Form Hud-92016-Ca-Application For Capital Advance Summary Information February 2001
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1
2Supportive Housing for Persons with Disabilities
U.S. Department of Housing
OMB Approval No. 2502-0462
(exp.6/30/2002)
and Urban Development
Section 811
Office of Housing
Application for Capital Advance
Federal Housing Commissioner
Summary Information
For HUD
HUD Project Number
PRAC Number
Use Only
Minority Sponsor Designation: A minority sponsor is one in which at least
1. Name(s), Address(es), Contact Person, and Telephone Number(s) of Sponsor(s)
2.
51 percent of the board members are minority.
Yes
No
Is this sponsor a minority applicant?
If "Yes," identify by numeric code as shown below ................
Codes: 2 - Black;
3 - Native American
4 - Hispanic;
5 - Asian Pacific
6 - Asian Indian
3a. Location of Site (city & State)
Will project be located within the boundaries of a Federally-designated: (1) Empowerment
3b.
Zone, (2) Enterprise Community, (3) Urban Enhanced Enterprise Community, or
(4) Strategic Planning Community?
(Contact local HUD Office for information on these designated areas.)
Yes
No
4a. Congressional District
5. Capital Advance
If "Yes," please indicate appropriate number as shown above.
Amount Requested
4b. Census Tract
$
6. Project Rental Assistance Contract Amount Requested
7. Application Contains
9a. Occupancy Type
9b.Restricted Occupancy Requested
Yes
Evidence of Site Control
Physically Disabled
$
No
Identification of Site
Developmentally Disabled
Note: For a group home(s)in 10. below, include the
number of disabled residents in both the "Total
Chronically Mentally Ill
If "Yes," identify subcategory
8. Type of Construction
Units" and the "Total Disabled Residents" catego-
New Construction
Mixed Occupancy
_______________________
ries. For an independent living project(s), include
Rehabilitation
Identify Categories
Resident Manager unit, if applicable, in the "Total
Units" category.
Acquisition
________________________
_______________________
Project Type & Number of Units/Residents Proposed
10.
a. Group Home
No. of
Resident Mgr.
Site
Disabled
Unit (Y/N)
Address
Residents
#1
#2
#3
#4
Independent Living Project
b.
Units by No.
Site
of Bedrooms
Total Disabled
Resident Mgr.
Total
Address
0
1
2
3
Units
Residents
Unit (Y/N)
Units
#1
#2
#3
#4
Condominium
c.
Units by No.
Site
of Bedrooms
Total Disabled
Resident Mgr.
Total
Address
0
1
2
3
Units
Residents
Unit (Y/N)
Units
#1
#2
#3
#4
Note: If an elevator structure in b or c above, indicate by placing an "E"
next to the total number of units for each applicable site.
Totals
Units (Section 811)
Disabled Residents
Mixed Finance or Mixed Use Project for Additional Units
Sites
Yes
No
# of Add'l Units _______
form HUD-92016-CA (02/2001)
ref Handbook 4571.2
Previous editions are obsolete
Page 1 of 2
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