Activity Name and Grant Number:

Address:

Activity Description:

Estimated total Activity cost: $    

Funding Source: CDBG HOME ESG HOPWA EDI Other: ______________

The activity falls into the category listed below, which is listed at 24 CFR 58.35(b) as a Categorically Excluded activity not subject to Section 58.5.

1. Tenant-based rental assistance

2. Supportive Services (including but not limited to):

▪  Health care

▪  Housing services

▪  Permanent housing placement

▪  Day care

▪  Nutritional services

▪  Short term payments for rent/mortgage/utility costs

▪  Assistance in gaining access to government benefits/services

3. Operating Costs:

▪  Maintenance

▪  Security

▪  Operation

▪  Utilities

▪  Furnishings

▪  Equipment

▪  Supplies

▪  Staff training and recruitment

4. Economic Development Activities:

▪  Equipment purchase

▪  Inventory financing

▪  Interest subsidy

▪  Operating costs

▪  Other expenses not associated with construction or expansion

5. Activities to assist homeownership of existing or dwelling units under construction not assisted with Federal funds:

▪  Closing costs and down payment assistance to homebuyers

▪  Interest buydowns or other actions resulting in transfer of title

6. Affordable housing pre-development costs

▪  Legal consulting

▪  Developer and other site-option costs

▪  Project financing

▪  Administrative costs for loan commitments, zoning approvals, and other activities which don’t have a physical impact

7. Approval of supplemental assistance (including insurance or guarantee) to a project previously approved under Part 58, if :the same responsible entity conducted the environmental review on the original project and re-evaluation of the environmental findings is not required under Section 58.47

Activity Name and Grant Number:

Address:

Activity Description:

Are funds for acquisition (including equipment) or construction (including repair and rehabilitation) purposes?

Yes

Continue

No

Proceed to Section 2-Act does not apply

Is the Activity in an area identified as having special flood hazards (SFHA)?

Identify FEMA flood map used to make this determination:

________________________________

Community Name and Number

_________________________________

Map panel number and date

Yes

Document and Continue

No

Document and Proceed to Section 2-Act does not apply

Is the Community participating in the National Insurance Program (or has less than one year passed since FEMA notification of Special Flood Hazards)?

Yes-Document and follow instructions below.

No-Federal Assistance may not be used for this project.

Flood Insurance under the National Flood Insurance Program must be obtained and maintained for the economic life of the project, in the amount of the total project cost. A copy of the flood insurance policy declaration must be kept on file.

Does the project involve HUD assistance, subsidy or insurance for the purchase or sale of an existing property?

Yes

Continue

No—Proceed to Section 3—regulation does not apply.

Is the project located within 2,500 feet of a civil airport or

15,000 feet of a military airfield?

Yes

Continue

No—Document and proceed to Section 3—regulation does not apply.

Is the project located within an FAA-designated civilian airport Runway Clear Zone (RCA) or Runway Protection Zone, or within the military Airfield Clear Zone (CZ) or Accident Potential Zone/Approach Protection Zone (APZ), based upon information from the airport or military airfield administrator identifying the boundaries of such zones?

Yes

Continue

No—Document and proceed to Section 3—regulation does not apply.

Comply with 24 CFR Part 51, Subpart D. This may include providing a written notice to a prospective buyer or leaser of the potential hazards from airplane accidents and the potential that an airfield operator may wish to purchase the property. Maintain copies of the signed notice. For properties located in a military clear zone, make and document a determination of whether the use of the property is consistent with DOD guidelines. Notice Sample: http://www.hud.gov/offices/cpd/energyenviron/environment/compliance/qa/airporthazards.pdf)