HUD2996_OZ_Certification_Form.pdf

OMB 2501-0036

Expiration Date: 03-31-2023

Certification for Opportunity Zone Preference Points I certify that the information provided on this form and in any accompanying documentation is true and accurate. (Type or clearly print the following information)

Applicant Organization: PRE-POPULATED FROM SF-424

Name of the Federal Program to which the applicant is applying:

PRE-POPULATED FROM SF-424

Opportunity Zone Census Tract(s) which the proposed activities/projects will benefit:

Designated Opportunity Zone Census Tracts can be found at: https://www.cdfifund.gov/Pages/Opportunity-Zones.aspx using the “List of designated Qualified Opportunity Zones”. Please provide the full 11-digit census tract number. (ex: 06067001101)

The application meets which of the following criteria (please select one):

The proposed activities/projects will occur solely within the Opportunity Zone Census Tract(s) listed above.

The proposed activities/projects will occur within the Opportunity Zone Census Tract(s) listed above and other communities.

The proposed activities/projects will occur outside Opportunity Zone Census Tracts, but substantial and direct benefits will accrue within the Opportunity Zone Census Tracts listed above.

Note: Projects which substantially and directly benefit Opportunity Zone Census Tracts, but which do not consist of activities delivered within Opportunity Zone Census Tracts may be considered for competitive preference. If applicable, the respective Federal Agency will clearly define “substantially and directly” in the relevant funding announcement.

Estimated Funding Allocations Estimate a percentage of the total dollar amount of awarded federal funding that would result in a direct benefit within the Opportunity Zone Census Tracts listed above:

76% - 100%

51% - 75%

26% - 50%

11% - 25%

1% - 10%

HUD Form 2996

Provide a narrative explaining and/or reference the section in the application that explains how the project will support public and private investment in urban and economically distressed areas, specifically qualified Opportunity Zones (300-word limit):

Example: “The Main Street project described in this application will stimulate economic opportunity and mobility, encourage entrepreneurship, expand quality educational opportunities, and promote workforce development for those families residing within the XYZ Opportunity Zone.”

Check the following boxes that accurately reflect the nature or purpose of the proposed project:

Access to Capital

Asset Building

Business Assistance

Community Capacity Building

Economic Development

Education

Healthy Food Access

Health

Housing

Human Services and Family Support

Community Infrastructure

Public Safety

Workforce Development

Low Income Housing Tax Credit (LIHTC) or other rent restricted housing

Market rate housing

Industrial development

Commercial or retail development

Other business development

“Above ground” infrastructure – streets, sidewalks, lighting

“Below ground” infrastructure – water, sewer, gas, electric

Schools or other educational facilities

Hospitals or other health care facilities

Name: PRE-POPULATED FROM SF-424

Title: PRE-POPULATED FROM SF-424

Organization: PRE-POPULATED FROM SF-424

Signature:

Date (MM/DD/YYYY): PRE-POPULATED FROM SF-424

Public reporting burden for this collection of information is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. This information is being collected to determine preference points in certain competitive federal grants and technical assistance applications. This information will be used to strategically target investment in communities designated as Opportunity Zones. This information is required to obtain the benefit of the preference point. The information collected is not confidential