Tenant Based Rental Assistance Set-up Form



U.S. Department of Housing and Urban DevelopmentOffice of Community Planning and DevelopmentOffice of Affordable Housing ProgramsRental Set Up and Completion FormTCAP Program Check the appropriate box: FORMCHECKBOX Original Submission FORMCHECKBOX RevisionName and Phone Number of Person Completing Form: FORMTEXT ?????Add Activity:Activity Owner (TCAP Grantee): FORMTEXT ?????SHARS ID #: FORMTEXT ?????IDIS Activity ID Number:(For HUD use only) FORMTEXT ?????IDIS Project ID/Project Title: FORMTEXT ?????Projecty Name: FORMTEXT ?????Environmental Assessment: (check one) FORMCHECKBOX Underwayx Completed FORMCHECKBOX ExemptActivity Description: FORMTEXT ?????Add TCAP Set-up Detail:Performance Objective (check one): FORMCHECKBOX Create suitable living environments FORMCHECKBOX Provide decent affordable housing FORMCHECKBOX Create economic opportunitiesPerformance Outcome (check one): FORMCHECKBOX Availability/accessibility FORMCHECKBOX Affordability FORMCHECKBOX SustainabilityWill this activity be carried out by a faith-based organization? FORMCHECKBOX Yes FORMCHECKBOX NoSpecial Characteristics (check all that apply): FORMCHECKBOX CDBG Strategy Area FORMCHECKBOX Brownfield Redevelopment Area FORMCHECKBOX Local Target Area FORMCHECKBOX Conversion of Nonresidential to Residential Use FORMCHECKBOX Presidentially Declared Major Disaster Area FORMCHECKBOX Colonia (For AZ, CA, NM, TX) FORMCHECKBOX Historic Preservation Area Setup Activity Type (check one): FORMCHECKBOX Rehabilitation Only FORMCHECKBOX Acquisition & Rehabilitation FORMCHECKBOX New Construction Only FORMCHECKBOX Acquisition & New Construction FORMCHECKBOX Acquisition OnlyFTE Jobs Created/ Retained total: FORMTEXT ?????Multi-Address: FORMCHECKBOX Yes FORMCHECKBOX NoLoan Guarantee: FORMCHECKBOX Yes FORMCHECKBOX NoActivity Street Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip Code: FORMTEXT ?????County: FORMTEXT ?????Estimated TCAP Units: FORMTEXT ?????Estimated TCAP Cost: FORMTEXT ?????Property Owned By (select type): FORMCHECKBOX Individual FORMCHECKBOX Not-for-Profit FORMCHECKBOX Partnership FORMCHECKBOX Publicly Owned FORMCHECKBOX Corporation FORMCHECKBOX OtherProperty Owner/Project Owner Name: FORMTEXT ?????Street Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip Code: FORMTEXT ?????Add TCAP Completion Detail (Page 1):Completion Narrative (Maximum 4000 Characters): FORMTEXT ?????Total Completed Units: FORMTEXT ?????TCAP-Assisted Units: FORMTEXT ?????Of the Total Completed Units, the Number of:TotalTCAP-AssistedUnits Qualified as Energy Star FORMTEXT ????? FORMTEXT ?????Section 504 Accessible Units FORMTEXT ?????Units Designated for Persons with HIV/AIDS FORMTEXT ????? FORMTEXT ?????Of Units Designated for Persons with HIV/AIDS, Number of Units for the Chronically Homeless FORMTEXT ????? FORMTEXT ?????Units Designated for Homeless Persons and Families FORMTEXT ????? FORMTEXT ?????Of Units Designated for Homeless Persons and Families, Number of Units for the Chronically Homeless FORMTEXT ????? FORMTEXT ?????Period of Affordability. If you are imposing a period of affordability that is longer than the LIHTC 15-year compliance period, enter the total years (LIHTC 15-year compliance period + extended use agreement period) of affordability.Total Years of Affordability: FORMTEXT ????? Energy Efficiency (Only Applicable to “Rehabilitation Only” and “Acquisition & Rehabilitation” Activity Types)YesNoWindows ENERGY STAR qualified replacement windows were installed FORMCHECKBOX FORMCHECKBOX Insulation and Air SealingWas Additional attic or roof insulation installed?Units were professionally air sealed? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Heating &Cooling Inefficient heating plants were replaced with high efficiency/ENERGY STAR qualified heating plants?Inefficient central air conditioners were replaced with efficient/ENERGY STAR qualified air conditioners? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX HVAC Temperature ControlsThermostats were replaced with programmable thermostats? FORMCHECKBOX FORMCHECKBOX Domestic Hot WaterInefficient water heaters were replaced with efficiency/ENERGY STAR hot water heaters? FORMCHECKBOX FORMCHECKBOX LightingIncandescent light bulbs and conventional indoor light fixtures were replaced with ENERGY STAR qualified compact fluorescent lighting and fixtures?Outdoor and common area lighting fixtures were replaced with ENERGY STAR qualified fixtures and lamps? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX AppliancesRefrigerators were replaced with ENERGY STAR qualified refrigerators? FORMCHECKBOX FORMCHECKBOX Water ConservationToilets were replaced with water-saving toilets?Showerheads and faucet aerators were replaced with low-flow shower? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Renewable/Green Energy MeasuresSolar photovoltaic panels were installed? FORMCHECKBOX FORMCHECKBOX Add TCAP Completion Detail (Page 2):NOTE: If this is a Multi-address activity, the Cost and Beneficiary sections must be completed for each building. Copies of these sections should be made to complete these sections.Additional Building Street Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip Code: FORMTEXT ?????County Code: FORMTEXT ?????CostsTCAP Funds (Including Program Income)Amortized Loan$ FORMTEXT ?????Grant$ FORMTEXT ?????Deferred Payment Loan $ FORMTEXT ?????Other $ FORMTEXT ?????Total TCAP Funds$ FORMTEXT ?????Public FundsOther Federal Funds (Includes other non-TCAP ARRA funds)$ FORMTEXT ?????State/Local Funds $ FORMTEXT ?????Tax Exempt Bond Proceeds$ FORMTEXT ?????Total Public Funds$ FORMTEXT ?????Private FundsPrivate Loans$ FORMTEXT ?????Owner Cash Contribution$ FORMTEXT ?????Private Grants$ FORMTEXT ?????Total Public Funds$ FORMTEXT ?????OtherLow Income Housing Tax Credit Proceeds$ FORMTEXT ?????Total Other Funds$ FORMTEXT ?????Activity TotalsTCAP Funds$ FORMTEXT ?????All Funds$ FORMTEXT ?????Total TCAP Funds Disbursed$ FORMTEXT ?????Mixed Use Y or NMixed Income Y or NProperty Type – (choose one) Apartment, Cooperative, Condominium, SRO FHA Insured Y or NBeneficiaries (Use codes indicated below)HouseholdUnit ## of BdrmsOccupantTotal Monthly Rent % Median IncomeHispanic / LatinoRaceSizeTypeAssistance Type FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????# of Bdrms - 0 SRO/Efficiency - 1 bedroom - 2 bedrooms - 3 bedrooms - 4 bedrooms - 5 or more bedroomsHousehold % of Med - 0 to 30% - 30+ to 50% - 50+ to 60% - 60+ to 80%Household Race - White - Black or African American - Asian - American Indian or Alaska Native - Native Hawaiian or Other Pacific Islander - American Indian or Alaska Native & White - Asian & White - Black or African American & White - American Indian or Alaska Native & Black or African American - Other Multi RacialOccupant - Tenant - Owner - Vacant UnitHousehold Type - Single, non-elderly - Elderly - Single parent - Two parents - OtherAssistance Type - Section 8 - HOME TBRA - Other federal, state, or local assistance - No assistanceHousehold Size - 1 person - 2 persons - 3 persons - 4 persons - 5 persons - 6 persons - 7 persons - 8 or more persons ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download