CDBG SUPPLEMENTAL ACTIVTIY REQUEST PROJECT – – Page | 2 JURISDICTION: ELIGIBILITY: NATIONAL OBJECTIVE: 1) Low/Moderate Area (LMA) 2) Low/Mod Housing (LMH) 3) Low/Mod Clientele (LMC) HUD LOW/MOD BENEFIT: Area Benefit: National Objective must be met by Low/Mod %: either: Based on HUD Low/Mod Data 1) Beneficiaries meeting income restriction; Based on Income Survey 2) Beneficiaries being members (Prior Department approval is required for submission of of a Limited Clientele; or, this form) 3) Service area being primarily Jurisdiction-Wide Service Area Low/Mod individuals (>51%). Income Restricted (Public Improvements in Support of Housing Only) Check the box that describes how this Project will meet the National Objective, and Limited Clientele: (Public Facility Only) describe the details requested. List Type(s) of Limited Clientele: Explain Benefit in Activity: DESCRIPTION OF SERVICE AREA: Entire Jurisdiction Service Area(s): Submit Map(s) and Identify: Describe Service Area of Project: (1) Census Tract/ Block Group; and, Map must be included (2) Zoning in description Note: Service area information is needed regardless of which Low/Mod benefit is being used. No CDBG Project can be approved without the required Citizen Participation being completed. Indicate the status of each of the following: Public Notice: Completed Not Completed Comments: CITIZEN Resolution of the Governing Body (Authorizing submittal of Supplemental Request, PARTICIPATION: designating the Authorized Representative) Completed Not Completed Comments: Please submit evidence of the above with this request.
CDBG SUPPLEMENTAL ACTIVTIY REQUEST – PROJECT – Page | 2 JURISDICTION: ELIGIBILITY: NATIONAL OBJECTIVE: 1) Low/Moderate Area (LMA) 2) Low/Mod Housing (LMH) 3) Low/Mod Clientele (LMC) HUD LOW/MOD BENEFIT: National Objective must be met by either: 1) Beneficiaries meeting income restriction; 2) Beneficiaries being members of a Limited Clientele; or, 3) Service area being primarily Low/Mod individuals (>51%). Check the box that describes how this Project will meet the National Objective, and describe the details requested. Area Benefit: Low/Mod %: Based on HUD Low/Mod Data Based on Income Survey (Prior Department approval is required for submission of this form) Jurisdiction-Wide Service Area Income Restricted (Public Improvements in Support of Housing Only) Limited Clientele: (Public Facility Only) List Type(s) of Limited Clientele: Explain Benefit in Activity: DESCRIPTION OF SERVICE AREA: Submit Map(s) and Identify: (1) Census Tract/ Block Group; and, (2) Zoning in description Note: Service area information is needed regardless of which Low/Mod benefit is being used. Entire Jurisdiction Service Area(s): Describe Service Area of Project: Map must be included CITIZEN PARTICIPATION: No CDBG Project can be approved without the required Citizen Participation being completed. Indicate the status of each of the following: Public Notice: Completed Not Completed Comments: Resolution of the Governing Body (Authorizing submittal of Supplemental Request, designating the Authorized Representative) Completed Not Completed Comments: Please submit evidence of the above with this request.
SUPPLEMENTAL_PROJECT_REQUEST_FORM.docx