4125.pdf

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Implementation Sc hedule Indian Community Development Block Grant (ICDBG)

OMB Approval No. 2577-0191 (exp. 1/30/2015) form 4125

See Instructions and Public Reporting Statement on back.

Submit a separate implementation schedule for each project category.

U.S. Department of Housing and Urban Development Office of Public and Indian Housing

10. Planned Drawdowns by Quarter $ $ $ $ $ $ $ $ $Total (Enter amounts non-cumulatively)

11. Cumulative Drawdown $ $ $ $ $ $ $ $ $Total (If more than one page, enter total on last page only)

1. Name of Applicant (as shown in Item 5, Standard Form 424) 2. Application/Grant Number (to be assigned by HUD) 3. Original (First submission to HUD) Date (mm/dd/yyyy)

Pre-Award Submission Amendment (submitted after grant approval)

4. Name of Project (as shown on form HUD-4123, item 4) 5. Effective Date (mm/dd/yyyy) Expected Completion Date (mm/dd/yyyy) Expected Closeout Date (mm/dd/yyyy)

6. Environmental Review Status Exempt (As described in 24 CFR 58.34) Under Review (Review underway; Finding of No Significant Impact (Finding made that request for release of findings not yet made) funds for project is not an action which may significantly affect the environment.)

EIS Required (Finding that project may Not Started Certification (Environmental review completed; Categorically Excluded 7. Tribal Fiscal Year (mm/dd/yyyy) significantly affect environment or (Review not yet begun) certification and request for release of funds (as described in 24 CFR 58.35) EIS automatically required by 24 CFR 58.37) being prepared for submission.)

8. Task List (List tasks such as environmental assessment, acquisition, etc.)

9. Schedule.

Use Calendar Year (CY) quarters. Fill-in the CY below. See detailed instructions on back.

CY _____ CY _____ Date (mm/dd/yyyy) 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 5th Qtr. 6th Qtr. 7th Qtr. 8th Qtr. (If exceeds 8th Q tr h46246 Text Box (exp. 12/31/2024)

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5. Period of Performance Start Date (mm/dd/yyyy)

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H46246 Text Box Period of Performance End Date (mm/dd/yyyy)

H46246 Text Box Expected Close Out Date (mm/dd/yyyy)

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Public reporting burden for this collection of information is estimated to average 40 hours per response, including the time f or reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or an y other aspect of this collection of information, including suggestion for reducing this burden, to the Reports Management Officer, Paperwork Reduction Project (2577-0191), Office of Information Technology, U.S . Department of Housing and Urban Development, Washington D.C. 204103600. This agency may not collect this information, and you are not required to complete this form, unless it displays a curre ntly valid OMB control number.

This collection of information requires that each eligible applicant submit information to enable HUD to select the best projec ts for funding during annual competitions for the ICDBG Program. The information will be used by HUD to determine whether applications meet minimum screening eligibility requirements and application submissio n requirements. Applicants provide general information about the project which is preliminary to the review of the applicant’s response to the criteria for rating the application. The information is essent ial for HUD in monitoring grants to ensure that grantees are making proper use of Federal dollars. Responses to the collection are required by Section 105 of the Department of Housing and Urban Development Reform Act (P.L. 101-235) as amended by the CranstonGonzales National Affordable Housing Act of l990. The information requested does not lend itself to confidentiality.

form 4125

Instructions for Item 9 Schedule: Use Calendar Year (CY) quarters. Fill-in the CY below. If the project begins in May, for example, enter under "1st Qtr. " , A(April), M(May), J(June). Indicate time period required to complete each activity, e.g., acquisition, by entering "X" under the months it will begin and end. Draw a horizontal line from the first to the second "X". If the completion date will extend beyond the 8th quarter, enter date in the far right column and attach an explanation.

i h46246 Text Box NOTE: Within 90 days of project completion, the grantee shall submit to the Area ONAP a copy of the final status and evaluation report described in §1003.506(a) and a completed Financial Status Report (SF-425). If acceptable reports are not submitted, an audit of the grantee's program activities may be conducted by HUD.

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