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AGENDA PACKET_2021-11-02
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AGENDA PACKET_2021-11-02
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EXHIBIT 2 <br />52 <br />AppendixH <br />CY2021HousingChoiceVoucherProgram <br />Application for $110 Million Set-Aside for Category 2b Portability; 3 Project-Based Vouchers; 4 - <br />HUD-VASH;and/or5Lower-than-average Leasing. <br />NameofPHA: <br />PHANumber:_________________________________________ <br />ExecutiveDirector: <br />CHECKALLBOXES THATAPPLY <br />Category2b:Portability(Pleasealsochecka.and/orb.belowasapplicable): <br />a.RegularHCVProgram,and/or <br />b.MainstreamVouchers <br />Category3:Project-BasedVouchers. <br />Category4:HUD-VASH(Pleasealsocheck a.and/orb.below,asapplicable):a.PerUnit <br />Cost Increase: PHAs whose program-wide funded CY 2021 HAP PUC is less than their <br />current HUD-VASH HAP PUC based on their latest HUD-VASH HAP expenses in CY <br />2020,and/or <br />b. Leasing Increase: PHAs whose total HUD-VASH leasing for CY 2021 will <br />exceed the leasing level included in their renewal funding plus the leasing that will be <br />supportedbytheRNPandHUD-HeldProgram Reserves. <br />Category5:Lower-than-averageLeasing. <br />DocumentationrequirementsandDeadlinesforeachoftheabovecategoriesarecontainedin <br />Paragraph13ofthisnotice. <br />ThiscertificationmustbesignedbytheappropriatePHAofficialandreturned. <br />Certification: I hereby certify that all the information stated herein, as well as any information provided in <br />the accompaniment herewith, is true and accurate. Warning: Anyone who knowingly submits a false claim or <br />makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, <br />fines,and civiland administrativepenalties(18U.S.C. §§287, 1001,1010,1012;31U.S.C.§3729,3802). <br />Signature of Executive Director and Date <br />ContactName and Phone Number <br /> <br />
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