Form Hud-92015ca - Application For Capital Advance Summary Information

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U.S. Department of Housing

OMB Approval No. 2502-0267

Supportive Housing for the Elderly Section 202

(exp. 9/30/2010)

and Urban Development

Application for Capital Advance

Office of Housing

Summary Information

Federal Housing Commissioner

Public reporting burden for this collection of information is estimated to average 30 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.

HUD

202 Project Number

PRAC Number

Use Only

1. Sponsor's Name(s), Address(es) & Telephone Number (s)

2. Minority Sponsor Designation. A minority sponsor is one in which at least

51 percent of the board members are minority.

Is this sponsor a minority applicant?

Yes

If "Yes," place the numeric code as shown below in this box

Codes: 2 - Black; 3 - Native American; 4 - Hispanic;

5 - Asian Pacific; 6 - Asian Indian

1a. Sponsor is a "grassroots" organization

Yes

3a. Address of Site

3b.Will project be located within the boundaries of a Federally-designated: (1) Empowerment

Zone, (2) Enterprise Community, (3) Urban Enhanced Enterprise Community, (4) Strategic

Planning Community, or (5) Renewal Community?

(Contact local HUD Office for information on these designated areas.)

Yes

If "Yes," please place the appropriate number as shown above in this box

4a. Congressional District

5. Type of Area

6. Capital Advance Amount Requested

7. Project Rental Assistance Contract

Amount Requested

Metropolitan

4b. Census Tract

Non-metropolitan

8. Total No. of

8a. Number & Type of Resident Units Proposed

8b. Resident Manager's Unit (check appropriate type)

Efficiency

One bedroom

Efficiency

One bedroom

Two bedroom

202 Units

9. Number of Buildings

10. Type of Project

Year Built (yyyy)

11. Type of Building(s)

New Construction

Row/Townhouse

Semi-detached

Rehabilitation

Walk-up

Detached

Acquisition

Elevator

12. Number of Stories

13. Number of Parking Spaces

14. Check utilities and services not included in the rent and to be paid directly by the tenant.

Electric

Water

Heat

Gas

16a. Community Spaces to be included in Project

16b. Mixed-Finance or Mixed-Use Project

15. Off-Site Facilities

For Additional Units

Public

At Site

Feet from Site

Water

Yes

Sewer

No. of Additional Units __________

Paving

Gas

Electric

18. Mark one box

Name, Address & Telephone Number

17. Unusual Site Features

Consultant

None

Poor Drainage

Cuts

Retaining Walls

Agent

Fill

Rock Foundations

Authorized

Erosion

High Water Table

Representative

Other

(specify)

19. If Sponsor is applying for more than one HUD program from the SuperNOFA, indicate which application(s) contain the forms with original signatures.

Program Name

Form

___________________________________________________________________________________________

___________________________

___________________________________________________________________________________________

___________________________

___________________________________________________________________________________________

___________________________

20. Sponsor's Attorney (name, address & telephone number)

By (Signature of Sponsor's Authorized Representative)

Type in Name

Type in Title