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CDBG Handbook, Forms and Samples

CDBG Handbook, Samples and Forms

  • Download the CDBG Handbook For ease of reading, please open bookmarks in PDF.
  • Grant Services Contact Information

    For the most current information please download the Grant Services Duties and Responsibilities list directly here.

    **Please note: Not all forms listed below are required to be filled out. If you have questions on certain forms, please contact Grant Services. Please also note, several forms on this page are now archived, but their form numbers remain listed for clarity purposes.


CDBG Forms

Citizen Participation

  • FORM 1: Letter Authorizing Firm to Conduct Public Meetings       doc | pdf

Procurement

  • FORM 1: Sample Request for Proposal       doc
  • FORM 2: Sample Request for Proposal Publication       doc | pdf
  • FORM 3: Proposal Evaluation       doc | pdf
  • FORM 4: Sample Letter to Short Listed Firms       doc | pdf
  • FORM 5: Sample Letter to Firms Not Short Listed       doc | pdf
  • FORM 6: Interview Evaluation and Scoring Form       doc | pdf
  • FORM 7: Sample Letter to Selected Firm       doc | pdf
  • FORM 8: Sample Letter to Firm(s) Not Selected       doc | pdf
  • FORM 9: Sample Request for Qualifications       doc | pdf
  • FORM 10: Sample Request for Qualifications Publication       doc | pdf
  • FORM 11: Statement of Qualifications Evaluation       doc | pdf
  • FORM 12: Letter Short Listed Forms       doc | pdf
  • FORM 14: Interview Evaluation and Scoring Form       doc | pdf
  • FORM 16:  Letters to Firms not Selected       doc | pdf
  • FORM 17: Sample Invitation for Bid Publication      doc | pdf
  • FORM 18: Sample Bid Tabulation       doc | pdf
  • FORM 19: Cost Price Analysis       doc | pdf
  • FORM 20: Small Purchase Request for Quotation       doc | pdf

Environmental Review

  • FORM 1: Certificate of Exemption       doc
  • FORM 2: Certification of Categorical Exclusion (not subject to 58.5)       doc | pdf
  • FORM 3: Certification of Categorical Exclusion (subject to 58.5)       doc | pdf
  • FORM 4: Statutory Worksheet (2021)       pdf
  • FORM 5: Sample Notice of Intent to Request Release of Funds (2021)       doc
  • FORM 6: Request for Release of Funds and Certification       pdf
  • FORM 7: ER Agency Contact Listing & Document Guide  pdf
  • FORM 8: Format II Environmental Review Record        doc | pdf
  • FORM 9: Sample Notice of Finding No Significant Impact (2021)       doc
  • FORM 10: Notice to Public of No Significant Impact on the Environment and Notice to Public of Release of Funds (2021)       doc
  • FORM 11: Notice for Early Public Review of a Proposal to Support Activity in the 100-Year Floodplain or Wetland (2021)       doc
  • FORM 12: Notice of Explanation of Project Located in a Floodplain or Wetland       doc

Acquisition and Relocation

  • FORM 1: Acquisition File Checklist       doc | pdf
  • FORM 2: Property Acquisition/Relocation Questionnaire      doc | pdf
  • FORM 3: Initial Notice to Property Owner       doc | pdf
  • FORM 4: URA Brochure: When a Public Agency Acquires Your Property       pdf
  • FORM 4A: URA Brochure Receipt       doc | pdf
  • FORM 5: Property Appraisal Invitation       doc | pdf
  • FORM 5A: Property Appraisal Invitation Receipt       doc | pdf
  • FORM 6: Letter of Purchase Offer       doc | pdf
  • FORM 7: Waiver of Acquisition Rights with Full Donation After Appraisal       doc | pdf
  • FORM 8: Waiver of Acquisition Rights with Partial Donation After Appraisal       doc | pdf
  • FORM 9: Waiver of Acquisition Rights with Full Donation With No Appraisal       doc | pdf
  • FORM 10: Willing Buyer/Willing Seller Transaction Letter       doc | pdf

Financial Management

  • FORM 1: Federal Cash Control Register- Federal Fiscal Year     excel
  • FORM 2: Contract Obligation Control Ledger     excel
  • FORM 3: Contractor Expenditure Ledger     excel
  • FORM 4: Property Inventory Ledger     excel
  • FORM 5: Local Match Ledger     excel
  • FORM 6.4: Professional Service Providers       doc | pdf
  • FORM 8: Program Income-Quarterly Report       doc | pdf

Contract Development and Modification

  • FORM 1: Applicant/Recipient Disclosure/Update Report       pdf
  • FORM 1.5: Request for Conflict of Interest Exception       doc | pdf
  • FORM 2: Category 1 Modification Request Letter: Sample Grant Completion Extension       doc | pdf
  • FORM 3: Category 1 Modification Request Letter: Sample Request of Category 1 (other than time extensions) doc | pdf
  • FORM 4: Category 2 and/or Category 3 Modification Request Budget Modification       doc | pdf
  • FORM 5: Category 2 and/or Category 3 Modification Sample Request       doc | pdf
  • FORM 6: Category 2 and/or Category 3- Notice of Grant Modification: Sample Public Notice       doc | pdf
  • FORM 7: Category 3: Grant Modification Sample Resolution       doc | pdf

Civil Rights

  • FORM 2: Sample Fair Housing Ordinance       doc | pdf
  • FORM 4: Sample Drug-Free Workplace Ordinance       doc | pdf
  • FORM 5: Resident Employment Opportunity Data       doc | pdf
  • FORM 6: Certification for Business Concerns Seeking Section 3 Preference in Contracting       doc | pdf
  • FORM 7: Examples of Efforts to Award Contracts to Section 3 Businesses       doc | pdf
  • FORM 8: Section 3 Compliance Form       doc | pdf
  • FORM 9: Certification of Accessibility       doc | pdf
  • FORM 10: Community Sample Language Access Plan for Limited English Proficiency Persons       doc

Labor Standards

  • FORM 2: Initial Wage Determination Assignment Notice       doc | pdf
  • FORM 3: Pre-Bid Conference Sign-In Sheet       doc | pdf
  • FORM 4: Pre-Bid Conference Guide Acknowledgement       doc | pdf
  • FORM 5: Wage Determination Lock-In Notice       doc | pdf
  • FORM 6: Contractor/Subcontractor Verification       doc | pdf
  • FORM 7: Contract Award       doc | pdf
  • FORM 8: Preconstruction Conference Acknowledgement       doc | pdf
  • FORM 9: Wage/Fringe Benefit Certification        excel | pdf
  • FORM 10: Contractor's Certification       doc | pdf
  • FORM 11: Subcontractor's Certification       doc | pdf (updated March 2019)
  • FORM 12: Notice to Start Construction       doc | pdf
  • FORM 14: Record of Employee Interview Instructions and Form HUD-11 (English 2021)     pdf
  • FORM 14: Record of Employee Interview Instructions and Form HUD-11 (Spanish 2021)     pdf
  • FORM 15: Final Wage Compliance Report       doc | pdf
  • FORM 16: Final Inspection/Project Completion        doc | pdf
  • FORM 17: Sample In-Kind Volunteer Labor Letter       doc | pdf
  • FORM 18: Persons Approved to Complete In-Kind Donation       excel | pdf
  • FORM 19: In-Kind Donation Tracking Sheet       excel | pdf

Closeout and Monitoring

  • Closeout Monitoring Form 1: Grantee’s Acknowledgments & Certifications Monitoring & Audit      pdf
  • Closeout Monitoring Form 2: Financial Settlement/Expenditure & Administrative Closeout Report pdf