Grants and Funding Program Forms

• HPRP Certificate of Completion (XLS)
• Year 3 HPRP Annual Performance Report (XLS)
• HPRP Annual Performance Report (XLS)
• Housing Status Requirements and Templates (HUD form) (PDF)
• Payee Data Record (DOC)
• Staff Certification of Eligibility for HPRP Assistance (PDF)
• Rental Reasonableness Checklist (DOC)
• HPRP Monthly Draw Down Request (DOC)
• HPRP Draw Down Schedule Revision Form (Revised 10/10) (DOC)
• HPRP Monthly Detailed Expenditure Report (XLS)
• HPRP HCD QPR (Revised 3-09-2010) (XLS)
• Instructions for Submitting the California ARRA and Accountability Tool (CAAT) (PDF)
• Instructions for Initial and Quarterly Performance Reports (IPR/QPR) (PDF)
• Example HPRP Initial and Quarterly Performance Report (IPR/QPR) (PDF)
• HPRP Budget Revision Request (DOC)

Mortgage Assistance

• Program Guideline Check Sheet - MA (DOC)
• Loan Servicing Plan Check Sheet (DOC)
• Reuse Account Plan Check Sheet (DOC)
• Homebuyer Education Plan Check Sheet (DOC)
• Draw Request (DOC)
• Borrower Summary - MA (DOC)
• Activity Delivery Fee - MA (DOC)

Owner-Occupied Rehabilitation

• Program Guideline Check Sheet - OOR (DOC)
• Loan Servicing Plan Check Sheet (DOC)
• Reuse Account Plan Check Sheet (DOC)
• Draw Request (DOC)
• Borrower Summary - OOR (DOC)
• Activity Delivery Fee - OOR (DOC)

Project Development Loans

• Project Development Loan Check Sheet (DOC)
• Loan Servicing Plan Check Sheet (DOC)
• Reuse Account Plan Check Sheet (DOC)
• Homebuyer Education Plan Check Sheet (DOC)
• Draw Request (DOC)
• Loan Activity Summary - PDL (DOC)
• Borrower Summary - PDL (DOC)
• Activity Delivery Fee - PDL (DOC)

Quarterly and Annual Reports

• Quarterly Status Report (DOC)
• Annual Status Report - Active Grant (DOC)
• Annual Status Report - Reuse Account (DOC)

Wage Income Calculations

• Wage Income Calculations 2A (DOC)
• Wage Income Calculations 2B (DOC)
• Gross Income (DOC)

Sample Documents

Mortgage Assistance

• First-Time Homebuyer Mortgage Assistance Promissory Note (DOC)
• First-Time Homebuyer Mortgage Assistance Deed of Trust (DOC)
• First-Time Homebuyer Escrow Instructions (DOC)

Owner-Occupied Rehabilitation/Replacement

• Owner-Occupied Rehabilitation/Replacement Promissory Note (DOC)
• Owner-Occupied Rehabilitation/Replacement Deed of Trust (DOC)
• Owner-Occupied Rehabilitation/Replacement Escrow Instructions (DOC)

Manufactured Housing

• First-Time Homebuyer Mortgage Assistance Promissory Note and Security Agreement for Purchase of Manufactured Home (DOC)
• Owner-Occupied Rehabilitation/Replacement Manufactured Housing Promissory Note and Security Agreement (DOC)

CDBG Annual Performance Reports (APR Forms)

• Annual Performance Notification (DOC)
• CDBG Annual Performance Report 2017/2018 Workbook (XLS) 6-6-2018
• APR Matrix
• Attachment A: CDBG Semi-Annual Program Income Report (XLS) - Revised 6-1-2018
• Attachment B: Minority Business Enterprise (MBE) and Women Business Enterprise (WBE)
• Attachment C-1, C-2, C-3: CDBG Public Service and/or Micro Technical Assistance Accomplishments
• Attachment D: Relocation and Real Property Acquisition
• Attachment E: Demographic Analysis Report
• Attachment F: Section 3 Summary Report

• Stand-Alone forms for CDBG Recipients to complete, if needed:
• Attachment A: CDBG Semi-Annual Program Income Report  (XLS) - Revised 6-1-2018
• Attachment C1: CDBG Public Service (Low/Moderate Area & Urgent Need) (XLS) - Revised 4/23/2018
• Attachment C2: CDBG Public Service (Limited Clientele and Low/Moderate Housing) (XLS) - Revised 4/23/2018
• Attachment C3: CDBG ED: Micro-Technical Assistance (XLS) - Revised 4/23/2018
• Attachment E: CDBG Demographic Analysis (XLS) - Revised 4/23/2018

• Stand-Alone form for Contractors and Subcontractors to complete
• Attachment B & F: Stand-Alone (XLS) - Revised 4/23/2018

APR Help Tools

2017-2018 What's New (PPT)

Webinar Trainings (MP4 Videos)

• Matrix
• Attachment A: Program Income Report (MP4 Video)
• Attachment B: MBE/WBE
• Attachment C: Public Service and TA (MP4 Video)
• Attachment D: Relocation and Real Property Acquisition (MP4)
• Attachment E: Demographic Analysis Report
• Attachment F: Section 3 Summary Report

Instructions

• Matrix (Rev. 6-1-17) (DOC)
• Attachment A: Program Income  (DOC)
• Attachment B: MBE/WBE  (DOC)
• Attachment D: Relocation and Real Property Acquisition  (DOC)
• Attachment E: Demographic Analysis Report  (DOC)
• Attachment F: Section 3 Summary Report  (DOC)

Contract Closeout Forms

• Closeout Certification Form  (DOC) Revised 2014

Disaster Recovery Initiative (DRI)

• DRI - Funds Request and Summary of Expenditures Workbook  (DOC)

Economic Development

Business Assistance

• Sample Program Guidelines – Business Assistance Activity  (DOC)
• Business Assistance Loan Certification Form (DOC) - Revised 9/2015
• Business Assistance Self-Certification of Income Form - Revised 8/2015 (PDF)
• CDBG Job Tracking  (XLS)
• No Job Pirating Certification  (DOC)
• Cost Categories Table  (PDF)
• CDBG Loan Disbursement  (XLS)
• Federal Overlay Compliance Certification  (DOC)
• No Conflict of Interest Certification  (DOC) 

Microenterprise Assistance

• Microenterprise Loan/Grant Certification Form  (PDF)
• Cost Categories Table  (PDF)
• Self-Certification Form - Microenterprise - Revised 8/2015 (PDF)
• Sample Program Guidelines - Microenterprise Technical Assistance  (DOC)
• Sample Program Guidelines - Microenterprise Financial Assistance  (DOC)
• Sample Program Guidelines - Microenterprise Support Services  (DOC)

Environmental

• Level of Environmental Review  (DOC)
• Rehabilitation Environmental Review 2011 (DOC) - Revised 7/2011
• Appendix A 2012 (DOC) - Revised 10/2012
• Statutory Worksheet 2011 and Instructions (DOC) -  Revised 11/2011
• Environmental Assessment Form - Revised 7/2011  (DOC)
• Request for Release of Grant Funds and Certification (PDF) - Revised 10-2014
• Instructions to Request for Release of Grant Funds & Certification (PDF) - Revised 10-31-2011
• Authority to Use Grant Funds Form (For CDBG Use Only)  (PDF)

Fiscal

Fiscal Forms

• CDBG Funds Request Form - Activities (XLS) - Revised 5/2016
• CDBG Funds Request Form - GA (XLS) - Revised 5/2016
• CDBG Return of Funds Form (XLS) - Revised 10/2014
• CDBG Signature Card (DOC) - Revised October 2013
• Payee Data Record  (PDF)

Setup and Completion Reports
Setup/Completion Report and Funds Request Webinar  (MP4 Video) 4/17/2015 Webinar
Setup/Completion Report and Funds Request Webinar  (MP4 Video) 4/28/2015 Webinar

• Instruction for the Setup and Completion Reports  (PDF)
• Clearance, Remediation and Cleanup Setup and Completion Report (XLS)
• ED: Business Assistance Setup and Completion Report (XLS) - Revised 5/2016
• ED: Micro Financial Assistance Setup and Completion Report (XLS) - Revised 5/2015
• ED: Micro Technical Assistance Setup and Completion Report - Revised 12/2015 (XLS)
• ED: Over the Counter Project Setup and Completion Report (XLS) - Revised 6/2015
• Housing: Homeownership Assistance and Housing Rehab (1-4 Units) Setup and Completion Report (XLS) - Revised 7/2015
• Housing: Multi-Unit Rehab (5+ Units) Setup and Completion Report  (XLS)
• Planning Setup and Completion Report  (XLS)
• Public Facilities Setup and Completion Report  (XLS)
• Public Improvement Setup and Completion Report  (XLS)
• Public Service Setup and Completion Report (XLS) - Revised 1/2017

General Conditions Clearance Checklists

• Business Assistance General Conditions Checklist (DOC) - Revised 8/2015
• Homeownership Assistance General Conditions Checklist (DOC) - Revised 8/2015
• Housing Rehabilitation (1-4 Units) General Conditions Checklist (DOC) - Revised 8/2015
• Microenterprise General Conditions Checklist (DOC) - Revised 8/2015
• Multi-Family Rehabilitation General Conditions Checklist (DOC) - Revised 8/2015
• Planning and Technical Assistance General Conditions Checklist  (DOC) - Revised 8/2015
• Public Facilities General Conditions Checklist (DOC) - Revised 8/2015
• Public Improvements/Improvements in Support of Housing General Conditions Checklist (DOC)
• Public Services General Conditions Checklist (DOC) - Revised 8/2015
• ED-OTC General Conditions Checklist (DOC) - Revised 8/2015

Homebuyer Assistance

• Homebuyer Program Guidelines Checklist  (XLS)

Income Calculation and Determination Guide

Appendix E - Self-Certification Forms

• Public Service Self-Certification Form (PDF) - Updated (8/2015)
• Microenterprise Self-Certification Form (PDF) - Updated (8/2015)
• Business Assistance Staffing Self-Certification Form (PDF) - Updated (8/2015)

Appendix F - Sample Applications

• Sample Application for Homebuyers  (DOC)
• Sample Application for TBRA  (DOC)

Appendix G - Eligibility Determination Worksheets

• Income Calculation and Certification Worksheet  (XLS)
• Tenant Income Calculation and Recertification Worksheet  (XLS)

Appendix H - Sample Format for Computing Tenant Share of Rent for Tenant Based Rental Assistance (TBRA)  (XLS)

Appendix I - Sample Verification Forms for Determining Annual (Gross) Incomes

• HOME Program Eligibility Release Form  (DOC)
• Verification of Employment Form  (DOC)
• Verification of Income from Business Form  (DOC)
• Verification of Social Security Benefits Form  (DOC)
• Verification of Pension and Annuities Form  (DOC)
• Verification of Veterans Administration Benefits Form  (DOC)
• Verification of Unemployment Benefits Form  (DOC)
• Verification of Public Assistance Income Form  (DOC)
• Verification of Child Support Payments Form  (DOC)
• Verification of Alimony or Separation Payments Form  (DOC)
• Verification of Recurring Cash Contributions Form  (DOC)
• Verification of Income from Military Service Form  (DOC)
• Verification of Assets on Deposit Form  (DOC)
• Verification of Assets Disposed Form  (DOC)
• Record of Oral Verification Form  (DOC)

Appendix J - Sample Verification Forms for Determining Part 5 Adjusted Incomes

• Verification of Full-Time Student Status Form  (DOC)
• Verification of Medical Expenses Form  (DOC)
• Verification of Transportation to Medical Treatment Form  (DOC)
• Verification of Prescription - Nonprescription Expense Form  (DOC)
• Verification of Child Care - Dependent Care Form  (DOC)

Appendix K - Annual Recertification of Income Forms

• Annual Recertification Notice Form  (DOC)
• Recertification Interview and Verification Record Form  (DOC)
• Recertification of Annual Income by Government Programs Form   (DOC)

Income Survey

• Income Survey Form  (DOC)
  • Income Survey Analysis up to 100 Respondents (XLS) - Revised 1/2015
  • Income Survey Analysis up to 200 Respondents (XLS) - Revised 1/2015
  • Income Survey Analysis up to 300 Respondents (XLS) - Revised 1/2015
  • Income Survey Analysis up to 400 Respondents (XLS) - Revised 1/2015
• Income Survey Form - Spanish  (DOC)

Labor Standards Reporting

• Appointment of Labor Standards Compliance Officer  (DOC)
• Force Account  (DOC)
• Request for Determination and Response to Request  (DOC)
• HUD 4230A Report of Additional Classification and Rate with Instructions –   (DOC)
• Notice of Award/Pre-Construction Conference/Starte of Construction/Notice of Completion  (DOC)
• CDBG Labor Standards Cover Memo  (DOC)
• HUD Section 5.7 Enforcement Report  (DOC)
• HUD 4710 Semi-Annual Enforcement Report  (DOC)
• HUD 4710i Instructions  (PDF)
• WH 347 Wage Report Form  (PDF)  - Expires 2-28-18
• HUD 11 Record of Employee Interview Form  (DOC)
• HUD 11 Instructions  (DOC)

MBE/WBE

• Please see Annual Performance Reports section.

Monitoring Checklists

• 1. Checklists and Activities Chart  (DOC)
• 1.1 National Objectives – LMA  (DOC)
• 1.2 National Objectives – LMC  (DOC)
• 1.3 National Objectives – LMH  (DOC)
• 1.4 National Objectives – LMJ  (DOC)
• 1.5 National Objectives – Slums or Blight  (DOC)
• 1.6 National Objectives – Urgent Needs  (DOC)
• 2. General Compliance  (DOC)
• 3.1 Equal Opportunity  (DOC)
• 3.2 Fair Housing  (DOC)
• 4. Relocation and Real Property Acquisition  (DOC)
• 5. Environmental Review  (DOC)
• 6. Lead Based Paint Compliance  (DOC)
• 7.Financial Management  (DOC)
• 8.1 Procurement – Competitive Bids (DOC)
• 8.2 Procurement – Sealed Bids (DOC)
• 8.3 Procurement – Small Purchase – Noncompetitive  (DOC)
• 8.4 Procurement – Summary  (DOC)
• 8.5 Subrecipient Management  (DOC)
• 9.1 Rehabilitation – Grantee or Developer  (DOC)
• 9.2 Rehabilitation Homeowner  (DOC)
• 10. Acquisition - Homebuyer Program  (DOC)
• 11. Continued Affordability  (DOC)
• 12. Disposition  (DOC)
• 13. Rental Projects  (DOC)
• 14. Construction and Lease-up Checklist  (DOC)
• 15. Labor Standards Administration  (DOC)
• 16. Force Account Labor  (DOC)
• 17.1 Economic Development – Business Assistance  (DOC)
• 17.2 Economic Development – Microenterprise  (DOC)
• 17.3 Economic Development – Over the Counter  (DOC)
• 18. Business Relocation  (DOC)
• 19. Program Income  (DOC)
• 20. ARRA Inspector General Advisory Guide on Monitoring  (DOC)

Neighborhood Stabilization Program

• Quarterly Performance and Expenditure Report (QPER)  (XLS)
• Quarterly Performance and Expenditure Report (QPER) Instructions  (XLS)
• NSP Authorized Signature Card  (DOC)
• NSP Funds Request  (XLS)
• NSP Funds Request Instructions  (DOC)
• NSP Program Income (PI) Report  (XLS)
• NSP Return of Funds/Interest/Program Income (DOC) - Revised 8/2013
• NSP Summary of Expenditures  (XLS)
• NSP Advance Justification  (XLS)

Program Income (PI)

Program Income Reuse Agreement

• CDBG PI Reuse Agreement (PDF) - Revised 7/2015

Program Income Semi-Annual Reports

• CDBG Semi-Annual Program Income Report - Revised 6-1-2018  (XLS)
• Webinar Program Income Report Instructions  (MP4 Video)

Program Income Waiver Request Forms

• Program Activity (DOC) - Revised 6/2015
• Public Service Activity  (DOC)
• Project Activity  (DOC)

Program Income Supplement Activity Forms

• Program Activity  (DOC)
• Public Service Activity  (DOC)
• Project Activity  (DOC)

Section 3

• See Annual Performance Report section.

• ESG Sample Request for Funds (RFF) and Detailed Expense Report (DER) (XLS)
• Review this document before submitting any RFFs
• ESG Request for Funds (RFF) and Detailed Expense Report (DER) (XLS)
• Use this form for requests for reimbursement
• The format shown on the Sample RFF and DER must be used or the RFF will not be accepted
• ESG Authorized Signatories Identity Form (XLS)
• Detailed list of positions and individuals authorized to sign the RFF in lieu of the Authorized Representative listed on the Resolution
• ESG Budget Revision Workbook (XLS)
• Use this form to request revisions (budget or line item) or Contract Amendments
• ESG Quarterly Report (XLS)
• This form must be submitted every quarter to report program expenditures
• ESG Staff Breakdown Form (XLS)
• List of all staff that will be paid with ESG funds
• ESG Equipment Request Form (XLS)
• For purchases over $500
• Must be submitted for pre-approval with 3 bids
• ESG Certificate of Completion (XLS)
• Use this form to close out the contract when funds have been exhausted or contract period ends, whichever comes first
• Authorizing Resolution (DOC)
• Must resubmit if the Authorized Representative changes during the grant period
• ESG Eligible Expense Guide (PDF)
• Detailed breakdown of eligible expenses
• STD 204 - Payee Data Record (DOC)
• Required when receiving payment from the State of California in lieu of IRS W 9
• ESG Staff Representatives by County (PDF)

Authorizing Resolutions Not Used For Balance of State Regional Competition

• Administrative Entity Authorizing Resolution  (DOC)
• Authorizing Resolution for Balance of State Noncompetitive Rapid Rehousing Funds (DOC)

2016 ESG:  Solicitation of Interest Forms

Solicitation of Interest forms were sent in January in order to identify local government AEs within the CoC Allocation and CoCs within the BoS Allocation willing to recommend providers for ESG funding.

• Solicitation of Interest (Continuum of Care Allocation)  (DOC)
• Solicitation of Interest (Balance of State Allocation)  (DOC)

Form fields on each of the documents listed below may be completed while open in your browser.  Once completed, the document may be printed with the data you entered.

• HOME-2—Quarterly Performance Report - Revised 4/2013 (XLS)
• HOME-2A—Quarterly Program Income Statement Report – Revised 10/2013 (XLS)
• HOME-3—Project Funding Source Detail Listing - Revised 6/12/09 (DOC)
• HOME-3A—County Code Listing - Revised 10/29/09 (DOC)
• HOME-4—Administrative Drawdown Request - Revised 12/11/14 (DOC)
• HOME-5—Project Drawdown Request - Revised 1/29/14 (DOC)
• HOME-6—Homeownership Project Set-Up and Completion Report - Revised 12/11/14 (XLS)
• HOME-7—Homeownership Assistance Rental Housing Project Set-up Report - Revised 1/29/14 (DOC)
• HOME-8—Tenant Based Rental Assistance Project Set-up Report - Revised 6/19/15 (XLS)
• HOME-10—FTHB Project Set-Up/Completion Report - Revised 12/11/14 (XLS)
• HOME-11—Rental Project Set-Up/Completion Report - Revised 4/27/2018 (XLS)

State Recipients who have been awarded HOME funds for Program Activities are required to complete each of the following applicable checklists as part of setting up your Program contract (Standard Agreement):

• General Setup Conditions Checklist (Contact HOME Program Representative.)

Other

• Short Sale Request Form (XLS)
• Reconstruction Test (2009) (XLS) - Revised 3/26/09
• HOME Program Property After-Rehabilitation Value Form (DOC)
• HOME FTHB Subsidy Calculation Worksheet (XLS) -  Revised 06/13
• HOME OOR Rehab Grant Calculation Worksheet (XLS) - Revised 06/18
• Semi-Annual Labor Standards Enforcement Report
  • Instructions (DOC)
  • Report (DOC)

Annual Performance Reports (APR Forms)

• Annual Performance Notification (DOC)
• HOME Annual Performance Report 2017/2018 Workbook (XLS) - 5/23/18

6 forms listed in this workbook are:

• Tab 1: APR Matrix
• Tab 2: Attachment A, Annual Program Income Statement
• Tab 3: Attachment B, Minority Business Enterprise (MBE) and Women Business Enterprise (WBE)
• Tab 4: Attachment D, Relocation and Real Property Acquisition
• Tab 5: Attachment E, Demographic Analysis Report
• Tab 6: Attachment F, Section 3 Summary Report

Stand-Alone Forms

• Attachment B and F – HOME MBE/WBE and Section 3 Stand-Alone 2017/2018 (XLS) - Revised 4/19/18
• Attachment E – HOME Demographic Analysis Stand-Alone 2017/2018 (XLS) - Revised 4/19/18

APR Help Tools

• 2017-2018 What's New (PPT)
• 2013-2014 APR Webinar Training Presentation (PPT)
• 2013-2014 Annual Performance Report Webinar (MP4 Video)
• Attachment A – Program Income Checklist (Rev. 6-10-16) (DOC)
• Attachment B – MBE/WBE Checklist (Rev. 6-10-16) (DOC)
• Attachment F – Section 3 – Detailed Instructions (DOC)

HRP Program Disbursement and Reporting Forms

• Request for Disbursement of Funds - 1/17/2018 (PDF)
• HRPP Annual Progress Report – 2/13/2017 (PDF)
• HRPP Final Closeout Report - 1/9/2013 (DOC)

Loan Closing Documents

Check the list for Publications and Loan Documents pertaining to all NOFAs.  See also Management Memos pertaining to the program.  Check the Notice of Funding Availability (NOFA) under which your loan was funded for additional information.

Important Notice: The Department of Housing and Community Development is providing the following sample loan documents for general information purposes only.  The Department reserves the right to make changes to its documents at any time prior to the closing of an individual loan.  Final loan documents will be modified to reflect the specific terms and conditions applicable to the particular loan and property.

• Architect's Completion Certificate (New Construction)  (DOC)
• Architect's Completion Certificate (Rehabilitation)  (DOC)
• Article XXXIV Guidelines  (PDF)
• Bond Financing Term Sheet  (DOC)
• Certificate of Completion  (DOC)
• Closing Checklist  (XLS)
• Cost Cert and Financial Reporting Requirements  (DOC)
• Cost Cert Sample Form  (XLS)
• Designated Payee Authorization Letter  (DOC)
• Lease Rider Estoppel  (DOC)
• Physical Needs Assessment - Fannie Mae Form 4327  (DOC)
• Physical Needs Assessment and Replacement Reserve Study Guidelines  (DOC)
• Prevailing Wage Compliance Certificate  (DOC)
• Project Construction Sign Requirements  (DOC)
• Project Funding Sources (Construction)  (XLS)
• Project Funding Sources (Permanent)  (XLS)
• Relocation Plan Implementation Certificate  (DOC)
• Request For Funds Form  (DOC)
• Utility Allowance Determination  (DOC)

Applications

Homeownership, including Manufactured Housing and owner-occupied rehabilitation – Single-Family Application (DOC) or (PDF)

All other rental projects – new construction or rehabilitation – Universal Application  (XLS)

• SERNA Application Attachments to be used with Universal Application  (XLS)

• WFH Cash Request form and instructions (PDF)
• WFH Bi-Annual Report (PDF)
• WFH Final Closeout Report (PDF)