Rhode Island by T6Wo1568

VIEWS: 8 PAGES: 8

									                                   Rhode Island
 Community Development Block Grant, Disaster Recovery
            Pre-Application for Assistance

                Housing Rehabilitation/Reconstruction

                                 Summary Information

Address of property to be rehabilitated:
              ______________________________________________
              ______________________________________________
              ______________________________________________

Property owner name:         __________________________________

Phone number:                ____________________

Total Amount Requested:                     $___________________*
This amount must match budget detail page. Program design limits assistance to $100,000 for
rehabilitation and $200,000 for reconstruction. A lien will be placed on properties assistance
in the total amount of the assistance.

Is unit to be rehabilitated owner-occupied?        Yes          No     (Circle One)
In accordance with program design, all units assisted must be owner-occupied.

Number of bedrooms in proposed unit:       _____


                              Return complete applications to:

                                         June House
                              Rhode Island Division of Planning
                       Office of Housing and Community Development
                                  One Capitol Hill, 3rd Floor
                                 Providence, R.I. 02908-5873




                                         Page 1 of 8
                                    Household Income

To qualify for assistance, all units rehabilitated/replaced must be occupied, at completion, by a
household earning at or below 80% of Area Median Income (AMI), as published by the U.S.
Department of Housing and Urban Development (HUD), for the area in which the unit is
located. A link to current income limits can be found at
http://www.hrc.ri.gov/CDBGForms.php

Please complete the following information to determine whether the household applying for
assistance meets this requirement.

Location (City/Town) of Unit:                                      ____________________

Household Size:                                                ___________
"Household" is defined as all persons who occupy a housing unit.

Total Household Income:

Source                               Weekly                Monthly                Annually
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
_________________________            ____________          ____________           ____________
TOTAL                                ____________          ____________           ___________*

"Income" is defined under the Section 8 Housing Assistance Payment program at 24 CFR
813.106, except that if the CDBG assistance being provided is homeowner rehabilitation under
Section 570.202, the value of the homeowner's primary residence may be excluded from the
calculation of Net Family Assets. Supporting documentation verifying accuracy of above
must be included in the local files related to this project.

ALL sources of income, including interest and asset income, for every member of the
"household" must be listed above.

HUD Income Limit for the Area:                           __________________
Total Household Income:                                  __________________
Total Household Income must be equal to or less than the HUD Income Limit noted above.

Please contact the State's Office of Housing and Community Development (OHCD) at 222-
2079 for additional information/forms, if the application applies to a multi-family and/or
mixed-use structure.
                                          Page 2 of 8
                                 Household Characteristics

Date Applicant/Household acquired property:                     ____________
The applicant must have owned the dwelling prior to the March, 2010 floods. Documentation
of ownership must be maintained in local files.

Is the household intended to be the occupant subsequent to assistance: Yes         No (Circle One)
The household must be the intended occupant subsequent to assistance.

Characteristics of person(s) living in the dwelling to be assisted with CDBG-DR funds for all or
part of the next 12 months:

Name                          Age     Wht    Blk     His     Ai/An Asn/PI

_________________           ___   ___     ___    ___    ___     ___
_________________           ___   ___     ___    ___    ___     ___
_________________           ___   ___     ___    ___    ___     ___
_________________           ___   ___     ___    ___    ___     ___
_________________           ___   ___     ___    ___    ___     ___
_________________           ___   ___     ___    ___    ___     ___
(Ai/An = American Indian/Alaskan Native; Asn/PI = Asian/Pacific Islander)

The racial/ethnic information solicited on this application is requested by the State in order to
assure the Federal Government that the Federal laws prohibiting discrimination against
applicants on the basis of race, color, national origin, religion, sex, familial status, age and
handicap are being complied with. Households are not required to furnish this information
but are encouraged to do so. This information will not be used in evaluating applications or to
discriminate against households in any way. However, if the household chooses not to furnish
it, the local official assisting with application preparation is required to note the race/national
origin and sex of the household members on the basis of visual observation or surname.




                                            Page 3 of 8
                                Rehabilitation/Replacement

All units rehabilitated/replaced with CDBG-DR funds must be brought into compliance with
State and local code standards. The applicant is instructed to complete the below chart,
providing an overview of inspection results. Additional information, retained in local files,
may be necessary to assess the unit's ability to meet code standards. All inspections must be
conducted by qualified individuals.

Describe requested rehabilitation activities to be completed:

Interior                               Excel. Good Fair         Poor   Note:
Heating System:
 gas_ oil_ propane_
 electric_ other_               ____   ____    ____    ____     ____________________
Electric Service:__amp          ____   ____    ____    ____     ____________________
Insulation                      ____   ____    ____    ____     ____________________
Plumbing facilities/ fixtures   ____   ____    ____    ____     ____________________
Paint/Stain                     ____   ____    ____    ____     ____________________
Ceilings                        ____   ____    ____    ____     ____________________
Floors                          ____   ____    ____    ____     ____________________
Stairs/entryways                ____   ____    ____    ____     ____________________
Windows                         ____   ____    ____    ____     ____________________
Doors                           ____   ____    ____    ____     ____________________
Support beams/shorings          ____   ____    ____    ____     ____________________
Interior walls                  ____   ____    ____    ____     ____________________
Hot/cold water supply           ____   ____    ____    ____     ____________________
Well                            ____   ____    ____    ____     ____________________
Seweage facilities              ____   ____    ____    ____     ____________________
Roof                            ____   ____    ____    ____     ____________________
Garage (if attached)            ____   ____    ____    ____     ____________________
Porch/breezeway                 ____   ____    ____    ____     ____________________
Stairs/decks                    ____   ____    ____    ____     ____________________
Foundation/crawl space          ____   ____    ____    ____     ____________________
Gutters/trim                    ____   ____    ____    ____     ____________________
Siding                          ____   ____    ____    ____     ____________________
Storm windows/doors             ____   ____    ____    ____     ____________________
Chimneys/stacks                 ____   ____    ____    ____     ____________________
Paint/stain                     ____   ____    ____    ____     ____________________




                                              Page 4 of 8
Year Unit Built:                       ______
If unit is built before 1978, consider Lead Based Paint compliance requirements.

Is unit currently lead safe/free?                        Yes    No      (Circle One)
Is the unit historic?                                    Yes    No      (Circle One)
Is the subject unit located in a flood zone?             Yes    No      (Circle One)
         If Yes, is flood insurance now maintained?      Yes    No      (Circle One)

To qualify for assistance:
    All units must be lead safe/free subsequent to assistance.
    All rehabilitation activities must be coordinated with and compliant with State Historic
      Preservation requirements.
    All units in a flood zone must maintain adequate insurance to protect the public-funds
      investment.

Will relocation expenses during rehabilitation be necessary? Yes No (Circle One)
If Yes, please detail how this will be provided/funded:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________




                                           Page 5 of 8
                                         Limitation

By program design, the State cannot assist any structure in which the total assistance and debt
(liens) exceeds 125% of the value of the property post-rehabilitation. In addition, all
households assisted must be evaluated to assure they are not paying in excess of 31% of their
income towards housing expenses. In such instances, the municipality may direct the
household to other assistance programs and services.

Existing Liens/Debt:

Source                                            Outstanding Balance
________________________                          ______________________
________________________                          ______________________
________________________                          ______________________
Examples may include mortgages, equity loans, liens placed on property for prior
rehabilitation/assistance.

Are there any additional liens/mortgages planned on this property? Yes   No        (Circle One)

       If Yes, detail: _____________________________________________
       Examples may include assistance and/or mortgages currently under consideration.


Total of all liens/mortgages detailed above:       $______________________
Total assistance requested:                        $______________________
        TOTAL                          $______________________ (A)

Total "Value" of property post-rehab/replacement       $______________________
       Value times 1.25              $______________________ (B)

(B) must be greater than (A). Documentation supporting value must be maintained in local
files.

In accordance with the program design, municipal applicants must place a (recapture) lien on
properties assisted in the total amount of the assistance provided, generally in accordance with
HOME program affordability restrictions. If CDBG-DR assistance exceeds $15,000, a 30-year
lien must be placed on the property, qualifying it to count towards the community's 10%
affordability housing goals (if applicable). The community should detail below how it will
comply with monitoring agent requirements applicable to such units.

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

                                          Page 6 of 8
                            ASSISTANCE BREAKDOWN

In accordance with regulations, CDBG-DR funds may not be used to supplant or replace any
other sources of funds received for assisted activities (See Stafford Act provisions).
Municipalities are cautioned to carefully review and document all sources of assistance
received to assure compliance with this requirement.

Based on inspection and rehabilitation needs, please provide an estimate of the total cost:

                                     $_________________*
Budget breakdown:
                              __________________             CDBG-DR
                              __________________             Other, Specify: ______________
                              __________________             Other, Specify: ______________
                              __________________             Total*

Detail any funds received to date related to March, 2010 disaster recovery:

Source                 Amount                 Use
Insurance:             ______________         ___________________________________
Insurance:             ______________         ___________________________________
Insurance:             ______________         ___________________________________
FEMA/SBA:              ______________         ___________________________________
FEMA/SBA:              ______________         ___________________________________
FEMA/SBA:              ______________         ___________________________________
State/Local Funds:     ______________         ___________________________________
State/Local Funds:     ______________         ___________________________________
State/Local Funds:     ______________         ___________________________________

Housing Costs:

Detail all housing costs paid. Mortgage, loan and utility costs must be listed.

Type                                          Annual Cost
_______________________________               ______________
_______________________________               ______________
_______________________________               ______________
_______________________________               ______________
_______________________________               ______________
_______________________________               ______________
_______________________________               ______________
      Total                                   ______________ (A)

Total Annual Income:                         _______________         31% = _____________(B)
(B) must be greater than (A) to qualify for assistance.
                                           Page 7 of 8
                                       Certification(s)

By regulation, the CDBG-DR program may only accept applications from and award funds to
Units of General Local Government (Cities and Towns). In instances of non-compliance, a
municipality will be responsible to the State for return of funds. Please complete the following
information on local point of contacts related to this proposal.

Person who assisted in the completion of this form:

Name: ___________________________

Address:      ___________________________
              ___________________________
              ___________________________

Phone:        ___________________________
Fax:          ___________________________
Email:        ____________________________


I certify that the information contained in this application is accurate to the best of my
knowledge:

_____________________________________________                      ____________________
City/Town Application Contact                                      Date


Completed applications will be awarded on a first-come, first-serve basis until funds are
exhausted. The State does not guarantee monies will be available to fund this application. Any
application which is submitted to OHCD incomplete/deemed ineligible will not have funds
committed to it and will be returned to the municipality. If multiple applications are received
concurrently, and funds are insufficient to fund all applications, a funding committee will
evaluate proposals received and make final award determinations.

The below parties hereby certify to the information contained on Pages 1through 8 of this
application is accurate to the best of my knowledge. Provision of false information on this
application may result in civil and/or criminal penalties.

_____________________________________________                      _______________
Applicant's (Homeowner) Signature                                        Date




                                          Page 8 of 8

								
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