HUD under 24 CFR part 50 Environmental Review: Responsible Entity (RE) under 24 CFR part 58 Check the box for the entity that conducted Name of RE: the Environmental Review (ER): Date ER was conducted: Attach a copy of approval of the Environmental Review (i.e. HUD-7015.16). See instructions. HUD’s Local Government Consultation: The PHA covers the following jurisdiction(s): Date(s) of letter(s) of support from (local) government officials: Attach copies of all letters of support from local government officials, along with a narrative description of the PHA’s consultation (if applicable) Section 4: Description of Existing Development Name of Development: Development Number: Date of Full Availability (DOFA): Number of Residential Buildings: Number of Non-Residential Buildings: Date Constructed: Is the Development Scattered Site? Yes No Number of Buildings (single family, duplexes, 3-plexes, 4-plexes, other): Number of Types of Structures (row houses, walk-up units, high-rise unit): Total Acres in Development: Total Units Being Used Existing Unit General Elderly/Disabled Total Units in for Non-Dwelling Distribution Occupancy Designated Units Development Purposes 0 Bedroom – 1 Bedroom – 2 Bedrooms – 3 Bedrooms – 4 - + Bedrooms Total Attach a description of the distribution of UFAS accessible units (bedroom size; unit type, e.g., mobility or sensory) Section 5: Description of Proposed Removal Type of Removal Action(s) (e.g., Demolition, Disposition, Disposition to allow for Public Housing Mixed-Finance Modernization, Demolition and Disposition, DeMinimis Exception under Demolition, Voluntary Conversion, Required Conversion, Homeownership, Eminent Domain, Retention under 2 CFR part 200) Proposed Action by Unit Type (e.g. bedroom size) UFAS UFAS Total Units Being Existing Unit General Elderly/Disabled Total Units in Mobility Sensory Used for Distribution Occupancy Designated Units Development Units Units Purposes 0 Bedroom – 1 Bedroom – 2 Bedrooms – 3 Bedrooms – 4 - + Bedrooms
Environmental Review: Check the box for the entity that conducted the Environmental Review (ER): HUD under 24 CFR part 50 Responsible Entity (RE) under 24 CFR part 58 Name of RE: Date ER was conducted: Attach a copy of HUD’s approval of the Environmental Review (i.e. HUD-7015.16). See instructions. Local Government Consultation: The PHA covers the following jurisdiction(s): Date(s) of letter(s) of support from (local) government officials: Attach copies of all letters of support from local government officials, along with a narrative description of the PHA’s consultation (if applicable) Section 4: Description of Existing Development Name of Development: Development Number: Date of Full Availability (DOFA): Number of Residential Buildings: Number of Non-Residential Buildings: Date Constructed: Is the Development Scattered Site? Yes No Number of Buildings (single family, duplexes, 3-plexes, 4-plexes, other): Number of Types of Structures (row houses, walk-up units, high-rise unit): Total Acres in Development: Existing Unit Distribution General Occupancy Elderly/Disabled Designated Units Total Units Being Used for Non-Dwelling Purposes Total Units in Development 0 – Bedroom 1 – Bedroom 2 – Bedrooms 3 – Bedrooms 4 - + Bedrooms Total Attach a description of the distribution of UFAS accessible units (bedroom size; unit type, e.g., mobility or sensory) Section 5: Description of Proposed Removal Type of Removal Action(s) (e.g., Demolition, Disposition, Disposition to allow for Public Housing Mixed-Finance Modernization, Demolition and Disposition, DeMinimis Exception under Demolition, Voluntary Conversion, Required Conversion, Homeownership, Eminent Domain, Retention under 2 CFR part 200) Proposed Action by Unit Type (e.g. bedroom size) Existing Unit Distribution General Occupancy Elderly/Disabled Designated Units UFAS Mobility Units UFAS Sensory Units Total Units Being Used for Purposes Total Units in Development 0 – Bedroom 1 – Bedroom 2 – Bedrooms 3 – Bedrooms 4 - + Bedrooms
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