Form HUD-50075.1.pdf

PDF 914 KB Posted Mar 6, 2026

Attached to: Housing-Related Hazards and Lead-Based Paint Capital Fund Program
Opportunity number: FR-6900-N-68
Issued by: Department of Housing and Urban Development

About this file

Written by GovTribe AI · Mar 7, 2026

This is a federal form (HUD-50075.1) used for Annual Statements and Performance and Evaluation Reports for the Capital Fund Program (CFP), Capital Fund Program Replacement Housing Factor, and Capital Fund Financing Program (CFFP) administered by the U.S. Department of Housing and Urban Development (HUD), Office of Public and Indian Housing. The form expires on January 31, 2027, with OMB control number 2577-0157 and carries an estimated public reporting burden of 2.2 hours.

The form serves to verify allowable and reasonable grant expenses and requires Public Housing Authorities (PHAs) to report funding allocation and expenditure across fourteen development account categories, including operations (not exceeding 20% of total grant), management improvements, administration (not exceeding 10% of total grant), general capital activity, moving to work demonstrations, collateralization expenses, debt service, RAD-related activities, debt reserves, and post-audit adjustments. PHAs with fewer than 250 units in management may allocate 100% of CFP grants to operations. The form includes sections for original and revised annual statements, reserve for disasters or emergencies, and final performance and evaluation reports. Signatories must certify under penalty of perjury that information is true and correct, with warnings that false submissions subject individuals to criminal and civil penalties including confinement up to five years. Supporting pages require detailed breakdowns by development number with descriptions of major work categories, quantities, estimated costs, and actual obligated and expended funds, along with implementation schedules for CFFP that can only be revised with HUD approval under Section 9j of the U.S. Housing Act of 1937.

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Form HUD-426.pdf	PDF	Mar 6, 2026
Grant Designation Statement.docx	DOCX document	Mar 6, 2026
NOFO-Content_FR-6900-N-68.pdf	PDF	Mar 6, 2026

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Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Office of Public and Indian Housing

Expires 1/31/2027

Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0157

“Public reporting burden for this collection of information is estimated to average 2.2 hours including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.. The information requested is required to obtain a benefit. This form is used to verify allowable and reasonableness of grant expenses. There are no assurances of confidentiality. HUD may not conduct or sponsor, and an applicant is not required to respond to a collection of information unless it displays a currently valid OMB control number. Comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to the Reports Management Officer, Office of Policy Development and Research, REE, Department of Housing and Urban Development, 451 7th St SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2577-0157.

Type of Grant Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no:

PHA Name

Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report

1 To be completed for the Performance and Evaluation Report.

2 To be completed for the Performance and Evaluation Report or a Revised Annual Statement.

3 PHAs with under 250 units in management may use 100% of CFP Grants for operations.

Page 1 form HUD-50075.1 (07/2014)

Grant Type and Number Capital Fund Program Grant No:

Replacement Housing Factor Grant No:

Date of CFFP:

FFY of Grant:

FFY of Grant Approval:

Line Summary by Development Account Total Estimated Cost Total Actual Cost 1

Original Revised2 Obligated Expended 1 Total non-CFP Funds

2 1406 Operations (may not exceed 20% of line 15) 3

3 1408 Management Improvements

4 1410 Administration (may not exceed 10% of line 15)

5 1480 General Capital Activity

6 1492 Moving to Work Demonstration

7 1501 Collaterization Expense / Debt Service Paid by PHA

8 1503 RAD-CFP

9 1504 RAD Investment Activity

Hard

RAD-CPT

Debt Reserves

Bond Debt Obligation

Loan Debt Obligation

Post Audit Adjustment

10 1505 RAD-CPT

11 9000 Debt Reserves

12 9001 Bond Debt Obligation paid Via System of Direct Payment 13 9002 Loan Debt Obligation paid Via System of Direct Payment

14 9900 Post Audit Adjustment

Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Office of Public and Indian Housing Capital Fund Financing Program OMB No. 2577-0157

Expires 1/31/2027

1 To be completed for the Performance and Evaluation Report.

2 To be completed for the Performance and Evaluation Report or a Revised Annual Statement.

3 PHAs with under 250 units in management may use 100% of CFP Grants for operations.

* I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties (18 U.S.C. § 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 5802)

Page 2 form HUD-50075.1 (07/2014)

Final Performance and Evaluation Report

Part I: Summary PHA Name: Grant Type and Number

Capital Fund Program Grant No:

Replacement Housing Factor Grant No:

Date of CFFP:

FFY of Grant:

FFY of Grant Approval:

Type of Grant Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: )

Performance and Evaluation Report for Period Ending:

Line Summary by Development Account Total Estimated Cost Total Actual Cost 1

Original Revised 2 Obligated Expended

15 Amount of Annual Grant:: (sum of lines 2 - 14)

16 Amount of line 15 Related to LBP Activities

17 Amount of line 15 Related Sect. 504, ADA, and Fair Housing Act Activities.

18 Amount of line 15 Related to Security - Soft Costs

19 Amount of line 15 Related to Security - Hard Costs

20 Amount of line 15 Related to Energy Conservation Measures

Signature of Executive Director * Date Signature of Public Housing Director Date

OMB No. 2577-0157 Expires 1/31/2027

Development Number General Description of Major Work Development Quantity Total Estimated Cost Total Actual Cost Status of Work Name/PHA-Wide Categories Account No.

Activities

Original Revised 1 Funds Funds Obligated2 Expended2

1 To be completed for the Performance and Evaluation Report or a Revised Annual Statement.

2 To be completed for the Performance and Evaluation Report.

Page 3 form HUD-50075.1 (07/2014)

Part II: Supporting Pages PHA Name: Grant Type and Number

Capital Fund Program Grant No: CFFP (Yes/ No):

Replacement Housing Factor Grant No:

Federal FFY of Grant:

H19159 Cross-out R

Expires 1/31/2027

Development Number General Description of Major Work Development Quantity Total Estimated Cost Total Actual Cost Status of Work Name/PHA-Wide Categories Account No.

Activities

Original Revised 1 Funds Funds Obligated2 Expended2

1 To be completed for the Performance and Evaluation Report or a Revised Annual Statement.

2 To be completed for the Performance and Evaluation Report.

Page 4 form HUD-50075.1 (07/2014)

Part II: Supporting Pages PHA Name: Grant Type and Number

Capital Fund Program Grant No: CFFP (Yes/ No):

Replacement Housing Factor Grant No:

Federal FFY of Grant:

Expires 1/31/2027

1 Obligation and expenditure end dated can only be revised with HUD approval pursuant to Section 9j of the U.S. Housing Act of 1937, as amended.

Page 5 form HUD-50075.1 (07/2014)

Part III: Implementation Schedule for Capital Fund Financing Program PHA Name: Federal FFY of Grant:

Development Number Name/PHA-Wide

Activities

All Fund Obligated (Quarter Ending Date)

All Funds Expended (Quarter Ending Date)

Reasons for Revised Target Dates 1

Original Obligation End

Date

Actual Obligation End Date

Original Expenditure End Date

Actual Expenditure End Date

Expires 1/31/2027

1 Obligation and expenditure end dated can only be revised with HUD approval pursuant to Section 9j of the U.S. Housing Act of 1937, as amended.

Page 6 form HUD-50075.1 (07/2014)

Part III: Implementation Schedule for Capital Fund Financing Program PHA Name: Federal FFY of Grant:

Development Number Name/PHA-Wide

Activities

All Fund Obligated (Quarter Ending Date)

All Funds Expended (Quarter Ending Date)

Reasons for Revised Target Dates 1

Original Obligation End

Date

Actual Obligation End Date

Original Expenditure End Date

Actual Expenditure End Date

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FFY of Grant Approval FFY of Grant:

Original Annual Statement: Off

Reserve for DisastersEmergencies: Off

Revised Annual Statement revision no: Off

Performance and Evaluation Report for Period Endin: Off

Final Performance and Evaluation Report: Off

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File details come from the government source that posted it. Updated Mar 7, 2026.