Home Contract Amendment Request Form
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2HOME CONTRACT AMENDMENT REQUEST FORM
This is a required form to be submitted with a contract amendment request. All items listed on the form are
requirements of the Nebraska HOME program to be considered for your contract amendment.
HOME Grant #
HOME Grantee
DED Program Representative
Person Completing this form
Name
Contact Number
Email
Please complete for each type of amendment requested.
Extension of Contract End Date
Original Contract End Date
Current Contract End Date including any previously approved extensions
Proposed Contract End Date
Required Attachments
Attachment 1: A letter from the Authorized Official stating the following:
1.
Certification that the governing body has approved the extension;
2.
Identification and reasons for the proposed amendment; including
a.
Changes to the nature of the project requiring the amendment;
b.
Steps being taken to avoid any future amendment requests for the same reasons.
3.
If additional local matching funds are required as a result of this extension, certification that such funds are
available.
Attachment 2: A revised implementation schedule showing when major milestones will be completed for each
activity.
Decrease in proposed accomplishments – request for DED approval
Original Proposed Accomplishments
Current Proposed Accomplishments
Required Attachments
Attachment 1: A letter from the Authorized Official stating the following:
1.
Certification that the governing body has approved the decrease in proposed accomplishments;
2.
Identification and reasons for the proposed amendment; including
a.
Changes to the nature of the project requiring the amendment;
b.
Steps being taken to avoid any future amendment requests for the same reasons.
3.
If additional local matching funds are required as a result of this decrease, certification that such funds are
available.
Attachment 2: A revised implementation schedule showing when major milestones will be completed for each
activity.
Amendment to housing program guidelines, tenant selection process and/or lease agreement – request for
DED approval
Required Attachments
Attachment 1: A letter from the Authorized Official stating the following:
1.
Certification that the governing body has approved the amendment;
2.
Identification and reasons for the proposed amendment;
3.
If additional local matching funds are required as a result of this amendment, certification that such funds
are available.
Attachment 2: If the amendment will affect major milestones, a revised implementation schedule showing when
major milestones will be completed for each activity
Attachment 3: A complete copy of the proposed revised housing program guidelines, tenant selection process
and/or lease agreement.
NE HOME Contract Amendment Request Form
Page 1 of 2
August 20, 2009
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