Form Hud-40093-A - Attachment A To The Funding Approval And Home Investment Partnerships Agreement

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Attachment A to the Funding
U.S. Department of Housing
OMB Approval No. 2501-0013
(exp. 11/30/2001)
and Urban Development
Approval and HOME Investment
Office of Community Planning
Partnerships Agreement
and Development
Title II of the National Affordable Housing Act
This form must be used if 1) the State is transferring funds to a new Jurisdiction or 2) if the City/Urban County is
declining HOME Funds. Send the form via fax (202-708-1744) or pouch mail to Headquarters, OAHP, Room 7164,
ATTN: Director, Financial and Information Services Division.
Check one box only.
1. The State is transferring HOME funds to a new Jurisdiction in order for them to meet the minimum
participation threshold amount to become a Participating Jurisdiction (PJ):
The State of
(Enter the name of the State that the HOME funds are being transferred from)
Grant Number
(Enter the State Grant Number)
(and the FY(yyyy))
is transferring $
to
(Enter the amount of HOME funds being transferred)
(Enter the name of the PJ receiving the HOME Funds)
Grant Number
.
(Enter the PJ Grant Number)
(and the FY(yyyy))
Revised obligation for the State
$
(original allocation minus the amount transferred)
Revised obligation for the new PJ $
(original allocation plus the amount transferred)
If the State and new Participating Jurisdiction are overseen by different Field Offices:
State’s Field Office
New Jurisdiction’s Field Office
2. The City/Urban County is declining HOME funds.
The City/Urban County of
is declining the FY (yyyy)
(Enter the name of the PJ that declined)
allocation of $
.
Revised obligation for the State
$
.
If the declining Jurisdiction and the State are overseen by different Field Offices:
State’s Field Office
Declining Jurisdiction’s Field Office
Prepared by
at
in
(Name)
(Phone/email)
(Field Office)
form HUD-40093-A
(03/30/2000)

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