Will the CDBG portion of the project for which funds are being requested involve the construction or rehabilitation (other than handicapped accessibility improvements) of buildings for the general conduct of government business (i.e. Town Hall)?

Is the applicant an eligible New York State non-entitlement municipality?

Will NYS CDBG funds be used for eligible project costs? Eligible costs may include direct construction, direct labor, direct material, engineering for planning and design, construction oversight/management, program delivery and administration (within the limits allowed).

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.

Will any component or phase of the project that is applying for CFA funding be underway at the time of submission of the application or prior to any award decision?

Will the project meet a CDBG National Objective? See Question Requirements for additional information.

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 county or counties.

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.)

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.)

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.)

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

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
City
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 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

Attach the Pre-Application Certification. See question requirements for more information.

Attach Budget Table. The budget must be consistent with the description provided in the application and reflect the total project cost (TPC) of all components. See question requirements for further guidance.

Attach Job Creation/Retention Table if applying for an economic development activity. See question requirements for more information.

Attach documentation of compliance with CDBG citizen participation requirements. Failing to submit all required documents may render the application ineligible. See question requirements for a detailed list of documents and additional guidance.

Attach the Project Schedule form

Attach Program Income Report Form

Attach Project Team Form

Attach Smart Growth Impact Evaluation Form

Applicant Certification Form

Attach documentation of compliance with HUD's National Objectives. Material attached here should align with the details described in Q_17343. Information related to the appropriate type of documentation can be found in question requirements.

Attach documentation of Affirmatively Furthering Fair Housing (AFFH) compliance. Refer to question requirements for further guidance.

Attach the draft Environmental Review Record. See question requirements for further guidance.

Attach all funding commitment letters, approval/rejection letters from funding agencies, evidence of bank financing, and any other supporting documentation demonstrating that non-CDBG funds have been pursued. Statements that describe a self-analysis of other funding sources do not constitute an effort to pursue other funding.

Attach a Vendor Responsibility Questionnaire (VRQ) completed by the subrecipient, if applicable.

Attach purchase agreements, property acquisition, easements or other documentation that supports the status of site control, if applicable

If the application is a joint application, attach a cooperation agreement and a resolution authorizing a joint application and one of the units of local government as the primary applicant. See question requirements for further guidance.

Attach documentation demonstrating the need for the project and for CDBG funds. See question requirements for further guidance.

Public Facility - Additional Attachments See question requirements for further guidance.

Community Planning - Additional Attachments See question requirements for further guidance.

Economic Development - Additional Attachments See question requirements for further guidance.

Imminent Threat - Additional Attachments See question requirements for further guidance.

Please provide the Federal Tax ID and the Unique Entity ID (UEI) for the Unit of Government serving as the Applicant.

Provide a brief abstract of the proposed project. The abstract must include formal applicant name, location of project, amount of request, general purpose of the project, and project beneficiaries. Sample text: [City, Town, Village, County Name] will use $500,000 in NYS CDBG funds to [one sentence description of project]. The total project cost will be $2,000,000 with $1,500,000 from other grant sources (specify). The project proposes to benefit 50 low-and moderate-income persons.

Provide a brief history of the community or project area with a concise description of the project and need to be addressed. Use quantitative data and information to describe the need for the project. Include a tentative schedule of key milestones.

Describe other planning and community development efforts to address the need. How is this project consistent with existing plans or initiatives at the local, county or state level? Describe its consistency with a Regional Economic Development Council strategic plan or initiative.

Is CDBG funding necessary to induce the project? See question requirements for further guidance.

Describe the documentation attached to this application to support demonstrate need for the project and CDBG funding, specifically, the documents attached to Q_17424.

Describe in detail how the project will meet HUD's National Objective(s). Details discussed here should align with the documentation attached to Q_17365. See question requirements for further guidance.

Describe the long-term benefits, or outcomes, of this project to the community. Include both qualitative and quantitatively measurable outcomes such as linear pipe replaced, persons benefitted, homes rehabilitated, jobs created, etc.

Describe financial benefits or cost savings that will accrue to the applicant, its residents, or beneficiaries of the funded activity because of the project. Include a description of any other impacts that will result. Measures may include, but are not limited to, user costs, tax levy, or property values.

Provide a detailed budget narrative. Identify each of the estimated costs, including the source of the funds and proposed use. This must include any administrative or program delivery costs. Describe how CDBG funds will be disbursed on a pro-rata basis with other sources, where applicable. Details discussed here should align with the documentation attached to Q_17487 of this CFA.

Describe the roles and responsibilities of specific staff members, subrecipients, and/or consultants, and their relevant experience and qualifications. How will the project be managed or administered? Details discussed here should align with the documentation attached to Q_17653 of this CFA.

If the Applicant has received CDBG and/or HOME funds in the past, describe the outcome of those projects, highlighting any administrative issues that occurred, and what corrective action was established to ensure the issues were resolved. If the applicant has not received CDBG and/or HOME funds in the past, a description of experience using similar state or federal sources may be substituted.

How will the applicant exercise strong control and accountability over CDBG funds? Describe the process used to track the movement of grant funds and the personnel involved in these functions.

Describe the plan of finance and/or services that will sustain the project moving forward. What happens once the project is completed? Details discussed here should align with the documentation attached to Q_17414 of this CFA.

Describe the applicant’s ability to immediately implement the project upon award, including any impediments such as permitting, site control, regulatory issues, environmental mitigation, etc. Provide a description of project related activities that have been undertaken to date in support of the project and attach any relevant documentation to the application to support readiness. Details discussed here should align with the documentation attached to this CFA, including Q's 17833 (Project Schedule), 17368 (Draft Environmental Review), 17659 (Commitment of Funds), and 17694 (Evidence of Site Control)

Is the project located in a municipality designated as a Pro-Housing Community, or has the municipality submitted a Letter of Intent initiating the Pro-Housing Community certification process?

Describe how the project will comply with the Buy American Preference (BAP) under the Build America, Buy America Act (BABA). Describe any delays associated with procurement or any project related waivers. See question requirements for additional information.

ContactNameSubrecipient

ContactNamePreparer

TitlePreparer

TitleSubrecipient

OrganizationPreparer

OrganizationSubrecipient

AddressPreparer

AddressSubrecipient

ZipCodePreparer

ZipCodeSubrecipient

TelephonePreparer

TelephoneSubrecipient

EmailPreparer

EmailSubrecipient

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.