HomeMy WebLinkAbout7 - APPLICATION FOR PBVS FOR HOMELESS VETERANS7-1
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U.S. Department of Housing and
Urban Development
Public and Indian Housing
_________________________________________________________________________
Special Attention of: Notice PIH 2016-11 (HA)
Directors of HUD Regional and Field
Offices of Public Housing; Issued: July 1, 2016
Agencies that Administer the
Housing Choice Voucher Program Expires: Effective until amended,
superseded, or rescinded
_______________________________
Cross References: Notices PIH 2014-03 and
2015-11; Implementation of the HUD-
Veterans Affairs Supportive Housing (HUD-
VASH) Program published in the Federal
Register on March 23, 2012.
Subject: Set-Aside Funding Availability for Project-Basing HUD-VASH Vouchers
1. Purpose. This notice announces the availability of a set-aside of approximately $15
million in HUD-VASH funding that will support approximately 2,000 units of project-
based voucher (PBV) assistance. These PBVs will enable homeless veterans and their
families to access affordable housing with an array of supportive services. The vouchers
are being made available from a set-aside from the Consolidated Appropriations Act,
2016 (the Act) (Public Law 114-113), enacted December 18, 2015, that provided
approximately $60 million dollars of funding for HUD-VASH vouchers as authorized
under section 8(o)(19) of the United Stated Housing Act of 1937.
2. Maximum Awards. Any PHA that administers a Housing Choice Voucher program
may apply for up to 150 units to be placed under PBV housing assistance payments
(HAP) contract(s). In order to receive any project-based voucher (PBV) funding under
this set-aside, a PHA must either be operating a PBV program or establish one in
accordance with the program regulations in 24 CFR part 983.
PHAs must submit separate applications for each project and may request no more than
75 PBVs for a single project. 1 If a PHA selects a project with both existing and new
construction/rehab housing types, the PHA must submit a separate application for each
type of housing. These applications will be scored separately, which may result in only
part of the total project receiving funding (for example, the units that fall under existing
1 Under the PBV program, a “project” is defined as a single building, multiple contiguous
buildings, or multiple buildings on contiguous parcels of land. Under PBV regulations at 24
CFR 983.202, a HAP contract covers only one project.
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projects may be funded while the new construction may not be funded). Please note that
no more than a total of 75 units per project will be awarded.
The maximum number of vouchers requested b y each PHA must be within the 20 percent
maximum budget authority that may be allocated to PBV assistance in accordance with
24 CFR 983.6(a), or in accordance with a HUD-approved exception granted under
Moving to Work (MTW) or HUD-VASH statutory waiver authority.
3. Application Due Date. Applications (form HUD-52515,) must be transmitted no later
than midnight in the time zone of the PHA on September 9, 2016. All applications must
be submitted electronically to VASH@hud.gov. Applications not received on time will
not be processed and no extensions will be granted. Faxes and hard copy submissions
will not be accepted.
4. Application Requirements. In order to apply for this set-aside, PHAs may submit (1)
applications for specific project(s) selected in accordance with program regulations at 24
CFR 983.51, or (2) an application indicating the PHA’s intention to select one or more
PBV projects in accordance with program regulations at 24 CFR 983.51. PHAs may only
submit one application for up to 75 units for project(s) the PHA intends to select after
award announcement.
PHAs must have selection policies for PBV units in its Administrative Plan prior to
selecting units and must select proposals in accordance with such policies. PHAs must
select proposals using either of the following two methods: (1) issue a request for PBV
proposals that does not limit proposals to a single site or impose restrictions that
explicitly or practically preclude owner submission of proposals for PBV housing on
different sites, or (2) select a proposal based on a previous competition under a federal,
state, or local government housing assistance, community development, or supportive
services program, provided that the competition occurred within three years of the PHA’s
PBV proposal selection date and the earlier competitive selection proposal did not
contemplate PBV assistance. 2
A. Applications with project selection prior to application submission under this
Notice
i. The selection of the PBV proposal must be conditional and subject to the
successful award of funding pursuant to this Notice, unless a PHA has
sufficient available voucher funding in its regular voucher program and/or
HUD-VASH program to fulfill the PBV commitment notwithstanding this set-
aside.
ii. If the project is accepted as an existing project, the selection must be
conditional on the completion of an environmental review as outlined at 24
2 Or, if applicable, in accordance with a HUD-approved exception granted under MTW waiver
authority.
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CFR 983.58 prior to the execution of a Housing Assistance Payments (HAP)
contract. The written notice given to the project owner that the proposal was
selected must state that the selection is conditional on a favorable
environmental review in accordance with 24 CFR 983.58 and that the selectee
may not take any action prohibited under 24 CFR 983.58(d) 3 until the
environmental process is completed.
If the project is selected as new construction or rehabilitation, the selection
must also be conditioned on the completion of an environmental review in
accordance with 24 CFR 983.58 and subsidy layering review prior to the
execution of an Agreement to Enter into a Housing Assistance Payments
contract (AHAP). The written notice given to the project owner that the
proposal was selected must state that the selection is conditional on favorable
subsidy layering and environmental reviews in accordance with 24 CFR 983.55
and 24 CFR 983.58, respectively, and that the selectee may not take any action
prohibited under 24 CFR 983.58(d) until the environmental process is
completed.
iii. The PHA must submit form HUD-52515, Funding Application, Section 8
Tenant-Based Assistance, Rental Certificate Program, Rental Voucher
Program for each project that the PHA submits for the competition. This form
may be downloaded from the following website:
http://portal.hud.gov/hudportal/documents/huddoc?id=52515.pdf. When
completing this form, include the five-digit PHA code (e.g. AL001) along with
the name and mailing address of the PHA. Only complete the box for total
dwelling units under vouchers in section B. Do not complete sections A or C.
In section D of the form you do not have to address Need for Housing
Assistance. Rather, the PHA applicant must provide the following information
for each project that the PHA submits for the competition, for which you may
attach extra paper:
a. The number of PBVs requested, which may not exceed 75 for each
application.
b. A description of the proposed project including: (1) the address;
(2) the county and Continuum of Care (CoC) in which the project
is located; (3) the VA Medical Center (VAMC) name and station
number associated with the project; (4) the total number of
buildings; (5) total number of units by bedroom size in each
building; (6) the number and bedroom sizes of HUD-VASH units
in each building; and (7) the target population, if any, of any non
3 Under 24 CFR 983.57(d), the PHA may not enter into an AHAP or HAP contract with an
owner and the PHA, the owner, and its contractors may not acquire, rehabilitate, convert, lease,
repair, dispose of, demolish, or construct real property or commit or expend program or local
funds for PBV activities until the environmental process is complete.
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HUD-VASH units.
c. Information regarding the threshold and scored factors, outlined in
sections 6 and 7 of this Notice, on which the application will be
assessed and scored.
iv. The form HUD-52515 must be signed by the Executive Director of the
PHA or designated official when the PHA does not have an Executive
Director.
B. Applications with project selection after award announcement
i. PHAs that receive an award based on an application for project(s) to be
selected after award announcement must promptly initiate a project selection
process using one of the two methods outlined in Section 4 of this Notice. All
PBV projects must be selected in accordance with HUD regulations and the
PHA’s Administrative Plan. MTW PHAs must follow the HUD-VASH
operating requirements and applicable regulations unless HUD grants a waiver
to the agency to apply MTW flexibilities to the HUD-VASH vouchers.
ii. PHAs that are awarded funds based on applications submitted prior to project
selection must follow regulations at 24 CFR 983.58 to complete an
environmental review and must not take any action prohibited under 24 CFR
983.58(d) until the environmental process is complete. Further, any project
selected as new construction or rehabilitation is subject to the subsidy layering
review requirements, outlined at 24 CFR 983.55.
iii. The PHA must submit form HUD-52515, Funding Application, Section 8
Tenant-Based Assistance, Rental Certificate Program, Rental Voucher
Program for each project that the PHA submits for the competition. This form
may be downloaded from the following website:
http://portal.hud.gov/hudportal/documents/huddoc?id=52515.pdf. When
completing this form, include the five-digit PHA code (e.g. AL001) along with
the name and mailing address of the PHA. Only complete the box for total
dwelling units under vouchers in section B. Do not complete sections A or C.
In section D of the form you do not have to address Need for Housing
Assistance. Rather, the PHA applicant must provide the following information,
for which you may attach extra paper:
a. The number of PBVs requested, which may not exceed 75. Please
note that applications for projects to be selected after award
announcement must estimate the number of PBVs that will be
selected. If, after award announcement, the PHA selects fewer
units than awarded under this competition, the funding for
unused units will be rescinded. If the PHA selects more units
than awarded under this competition, the PHA must use vouchers
from its regular or HUD-VASH tenant-based voucher program to
fund the additional units, which must be selected in accordance
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program regulations at 24 CFR 983.51(a) or (b).
b. The name and station number of the partnering VAMC. Please
note that PHAs must partner with a VAMC prior to applying under
this Notice.
c. A description of the general geographic area where projects will
be considered at the time of application. This geographic area
must include the county(ies) and CoC(s) from which the project
will be selected. PHAs may include multiple counties and CoCs in
this description, if appropriate. HUD and VA will calculate the
need scores for applications that include multiple counties and/or
CoCs in this description using an average score across all areas
listed.
d. Information regarding the threshold and scored factors, outlined in
sections 6 and 7 of this Notice, on which the application will be
assessed and scored.
iv. The form HUD-52515 must be signed by the Executive Director of the
PHA or designated official when the PHA does not have an Executive
Director.
v. Within 6 months of award announcement, awardees of projects selected
after award announcement must supply a detailed description of the selected
project(s), including: (1) the address; (2) county and CoC in which the project
is located; (3) the total number of buildings; (4) total number of units by
bedroom size in each building; (5) the number and bedroom sizes of HUD-
VASH PBV units in each building; (6) the target population, if any, of any non
HUD-VASH units; (7) a signed certification that the Administrative Plan
contains all required PBV policies and the application for HUD-VASH funding
under this competition is consistent with the PHA’s administrative policies and
PHA Plan; and (8) a signed certification from the project owner that the owner
will comply with Housing First (see section 6 (C)).
5. Target Dates:
Where PHAs are submitting a proposal for a particular project selected prior to this set-
aside application, the target date for occupancy of an existing PBV project must be stated
in the PHA’s application. For new construction and rehabilitation projects, in addition to
the target date for occupancy, the PHA must also include the date construction or
rehabilitation will begin.
PHAs submitting an application with project selection after award announcement must
submit a target date for project selection, which must be within 6 months of award
announcement. Further, after selecting the project, the PHA must submit (1) an
anticipated target date of occupancy for existing projects or (2) a target date of the start of
construction or rehabilitation and the target date of occupancy for new construction or
rehabilitation projects.
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A. Existing Housing
For any applications for existing housing funded through this set-aside, the PHA must
submit a PBV HAP contract (form HUD-52530B) to HUD Headquarters at
VASH@hud.gov to verify available occupancy of at least one unit in the project
within (a) 60 days of award announcement for projects selected prior to application or
(b) 60 days after project selection for applicants with project selection after award
announcement. The PHA must submit one HAP contract for every project selected.
After the HAP contract is executed for at least one unit, the PHA may add units, up to
the number of HUD-VASH PBV units requested under part 4(A)(iii)(a) or
4(B)(iii)(a), until 12 months after award announcement for projects selected prior to
application or 12 months after project selection for applicants with project selection
after award announcement. At the end of the 12-month deadline, any funds for units
above the number of units included on the HAP contract will be rescinded. If a PHA
plans to add units through this 12-month period, the PHA must send in a HAP
contract 60 days after award announcement confirming that at least one unit is under
contract and, 12 months after award announcement, an updated HAP contract
reflecting the total number of units. All requested PBV units must be vacant at the
time that the unit is added to the HAP contract.
B. New Construction/Rehabilitation
For any funded proposals for new construction or rehabilitation projects, regardless of
whether the PHA applied with a particular project or prior to selecting a project, the
PHA must sign an AHAP with the project owner for each project within 24 months of
award announcement.
6. Threshold Factors: Threshold factors must be met in order for the application to be
given further consideration. If the HUD-52515, or any of the threshold items listed
below are incomplete or missing, they will be treated as a curable deficiency and HUD
may contact an applicant to clarify or request the missing information. Applicants must
provide the requested information, in accordance with HUD instructions, within 10
business days from the date of the request or the application will no longer be considered
for funding under this notice.
A. The application must include a signed letter of support from the Director of the
VAMC or Veterans Integrated Service Network (VISN). The letter from VA must
confirm the need for the number of vouchers requested in the application. If a project
has been selected prior to submission of application for this competition, the letter of
support must be specific to the chosen project. If the PHA plans to select a project
after award announcement, (1) the letter of support must be general and address the
need for additional affordable housing in the PHA’s and VAMC’s jurisdiction and (2)
the PHA must submit a letter of support from the Director of the VAMC or VISN
specific to the selected project once the PHA selects the project.
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B. The application must include a statement that (1) the Administrative Plan contains all
required PBV policies and (2) the application for HUD-VASH funding under this
competition is consistent with the PHA’s administrative policies and PHA Plan. For
administrative plan policies, please reference sections 2.a.(1), (2), (3), (6), and (7) of
Notice PIH 2011–54 (Guidance on the Project-Based Voucher Program). For the PHA
Plan, please reference section 2.b. of that Notice. The signature on the application will
serve as a certification of this statement. For those applications where a project will
be selected after awards are announced, PHAs must submit this certification with the
notification of the selected project, within six months of award announcement.
C. The application must include a statement that the PHA will enforce compliance with
a Housing First approach at the project. If a project has been selected prior to the
application under this Notice, the application must include a signed statement from
the project owner that the project will comply with a Housing First approach. If a
project is selected after award announcement, a signed statement from the project
owner that the project will comply with a Housing First approach must be submitted
to HUD within 6 months after award announcement.
Housing First is an approach where homeless persons, usually chronically homeless or
especially vulnerable homeless individuals and families, are provided immediate
access to housing and then offered the supportive services that may be needed to foster
long-term stability and prevent a return to homelessness. This approach removes
unnecessary barriers and assumes that supportive services are more effective in
addressing needs when the individual or family is housed and the daily stress of being
homeless is addressed. Key components of this model include a simple application
process, a harm reduction approach, and no conditions of tenancy beyond those
included in the lease. Housing First specifically does not require sobriety or testing
for substance abuse to obtain or sustain tenancy and thus must not be required in the
lease. In serving these populations, projects cannot discriminate against families with
children. More information on Housing First is available at:
https://www.hudexchange.info/resources/documents/Housing-First-Permanent-
Supportive-Housing-Brief.pdf .
D. The PHA applicant must not have any major unresolved program management
findings from an Inspector General audit, HUD management review, or Independent
Public Accountant (IPA) audit for the PHA’s HCV program or other significant
program compliance programs that were not resolved or in the process of being
resolved (as determined by the local field office) prior to this Notice’s application
deadline. Major program management findings or significant program compliance
problems are those that inhibit the capacity of the applicant to effectively administer a
HUD-VASH PBV project. In addition, the PHA must not be involved in litigation
that HUD determines may seriously impede the ability of the applicant to administer
the HUD-VASH PBV project. The local HUD field office will provide the necessary
information on this factor.
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E. The PHA must resolve all outstanding civil rights matters prior to the application
deadline. Applicants having any of the charges, cause determinations, lawsuits or
letters findings referenced in Section V.B.1(a) of the FY2016 General Section of the
Notice of Funding Availability that have not been resolved to HUD’s satisfaction
before or on the application deadline date are ineligible for funding consideration.
Examples of actions that may be considered sufficient to resolve such matters can be
found in the General Section of the NOFA which can be found at:
http://portal.hud.gov/hudportal/documents/huddoc?id=2016nofa-gensec.pdf. HUD
Headquarters will contact the applicable HUD local field office for this information.
7. Scored Factors: A maximum of 85 points may be awarded.
A. Participation in the Enhanced Use Lease (EUL) Program: In order to receive
points under this scored category, applicants must submit a project-specific
application. No points under this category will be awarded to applicants that intend
to select a project after the award announcement. The PHA must indicate if the
project is part of an EUL program. Please note that a PHA’s selection of an EUL site
meets the alternative competitive selection requirements under 24 CFR 983.51(b)(2).
The means of selection must be consistent with the PHA’s administrative plan. More
information on the EUL program can be found at
http://www.va.gov/AssetManagement/
25 points: The project is being developed in coordination with the EUL program.
0 points: The project is not associated with the EUL program.
B. Relative Need: Number of Veterans experiencing homelessness. HUD and the VA
will rate this factor based on an analysis of homeless veteran data, provided by local
CoCs and VAMCs in the geographic area of the proposed or anticipated PBV project.
HUD and VA will determine the level of need by the number of homeless veterans,
with an emphasis on chronically homeless veterans, in the project’s geographic area
and the number of permanent supportive housing resources in the area available to
address the need. HUD and VA will divide applications into three levels of need
based on the available data. HUD will use the proposed or anticipated project
information supplied requisite to part 4(B)(iii)(b) and (c) of this Notice to score
this category. If, after receiving an award, the PHA selects a project outside of
the CoCs considered under this scoring factor, funds for those units will be
rescinded.
30 points: Very high need is determined
15 points: High need is determined
5 points: Medium need is determined
C. Relative Need: Affordable Housing. HUD and VA will rate this factor based on the
availability of affordable housing in the neighborhood of the proposed or anticipated
project. HUD and VA will divide applications into three levels of need based on the
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rental vacancy rates and rates of cost burden among low income households in the
geographic area of the proposed or anticipated project. HUD will use the proposed
or anticipated project information supplied requisite to part 4(B)(iii)(c) of this
Notice to score this category. If, after receiving an award, the PHA selects a
project outside of the county(ies) considered under this scoring factor, funds for
those units will be rescinded.
30 points: Very high need is determined
15 points: High need is determined
5 points: Medium need is determined
8. PBV Requirements. All projects must be selected (see Section 4 of this notice),
developed, and operated in accordance with the PHA’s application, PBV program
requirements found at 24 CFR part 983, Implementation of the HUD-VASH Program
(Operating Requirements) published in the Federal Register on March 23, 2012, the
requirements found in section 3 of Notice PIH 2015-10 (Project-basing of HUD-VASH
Vouchers) and Notice PIH 2015-05(Guidance on the PBV Program) or any successor -
notices. If a PHA applicant requires a waiver of any of the requirements noted
above, it must submit the waiver request with its application.
9. Nondiscrimination Requirements. All projects must comply with the nondiscrimination
provisions of Federal civil rights laws and requirements, including but not limited to the
Fair Housing Act, Section 504 of the Rehabilitation Act, Title VI of the Civil Rights Act,
and Titles II or III of the Americans with Disabilities Act, as applicable, and HUD’s
Equal Access Rule. See 24 CFR § 5.105(a).
10. Selection of Applications. Applications will be jointly reviewed by HUD and VA and
selected in order of points awarded until all funding is exhausted. If, at the end of the
selection process, two or more applications have tied scores and there is not enough
funding to select all of the tied-score applications, selection will be based on this order:
(1) Score for Relative Need: Number of Veterans experiencing homelessness; (2) if
scores are still tied, the score for Relative Need: Affordable Housing; (3) if the scores are
still tied, the score for Participation in the Enhanced Use Lease (EUL) Program. If there
are still tied scores remaining after these tiebreakers have been applied, the
application/applications selection will be based on a lottery drawing.
11. Information Contact. Inquiries about this notice should be directed vash@hud.gov.
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12. Paperwork Reduction Act. The information collection requirements contained in this
Notice have been approved by the Office of Management and Budget (OMB) under the
Paperwork Reduction Act (PRA) of 1995 (44 U.S.C 3520). In accordance with the PRA,
HUD may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless the collection displays a currently valid OMB control number. The
active information collections contained in this Notice have been approved under the
PRA OMB Control Number 2577-0169.
___________/s/_______________________
Lourdes Castro Ramirez
Principal Deputy Assistant Secretary
for Public and Indian Housing
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Previous editions are obsoleteform HUD-52515 (04/15)
Page 1 of 4 ref. Handbook 7420.8
Funding Application
Section 8 Tenant-Based Assistance
Rental Certificate Program
Rental Voucher Program
U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing
OMB Approval No. 2577-0169
(exp.04/30/2018)
Send the original and two copies of this application form and attachments to the local HUD Field Office
Eligible applicants (HAs) must submit this information when applying for grant funding for tenant-based housing assistance programs under Section 8 of the
U.S. Housing Act of l937 (42 U.S.C. 1437f). HUD will use the information to evaluate an application based on selection crit eria stated in the Notice of
Funding Availability (NOFA). HUD will notify the HA of its approval/disapproval of the funding application. Responses are required to obtain a benefit from
the Federal Govenment. The information requested does not lend itself to con fidentiality.
Name and Mailing Address of the Housing Agency (HA) requesting housing assistance payments
Do you have an ACC with HUD No Yes Date of Application Legal Area of Operation
(area in which the HA has authority under State and local law to administer the program)
for Section 8 Certificates?
for Section 8 Vouchers?
A. Area(s) From Which Families To Be Assisted Will Be Drawn.
Locality (city, town, etc.)County Congressional
District
Units
B. Proposed Assisted Dwelling Units.
(Complete this section based on the unit sizes
of the applicants at the top of the w aiting list
) 0-BR 1-BR
Number
ofDwelling
2-BR
UnitsbyBedroom
3-BR
Size
4-BR 5-BR 6+BR
TotalDwelling Units
Certificates
Vouchers
C. Average Monthly Adjusted Income.Complete this section based on actual incomes of current participants by unit size. Enter average monthly adjusted
income for each program separately and only for the unit sizes requested in Section B.
0-BR 1-BR 2-BR 3-BR 4-BR 5-BR 6+BR
Certificates $$$$$$$
Vouchers $$$$$$$
D. Need for Housing Assistance.Demonstrate that the project requested in this application is responsive to the condition of the housing stock in the community
and the housing assistance needs of low-income families residing in or expected to reside in the community. (If additional space is needed, add separate pages
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Previous editions are obsoleteform HUD-52515 (04/15)
Page 2 of 4 ref. Handbook 7420.8
E. Housing Quality Standards (HQS).(Check applicable box) HUD’s HQS will be used with no modifications Attached for
HUD approval are HQS acceptability criteria variations
F. New HA Information.Complete this section if HA currently does not administer a tenant-based certificate or voucher program.
Financial and Administrative Capability. Describe the experience of the HA in administering housing or other programs and prov ide any
other relevant information which evidences present or potential management capability for the proposed rental assistance program. Submit
this narrative on a separate page.
Qualification as an HA. Demonstrate that the applicant qualifies as an HA and is legally qualified and authorized to administer the funds
applied for in this application. Submit the relevant enabling legislation and a supporting legal opinion.
Note: If this application is approved, the HA must submit for HUD approval a utility allowance schedule and budget documents.
G. Certifications.The following certifications are incorporated as a part of this application form. The signature on the last page of this ap plication of the HA
representative authorized to sign the application signifies compliance with the terms of these certifications.
Equal Opportunity Certification
The Housing Agency (HA) certifies that:
(1) The HA will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d) and regulations issued pursuant thereto (24 CFR
Part 1) which state that no person in the United States shall, on the ground of race, color, or national origin, be excluded fr om participation
in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives
financial assistance; and will take any measures necessary to effectuate this agreement.
(2) The HA will comply with the Fair Housing Act (42 U.S.C. 3601-19) and regulations issued pursuant thereto (24 CFR Part 100) which
prohibit discrimination in housing on the basis of race, color, religion, sex, handicap, familial status, or national origin, and administer its
programs and activities relating to housing in a manner to affirmatively further fair housing.
(3) The HA will comply with Executive Order 11063 on Equal Opportunity in Housing which prohibits discrimination because of race,
color, creed, or national origin in housing and related facilities provided with Federal financial assistance and HUD regulations (24 CFR
Part 107).
(4) The HA will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and regulations issued pursuant ther eto (24
CFR Part 8) which state that no otherwise qualified individual with handicaps in the United States shall solely by reason of th e handicap
be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity r eceiving
Federal financial assistance.
(5) The HA will comply with the provisions of the Age Discrimination Act of 1975 (42 U.S.C. 6101-07) and regulations issued pursuant
thereto (24 CFR Part 146) which state that no person in the United States shall on the basis of age be excluded from participation in,
be denied the benefits of, or be subjected to discrimination under a program or activity receiving Federal financial assistance .
(6) The Housing Agency will comply with the provisions of Title II of the Americans with Disabilities Act (42 U.S.C. 12131)and regulations
issued pursuant thereto (28 CFR Part 35) which state that subject to the provisions of Title II, no qualified individual with a disability shall,
by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs or activiti es of a public
entity, or be subjected to discrimination by any such entity.
The following provisions apply only to housing assisted with Project-Based Certificates:
(7) The HA will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60-1) which state that no person
shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the
performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity.
(8) The HA will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701u) and regul ations
issued pursuant thereto (24 CFR Part 135), which require that, to the greatest extent feasible, opportunities for training and employment be
given to low-income persons residing within the unit of local government for metropolitan area (or non-metropolitan county) in which the
project is located.
Certification Regarding Lobbying
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 influen cing or
attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an em ployee
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 modificat ion 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 attempt ing to
influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a M ember
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.
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(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.
Certification Regarding Drug-Free Workplace Requirements
Instructions for Drug-Free Workplace Requirements Certification:
1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.
2. The certification set out below is a material representation of fact upon which reliance is placed when the agency awards the grant.
If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free
Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized un der
the Drug-Free Workplace Act.
3. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may be
identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award , if there is
no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal
inspection. Failure to identify all known workplaces constitutes a violation of the grantee’s drug-free workplace requirements .
4. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work un der the grant
takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in
operation, State employees in each local unemployment office, performers in concert halls or radio studios).
5. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the
change(s), if it previously identified the workplaces in question (see paragraph three).
6. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply
to this certification. Grantees’ attention is called, in particular, to the following definitions from these rules:
Controlled substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812)
and as further defined by regulation (21 CFR 1308.11 through 1308.15);
Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body
charged with the responsibility to determine violations of the Federal or State criminal drug statutes;
Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or
possession of any controlled substance;
Employee means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) All directcharge
employees; (ii) All indirectcharge employees unless their impact or involvement is insignificant to the performance of the grant; and,
(iii) Temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the
grantee’s payroll. This definition does not include workers not on the payroll of the grantee (e.g., volunteers, even if used to meet
a matching requirement; consultants or independent contractors not on the grantee’s payroll; or employees or subrecipients or
subcontractors in covered workplaces).
A. The grantee certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled
substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
(b) Establishing an ongoing drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee’s policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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 grant be given a copy of the statement r equired
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:
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no
later than five calendar days after such conviction;
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(e) Notifying the agency in writing, within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise
receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant
officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a
central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant;
(f) Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d)(2), with respect to an y employee
who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements
of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such
purposes 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 grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:
Place of Performance (Street address, city, county, State, zip code)
HousingAgencySignature
Phone No.Date
Check if there are workplaces on file that are not identified here.
Signature of HA Representative Print or Type Name of Signatory
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