"Alabama Cdbg Application Summary Form" - Alabama

Alabama Cdbg Application Summary Form is a legal document that was released by the Alabama Department of Economic and Community Affairs - a government authority operating within Alabama.

Form Details:

  • Released on March 1, 2019;
  • The latest edition currently provided by the Alabama Department of Economic and Community Affairs;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Alabama Department of Economic and Community Affairs.

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FOR ADECA USE ONLY
Grant Number:
ALABAMA CDBG APPLICATION SUMMARY FORM
Select One
________________ Select One (if applicable): ___________________________
:
Community Name:
Chief Elected Official:
Mailing Address:
STREET
AL
CITY
AL
ST
ZIP
Phone Number:
E-mail Address:
FEIN:
COUNTY:
DUNS No.:
SAM.gov Expiration Date:
Amount Requested:
$
2010 Census Population:
Cash: $
Source:
Local Match:
$
In-Kind: $
Source:
Non-Local Funds:
$
Source:
Federal Congressional District: __________ / __________
State District:
(Senate) ______ / ______ / ______
(House) ______ / ______ / ______
Total Beneficiaries:
No. of LMI Bnf:_____________
% of LMI Bnf:
Prevention of Slum and Blight: ______________
No. of Units Rehab/Demo:
Contact Person/Grant Writer:
Firm or Organization:
Mailing Address:
City, State & Zip:
CITY
STATE
ZIP
/
Phone / E-mail Address:
Select Activity(ies):
Activity 1: ___________________
Activity 2: ___________________ Activity 3: __________________
Other/Additional Activity(ies):
__________________________________________________________
For ADECA Use Only
 Single/Primary (CM)
 Comprehensive (CP)
Minority  Yes  No Black Belt  Yes  No
 Residential Rehab (RR)
 Special Fund (SF)
Completed
AS 400
IDIS
Date
Date
Date
>>
<<
PLEASE SEE NEXT PAGE TO COMPLETE APPLICATION FORM
FOR ADECA USE ONLY
Grant Number:
ALABAMA CDBG APPLICATION SUMMARY FORM
Select One
________________ Select One (if applicable): ___________________________
:
Community Name:
Chief Elected Official:
Mailing Address:
STREET
AL
CITY
AL
ST
ZIP
Phone Number:
E-mail Address:
FEIN:
COUNTY:
DUNS No.:
SAM.gov Expiration Date:
Amount Requested:
$
2010 Census Population:
Cash: $
Source:
Local Match:
$
In-Kind: $
Source:
Non-Local Funds:
$
Source:
Federal Congressional District: __________ / __________
State District:
(Senate) ______ / ______ / ______
(House) ______ / ______ / ______
Total Beneficiaries:
No. of LMI Bnf:_____________
% of LMI Bnf:
Prevention of Slum and Blight: ______________
No. of Units Rehab/Demo:
Contact Person/Grant Writer:
Firm or Organization:
Mailing Address:
City, State & Zip:
CITY
STATE
ZIP
/
Phone / E-mail Address:
Select Activity(ies):
Activity 1: ___________________
Activity 2: ___________________ Activity 3: __________________
Other/Additional Activity(ies):
__________________________________________________________
For ADECA Use Only
 Single/Primary (CM)
 Comprehensive (CP)
Minority  Yes  No Black Belt  Yes  No
 Residential Rehab (RR)
 Special Fund (SF)
Completed
AS 400
IDIS
Date
Date
Date
>>
<<
PLEASE SEE NEXT PAGE TO COMPLETE APPLICATION FORM
Project Location – Street addresses and zip code(s) required even if town-wide project
(Include street name(s) with number (or range), city and zip – if address is unknown use closest location’s zip code):
Brief Description
:
(Include activities, beneficiaries, LMI, location, etc.; / include companies, jobs, etc. for ED projects)
Procurement
:
Has the Applicant competitively procured the professional services of Grant Writer and Engineer for
this project (to include this project)?
Grant Writer:
Yes
No
N/A
Engineer:
Yes
No
N/A
If Yes: Provide documentation
If No:
Please note that the Grant Writer/Engineer providing professional services for this project
will be prohibited from bidding on this project should this project be awarded.
N/A:
Procurement of professional services is not required for Regional Planning Commissions,
County Engineers, etc.
Audit Information
(Include copy of most recent audit or a professionally prepared financial statement)
YEAR: _________
Revised 3/2019
CDBG Application
State of Alabama
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