Form Hud-2880 - Applicant/recipient Disclosure/update Report

Download a blank fillable Form Hud-2880 - Applicant/recipient Disclosure/update Report in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Hud-2880 - Applicant/recipient Disclosure/update Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Applicant/Recipient
OMB Approval No. 2510-0011 (exp. 12/31/2015)
U.S. Department of Housing
and Urban Development
Disclosure/Update Report
Instructions
.
See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2.)
(
Applicant/Recipient Information
Indicate whether this is an Initial Report
or an Update Report
1. Applicant/Recipient Name, Address, and Phone (include area code):
2. Social Security Number or
Employer ID Number:
4. Amount of HUD Assistance
3. HUD Program Name
Requested/Received
5. State the name and location (street address, City and State) of the project or activity:
Part I Threshold Determinations
1. Are you applying for assistance for a specific project or activity? These
2. Have you received or do you expect to receive assistance within the
terms do not include formula grants, such as public housing operating
jurisdiction of the Department (HUD) , involving the project or activity in
subsidy or CDBG block grants. (For further information see 24 CFR Sec.
this application, in excess of $200,000 during this fiscal year (Oct. 1 -
4.3).
Sep. 30)? For further information, see 24 CFR Sec. 4.9
Yes
No
Yes
No.
If you answered “No” to either question 1 or 2, Stop! You do not need to complete the remainder of this form.
However, you must sign the certification at the end of the report.
Part II Other Government Assistance Provided or Requested / Expected Sources and Use of Funds.
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit.
Department/State/Local Agency Name and Address
Type of Assistance
Amount
Expected Uses of the Funds
Requested/Provided
(Note: Use Additional pages if necessary.)
Part III Interested Parties.
You must disclose:
1.
All developers, contractors, or consultants involved in the application for the assistance or in the planning, development, or implementation of the
project or activity and
2. any other person who has a financial interest in the project or activity for which the assistance is sought that exceeds $50,000 or 10 percent of the
assistance (whichever is lower).
Alphabetical list of all persons with a reportable financial interest
Social Security No.
Type of Participation in
Financial Interest in
in the project or activity (For individuals, give the last name first)
or Employee ID No.
Project/Activity
Project/Activity ($ and %)
(Note: Use Additional pages if necessary.)
Certification
Warning: If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Title 18 of the
United States Code. In addition, any person who knowingly and materially violates any required disclosures of information, including intentional non-
disclosure, is subject to civil money penalty not to exceed $10,000 for each violation.
I certify that this information is true and complete.
Signature:
Date:
(mm/dd/yyyy)
X
Form HUD-2880 (3/13)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 3