the Checklist at

Appendix 1 to ensure that all necessary items are

included in the application package submitted to the

field office.

B. Application Deadline

The application deadline is close of business in the

appropriate HUD field office on the date stated in the

NOFA.

NOTE: Reminder to HUD Field Staff: Projects

requesting funds under the Act with or

without residual receipts can ONLY apply

within the 45 day application period

stipulated in the NOFA. However, projects

requesting to use residual receipts WITHOUT

funds from the Act may apply at any time

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between the publication of the NOFA and

September 30, 1992.

All applications should be time and date-stamped upon

delivery to the field office; applicants wanting

receipts for the delivery of the application package

should be given them directly, or through the mail.

Applications which are received in the field office

after the deadline should not be accepted, but returned

to the sending organization.

The field office may only accept applications from

projects physically located in its jurisdiction.

others may be termed ineligible and returned to the

sender.

Once the applications are date stamped into the field

office, they should be turned over to the Director of

Housing Management for appropriate control and

distribution.

C. Preliminary Screening Review

Only those applications which were received in a timely

fashion may be screened for completeness.

The field offices should move immediately to review

applications for funds under the Act which want

consideration for the lottery.

1\. Preliminary Screening Process

Loan Management staff in the field offices will

screen all submitted applications to ensure that

they are complete and conform to the requirements

of the NOFA (see format at Appendix 2). This

process must be completed within three days of the

deadline for applications for those applications

requesting funds under the Act; applications

requesting to use residual receipts only must be

screened within five work days of receipt.

Items Which May be Addressed During the Screening

Process by applicants are:

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a\. The transmittal letter (unsigned, incorrect

signatory, lack of statement of which source

of funds is proposed, lack of statement on

sufficient office space).

b\. SF-424 (unsigned or signed by incorrect

official). (Must be submitted ONLY by

applicants requesting funds under the Act.)

c\. the following certifications (missing or

unsigned):

\- data collection requirements

\- drug-free workplace

\- lobbying certification form (only if

application is for \$100,000 or more).

\- SF-LLL, if appropriate (submitted only

if other than Federally appropriated

funds are used for influencing

activities and if application is for

\$100,000 or more. If neither of these

apply, an SF-LLL will not be submitted.

\- HUD-2880, Applicant/Recipient

Disclosure Update Report

\- Certification regarding transfer of

service coordination costs to HUD.

\- Civil Rights Certification

\- Operation under the annual HUD-approved

budget process or willingness to convert

thereto

\- Having a separate residual receipts

account or willingness to convert

thereto

2\. Deficiency Letters Per Section IV of the NOFA

Letters informing applicants of preliminary

screening deficiencies must be sent to all

applicants, as needed, by the Loan Management

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Branch Chief, within five work-days of the

deadline for applications in the field office (see

sample letter format at Appendix 3).

Projects which are deficient in the items listed

above must submit missing/corrected items within

14 calendar days of the date of the notification

letter from the field office to the applicant.

This means, for example, that if the field

office\'s date of the letter to the applicant is

June 5, 1992, the response is due in the field

office by close of business, June 19, 1992.

Applicants which do not submit the missing/

corrected materials within the appropriate time

frame, or do so incorrectly, must be rejected

without further review.

D. Threshold Review

Only those projects which pass the screening review

(including satisfactory return of documents, if

necessary) may be reviewed for threshold acceptability.

The Director of Housing Management shall insure that

the threshold review is carried out by Loan Management

staff, with assistance from field office General

Counsel and FH&EO staff, as appropriate.

Loan Management, Field Office Counsel and FH&EO staff

must determine that all applicants meet the following

threshold criteria (see check-list at Appendix 4).

1\. The applicant is eligible (it is a section 202 or

section 202/8 project(s) serving the elderly and

disabled).

2\. The application meets the minimum size criteria:

\- it has at least 75 units; OR,

\- if two projects in the immediate geographic

area are grouped in the application, the

group must contain a minimum of 75 units.

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3\. Sustaining Occupancy

Each borrower/owner proposing to hire a service

coordinator must have a project (or a group of two

projects) which have reached sustaining occupancy,

that is 97 percent occupied at the time of

application to HUD. Sustaining occupancy is

necessary to assure that the project has a

positive cash flow before another cost is added to

management.

4\. The borrower/owner has provided evidence that at

least 25 percent of the residents of the

project(s) are frail or at risk, pursuant to

section VII.

5\. Service coordination/case management or a service

coordinator are paid for by the borrower/owner or

a third party agent(cy) and the proposal will not

transfer these costs to HUD.

(The borrower/owner has certifilied that the cost

of service coordination, consistent with section V

and VI of this Notice (if in place and being

supported by an entity other than HUD (i.e., paid

for by the borrower/owner from non-HUD funds, or

by a community agent(cy), is not being shifted to

HUD.)

6\. The project loan is current or current under a

HUD-approved workout arrangement.

7\. It has been finally closed.

8\. The borrower/owner, if under an annual adjustment

factor (AAF), has agreed to amend the section 8

contract to substitute the annual HUD-approved

budget process for all future rent increases.

9\. The borrower/owner has a separate residual;

receipts account or has agreed to amend the

project\'s(s\') regulatory agreement(s) to provide

for same.

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10\. One or more of the following items are NOT

outstanding:

\- a pending civil rights suit against the

applicant brought by the Department of

Justice;

\- a outstanding finding of noncompliance with

civil rights statutes, executive orders or

regulations as a result of formal

administrative proceedings;

\- a charge issued by the Secretary of HUD

against the applicant under the Fair Housing

Act, unless the applicant is operating under

a conciliation or compliance agreement

designed to correct the area of

non-compliance;

\- a pending denial of application processing by

HUD under Title VI of the Civil rights Act of

1964, under the attorney general\'s guidelines

(28 CFR 50.3), and HUD\'s Title VI regulations

(24 CFR 1.8) and procedures (HUD Handbook

8040.1);

\- there exists serious, unaddressed or

outstanding Inspector General audit findings

or HUD Headquarters/Field Office Management

monitoring review findings for any of the

applicant\'s ongoing management operations or

in its connection with the administration of

existing grants;

\- there exists serious, unaddressed or

outstanding Inspector General audit findings

or HUD Headquarters/Field Office/FH&EO fair

housing monitoring review findings for any of

the applicant\'s ongoing management

operations or in its connection with the

administration of existing grants;

\- the applicant is involved in litigation which

could seriously jeopardize its ability to

administer the service coordinator function.

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If a project meets one or more of above items

1-10, it should be placed in reject status, and so

evidenced in the report to the Regional office

(see Paragraph XI.G(2), below).

E. Review for Technical Adequacy

If a project passes preliminary screening and threshold

review, it will be reviewed for technical adequacy.

Loan Management staff in the field offices, with the

assistance of field office counsel, as appropriate will

determine that each application received is technically

adequate for approval. In order to do so it must be

reviewed upon the following items (see review checklist

at Appendix 5, following):

1\. The application states that the project is

applying for section 8 funds designated for

service coordinators, using residual receipts

only, or proposing to use both.

2\. If section 8 funds are requested, documentation

should be provided that residual receipts are

insufficient to cover the costs that are proposed

for section 8.

3\. The application has documented that there is

adequate space for confidential meetings and a

location to secure files, OR, if community space

is utilized, such usage will not adversely affect

the normal activities of the residents of the

project.

4\. The borrower/owner has documented the need for the

service coordinator.

5\. The time period for the service coordinator

(number of hours to be worked) corresponds with

the need for the service coordinator, as

described.

6\. The total amount requested (salary, fringe,

operating expenses) is within the per unit maximum

(\$25.00/unit/month);

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7\. The salary and other costs proposed for the first

year are consistent with the local market and the

rest of the management team and fringe benefits

and other costs are consistent with other similar

costs allowed for that organization. Costs for

years two-five are consistent with year one, less

any one-time start-up costs in year one;

8\. The funds requested for a service coordinator are

for new time allocations and staffing, NOT to

augment the salary of an existing staff person

whose time on the job will not be increased.

9\. The position description relates to the

responsibilities and qualifications of sections

VI.D and VIII of this Notice.

10\. If the applicant proposes to contract out the

service coordination function, a copy of the

contract between/among the sponsor/borrower/owner

with the third party agent(cy) must satisfactorily

address the following: Dates of the contract,

number of hours to be worked weekly, the name of

the single individual assigned to the

responsibility, the rate of pay and related

expenses for the work to be performed, a

description of the work to be performed consisted

with section VI.D of this Notice, location of

office and meeting space and the location/security

of records and their availability to HUD.

11\. If a multi-project application, the proposed

agreement between the two sponsors/borrowers/

owners satisfactorily addresses the following:

space-sharing, location and security of records,

payment of salary(ies) and expenses, allocation of

days and hours between/among the housing projects.

Applications determined technically adequate are

eligible for the regional lotteries and shall be so

recommended in the report to the Regional offices by

the field offices; all applications which do not pass

technical review are placed in reject status and shall

be listed in the report to the Regional offices.

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Field offices may reduce the amount of funding

requested in any application. Examples of reasons to

reduce initial funding requests include, but are not

limited to: (1) activities proposed are not eligible or

approvable by HUD; or, (2) the field office determines

that the cost of the service coordinator is not

consistent with similar salaries in the local

jurisdiction.

F. Field Office Action on Projects Requesting Residual

Receipts Only

Applications should be processed by the field office

within 30 days of receipt, with all approval actions

completed by November 1, 1992.

Field offices are authorized to approve requests for

applications which are to use only residual receipts.

Such approvals may be given in writing to applicants

which pass preliminary screening, threshold and are

determined technically adequate. If there is more than

one project covered by the application, there must be a

separate letter written to each project covered by the

application.

The approval letters must be consistent with Handbook

4350.1 and include the following:

\- project name, address and EH or SH number.

\- the amount of residual receipts approved for use,

on a year-by-year basis, up to a maximum of five

years.

\- approval is renewable at the end of the term of

the modification, subject to continuation of the

need and the availability of additional funds.

\- Any changes from the initial proposal submitted by

the applicant which must be incorporated by the

owner/borrower.

These letters may be sent to approved applicants after

the decision to approve them.

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The approved applicant shall be notified in the

approval letter to inform the field office of

acceptance of the terms of the letter within 14 days of

the date of the field office letter to the applicant.

The response to the field office must be signed by the

Chairperson of the Board of Directors.

Once accepted, projects may utilize residual receipts

consistent with the Handbook 4350.1.

G. Field Office Lists to the Regional Office

There are two lists which the field offices must

utilize. Each field office submission must be

transmitted over the field office manager\'s signature.

There are two lists to be submitted. They are as

follows:

1\. List 1: Approval of Projects to Utilize Residual

Receipts

This is a list of all projects approved to utilize

ONLY residual receipts for a multi-year period up

to five years in that field office.

The report will list applicant and project name

and address, Congressional District, EH or SH

number, length of time period for the request,

amount requested per year, total amount requested,

total number of projects, and total amount of

residual receipts requested (see HUD-92292,

Appendix 6).

This list must be submitted to the HUD Regional

Office by November 15, 1992.

2\. List 2: Recommendation for Inclusion in the

Lottery or Rejection

This is a list of all projects for inclusion in

the lottery or recommanded for rejection. The

report will list applicant and project name and

address, identification of projects which are

non-elderly disabled. Congressional District, contact

person and phone number, EH or SH number, length

of time period for the request, amounts requested

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from the Act, and residual receipts, if some

available, total amount requested for both funds

from the Act and residual receipts, and total

number of applications processed (see HUD-92293,

Appendix 7). Projects which are proposed for

rejection must be noted by an asterisk (\*).

This list must be submitted to the HUD Regional

Office within 45 days of the application deadline

to HUD. For all projects recommended for

rejection, the package to the Regional office

should include the original of each review

checklist for that application, with appropriate

documentation. A copy of each application should

also be included.

A copy of all review checklists transmitted to the

Region must be retained by the field office along

with the original of the application.

H. Regional Action on Field Office Reports

1\. Regional Action to Headquarters Regarding Projects

Approved for Residual Receipts.

The Regional Director of Housing must send to

Headquarters a copy of the list of applications

submitted by the field office approved for only

residual receipts. This list must be submitted to

HUD Headquarters by November 30, 1992.

2\. Regional Action to Headquarters on Projects

Recommended for inclusion in the Regional and

National Lotteries or Rejected.

The Regional office must review the field office

reports to ensure that correct procedures and

policy have been followed. Each Regional office

must report to Headquarters regarding:

\- projects rated eligible by the field office

for inclusion in the lotteries; and,

\- projects recommended for rejection by the

field office which were overturned by the

Regional office so that they are now eligible

for the lotteries.

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(Regional offices, in consultation with field

office staff, may recommend to Headquarters the

approval of a project the field office recommended

for rejection.)

Documentation must be included in the Regional

office package to Headquarters, along with copies

of the application and all review sheets, for any

such action(s). The only reasons for Regional

staff to overturn a field office recommendation

for rejection are as follows:

\- The field office incorrectly rejected

projects during preliminary screening (e.g.,

materials were submitted on time and were

correct when resubmitted);

\- The field office made an error on the

threshold examination and incorrectly

determined that one or more threshold items

as stated in section XI.D of this Notice,

were not met; and/or,

\- The field office made an error during the

review for technical adequacy and determined

that one or more of the requirements for

technical adequacy as stated in section XI.E

of this Notice, were not met.

a\. Summary list

The Regional Director of Housing must prepare

a one-page summary sheet for Headquarters

(see HUD-92294, Appendix 8), regarding the

both the projects to be included in the

lotteries and those approved for residual

receipts only.

This list shall be include the following

information:

\- number of projects for consideration

from that Region wanting residual

receipts or funds from the lottery.

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\- number of projects in that region

approved for either residual receipts or

the lottery.

\- total amount of funds requested in that

Region under the Act.

\- total amount of funds requested in that

Region for residual receipts.

\- Field office totals:

o number of projects using funds from

the Act, with or without residual

receipts.

o amount of funds under the Act

o amount of residual receipts

The summary sheet for those projects to be

included in the lotteries must be submitted

along with the list of applications (HUD-92295,

see section XI.H(2)(b), below). On

the HUD 92294, ONLY Fill out items 1b, 2b, 3,

5a, 5b, 5c, 6b, 7b and 7c.

The summary sheet for those projects using

residual receipts only should be submitted to

Headquarters no later than November 30, 1992,

filling out ONLY items 1a, 2a, 3, 4a, 4b, 6a,

7a, repeat 7b and 7c from the HUD-92295

submitted earlier, and total all in 8.

b\. Application List

The Regions must also prepare a list for

Headquarters of the approvable applicants to

be included in the lottery and those rejected

(see HUD-92295, Appendix 9). This list shall

be by field office covering all approvable

and rejected applications within that field

office.

The information on each project will include

the following:

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\- project name, address, identification of

the projects for the non-elderly

disabled, Congressional District, EH or

SH number and the section 8 number.

\- contact person and telephone number.

\- the amount requested, per year.

\- the time period for the agreement.

\- Any change from the proposal submitted

by the applicant which must be

incorporated in that proposal.

There must also be an indication of which

projects were rejected by the field office

See (\*) AND a notation for any field office

rejections which are proposed to be

overturned by the Regional office (use a

double asterisk (\*\*). The only reasons for

overturning a field office recommendation for

rejection are as follows:

\- The field office incorrectly rejected

projects during preliminary screening

(e.g., materials were submitted on time

and were correct when resubmitted);

\- The field office made an error on the

threshold examination and incorrectly

determined that one or more threshold

items as stated in section XI.D of this

Notice, were not met.

\- The field office made an error during

the review for technical adequacy and

determined that one or more of the

requirements for technical adequacy as

stated in section XI.E of this notice,

were not met.

For each application rejected by the field

office which the Regional office proposes to

overturn, the Director of Regional Housing

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must attach to the list a copy of the

application, the original of the field office

review checklists and other documentation and

justification for the proposed Regional

action.

This list, the summary sheet, and supporting

documents as necessary, must be transmitted

to Headquarters over the Regional

Administrator\'s signature within 75 days of

the application deadline in the field

offices.

The package to Headquarters should be sent

to: Mr. Robert W. Wilden, Acting Deputy

Director, office of Elderly and Assisted

Housing, ATTN: Mr. Jerry Nachison.

I. Headquarters Action on Regional Lists

1\. List of Applications Approved Only for Residual

Receipts.

Headquarters will retain the information submitted

for reporting and follow-up purposes.

2\. Inclusion for the Lotteries.

All applications recommended for selection will be

included in the regional lotteries.

3\. Rejections.

Headquarters may discuss with the Regions, as

appropriate, any proposed reversal of a rejection

within 10 work days of receipt of the reports.

The only reasons for Headquarters to overturn a

Regional office recommendation to overturn a field

office rejection to an approvable project which

may be placed in the lottery are;

\- The Regional office incorrectly determined

that a field office rejection based on

preliminary screening (e.g., materials were

submitted on time and were correct when

resubmitted), was incorrect;

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\- The Regional office incorrectly determined

that a field office rejection based on

threshold examination (i.e., determined that

one or more threshold items as stated in

section XI.D of this Notice were not met) was

incorrect.

\- The Regional office incorrectly determined

that a field office rejection based on the

technical adequacy review (i.e., determined

that one or more of the requirements for

technical adequacy as stated in section XI.E

of this notice were not met) was incorrect.

All field office rejections or Regional

overturning of field office rejections shall stand

if the Regional office has not received a

memorandum regarding any proposed rejection or

overturning of a rejection from Headquarters

within 15 workdays of the submission date of the

lists and documentation to Headquarters.

4\. Regional Actions on a Headquarters Notification of

Change in an Applications\' Status.

The Regional offices must notify the field offices

of any change in application status from that

originally proposed by the field office (and the

reason(s) for that change), by FAX, within one

workday of any written memorandum from

Headquarters.

XII\. SELECTION PROCESS AND FUNDING OF APPLICATIONS. Headquarters

will hold regional lotteries, and a national lottery using

residual regional amounts, within 100 days of the

application deadline.

A. Anouncement of Selections in the Lotteries

At the completion of the lotteries, a press release

will be issued which lists all selected applicants. A

copy of the press release will be FAXed to all Regional

and field offices. Applicants will be notified per

Paragraph XII.E, below.

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B. Field Office Actions on Rejections

The field offices must notify in writing all applicants

which were rejected within five work days of the

announcement of selection of projects in the lotteries.

The rejection letter must include the reasons for the

rejection (see format at Appendix 10).

C. Field Office Actions on Approvable Applications Not

Funded

Within five work days from the date of announcement of

selection of projects in the lotteries, the field

offices must notify all approvable applicants which

were not selected in the lottery of their non-selection

(see sample letter, Appendix 11).

D. Issuance of the HUD-185

The Regional Accounting Division (RAD) will issue a

Regional Fund and Contract Authority Assignment

(HUD-185.1) with a list of sub-assignments to the Regional

Housing Directors. The Regional Housing Directors will

send a copy of the HUD-185.1 and the sub-assignment

list to each field office in that region within two

workdays of the announcement of the service coordinator

selections.

E. Notification to Selected Applicants

HUD field offices must notify in writing applicants

having one or more projects selected within five

workdays of the receipt of the HUD-185.1 from the RAD.

\- The field office manager must send a transmittal

letter to the selected applicant, along with an

amendment to the HAP contract(s). If the

applicant submitted more than one project, a HAP

contract amendment must be written for each

project covered in the application. If the

project is a section 202 project without section

8, a HAP contract must be written. The HAP

contract or the HAP contract amendment must

contain at least the following information:

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o project name, address, EH or SH number and

Section 8 number.

o the amount of funds approved on a year by

year basis, up to a maximum of five years.

o the time period for their use.

o that the amendment is renewable at completion

of term, subject to continued need and

availability of funds.

o Any changes from the initial proposal

submitted by the applicant which must be

incorporated by the owner/borrower.

\- For projects which are currently under an Annual

Adjustment factor (AAF), the field office must

attach an amended regulatory agreement(s)

converting the project to the annual HUD-approved

budget process for all rent increases

\- For projects which do not currently have a

residual receipts account separate from the

reserve for replacement account, the field office

must attach an amended regulatory agreement(s)

establishing such an account into which future

residual receipts will be deposited.

In cases in which the applicant requested both funds

under the Act and residual receipts, the applicant must

also be given approval to utilize residual receipts,

consistent with Paragraph XI.F, prior.

Selected applicants must return a signed acceptance of

the amended HAP contract (the amended regulatory

agreement(s) and acceptance of the use of residual

receipts, if appropriate), to the Director of Housing

Management in the field office within 14

calendar days of the date of the transmittal letter to

the applicant.

F. The Draw-Down Process Using Section 8 Funds

Selected applicants shall draw-down Section 8 funds

from the Act utilizing the same process they now use to

draw Section 8 funds for tenant payments. (See

33

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Handbook 4350.3, Chapter 6, dated 6/91, and HUD

Form-52670, which is at Appendix 28.)

Modification to the HUD-52670 is as follows, until such

time as the form is officially revised:

1\. Part. III, line No. 4, column 10, cross out \"1983

HURRAH Rebates\" and write in \"Service Coordinator\"

(this is done by the project manager or person at

the project preparing the HUD-52670).

2\. Part III, line No. 4, column 11, leave blank.

3\. Part II, No. 4 line, column 12, fill in the amount

requested for that month. (Should be

approximately no more than 1/12 of the amount

requested for the year. May be larger if the last

portion of the multi-year period is less than one

year.))

(Field office staff will fill in Part III, No. 4,

column 13(b) with the appropriate OFA accounting code,

when assigned.)

XIII.PROJECT AND FIELD OFFICE RECORD KEEPING AND REPORTING:

A. Project Recordkeeping - Client Files

Each borrower/owner approved to provide a service

coordinator as part of its operating budget must agree

to keep certain files on the clients served by the

coordinator.

These files must be kept in a secured location and

accessible ONLY to the service coordinator, and project

management to the extent necessary. The project must

maintain confidentiality of information related to any

individual, per the Privacy Act of 1974. The files

must contain;

1\. Intake form, including information on referrals to

community agencies.

2\. Case management plan, if appropriate.

34

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3\. Quarterly monitoring plan and follow-up, as

appropriate.

4\. Information relating to any reports, alleged or

otherwise, of human or civil rights abuse, adult

abuse of any type (i.e., mental, physical,

financial), violations of personal property or

dignity, and follow-up, case resolution, or

status, as appropriate.

5\. Results of all monitoring and agency follow-up(as

appropriate).

6\. Notes on all meetings with client/family members.

7\. Disposition/termination of case.

B. Project Reporting

Each project approved for a Service Coordinator under

this Notice is required to report annually to the Field

office in narrative format. This report from the

service coordinator must be mailed to the Field Office

annually, ATTN: Loan Management Branch Chief, with the

reporting due date based upon date of execution of the

original service coordinator agreement.

The information requested is as follows:

1\. Project Information

a\. Average number of hours worked per service

coordinator.

b\. case load per coordinator.

c\. Median amount of time per case.

d\. Median number of units of service provided to

residents.

e\. total number of units of service provided, by

service (e.g., housekeeping, meals-on-wheels,

transportation, counseling).

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2\. Case Information

Problems noted by project in getting access to

services for particular resident needs.

The required information should be mailed to the

appropriate Loan Servicer in the Field Office.

C. Field Office Management Review

On-site reviews must be done consistent with Handbook

4350.1, Chapter 6, \"Project Monitoring\", dated June

1991\.

When doing an on-site review, the Field Office should

include a review of the adequacy of the service

coordination function, based upon discussions with

management, a review of the adequacy of the client

files (looking at a 10 percent sample of files, or a

maximum of 10 cases), file notes and review of the

reports submitted by the project.

This portion of the review would be done by the Loan

Servicer. Findings should be written-up in narrative

format as an ADDENDUM to Form HUD 9834B, \"Management

Review Questionnaire\" and summarized on the Form

HUD-9834, \"Management Review Report\", under Section 5,

General Management Practices, which is sent to the

project manager. Problematic findings should be

discussed with the Headquarters Desk Officer prior to

their being shared with the project.

Copies of problem reviews concerning the service

coordination function should be sent by the Field

Office Director of Housing Management to the Regional

Director of Housing Management for his/her information

with a copy to Headquarters to: Mr. Robert W. Wilden,

Acting Deputy Director, Office of Elderly and Assisted

Housing, ATTN: Mr. Jerry Nachison, Chief, Services

Branch. Headquarters staff will consult with the Field

Office, as appropriate.

Questions regarding this Notice from HUD Regional an field

office staff should be directed to the appropriate Desk Officer,

Services Branch, Office of Elderly and Assisted Housing, at

FTS-(8)-458-3291, as follows: Otelia Hebert - Regions II, IV, V

36

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and VI; Carissa Janis - Regions I, VII and VIII; and, Dee Ann

Walker - Regions III, IX and X.

Questions regarding this Notice from potential applicants

for a service coordinator must be directed to the appropriate

loan servicer in the HUD field office which currently services

the project.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Assistant Secretary for

Housing-Federal Housing

Commissioner

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LIST OF APPENDICES

1\. Applicant Checklist

2\. Preliminary Screening Checklist

3\. Sample Deficiency Letter

4\. Threshold Criteria Checklist

5\. Technical Adequacy Checklist

6\. Section 202 Field Office List of Applications for

Service Coordinators, FY 19\_\_, Using Residual receipts

ONLY, HUD-92292

7\. Section 202 Field Office List of Applications for

Service Coordinators, FY 19\_\_, Using Funds Under the

Act (and Residual Receipts) for Inclusion in the

Lottery, HUD-92293

8\. Section 202 Regional Office Summary Report for FY 19\_\_

on Service Coordinator Applications, HUD-92294

9\. Section 202 Regional List of Applications for Service

Coordinators, FY 19\_\_, Using Funds Under the Act (and

Residual Receipts) for Inclusion in the Lottery,

HUD-92295

10\. Field Office Rejection Letter Format

11\. Field Office Not Funded Letter Format

12\. SF-424

13\. Drug-Free Workplace Certification

14\. Lobbying Certification Form

15\. SF-LLL

16\. HUD-2880

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LIST OF APPENDICES (continued)

17\. Certification regarding Transfer of Existing Service

Coordination Costs to HUD

18\. Data Collection Certification

19\. Civil Rights Certification

20\. Certification for HUD-approved budget

21\. Certification for separate residual receipts account

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APPENDIX 1

Applicant Checklist

This checklist is for applicants to use to review their

package and insure that all necessary materials are included. It

covers the required information and certifications which must be

submitted. Requirements which may be corrected during the

preliminary screening period are noted with an asterisk (\*).

Items noted with a double asterisk (\*\*) are needed for threshold

review.

\(1\) Transmittal letter containing:

\_\_\_\_\_ - date of letter

\_\_\_\_\_ - purpose of the request for funding

\_\_\_\_\_ - source(s) of funds \*

\_\_\_\_\_ - amount requested for each source,

per year

\_\_\_\_\_ - term of agreement

\_\_\_\_\_ - statement on sufficient office space \*

\_\_\_\_\_ - signature of chairperson of the

Board of Directors \*

Attached:

\_\_\_\_\_ - evidence of insufficient residual

receipts to fund a service coordinator \*

\_\_\_\_\_ - evidence of sufficient office space \*

\(2\) SF-424

\_\_\_\_\_ - filled out correctly \*

\_\_\_\_\_ - signed by chairperson of the Board of

Directors \*

\(3\) Explanation of the need, containing:

\_\_\_\_\_ - estimated number of residents

frail/at-risk/healthy \*\*

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APPENDIX 1

Evidence presented \*\*

\_\_\_\_\_ - list of individuals citing frailties;

or,

\_\_\_\_\_ - lists of anecdotes; or

\_\_\_\_\_ - lists of information from assessments

\(4\) Annual costs proposed for first year:

\_\_\_\_\_ - salary

\_\_\_\_\_ - fringe benefits

\_\_\_\_\_ - administrative/overhead costs

\_\_\_\_\_ - estimate for years 2-5 of the contract,

per year

\_\_\_\_\_ - estimate for the total term of the

contract

\_\_\_\_\_ - adjustment for first year start-up costs

\_\_\_\_\_ - evidence of salary comparability

\(5\) Functional position descriptions:

\_\_\_\_\_ - coordinator

\_\_\_\_\_ - aide(s), if utilized

\(6\) Contracting Out

\_\_\_\_\_ - contract ratified, subject to approval

of funds

\_\_\_\_\_ - dates of the covered contract period

\_\_\_\_\_ - number of hours to be worked weekly

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APPENDIX 1

\_\_\_\_\_ - the name of the single individual

assigned to the responsibility

\_\_\_\_\_ - location of office and meeting space

\_\_\_\_\_ - location and security of records

\(7\) Sharing of a Coordinator

\_\_\_\_\_ - contract ratified, subject to approval

of funds, covering:

\_\_\_\_\_ - dates of the covered contract period

\_\_\_\_\_ - explanation: how arrangement will work

\_\_\_\_\_ - where ultimate responsibility lies for

hiring and firing

\_\_\_\_\_ - space sharing

\_\_\_\_\_ - location and security of records

\_\_\_\_\_ - payment of salary(ies) and expenses

\_\_\_\_\_ - allocation of days and hours between/

among housing projects

\(8\) Certifications for:

\_\_\_\_\_ - collection of information

\_\_\_\_\_ - client files \*

\_\_\_\_\_ - annual report to HUD \*

\_\_\_\_\_ - transfer of service coordination costs

to HUD \*\*

\_\_\_\_\_ - Drug-free Workplace \*

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APPENDIX 1

\_\_\_\_\_ - lobbying certification, if the amount

requested exceeds \$100,000 \*

\_\_\_\_\_ - SF-LLL, if appropriate \*

\_\_\_\_\_ - HUD-2880 \*

\_\_\_\_\_ - civil rights certification \*

\_\_\_\_\_ - Certification for HUD-approved budget \*

\_\_\_\_\_ - Certification for separate residual

receipts account \*

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APPENDIX 2

Field Office \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Applicant Name \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Second project name, if

appropriate)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Project Number(s)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Preliminary Screening Checklist

The following checklist must be utilized by the field

offices to ensure that all required items are included in

the proposal. Any item listed which receives a \"missing\" or

\"incorrect\" check-off must be treated as deficient; in such

cases a letter must be sent to the applicant within five

days of the application deadline telling the principals

which information is deficient (see Appendix 3, following

for sample letter).

N/A O.K. Missing Incorrect

\(1\) Transmittal letter

\_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- source(s) of funds \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- signature of chairperson

of the Board of Directors \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- evidence of insufficient

residual receipts to fund

a service coordinator \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- evidence of sufficient office

space \_\_\_\_ \_\_\_\_ \_\_\_\_\_

Comments:

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APPENDIX 2

N/A O.K. Missing Incorrect

\(2\) SF-424: \_\_\_\_\_ \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- filled out correctly \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- signed by Bd. Chairperson \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

Comments:

\(3\) Certifications for:

\- Data collection

o client files \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

o annual report to \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

HUD

\- Transfer of service coordination

costs to HUD \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- Drug-free Workplace \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- lobbying certification, if request

is over \$100,000 \_\_\_\_ \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- SF-LLL, if

appropriate \_\_\_\_ \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- HUD-2880 \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- civil rights

certification \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_

\- HUD-approved budget \_\_\_\_ \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- Separate residual

receipts account \_\_\_\_ \_\_\_\_ \_\_\_\_ \_\_\_\_\_

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APPENDIX 2

Comments:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_

Reviewer Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_

Chief, Loan Management Date

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APPENDIX 3

Sample Deficiency Letter

Dear :

This is to inform you that the proposal submitted to the HUD

\_\_\_\_\_ Field Office on \_\_\_\_\_\_\_\_\_\_ is deficient in
\_\_\_\_\_ items as

noted below. Corrections must be submitted to the Director of

Housing Management in the \_\_\_\_\_ Field Office within 14 days of

the date of this letter to you. This means, for example, if the

letter is dated July 15, 1992, the response must be in the field

office no later than close of business in that field office on

July 29, 1992. If materials are either not complete or remain

incorrect, the application will be placed in reject status.

The following items are deficient:

N/A Missing Incorrect

\(1\) Transmittal letter

containing: \_\_\_\_ \_\_\_\_\_

\- source(s) of funds \_\_\_\_ \_\_\_\_\_

\- signature of chairperson

of the Board of Directors \_\_\_\_ \_\_\_\_\_

\- Evidence of insufficient

residual receipts to fund

a service coordinator \_\_\_\_ \_\_\_\_\_

\- evidence of sufficient office

space \_\_\_\_ \_\_\_\_\_

Comments:

\(2\) SF-424:

\- filled out correctly \_\_\_\_ \_\_\_\_\_

\- signed by Bd. Chairperson \_\_\_\_ \_\_\_\_\_

Page 1 of 2

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APPENDIX 3

Comments

N/A Missing Incorrect

\(3\) Certifications for:

\- data collection requirements

o client files \_\_\_\_ \_\_\_\_\_

o annual report to HUD \_\_\_\_ \_\_\_\_\_

\- transfer of service coordination

costs to HUD \_\_\_\_ \_\_\_\_\_

\- Drug-free Workplace \_\_\_\_ \_\_\_\_\_

\- lobbying certification, if

request over \$100,000 \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- SF-LLL, if appropriate \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- HUD-2880 \_\_\_\_ \_\_\_\_\_

\- civil rights

certification \_\_\_\_ \_\_\_\_\_

\- HUD-approved budget \_\_\_\_ \_\_\_\_ \_\_\_\_\_

\- Residual receipts

account \_\_\_\_ \_\_\_\_ \_\_\_\_\_

Comments:

Thank you for submitting an application for service

coordinator funds.

Very Truly Yours,

Chief, Loan Management

Branch

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APPENDIX 4

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Applicant Name

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Second Project Name, if applicable

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Project Number(s) Field Office

Threshold Criteria Checklist

Loan management staff (and General Counsel and FH&EO staff as

needed) must determine that all applicants meet the following

threshold criteria,

Yes No

1\. The applicant is eligible (it is a section

202 or section 202/8 project(s) serving the

elderly and disabled). (Loan Management and/or

Field Office Counsel); \_\_\_\_ \_\_\_\_

Comments:

2\. The project meets the minimum size criteria

(Loan Management):

\_\_ it has at least 75 units; OR, \_\_\_\_ \_\_\_\_

\_\_ if two projects in the immediate

geographic are grouped in the

application, the group contains

a minimum of 75 units. \_\_\_\_ \_\_\_\_

Comments:

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APPENDIX 4

Yes No

3\. Sustaining Occupancy

Each borrower/owner proposing to hire a

services coordinator must have a project

which has reached sustaining occupancy,

that is, 97 percent occupied, at the time

of application to HUD (Loan Management) \_\_\_\_ \_\_\_\_

Comments:

4\. The borrower/owner has provided evidence

that at least 25 percent of the residents

of the project(s) are frail or at risk, per

section VII of this Notice and Section

II.B(3)(b) of the NOFA (Loan Management

and/or Field Office Counsel). \_\_\_\_ \_\_\_\_

Comments:

5\. The costs of a service coordinator, or service

coordination/case management are not being

transferred to HUD. (Loan Management); \_\_\_\_ \_\_\_\_

Comments:

6\. The project loan is current or

current under a HUD-approved workout

arrangement. (Loan Management) \_\_\_\_ \_\_\_\_

Comments:

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APPENDIX 4

Yes No

7\. The project has been finally closed

(Loan Management). \_\_\_\_ \_\_\_\_

Comments:

8\. The owner/borrower, if under an annual adjustment

factor (AAF,) has agreed to amend the section 8

contract to substitute the annual HUD-approved

budget for rent increases for the AAF (Loan

Management). \_\_\_\_ \_\_\_\_

Comments:

9\. The owner/borrower has a separate residual receipts

account, or, has agreed to amend the project\'s(s\')

regulatory agreement(s) to provide for same

(Loan Management). \_\_\_\_ \_\_\_\_

Comments:

10\. One or more of the following items is outstanding:

\- a pending civil rights suit against the

applicant brought by the Department of

Justice (FH&EO); \_\_\_\_ \_\_\_\_

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APPENDIX 4

\- an outstanding finding of noncompliance

with civil rights statutes, executive

orders or regulations as a result of

formal administrative proceedings

(FH&EO); \_\_\_\_\_ \_\_\_\_\_

\- a charge issued by the Secretary of HUD

against the applicant under the Fair

Housing Act, unless the applicant is

operating under a conciliation or

compliance agreement designed to correct

the area of non-compliance (FH&EO); \_\_\_\_\_ \_\_\_\_\_

\- a pending denial of application processing

by HUD under Title VI of the Civil Rights

Act of 1964, under the attorney general\'s

guidelines 928 CFR 50.3), and the HUD Title

VI regulations (24 CFR 1.8) and procedures

(HUD Handbook 8040.1) (FH&EO); \_\_\_\_\_ \_\_\_\_\_

\- there exists serious, unaddressed or

outstanding Inspector General audit

findings or HUD Headquarters/Field

Office Management monitoring review

findings for any of the applicant\'s

ongoing management operations or in

its connection with the administration

of existing grants; (Loan Management); \_\_\_\_\_ \_\_\_\_\_

\- there exists serious, unaddressed or

outstanding Inspector General audit

findings or HUD Headquarters FH&EO fair

housing monitoring review findings for

any of the applicant\'s ongoing management

operations or in its connection with the

administration of existing grants;

(FH&EO); \_\_\_\_\_ \_\_\_\_\_

\- the applicant is involved in litigation which

could seriously jeopardize its ability to

administer the contract (OGC and/or Loan

Management and/or FH&EO); or, \_\_\_\_\_ \_\_\_\_\_

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APPENDIX 4

\- The project borrower/owner is the subject

of a charge issued following a reasonable

cause determination under the Fair

Housing Act (FH&EO) \_\_\_\_\_ \_\_\_\_\_

Comments:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Reviewer (Loan Management) Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Reviewer, FH&EO Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Reviewer, General Counsel Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Chief, Loan Management Date

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APPENDIX 5

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Applicant Name

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Second project name, if applicable

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Project Number(s) Field Office

Technical Adequacy Checklist

YES NO

1\. the application should state that the project is

applying for Section 8 funds, using residual

receipts only, or proposing to use both. \_\_\_\_ \_\_\_\_

Comments:

2\. If section 8 funds are requested, documentation

must be provided showing that residual receipts

are insufficient to cover the costs that are

proposed for section 8. \_\_\_\_ \_\_\_\_

Comments:

3\. The application has documented adequate space to

carry out the service coordination function. \_\_\_\_ \_\_\_\_

Comments:

Page 1 of 4

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APPENDIX 5

YES NO

4\. The borrower/owner has documented the need for the

service coordinator. \_\_\_\_ \_\_\_\_

Comments:

5\. the time period for the service coordinator

(number of hours to be worked) corresponds

with the need described. \_\_\_\_ \_\_\_\_

Comments:

6\. the total amount requested annually (salary,

fringe,operating expenses) is within the per

unit maximum (\$25.00/unit/month); \_\_\_\_ \_\_\_\_

Comments:

7\. the salary and other costs proposed for the first

year are consistent with the local market and the

rest of the management team and fringe benefits and

other costs are consistent with other similar costs

allowed for that organization. Costs for years

two-five are consistent with year one, less any

one-time start-up costs in year one; \_\_\_\_ \_\_\_\_

Comments:

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APPENDIX 5

YES NO

8\. The funds requested for a service coordinator

are for new time allocations and staffing, NOT to

augment the salary of an existing staff person

whose time on the job will not be increased. \_\_\_\_ \_\_\_\_

Comments:

9\. the position description relates to the responsibilities

and qualifications as stated in sections VI.B

and VIII of this Notice; \_\_\_\_ \_\_\_\_

Comments:

10\. If the applicant proposes to contract out the

service coordinator, a copy of the contract

between/among the sponsor/borrower/owner with

the third party agent(cy) must satisfactorily

address the following: Dates of the contract,

number of hours to be worked weekly, the name

of the single individual assigned to the

responsibility, the rate of pay and related

expenses for the work to be performed, a

description of the work to be performed, a

description of the work to be performed,

consistent with section VI.B of the Notice,

location of office and meeting space and the

location/security of records and their

availability to HUD (field office counsel and

loan management) \_\_\_\_ \_\_\_\_

Comments:

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APPENDIX 5

Yes No

11\. If a multi-project application, the proposed

agreement between the sponsors/borrowers/

owners satisfactorily addresses the following:

space-sharing, location and security of

records, payment of salary(ies) and expenses,

allocation of days and hours between/among

the housing projects (field office counsel and

loan management. \_\_\_\_ \_\_\_\_

Comments:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Reviewer Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Loan Management Branch Chief Date

Page 4 of 4

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APPENDIX 6

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Section 202

Field Office List of Applications for Service Coordinators

(FY 19\_\_\_) Using Residual Receipts Only

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APPENDIX 7

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Section 202

Field Office List of Applications for Service Coordinators

(FY 19\_\_\_) Using Funds under the Act & Residual Receipts

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APPENDIX 8

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Section 202

Regional Office

FY 19\_\_\_\_\_Summary Report

on Service Coordinators Applications

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Page 1 of 1

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APPENDIX 9

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Section 202

Regional Office List of Applications for Service Coordinators

(FY 19\_\_\_) Using Funds under the Act & Residual Receipts

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APPENDIX 10

Field office Rejection Letter Format

Dear :

This is to inform you that the application submitted on

\_\_\_\_\_\_\_\_\_\_\_\_\_ for a service coordinator in your project(s)
has

been rejected.

The reason(s) for rejection are:

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If you have any questions or would like to discuss your

application so that it can be technically improved to possibly

qualify for funding in the future, if such funds are available,

please feel free to call \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ at

We appreciate your interest in the service coordinator

position.

Very truly yours

Field Office Manager

Page 1 of 1

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APPENDIX 11

Field Office Not Funded Letter Format

Dear :

This is to inform you that the application your organization

submitted to the HUD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Field Office on
\_\_\_\_\_\_\_\_\_\_\_\_

for a service coordinator was complete and technically adequate,

but was not selected for funding in either the regional or

the national lottery.

We encourage you to consider updating the application, and

resubmitting it next year, should funds become available. The

Department appreciates your interest in programs which assist the

frail elderly and non-elderly disabled.

Very sincerely yours,

Director of Housing

Management

Page 1 of 1

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APPENDIX 12 (Page 1 of 2)

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APPLICATION FOR

FEDERAL ASSISTANCE

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APPENDIX 12 (Page 2 of 2)

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INSTRUCTIONS FOR THE SF 424

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APPENDIX 13

Drug-Free Workplace Certification

Instructions for certification

1\. By submitting this application, the applicant is providing

the certification set out below.

2\. The certification set out below is a material representation

of fact upon which reliance will be placed if HUD determines to

fund the applicant. If it is later determined that the applicant

(or project, if multiple-site application) knowingly rendered a

false certification or otherwise violates the requirements of the

Drug-Free Workplace Act, HUD, in addition to any other remedies

available to the Federal Government, may take action authorized

under the Drug-Free Workplace Act.

Certification Regarding Drug-Free Workplace Requirements

A. The applicant (and each project, if a multiple project

application) certifies that it will provide a drug-free workplace

by:

\(1\) Publishing a statement notifying employees that the

unlawful manufacture, distribution, dispensation,

possession or use of a controlled substance is

prohibited in the project\'s workplace and specifying

the actions that will be taken against employees for

violation of such prohibition;

\(2\) establishing a drug-free awareness program to inform

employees about:

a\. Publishing a statement notifying employees that

the unlawful manufacture, distribution,

dispensation, possession or use of a controlled

substance is prohibited in the project\'s

workplace and specifying the actions that will be

taken against employees for violation of such

prohibition;

b\. Establishing a drug-free awareness program to

inform employees about:

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APPENDIX 13

i\. the dangers of drug abuse in the workplace;

ii\. the applicant\'s (or project\'s) policy of

maintaining a drug-free workplace;

iii\. any available drug counseling, rehabilitation

and employee assistance programs; and

iv\. the penalties that may be imposed upon

employees for drug abuse violations occurring

in the workplace;

c\. Making it a requirement that each employee to be

engaged in the performance of the award be given a

copy of the statement required by paragraph (a);

d\. Notifying the employee in the statement required

by paragraph (a) that, as a condition of

employment under the grant, the employee will :

i\. abide by the terms of the statement; and

ii\. notify the employers of any criminal drug

statute conviction for a violation occurring

in the workplace no later than five days

after such conviction;

e\. Notifying HUD within ten days after receiving

notice under subparagraph (d)(ii) from an employee

or otherwise receiving actual notice of such

conviction;

f\. Taking one of the following actions, within 30

days of receiving notice under subparagraph

(d)(ii), with respect to any employee who is so

convicted :

i\. taking appropriate personnel; action against

such an employee, up to and including

termination; or

Page 2 of 3

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APPENDIX 13

ii\. requiring such employee to participate

satisfactorily in a drug abuse assistance or

rehabilitation program approved for such

purpose by a Federal, state, or local health,

law enforcement or other appropriate agency;

g\. Making a good faith effort to continue to maintain

a drug-free workplace through implementation of

paragraphs (a), (b), (c), (d), (e), and (f).

B. The applicant (and each project, if a multiple-site

application) shall insert in the space provided below the site(s)

for the performance of work done in connection with this specific

award:

Place of Performance (street address, city, county, state,

zip code)

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C. The applicant (and each project, if a multiple-site

application) certifies that as a condition of this award, he or

she will not engage in the unlawful manufacture, distribution,

dispensing, possession or use of a controlled substance in

conducting any activity with the award.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Chairperson, Board of Directors

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Signature Date

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APPENDIX 14

Certification for Contracts, Grants, Loans, and Cooperative

Agreements

The undersigned certifies, to the best of his or her knowledge

and belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid,

by or on behalf of the undersigned, to any person for influencing

or attempting to influence an officer or employee of any agency,

a Member of Congress, an officer or employee of Congress, or an

employee of a Member of Congress in connection with the awarding

of any Federal contract, the making of any Federal grant, the

making of any Federal loan, the entering into of any cooperative

agreement, and the extension, continuation, renewal, amendment,

or modification of any Federal contract, grant, loan, or

cooperative agreement.

\(2\) If any funds other than Federal appropriated funds have

been paid or will be paid to any person for influencing or

attempting to influence an officer or employee of any agency, a

Member of Congress, an officer or employee of Congress, or an

employee of a Member of congress in connection with this Federal

contract, grant, loan, or cooperative agreement, the undersigned

shall complete and submit Standard Form-LLL, \"Disclosure Form to

Report Lobbying,\" in accordance with its instructions.

\(3\) The undersigned shall require that the language of this

certification be included in the award documents for all

subawards at all tiers (including subcontracts, subgrants, and

contracts under grants, loans, and cooperative agreements) and

that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon

which reliance was placed when this transaction was made or

entered into. Submission of this certification is a

prerequisite for making or entering into this transaction imposed

by section 1352, title 31, U.S. Code. Any person who fails to

file the required certification shall be subject to a civil

penalty of not less than \$10,000 and not more than \$100,000 for

each such failure.

Executed this \_\_\_\_\_\_\_\_\_\_ day of \_\_\_\_\_\_\_\_\_\_\_\_\_,
19\_\_.

By \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(typed or printed name)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(title)

Covered Action:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(type and identity of program project, or activity)

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APPENDIX 15 (Page 1 of 3)

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DISCLOSURE OF LOBBYING ACTIVITIES

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APPENDIX 15 (Page 2 of 3)

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INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

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APPENDIX 15 (Page 3 of 3)

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DISCLOSURE OF LOBBYING ACTIVITIES

CONTINUATION SHEET

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APPENDIX 16 (Page 1 of 7)

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Applicant/Recipient

Disclosure/Update Report

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APPENDIX 16 (Page 2 of 7)

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APPENDIX 16 (Page 3 of 7)

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APPENDIX 16 (Page 4 of 7)

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APPENDIX 16 (Page 5 of 7)

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APPENDIX 16 (Page 6 of 7)

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APPENDIX 16 (Page 7 of 7)

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APPENDIX 17

Certification Regarding Transfer of Existing Service

Coordination Costs to HUD

The \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ of the
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certifies that the costs of a service coordinator, service

coordination and/or case management as described or referred to

in Sections V and VI of the HUD Notice \"Processing of

Applications for Service Coordinators in Section 202 Housing and

Monitoring of Approved Applicants,\" if in place, are not being

transferred to HUD in this application.

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Chairperson, Board of Signature

Directors

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Date

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APPENDIX 18

Data Collection Certification

The undersigned agrees to keep client files in a secured location

and accessible ONLY to the service coordinator, and project

management to the extent necessary. The project must maintain

confidentiality of information related to any individual, per the

Privacy Act of 1974.

The files must contain:

Intake form, including information on referrals to community

agencies; Case management plan, if appropriate; Quarterly

monitoring plan and follow-up, as appropriate; Information

relating to any reports, alleged or otherwise, of human or civil

rights abuse, adult abuse of any type (i.e., mental, physical,

financial), violations of personal property or dignity, and

follow-up, case resolution, or status, as appropriate; Results of

all monitoring and agency follow-up (as appropriate); Notes on all

meetings with client/family members; Disposition/termination of

case.

Each project approved for a Service Coordinator per this Notice

is required to report annually to the Field office in narrative

format, beginning one year after the date of execution of the HAP

amendment or approval to use residual receipts.

The report must cover:

Project Information: Average number of hours worked per

service coordinator; case load per coordinator; median amount of

time per case; median number of units of service provided to

residents; total number of units of service provided, by service

(e.g., housekeeping, meals-on-wheels, transportation,

counseling); and Case Information: Problems noted by project in

getting access to services for particular resident needs.

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Chairperson, Board of Signature

Directors

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Date

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APPENDIX 19

Civil Rights Certification

The undersigned is willing to comply with Title VI of the Civil

Rights Act of 1964 (42 U.S.C. 2000d) and the implementing

regulations at 24 CFR Part 1; the Fair Housing Act (42 U.S.C.

3600-3619) and the implementing regulations at 24 CFR Parts 100,

109, and 110; section 504 of the Rehabilitation act of 1973 (29

U.S.C. 794) and the implementing regulations at 24 CFR part 8;

the Age Discrimination Act of 1975 (42 U.S.C. 6101-6107) and the

implementing regulations at 24 CFR part 146; section 3 of the

Housing and Urban Development Act of 1968 (12 U.S.C. 1701u) and

the implementing regulations at 24 CFR part 135; Executive Order

11246 (as amended) and the implementing regulations at 41 CFR

Chapter 60; the regulations implementing Executive Order 11063

(Equal Opportunity in Housing) at 24 CFR part 107; and the

affirmative fair housing marketing requirements of 24 CFR Part

108\.

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Chairperson, Board of Signature

Directors

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Date

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APPENDIX 20

Certification of HUD-Approved Budget Process

The undersigned Chairperson of the Board of Directors of the

applicant agency (or both agencies, if a joint application) shall

check off and fill out one of the two following items, and

sign below:

1\. \_\_\_\_\_ The borrower/owner of the
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ certifies
that the project

currently operates under the HUD-approved budget process.

OR,

2\. \_\_\_\_\_\_ The borrower/owner of the
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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ certifies
that the project

currently operates with an annual adjustment factor and

agrees to have its Section 8 contract amended to

substitute the annual HUD-approved budget process for all

future rent increases under section 8.

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Chairperson, Board of Signature

Directors

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Date

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APPENDIX 21

Residual Receipts Certification

The undersigned Chairperson of the Board of Directors of the

applicant agency (or both agencies, if a joint application) shall

check off and fill out one of the two following items, and

sign below:

1\. \_\_\_\_\_ The borrower/owner of the
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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ certifies
that the project

currently has and utilizes an established separate residual

receipts account.

OR,

2\. \_\_\_\_\_ The borrower/owner of the
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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ certifies
that the project

currently does not have a residual receipts account separate

from the reserve and replacement account and agrees to have

its regulatory agreement amended to provide for a residual

receipts account(s) separate from the reserve and

replacement account into which all future residual receipts

will be deposited.

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Chairperson, Board of Signature

Directors

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Date

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