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[]
["DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT"]
["DIVISON OF STATE FINANCIAL ASSISTANCE "]
["STATE GRANT MANAGEMENT"]
["2020 West El Camino, 4th Floor"]
["Sacramento, CA 95833"]
["HHCIISGM@hcd.ca.gov"]
["Housing for a Healthy California (HHC) Article II "]
["Budget Revision Form"]
["Last Revised:  04/21/2021"]
["HCD Contract #:",null,null,null,"Preparer  Name:"]
["County Name: ",null,null,null,"Preparer Title:"]
["County   Address\n(Number and Street):",null,null,null,"Preparer E-mail:"]
["County City, State, Zip",null,null,null,"Phone Number:"]
[" Budget Revision Breakdown"]
["Housing for a Healthy California (HHC) Article II Activities",null,null,"Original Approved Budget","Current Approved Budget","New Budget Requested","HCD Approved Amount"]
["Acquisition, new construction, or reconstruction and rehabilitation of (a) project(s). "]
["Operating Assistance: Long-Term Rental Assistance "]
["Operating Assistance: Capitalized Operating Subsidy Reserve (COSR)"]
["Administrative Costs"]
["TOTAL",null,null,{"$f":"SUM(D17:D20)","v":0},{"$f":"SUM(E17:E20)","v":0},{"$f":"SUM(F17:F20)","v":0},{"$f":"SUM(G17:G20)","v":0}]
["CERTIFICATION"]
["*I hereby agree that this Budget Revision Request constitutes allowable costs in accordance with terms of the approved Standard Agreement."]
["Note: You may choose \"Certification by Printed Name\" from the drop-down below and by doing so you are agreeing to all the information detailed in the above Certification without having to submit a copy of this document with a digital signature. If you select this option, please be sure to type out your name in both the \"Name of Authorized Person\" and \"Signature of Authorized Person\" fields. If you select \"Certification by Digital Signature,\" you must submit the following: 1) Copy of the Excel version of this document and 2) PDF copy with digital signature. "]
["Signature Method:",null,"Certification by Digital Signature"]
["Name of Authorized Representative",null,null,"Title of Authorized Representative"]
[]
["Signature of Authorized Representative",null,null,"Date"]
[]
["HCD USE ONLY"]
["Signature Method:",null,"Certification by Digital Signature"]
["SGM Representative Printed Name                                               ",null,null,"Representative Signature",null,null,"Date"]
[]
["SGM Manager Printed Name                                               ",null,null,"Manager Signature",null,null,"Date"]

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[]
[]
["Housing for a Healthy California (HHC) Article II "]
["Budget Revision Form"]
["HCD Contract #:",{"$f":"'HHC II Budget Revision Form'!$B$11","v":0},null,null,"Preparer  Name:",{"$f":"'HHC II Budget Revision Form'!$F$11","v":0}]
["Contractor Name: ",{"$f":"'HHC II Budget Revision Form'!$B$12","v":0},null,null,"Preparer Title:",{"$f":"'HHC II Budget Revision Form'!$F$12","v":0}]
["Contractor  Address\n(Number and Street):",{"$f":"'HHC II Budget Revision Form'!$B$13","v":0},null,null,"Preparer E-mail:",{"$f":"'HHC II Budget Revision Form'!$F$13","v":0}]
["Contractor City, State, Zip",{"$f":"'HHC II Budget Revision Form'!$B$14","v":0},null,null,"Phone Number:",{"$f":"'HHC II Budget Revision Form'!$F$14","v":0}]
[" Budget Revision Justification"]
["PLHA Activity",null,null,"Budget Revision Justification"]
["Acquisition, new construction, or reconstruction and rehabilitation of (a) project(s). "]
["Operating Assistance: Long-Term Rental Assistance "]
["Operating Assistance: Capitalized Operating Subsidy Reserve (COSR)"]
["Administrative Costs"]