Community Development Block Grant

Applicant and Basic Project Information

PageID: 136

Applicant Information

GrpID: 1498

Municipality in Which Project is Located* (Not Service Area for Project)

Legal Name of Applicant*

Applicant EIN*

Applicant UEI*

GrpID: 1499

Legal Address of Applicant*

GrpID: 1500

City*

GrpID: 1501

State*

GrpID: 1502

Zip*

GrpID: 1503

Is the agency a M/W/DBE or a VOSB?*

If yes, is the agency certified?

Has this organization ever received CDBG funding in the past?*

Applicant Contact

Contact Person First Name*

Contact Person Middle Name

Contact Person Last Name*

Contact Person Title*

Contact Person Phone Number*

Contact Person Alternate Number

Contact Person Email*

Basic Project Information

Project Name*

Proposal Number (Enter only if you completed a pre-application for this project.)

Brief Description of Project*

Project Activity Status*

Amount of CDBG Funds Requested* (Round to nearest dollar)

Total Project Cost*

Is this project a priority of the organization or municipality?*

Is this project part of a comprehensive or other type of local plan?*

Outcome Performance Measurement

PageID: 138

I. Goals

The proposed activity meets which of the following goals*

II. Objectives

The proposed activity meets which of the following objectives*

III. Performance Measurement Outcome Statement

Combine the elements from the categories above to summarize why the proposed activity is needed and what outcomes will be achieved from the proposed project or program. Outcomes are the changes expected to occur in clients' lives and/or the community as a result of the proposed activity. A complete statement includes output (quantified) + outcome (from categories above) + activity (description) + objective.*

Examples:

"52 households will have new access to public sewer for the purpose of creating a suitable living environment."
"7 households have affordable housing through a down payment assistance program for the purpose of creating decent affordable housing."
"50 persons have access to new jobs through extension of a water line to a business for the purpose of creating economic development."

Detailed Project Information

PageID: 139

Detailed Project Information

GrpID: 1510

Site Location

Provide a street address or other locational information indicating specifically where the activity is physically being carried out. For activities, such as street reconstruction or sewer lines not located at a specific street address, provide beginning and ending points, e.g. James Street from 5th to 10th Street.*

Detailed description of project

In concise, measurable, and quantifiable terms, describe the work to be accomplished, including specific physical description (i.e. 500 L.F. of 4" pipe along Painter Street; 1,500 feet of sidewalk and curb replacement on Spencer Street). Keep in mind that the detailed description of your project should related directly to the information you provide in Section 6: Budget-Project Sources and Uses Table.*

GrpID: 1511

Additional detail of project

Does the project involve any environmental impact where Department of Environment Resources mandates or Health Department citations are involved?*

If yes, then please specify

Does the applicant or operating agency own the structure where the project is located?*

If yes, then please explain

Nature of Problem/Remedy

If the project is proposed to remedy a problem, provide a detailed description of the nature of the problem and indicate how the proposed work will correct the situation. For sewer and water activities, indicate if any specific state or local compliance requirements are in effect (i.e. EPA, DEP, and ACHD). If this does not apply to the applicant, then enter "Not applicable."*

Construction Information

If this project does not involve construction, then check the box below and leave the remainder of this section blank.

This project does not involve construction

GrpID: 1782

A. Describe applicant's familiarity with Davis-Bacon prevailing wage requirements. (Labor Standards Provisions for construction projects)

B. Describe applicant's familiarity with oversight of construction projects.

C. If applicant currently does not have the construction capacity or has identified a weakness in capacity, how will this be remedied? If this does not apply to the applicant, then enter "Not applicable."

Estimated date construction will commence

Estimated completion date

Projects must be awarded or under construction within 180 days after the CDBG Program Year begins, which takes effect July 1. Failure to comply shall result in the reprogramming of funds.

Project Financial Summary - Performance Measurement Requirement

PageID: 140

Enter all Project Funding Sources in the table below.

According to 2 CFR Part 200, ACED may require a single audit of the applicant.

NOTE: A project will be re-evaluated for eligibility if there are any deviation(s) from the submitted application’s scope of work or project location(s).

Project Funding Sources

GrpID: 1775

This CDBG Application

GrpID: 1564

GrpID: 1565

GrpID: 1566

Funding Type*

GrpID: 1567

GrpID: 1568

Amount*

GrpID: 1774

GrpID: 1780

Other Funding Sources

GrpID: 1513

Funding Source

GrpID: 1514

Funding Name/Notes

GrpID: 1515

Funding Type

GrpID: 1516

Status

GrpID: 1517

Amount

Add Another (Max: 255)

GrpID: 1547

GrpID: 1548

Total Amount*

Budget - Project Sources and Uses Table

PageID: 141

According to 2 CFR Part 200, ACED may require a single audit of the applicant.

NOTE: A project will be re-evaluated for eligibility if there are any deviation(s) from the submitted application’s scope of work or project location(s).

Budget - Project Sources and Uses Table

GrpID: 1549

GrpID: 1550

Proposed Project Cost Category*

Comments

GrpID: 1551

Proposed CDBG Funding*

GrpID: 1552

Local Funding Sources*

GrpID: 1553

Other Funding Sources*

GrpID: 1554

Total*

Add Another (Max: 255)

GrpID: 1555

Total Proposed Costs

GrpID: 1556

GrpID: 1557

GrpID: 1558

GrpID: 1559

Demolition Questionnaire

PageID: 142

Demolition Questionnaire

If this project does not involve demolition, then check the box below and leave the remainder of the page blank.

This project does not involve demolition

GrpID: 1519

Are the structures contiguous in blocks or large groups?

If so, please describe.

Are there safety issues with proposed project?

If so, please describe.

Is the project a multi-municipal collaboration which will connect municipalities?

If so, please describe.

Once the structure is demolished, is there a re-use plan for future development?

If so, please describe.

Has the Municipality received prior CDBG funding for demolition projects?

If so, please describe.

GrpID: 1520

Are the sites scattered?

If so, please describe.

Is the project part of a designated revitalization area in the Municipality’s Master Plan?

If so, please describe.

Is the project part of a previously funded, multiple-phased project?

If so, please describe.

Are there additional funding sources committed to the project?

If so, please describe.

Is the project unique or innovative in nature? (Example: Does this project consist or new demolition techniques.)

If so, please describe.

ACS Census Tract Map

PageID: 163

Census Tract Map

Census Tract Map Data

GrpID: 1779

CensusTract

BlockGroup

GEO ID

Add Another (Max: 9)

Attachments

Name	Notes	File Exts.
Required Attachments
Fair Labor Standards Certifications AttchID: 141	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Concurring Resolution AttchID: 142	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Professional Certification AttchID: 143	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Planning Commission Resolution AttchID: 144	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Resolution of Council AttchID: 145	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Slum and Blight Resolution AttchID: 146	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Footprint Map AttchID: 147	Using the map interface, identify the footprint of your project, such as the specific location of the demolition or construction.	*
Topography Map (Sewer and Water Projects) AttchID: 148	Use the map interface to generate and edit the map.	*
Project or Site Photograph AttchID: 149	Upload all photos as a single file by inserting the photos into a Word document or by creating a PDF. Demolitions require a minimum of 6 photos. All other activities requiring photos should have enough photos to give proper perspective of the proposed project. Failure to upload the proper photos will result in your application being returned.	*
Household Survey Summary Sheet AttchID: 151	Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Subrecipient Pre-Award Assessment AttchID: 152	To be completed by agencies that have not applied for or been awarded CDBG funds from the County in the past. Download, complete, sign and/or have notarized as needed the PDF document below and then upload the completed document to this file attachment record.	*
Proof of SAM Registration AttchID: 153		*
Income Limits AttchID: 155	2020 HUD CDBG-HOME Income Limits	*
CPD Income Eligibility Calculator User Manual AttchID: 156	The CPD Income Eligibility Calculator User Manual presents information on using the CPD Income Eligibility Calculator. It contains useful background information, glossary of terms, instructions, and links to additional resources.	*
Determining Annual Income AttchID: 157	Determining Annual Income Instructions	*
Other AttchID: 154	Upload other documentation relevant to the proposal. Please limit uploads to project specific documentation in pdf format.	pdf

File attachment requirements may change based on responses to form questions.

Community Development Block Grant

Applicant and Basic Project Information

Applicant Information

Applicant Contact

Basic Project Information

Project Type and Sub-Type Selections

Project Type and Sub-Type Selections

National Objective

Benefit to Low/Moderate Income Persons/Households

Job Creation

Elimination and Prevention of Slums and Blight

Outcome Performance Measurement

I. Goals

II. Objectives

III. Performance Measurement Outcome Statement

Detailed Project Information

Detailed Project Information

Construction Information

Project Financial Summary - Performance Measurement Requirement

Project Funding Sources

This CDBG Application

Other Funding Sources

Budget - Project Sources and Uses Table

Budget - Project Sources and Uses Table

Demolition Questionnaire

Demolition Questionnaire

ACS Census Tract Map

Census Tract Map

Census Tract Map Data

Attachments

Community Development Block Grant

Applicant and Basic Project Information

Applicant Information

Applicant Contact

Basic Project Information

Project Type and Sub-Type Selections

Project Type and Sub-Type Selections

National Objective

Benefit to Low/Moderate Income Persons/Households

Job Creation

Elimination and Prevention of Slums and Blight

Outcome Performance Measurement

I. Goals

II. Objectives

III. Performance Measurement Outcome Statement

Detailed Project Information

Detailed Project Information

Construction Information

Project Financial Summary - Performance Measurement Requirement

Project Funding Sources

This CDBG Application

Other Funding Sources

Budget - Project Sources and Uses Table

Budget - Project Sources and Uses Table

Demolition Questionnaire

Demolition Questionnaire

ACS Census Tract Map

Census Tract Map

Census Tract Map Data

Attachments

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