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["Required Pre-Disbursement Documents:"]
["1.     If your Standard Agreement has any special pre-disbursement conditions, those must be met before funds can be disbursed.  These can be found in Exhibit E."]
["2.     A Relocation Plan that has been reviewed and approved by HCD’s Legal Division"]
["3.     Current Insurance Certificate, in accordance with the NOFA §606."]
["4.     Signed Statement of Assurances for State Prevailing Wages. \nMust include Grantee and Contractor signatures if requesting funds for Rehabilitation or Construction, in accordance with NOFA §509"]
["5.     A Current Preliminary Title Report dated within 15 days of the first Request for Funds"]
["6.     Request for Funds Form (the final submission must be dated on or after the date of the Standard Agreement execution, but you may submit unsigned drafts of this form in advance to receive technical assistance from MGM staff). "]
["7.   Draft Use Restriction: \n   a. For Wire Transactions, the draft Use Restriction needs to be submitted, reviewed, and approved to ahead of the wire transaction to be recorded simultaneously at closing. \n   b. For Rounds 2 and 3 check disbursements, a Draft Use Restriction is required. A template for interim housing projects is available on the Homekey website).  HKT - Please note that draft Use Restrictions are not a required pre-disbursement item for Tribal Grantees."]
["8.   Proof of Expenditures (if applicable), if requesting funds for a Reimbursement for any eligible costs incurred on or after March 3, 2021 (for Round 3) or on or after March 5, 2024 (for Homekey+). \nFor acquisition costs, acceptable evidence is a Final Buyer’s Settlement Statement. For all other costs, provide a General Ledger. "]
["9.     Authorizing Resolution: The RFF form requires the signature of the Authorizing Signatory of the Payee listed in the Standard Agreement."]
["10. Government Agency Taxpayer ID Form (GOV TIN) or Payee Data Record (STD 204): Please provide a GOV TIN form if a government agency, or a Payee Data Record for a non-governmental entity."]
["If you are submitting your first RFF for HK+ or Tribal Homekey+, funds MUST be wired directly to an escrow company, as part of closing escrow. To process a wire transaction, the following is needed: "]
["11.  HCD Wire Transfer Request Form"]
["12.  Wiring instructions from your title company in addition to the aforementioned listed items. "]
["13.  Escrow Officer acknolwedgement of HCD Escrow Instructions (HCD will send their instructions to Escrow Officer after receiving items 11 and 12)"]
["These forms and more detailed instructions are available on our Monitoring and Disbursement webpage under Disbursement."]

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[]
[null,"DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT "]
[null,"DIVISION OF STATE FINANCIAL ASSISTANCE"]
[null,"MULTIFAMILY GRANTS MANAGEMENT"]
[null,"651 BANNON STREET, 8TH FLOOR"]
[null,"SACRAMENTO, CA  95811"]
[null,"MULTIFAMILYGRANTS@HCD.CA.GOV "]
[]
[null,"HOMEKEY PROGRAM \nREQUEST FOR FUNDS (RFF) FORM"]
[]
[null,"Last Revised 5/2025"]
[null,"Instructions: Fill out yellow cells as instructed. Ensure that names of Grantee and Payee match names listed in the Standard Agreement and on the Government Agency Taxpayer ID Form (GovTIN) or Payee Data Form (STD 204). If this is the Project's first RFF, the funds must be disbursed through a Wire Transaction; please submit the necessary forms to process a wire, as detailed in the Pre-Disbursement Requirements Checklist available on our website: https://www.hcd.ca.gov/grants-and-funding/homekey/monitoring-forms-and-disbursement. If requesting reimbursement for previous expenditures, please attach proof of expenditure documentation."]
[null,"HCD Contract Number:",null,"Homekey Award Round:","Select One"," RFF Number:",null,"Date of Request:"]
[null,"Project Lead Applicant:",null,null,null,"Project Name: "]
[null,"Preparer Name",null,null,null,"Preparer Title:",null,null,null,null,null,null,null,null,null,null,null,null,null,1,2,3,4,5,6,7,8,9,10]
[null,"Payee per Standard Agreement Exhibit E:",null,null,null,"Payee Full Address:"]
[null,"Payee Contact Person:",null,null,"Payee Email:",null,null,"Payee Phone Number:"]
[null,"Is this an Acquisition-Only project? (No Rehabilitation or Construction needed after acquisition)","Select One",null,"Construction Start Date\nEnter \"N/A\" if acquisition-only",null,null,"If not Homekey, what funding source(s) will be used for rehabilitation/construction? "]
[null,"REIMBURSEMENT \nIf you are submitting a request for reimbursement of any eligible expenses incurred with the timing shown below, please fill out this section. \nProof of expenditures must be attached to this document when submitted. "]
[null,"Homekey Round 3 - Incurred on or after March 3, 2021 and before the execution of the Standard Agreement, per NOFA§204.\nHomekey+ - Incurred or on or after March 5, 2024 and before the execution of the Standard Agreement. Operating Costs are not eligible for reimbursement for HK+, per NOFA§204.\nHomekey Tribal - Incurred on or after January 1, 2022 and before the execution of the Standard Agreement, as outlined in NOFA§602(A)\nTribal Homekey+ - Incurred or on or after January 1, 2024 and before the execution of the Standard Agreement,  as outlined in NOFA§602(A)"]
[null,"If no funds were expended on Homekey-eligible activities prior to Standard Agreement execution, please skip this section."]
[null,"Are you submitting any eligible expenses incurred wiith the timing shown above and before the execution of the Standard Agreement?","Select One",null,"Has Grantee attached proof of prior expenditures?\nAcceptable forms of supporting documentation: Acquisition - Escrow Settlement Statement.  \nAll other Capital or COSR expenses must be supported by a General Ledger (GL) that specifically outlines the amounts that are being reimbursed.",null,null,null,"Select One"]
[null,"WIRES\nHomekey Round 3: Only Homekey Acquisition funds may be issued directly to an approved escrow company per NOFA §402\nHomekey+ and Tribal Homekey+: All first Homekey disbursements must be issued directly to an approved escrow company per NOFA §602"]
[null,"Are you requesting a Wire to Escrow for award funds in this form?\n","Select One",null,"Date of Escrow Close\nIf unknown, please provide best estimate. ",null,null,"Date Funds to be Wired"]
[null,"Escrow Company Name:",null,null,"Escrow Officer:",null,null,"Escrow Number:"]
[null,"Escrow Officer E-mail:",null,null,"Escrow Officer Phone #:",null,null,"Title Company Full Address:"]
[null,"EXPENDITURE BREAKDOWN"]
[null,"Homekey+: Is this project a New Construction Cost Containment project in the Standard Agreement per (NOFA §501)? Please select Yes or No.  NOTE:  The Department will disburse up to 80% of the Capital Award after Grantee has cleared all conditions of disbursement upfront. The remaining 20% of the Award will be disbursed upon submission of the temporary certificate of occupancy (TCO).",null,null,null,null,null,null,"Select one"]
[null,"Homekey+: If this project is a New Construction Cost Containment project in the Standard Agreement (per NOFA §501), has construction completed and proof of construction (such as a TCO) submitted to the Department? Please select Yes or No. Please note, until proof is submitted, the Department can only disburse up to 80% of the Capital Award. If over 80% is requested and proof has not yet been submitted, the cells will turn red. NOTE: If this project is not a New Construction Cost Containment project, please select N/A.",null,null,null,null,null,null,"Select One"]
[null,"Eligible Use\nPer NOFA §201 (i) (a-h)",null,"Total Award Amount\nInclude all amounts for activities in Exhibit E even if not requesting","Total Draw Amounts Previously Approved","Draw Amount Requested This Period","Total Drawn To Date ","Percent of Award Drawn","Amount of Award Remaining","HCD Approved Draw Amount This Period"]
[null,"Acquisition of motels, hotels, or hostels, or other sites and assets",null,null,null,null,{"$f":"SUM(E31+F31)","v":0},{"$f":"IF(D31,G31/D31,0)","v":0},{"$f":"SUM(D31-G31)","v":0}]
[null,"Rehabilitation of motels, hotels, or hostels, or other sites and assets",null,null,null,null,{"$f":"SUM(E32+F32)","v":0},0,0]
[null,"Master leasing of properties for non-congregate housing",null,null,null,null,{"$f":"SUM(E33+F33)","v":0},0,0]
[null,"Conversion of units from nonresidential to residential",null,null,null,null,0,0,0]
[null,"New Construction of Dwelling Units",null,null,null,null,0,0,0]
[null,"Purchase of affordability covenants and restrictions for units",null,null,null,null,0,0,0]
[null,"Relocation costs for individuals who are being displaced as a result of the Homekey project",null,null,null,null,0,0,0]
[null,"TOTAL CAPITAL",null,{"$f":"SUM(D31:D37)","v":0},{"$f":"SUM(E31:E37)","v":0},{"$f":"SUM(F31:F37)","v":0},0,0,0,{"$f":"SUM(J31:J37)","v":0}]
[null,"Capitalized operating subsidies for units purchased, converted, constructed or altered",null,null,null,null,0,0,0]
[null,{"$f":"IF(C24=\"Yes\",\"Please only include Acquisition funds on this RFF Form. If you intend to request award funds for other eligible uses, you must submit a separate RFF form.\",\"\")","v":""}]
[null,"TOTAL:\n",null,{"$f":"SUM(D31:D37,D39)","v":0},{"$f":"SUM(E31:E37,E39)","v":0},{"$f":"SUM(F31:F37,F39)","v":0},{"$f":"SUM(G31:G37,G39)","v":0},{"$f":"IF(D41,G41/D41,0)","v":0},{"$f":"SUM(I38,I39)","v":0},{"$f":"SUM(J38,J39)","v":0}]
[null," CERTIFICATION"]
[null,"***By signing this request, I certify to the best of my knowledge and belief that the request is true, complete, and accurate, and the expenditures, disbursements and cash receipts will be  for the purposes and objectives set forth in the terms and conditions of the State award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)"]
[null,"Name of Authorized Representative per authorizing resolution",null,"Title of Authorized Representative ",null,null,null,"Date"]
[]
[null,"Signature of Authorized Representative"]
[]
[null,"HCD USE ONLY"]
[null,"Instructions: Review and fill out the pre-disbursement checklist to confirm compliance prior to routing this form for approval"]
[null,"Reimbursement Request Amount:",null,null,"Advance Request Amount:",null,null,"Total Request:",{"$f":"C50+F50","v":0}]
[null,"     MGM Representative Signature                                                                ",null,null,null,"     Date"]
[]
[null,"     MGM Manager Signature                                                                ",null,null,null,"     Date"]

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[]
[null,"HK+ New Construction Cost Containment",null,null,null,null,null,"Follow Up Drop Down"]
[null,"Select One","Homekey+","Homekey Tribal+","Homekey Round 3","Homekey Tribal",null,"Select One","Yes","No"]
[null,null,"Select one",{"$f":"\"\"","v":""},null,null,null,null,"Select One"]
[null,null,"Yes",null,null,null,null,null,"Yes"]
[null,null,"No",null,null,null,null,null,"No"]