Is the applicant a City, Town or Village in Nassau or Suffolk County with local zoning authority?

Does the applicant acknowledge and commit to meeting the LIFHP requirements, including designating a point person or department and entering into a Memorandum of Understanding (MOU) with ESD?

Is the applicant willing and able to fast-track the permitting and approval processes for developments under the LIFHP to support timely project completion?

Is the applicant willing to comply with all statutes of the federal Fair Housing Act and the New York State Human Rights Law?

Will the applicant ensure that future developments supported by the LIFHP program will include affordable housing units?

Project City

Project State

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

Project county or counties.

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 Salutation

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 Salutation

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 Salutation

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

Applicants must provide a Letter of Intent signed by the municipality's chief administrative official that describes their objectives in applying for Long Island Forward Housing Program technical assistance.

Does the municipality have a current housing needs assessment plan or other strategic housing plan?

Please upload any recent housing needs assessments or similar study or plan conducted within the past 10 years.

If an applicant has identified one or more sites that may be suitable for multifamily housing development, applicants must attach evidence of site control.

If an applicant has identified one or more sites that may be suitable for multifamily housing development, applicants are encouraged to attach letters of support from neighborhood associations, local community groups or interested developers.

If an applicant has identified one or more sites that may be suitable for multifamily housing development that is privately owned, applicants must provide a letter of support from the owner.

Please upload any additional documents relevant to the application such as project renderings, a map of the proposed site, etc.

If you are applying with more than one site, please attach the answers to questions Q_16964 through Q_16973 for each site here.

Please describe the primary housing needs in your municipality (e.g., affordability, rental vs ownership, housing for specific populations).

Does the municipality have a zoning district that allows by-right multifamily housing?

Can the municipality fast-track a proposed new multifamily development through the local approval and permitting process?

Has an application been submitted to this program for this project already?

What was the application number? List multiple application numbers using commas to separate.

Is the applicant already certified by NYS Homes and Community Renewal (HCR) as a Pro-Housing Community?

Has the applicant submitted a letter of intent to NYS Homes and Community Renewal (HCR) to be a Pro-Housing Community?

Has the municipality identified a specific project site(s) to consider for multifamily housing development? (If yes, and more than one site has been identified, please attach answers to the following questions as a word document to the attachment section)

How many sites has the municipality identified for multifamily housing development consideration?

What is the site's address?

Is the site publicly-owned, privately-owned or both? State the name of the owner.

What is the lot size? (Square Footage or Acreage)

Which best describes how the site is currently used?

Is the site currently zoned to permit multifamily housing? If not, please tell us how it can be.

Are there any known environmental or feasibility issues on the site, such as environmental contamination, floodplain issues, or steep slopes? Please select all that apply.

Are there any regulatory, financial, or community opposition barriers that have hindered or may hinder the development of the site? Please select all that apply.

What is a rough estimate of the total number of housing units you envision for the site (with the understanding that this figure may change)?

The program focuses on strategic locations with vacant or blighted properties, including areas near Long Island Railroad stations and downtown centers. Are there areas such as these within your municipality that you consider suitable for multifamily housing development? If so, please describe them.

Has your municipality completed any recent of the following?

Are there any potential barriers to multifamily housing development in your municipality? Please select all that apply.

How might technical assistance help you overcome these challenges?

What kind of technical assistance services are needed to advance a prospective multifamily housing development project in your municipality? Select up to three (3).

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, under penalty of perjury, that the information given herein is true and correct in all respects for the company or organization applying for funding (the "Company"), presently and for the past five years: -the Company is not a party to any litigation or any litigation is not pending or anticipated that could have an adverse material effect on the company's financial condition;

-the Company does not have any contingent liabilities that could have a material effect on its solvency;

-the Company, its affiliates or any member of its management or any other concern with which such members of management have been officers or directors, have never been involved in bankruptcy, creditor's rights, or receivership proceedings or sought protection from creditors;

-the Company is not delinquent on any of its state, federal or local tax obligations;

-No principal, officer of the Company, owner or majority stockholder of any firm or corporation, or member of the management has been charged or convicted of a misdemeanor or felony, indicted, granted immunity, convicted of a crime or subject to a judgment, or the subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation for: (i) any business-related activity including, but not limited to, fraud, coercion, extortion, bribe or bribe receiving, giving or accepting unlawful gratuities, immigration or tax fraud, racketeering, mail fraud, wire fraud, price fixing or collusive bidding; or (ii) any crime, whether or not business related, where the underlying conduct relates to truthfulness, including but not limited to, the filing of false documents or false sworn statements, perjury or larceny;

-the Company or any of the Company's affiliates, principal owners or Officers has not received a violation of State Labor Law deemed "willful";

-the Company or any of its affiliates has never been cited for a violation of State, Federal, or local laws or regulations with respect to labor practices, hazardous wastes, environmental pollution or other operating practices;

-there are not any outstanding judgments or liens pending against the Company other than liens in the normal course of business.

-the Company or any of its affiliates, principal owners or officers the company has not been the subject of any judgments, injunctions, or liens including, but not limited to, judgments based on taxes owed, fines and penalties assessed by any governmental agency, or elected official against the Company.

- the Company or any of its affiliates, principal owners or officers the company has not been investigated by any governmental agency, including, but not limited to, federal, state and local regulatory agencies

-the Company or any of its affiliates, principal owners or officers the company has not been debarred from entering into any government contract; been found non-responsible on any government contract; been declared in default ore terminated for cause on any government contract; been determined to be ineligible to bid or propose on any contract; been suspended from bidding on any government contract; received an overall unsatisfactory performance rating from any government agency on any contract; agree to a voluntary exclusion from bidding or contracting on a government contract.

- the Company or any of its affiliates, principal owners or officers the company has not failed to file any of the required forms with any government entity regulating the Company. By entering your name in the box below, you agree to allow the Department of Taxation to share the Company tax information with ESD. By entering your name in the box below, you agree to allow the Department of Labor to share tax and employer information with ESD. Note: If any of the statements above are not true, in addition to entering your name, also include an explanation in the box below, indicating which issue you are addressing.