Is the applicant an eligible New York State non-entitlement municipality? See question requirements for additional guidance.

Is the applicant applying to establish a local Microenterprise Grant Program or to assist an individual for-profit business?

Will the proposed program assist not-for-profit entities?

Will the CDBG funds be used toward eligible project costs?

Will the proposed program only support activities that will either create jobs for low- to moderate-income (LMI) persons or, in the case of a microenterprise, assist a business owner who is LMI?

Does the proposed activity include assistance to a for-profit business in the form of lobbying or other political activities?

Lobbying and political activities are not eligible under Section 105(a)(17) of the Housing and Community Development Act of 1974.

Does the proposed activity include planning for economic development projects, including conducting market surveys to determine an appropriate type of business to attempt to attract to a particular area, developing individual commercial or industrial project plans, and identifying actions to implement those plans?

The above activities are not eligible under Section 105(a)(17) of the Housing and Community Development Act of 1974.

Will any of the costs identified in the application budget be incurred prior to award?

Will the proposed project be complete within 24 months from project award?

NYS Assembly District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

NY Senate District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

US Congressional District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Project county or counties.

Project Street Address: Please input the project street address (Street Number and Street Name only).

If the project has multiple locations, please input the primary street address of the project. If the project does not have a definite street address, please input the approximate street address of the project (Street Number and Street Name only).

Project City

Project State

Project ZIP Code. (please use ZIP+4 if known)

For more than one project location, please provide full address(es) for each location. If Not Applicable, indicate "NA".

Project Latitude (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Project Longitude (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Type of Applicant (select one)
Applicants will first select a single applicant type from the categories below and then a subtype based on their initial selection. Applicants should review the selections below which provides a list of subtypes by main applicant type.

1. For Profit entity options:
Limited Liability Corporation (LLC)
Limited Liability Partnership (LLP)
Sole Proprietorship
S Corporation
C Corporation
Limited Partnership (LP)
Other- applicant will be required to list their other for-profit designation.

2. Not-for profit entity options:
501(c)(1) Any corporation that is organized under an act of Congress that is exempt from federal income tax;
501(c)(2) Corporations that hold a title of property for exempt organizations;
501(c)(3) Corporations/funds/foundations that operate for religious/ charitable/ scientific/ literary/ educational purposes;
501(c)(4) Nonprofit organizations that promote social welfare;
501(c)(5) Labor, agricultural, or horticultural associations;
501(c)(6) Business leagues/chambers of commerce/etc. that are not organized for profit;
501(c)(7) Recreational organizations; and
Other- applicant will be required to list their other not-for-profit designation.

3. Government entity options:
Federal
State
County
Town
Village
Tribal
School District
County or Town Improvement District
District Corporation
Public Authority
Business Improvement District
Fire District
Board of Cooperative Education Services (BOCES)
Public Library
Association Library
Other- applicant will be required to list their other government designation.

Select the for-profit entity of the applicant applying for funding:

Enter the applicant's 'Other' for-profit entity designation.

Select the not-for-profit entity of the applicant applying for funding:

Enter the applicant's 'Other' not-for-profit entity designation.

Select the government entity of the applicant applying for funding:

Enter the applicant's 'Other' government entity designation.

Organization Legal Name

Applicant First Name

Applicant Last Name

Applicant Street Address

Applicant City

Applicant State

Applicant ZIP Code. (please use ZIP+4 if known)

Applicant Telephone Number (please include area code)

Applicant Email Address

Contact First Name

Contact Last Name

Contact Title

Primary Organization

Contact Street Address

Contact City

Contact State

Contact ZIP Code (please use ZIP+4 if known)

Primary Contact Phone Number. (please include area code)

Contact Email

Contract First

Contract Last

Contract Title

Authorized Organization

Contract Street

Contract City

Contract State

Contract Zip (please use ZIP+4 if known)

Contract Phone (please include area code)

Contract Email

Additional Project Contact First Name

Additional Project Contact Last Name

Additional Contact Title

Additional Organization

Additional Contact Street Address

Additional Contact City

Additional Contact State

Additional Contact ZIP (please use ZIP+4 if known)

Additional Contact Telephone Number (please include area code)

Additional Contact Email Address

Please select the primary sector or characterization that best defines this project.

Please select the secondary sector or characterization that best defines this project.

Project Description. Concisely describe the project, indicating the location, what will be planned, designed, acquired, and/or constructed, the issues/opportunities to be addressed, and expected outcomes and deliverables. Additional details will be collected later in the application process.

Statement of need: Provide a brief summary of the need for the project in the geographic area proposed and the project's financing needs, including funding gaps of the proposed project.

Current State of Project Development (i.e. planning, preliminary engineering, final design, etc. You may enter N/A for non-project related applications)

Provide a list of all federal, state, and local reviews, approvals, or permits needed or completed, including the dates when they are expected to be completed or were completed. If Not Applicable, indicate "NA".

Does this project require State and/or Federal Environmental Review?

What is the status of State and/or Federal Environmental Review?

Please indicate the lead agency (if applicable).

Has a National Environmental Policy Act (NEPA) Record of Decision been issued?

Please explain decision and include date of Record of Decision.

Has the applicant or project been awarded funding in prior CFA rounds?

What were the CFA numbers for which funding was awarded? (separate multiple CFA numbers with commas)

For each program to which you are applying under the CFA, explain your strategy for proceeding if the full amount of requested funding, required matching funds, and temporary financing are not secured as expected, or committed sources become unavailable.This explanation must address any proposed project phases, and both CFA and non-CFA sources of funds.

Pre-Submission Form Certification

Preliminary Budget Table

Job Creation/Retention Table

Choose the applicable activity type. Only questions and requests for attachments associated with that project type will appear below

Certification of Business Form (for Stand-Alone projects)

For job retention projects, documentation that at least 51% of the jobs on a full-time equivalent basis are held by low- and moderate- income persons. This can be accomplished using NYS CDBG Family Income Forms or similar self-certification of income.

If jobs will be retained as a result of CDBG assistance, provide documentation of clear and objective evidence that those jobs would be lost without CDBG assistance.

Upload a description of the business' hiring process when indicating that at least 51% of the jobs will be "taken by" or "made available to" low- and moderate- income persons.

Appraisals of real property (if applicable). See question help for more information.

Evidence of site control and/or lease agreements (if applicable).

Engineering Report (required for infrastructure in support of a stand-alone business project only)

Provide a detailed business underwriting analysis with a description of the supporting documentation used to conduct that review. See scoring tips for additional information.

Program Design Plan.

Entrepreneurial training program syllabus.

Draft program application and any other applicable forms that are to be completed by each microenterprise program applicant.

List of grant committee members and experience (Grant committee is a panel chosen by the applicant to review grant applications and to make recommendations and/or approval of grant awards)

Draft Grant Agreement Between Recipient and Business(es).

Documentation for all third party costs. See question requirements for additional guidance.

Proposed Project Financing and Lien Structure Form

If the applicant has already entered into an agreement with a qualified Not-for-Profit subrecipient, please attach a Vendor Responsibility Questionnaire (VRQ). This may include, but is not limited to, a Local Development Corporation or other non-profit partner that may have an administrative role in the administration of the grant.

Citizen Participation Compliance Materials Note that If the required documents are not submitted with the application, it may be deemed ineligible. Refer to the question requirements for additional guidance. Materials must include the following: • Evidence of conspicuous public posting • Public hearing notice • Affidavit of publication of public hearing notice • Public hearing minutes/evidence of a full quorum Full applications must be submitted within six (6) months of the public hearing. Beyond six (6) months, the applicant must hold an additional hearing.

As an attachment, upload a draft Environmental Review Record. See question requirements for additional guidance.

Written documentation of support for the project. This could include support letters or other third-party description of need.

Applicant Certification Form

Program Income Report Form

Project Team

Civil Rights - Documentation of Affirmatively Furthering Fair Housing compliance. See question requirements for additional guidance.

Civil Rights - Documentation of Section 3 compliance. See question requirements for additional guidance.

Commitment letter(s) from all other funding sources, including proposed terms. This documentation must evidence the availability of all funds including owner equity.

Documentation of unsuccessful attempts at pursuing non-CDBG funding sources

Refer to question requirements for additional guidance.

For job creation projects, a written commitment from the business that at least 51% of the jobs on a full-time equivalent basis will either be made available to, or taken by, low- and moderate-income persons as well as a commitment of the equity contribution, if any, proposed in the budget

If the project includes improvement of municipal infrastructure necessary to stimulate business expansion and job creation, attach the Smart Growth Compliance Form.

Has the municipality where the project is located submitted a letter of intent or been designated as a Pro-Housing Community?

Provide a project abstract. The abstract must include formal applicant name, location of project, amount of request, business to be assisted, jobs to be created and general purpose of project. Sample text: [City, Town, Village, County Name] will use $200,000 in NYS CDBG funds to assist in the establishment of [Program Name]. The total program cost will be $225,000 with $25,000 from owner equity. The program proposes to assist 10 microenterprises, of which 5 will be owned by LMI owners. Additionally, the program proposes to create 5 full-time LMI jobs.

I understand that all CDBG-funded economic development activities must meet HUD underwriting guidelines for evaluating project costs and financial requirements. See question requirements for additional guidance.

Please provide the Unique Entity ID for the Unit of Government serving as the Applicant.

Is the proposed project a Stand-Alone or Microenterprise activity? Applicants must propose assistance under one category, and only one type of assistance will be awarded for the proposed project. Please read Question Help for guidance.

Provide a detailed explanation of the project need and impact.

The description should be specific and provide sufficient detail concerning:

• the nature, scope, location, and purpose of activities that will be addressed by the proposed project and coordination of related activities;
• any past efforts to resolve the needs identified;
• any limitations on funding or other resources to address the need identified;
• why the proposed project is the best approach to addressing the need identified; and
• quantifiable information, such as how CDBG funding will be provided to the beneficiary (loan, grant, terms, etc.); impact on residents, suppliers or end users, etc.

Provide a brief description of the community’s economic development needs including a discussion of economic trends and the community’s plan to address the needs identified.

Refer to the Help section for a detailed list of information required to answer the question completely.

Explain the proposed NYS CDBG program budget. Identify each of the estimated costs, including the source of the funds and proposed use: purchase of machinery and equipment, working capital, new construction, building renovation, etc. For each source identified, indicate whether the source is formally committed or pending approval. Please be specific, and list each source in a consistent format.

This explanation of your program budget must be consistent with the budget table included in this application, as well as the Proposed Project Financing and Lien Form included as an attachment to this application. If a source is identified as committed, the applicable commitment letter must be attached where requested in the application.

Please identify and explain any components of the proposed project that have been started as of the submission of this application, as well as any subsequent activities that are part of the total project. Indicate the actual or anticipated start and end dates for all of the activities.

Please note: If any project costs, regardless of their funding source, are incurred prior to the CDBG award date and the approval of the Request for Release of Funds by the Office of Community Renewal, the entire project may be deemed ineligible for NYS CDBG funds.

Describe efforts to secure alternative or additional funds from all appropriate public or private sources available to assist in financing the proposed activity. In detail, explain the impact of the NYS CDBG funds on the total cost of the project and the beneficiaries (e.g. lack of other sources of funding). List the sources of cost estimates (where appropriate, project costs should be as recent as possible and documented by a qualified third party). If the project is subject to review or provided funds by other agencies, organizations, or authorities, what is the status of any on-going consultations?

Provide a detailed description of the program delivery and administration tasks required to undertake this project including who will undertake these tasks, the costs associated with the tasks, and how the costs were determined. Provide the actual amount of program delivery and administrative funds allocated to the project from the State CDBG funds requested.

Will the proposed project generate CDBG program income?

Refer to the scoring tips for additional guidance.

Describe how the applicant and business will comply with the job reporting requirements contained in the NYS OCR Grant Administration Manual.

Provide a brief summary of the business, including the types of product(s) and/or services, clientele, and geography. In addition, include a detailed description of the proposed project, how it will achieve the CDBG National objective of creating and/or retaining opportunities for persons from low- and moderate-income families. If the proposed project involves public infrastructure activities, provide a summary of the proposed activities including the conditions that currently exist and a description of the benefit to be provided.

For the business to be assisted, describe how the proposed activities meet the following HUD underwriting guidelines for evaluating project costs and financial requirements:

1. That project costs are reasonable;
2. That all sources of project financing are committed;
3. That to the extent practicable, CDBG funds will not be substituted for non-federal financial support;
4. That the project is financially feasible;
5. That to the extent practicable, the return on owner's equity investment will not be unreasonably high; and
6. That to the extent practicable, CDBG funds will be disbursed on a pro rata basis with other financing.

A thorough financial underwriting of the business and proposed project must be conducted. Each of the six (6) criteria listed above must be addressed.

Describe the methodology used to evaluate the proposed project against HUD’s underwriting guidelines found above, including the specific documentation acquired from the business owner(s) and attached to the application.

The underwriting analysis along with supporting documentation must be provided as an attachment to the application.

Will the proposed project result in the relocation of a plant, facility or operation? If so, provide the address of the plant/facility/operation being relocated and identify how many positions will be eliminated.

Enter the number of full-time equivalent employees (at the time of application), employed by the business to be assisted.

What is the total number of jobs to be created as a result of the proposed project, and how many of those jobs will benefit persons of low- to moderate- income (LMI)?

How many jobs will be retained as a result of the proposed project, and how many of those jobs are held by low-to-moderate income persons and/or can be reasonably expected to "turn over" to LMI persons within two (2) years? Also, provide an explanation of how the LMI job standard will be met.

For further guidance, please reference program guidelines available here: https://hcr.ny.gov/community-development-block-grant-economic-development-program

Refer to the Help section for additional information.

Will the proposed project include any construction? If yes, what is the estimated total cost of the construction to be funded by CDBG and all other funding sources? Construction projects over $2,000 must comply with Davis Bacon labor standards. Provide a brief description of how construction projects of over $2,000 will comply with Davis Bacon Standards.

How will the proposed project comply with the NYS CDBG Microenterprise Program Guidelines? Address each guideline specific to the activity being proposed individually in your response.

How will the Microenterprise Program meet the requirement that at least 50% of the total CDBG award (less grant administration costs) must fund start-up businesses? A start-up business is defined as a business that has been in operation for less than 6 months prior to submitting their application to the NYS CDBG Microenterprise Program.

Describe how the applicant will evaluate potential microenterprise projects according to the required underwriting guidelines for evaluating project costs and financial requirements. Applicants are required to establish scoring criteria for the selection of microenterprise applicants. The scoring criteria serve as an evaluation system for selecting the most qualified and capable applicants and must describe strategies for providing resources to underserved communities and business owners.

Address each of the underwriting guidelines below in your response:

1. That project costs are reasonable;
2. That all sources of project financing are committed;
3. That to the extent practicable, CDBG funds will not be substituted for non-federal financial support;
4. That the project is financially feasible;
5. That to the extent practicable, the return on the owner's equity investment will not be unreasonably high; and
6. That to the extent practicable, CDBG funds will be disbursed on a pro rata basis with the other financing.

Please be specific as to what information and/or documentation will be required from microenterprise applicants and what types of analysis will be performed.

What is the estimated number of jobs that the proposed Microenterprise Program will create? Please note job retention is not eligible under the NYS CDBG Microenterprise Program.

ContactNamePreparer

ContactNameSubrecipient

TitlePreparer

TitleSubrecipient

OrganizationPreparer

OrganizationSubrecipient

AddressPreparer

AddressSubrecipient

ZipCodePreparer

ZipCodeSubrecipient

TelephonePreparer

TelephoneSubrecipient

EmailPreparer

EmailSubrecipient

StartGA

EndGA

StartERR

EndERR

StartActivities

EndActivities

StartReimbursements

EndReimbursement

StartJopReporting

EndJobReporting

EndCompletion

BusinessName

NumberOwners

PercentOwners

DateEstablished

CurrentEmployees

Business Zip Code

NAICS

I certify that I understand that, once awarded, all persons applying for a job, not just those categorized as LMI, are required to fill out a Family Income Form and that these forms should be maintained within the files. The Family Income Form is available in the link below.

I understand that NYS Homes and Community Renewal may require additional project information or modifications to the original project proposal as a condition of award.

By entering your name in the box below, you certify that you are authorized on behalf of the applicant and its governing body to submit this application. You further certify that all of the information contained in this Application and in all statements, data and supporting documents which have been made or furnished for the purpose of receiving Assistance for the project described in this application, are true, correct and complete to the best of your knowledge and belief. You acknowledge that offering a written instrument knowing that the written instrument contains a false statement or false information, with the intent to defraud the State or any political subdivision, public authority or public benefit corporation of the State, with the knowledge or belief that it will be filed with or recorded by the State or any political subdivision, public authority or public benefit corporation of the State, constitutes a crime under New York State Law.

By entering your name in the box below, you certify and agree that you are authorized on behalf of the applicant and its governing body to commit the applicant to comply with the requirements of Article 15-A of the New York State Executive Law: Participation By Minority Group Members and Women With Respect To State Contracts by providing opportunities for Minority-owned Business Enterprise (MBE)/Woman-owned Business Enterprise (WBE) participation. You further certify that the applicant will maintain such records and take such actions necessary to demonstrate such compliance throughout the completion of the project.