tenant based rental assistance application city of mesa

Tenant Based Rental Assistance Application City of Mesa Housing and Community Development 20 East Main Street, Mesa, Arizona 85201

Tenant Based Rental Assistance (TBRA)

Application

CityofMesaDepartmentofHousingandCommunityDevelopment

20EastMainStreet,Suite250Mesa,Arizona85201Phone:(480)644‐3536

TDD/TDY:711

Online:http://mesaaz.gov/

HCD's Tenant Based Rental Assistance Program provides several forms of housing rental assistance for residents in the City of Mesa for low- and moderate-income households. The program’s primary purpose is to expand the supply of affordable housing through rental assistance, security and utility deposit assistance.

Last Updated: 11/05/2019


Page1

http://mesaaz.gov/residents/housing‐community‐development

PartI

Date: 20

I. GeneralInformation

OrganizationName: StreetAddress:City:State:ZipCode:Telephone#: FaxNumber:

ContactPerson:Title:Email:

APPLICANT/SPONSORTYPE:

Municipality Non‐Profit

II. ProjectDescription

Describethetypeofproposalyouaresubmitting(checkallthatapply):

TenantBasedRentalAssistance(TBRA)

HOME Investment Partnership Program Application

City of Mesa Housing and Community Development

HOME Program Tenant Based Rental Assistance (TBRA)


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Clearly and objectively describe a summary of the program you propose to undertake. (Add additional sheets as necessary.)

$

Application fiscal year:

Amount of HOME Funds requested:

Other funding sources if applicable (please specify): $

$

$

$Total Project Cost

Have necessary funds been budgeted? Yes No

If you received prior year funding, what dollar amount was received? $

Will this program be undertaken if HOME funds are not available or the amount granted is less than requested? Yes No Have provisions been made to this effect? Explain:

III. Program Schedule (Provide detailed timeline in Attachment C)

Date program will begin:

Date program will be completed:



List the activities' measurable goals (numeric) and objectives for this activity. (Add additional sheets as necessary.)

Numberofhouseholdstobeservedbythisactivity:

Target area median income to be served: 30% 40% 50% 60% 80%

Program Budget

BudgetItem HomeFundsRequested ExplanationofCost

Who will be in charge of planning, implementing, follow‐up, and seeing that the program is completed as planned?

Name/Title:

PhoneNumber:

EmailAddress:

Please describe the type of financial management system that you have. (Add additional sheets as necessary.)

Total:

Who will be responsible for keeping appropriate records concerning HOME grant funding expenditures and preparing the monthly reports?

Name/Title:

PhoneNumber:

EmailAddress:



I certify that the activities to be undertaken herein by the applicant are set forth in the 5- Year Consolidated Plan and specific project activity for the current program year is set forth in the Annual Action Plan.

I have read the program guidelines and am willing and capable of compliance. I am also authorized to apply for funds.

Date

Date

Submitted By:

Certifying Officer or Executive Director:

Board Chair: Date

Tenant Based Rental Assistance Application Guidelines City of Mesa Housing and Community Development 20 East Main Street, Mesa, Arizona 85201

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Program Schedule – Attachment C

Work to be Completed Start DateFirst Quarter Milestones:

Second Quarter Milestones:

Third Quarter Milestones:

Fourth Quarter Milestones:

http://mesaaz.gov/residents/housing-community-development


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Part II

HOME Financial Assessment Section FY 2018/2019

HOME Investment Partnership Program Application

HOME Program Tenant Based Rental Assistance

New areas of emphasis for FY18/19:

• Assessing the financial health of your organization• Program budget vs. your organization’s overall budget• Program monitoring• Making sure your award is fully expended by 6/30/19

Items to include in your application:

• Copy of your most recent single audit or financial statements (required fororganizations that receive $750,000 or more in federal funds). If you do not meet thisaudit threshold, please provide last fiscal year’s financial statements.

• Any written financial policies and procedures for your organization• Program and agency budgets• If you received any audit finding, include a copy of the corrective action plan. Audits

include:

o Single Audito HUDo OIGo Any other



Financial Section

1. Attach your most recent single audit or financial statement. For entities that receive$750,000 or more in federal funding, a single audit is required. For entities underthis threshold, attach your most recent financial statement.

2. In the last two years, have you received an audit or monitoring finding (single audit,HUD, Office of Inspector General, or any other federal, state, or local agency? Yes No (If yes, attach your corrective action plan.)

3. Agencies that received federal funds are subject to the uniform administrativerequirements of 2CFR part 200. Attach your organization’s financial policies andprocedures (or the sections) that include, but are not limited to, the followinginformation:

a. Accounts payable and accounts receivable procedures

b. Purchasing procedures and standards

c. Bank reconciliation

d. Internal controls

e. Conflict of interest statement

f. Separation of duties

4. Budget for this application activity/program only (Attachment A).

Funding Source/Revenue:

CDBG – City of Mesa Award/Request $

Other Federal Grants (total) $

Local/State Grants (total) $

Donations/Fund Raising $

Other (please specify) $

Total ACTIVITY/PROGRAM Funding Sources $



Funding Use/Expenses

Funding Use/Expenses

City of Mesa HOME Funds

Other Funding Sources

Total Activity Expense

Administrative Expenses $ $ $

Personnel/Salary $ $ $

Fringe Benefits $ $ $

Rent/Utilities Space $ $ $

Advertising $ $ $

Staff Training $ $ $

Staff Travel $ $ $

Materials and Supplies $ $ $

Professional and Outside Services $ $ $

Rental Assistance $ $ $

SecurityDepositAssistance $ $ $

Utility Deposit Assistance $ $ $

Total Administrative Expenses $ $ $



Pogram Revenues

Committed Funds

Individual Contributions $

ABC Foundation $

Other Foundations $

Government Grant

Please identify grant by title:

$

In‐kind Donations $

Fundraising Events/Products $

Other Agency Funds Assigned $

Pending Requests

City of Mesa HOME Request $

DEF Foundations $

Other Foundations $

Total Revenues $

If you included committed revenue funds from other sources for this program in the above budget, you must attach the confirmation of commitment from each source (i.e., commitment letter, award documents, etc.).


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5. Total Agency Funding Resources Budget

Funding Source Current Year

ProposedYear

CDBG – City of Mesa Award/Request $ $

Other Federal Grants (total) $ $

Local/State Grants (total) $ $

Donations/Fund Raising $ $

Other Please specify:

$ $

Total Agency Funding Sources $ $

I certify that this information provided is correct to the best of my knowledge and no deliberate misrepresentation has been put forth herein.

My signature indicates that I have read the program guidelines and am willing and capable of compliance. I am also authorized to apply for funds.

Date

Date

Submitted By:

Certifying Officer or Executive Director:

Board Chair: Date



DepartmentofHousingandCommunityDevelopmentResourcesandUsefulContacts

GeneralHCDInformation,Applications&Forms

Ray ThimeschRa’Chel’Ni Mar’Na

HCDCommunityRevitalization&DevelopmentManagementTeam

DevelopmentProjectManager–RayThimeschHOMEProgramManager–Ra’Chel’NiMar’NaNSPProgramManager‐RayThimeschCDBGProgramManager–

[email protected],(480)644‐[email protected],(480)644‐3020

HCDCommunityRevitalization&DevelopmentStaff

HOMEProgramSpecialist,MauriceBrundidgeCDBGProgramSpecialist,DeannaGroganCDBGProgramSpecialist,ConstanceBockman

[email protected],(480)644‐[email protected],(480)644‐[email protected],(480)644‐3364

FairHousing Andrea Alicoate [email protected] (480)644‐5034

EnvironmentalReviewRayThimeschMauriceBrundidge

[email protected],(480)644‐2967

CBDG Ray Thimesch [email protected] , (480) 644-54215867

CHDOCertification Ra’Chel’NiMar’[email protected],(480)644‐3020

HomebuyersAssistanceDownPayment&ClosingCostAssistance

MauriceBrundidge [email protected],(480)644‐2967

Section106HistoricReview RayThimesch [email protected],(480)644‐5421

CityofMesaConsolidatedPlan

RayThimeschRa’Chel’NiMar’Na



tenant based rental assistance application city of mesa

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