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NCORR CDBG-DR URA Relocation Procedures 2-i

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Version 1.0 I January, 2019

URA Standard Operating

Procedure & Optional

Relocation Policy

State of North Carolina Office of Recovery and Resiliency

(NCORR)

For CDBG-DR Funds (Public Law 114-254, January 18, 2017 and Public Law 115-31, August 7, 2017)

NCORR CDBG-DR URA Relocation Procedures 2-ii

Table of Contents

1. Standard Operating Procedures for URA Compliance ....................................................................... 1

2. Temporary Relocation Assistance (TRA) – Optional Relocation Policy for Owner-Occupied Units ... 2

TRA Eligibility Requirements .................................................................................................. 2

Eligible TRA Expenses ........................................................................................................... 2

Ineligible TRA Expenses ........................................................................................................ 3

Application for TRA Assistance .............................................................................................. 4

Coordination of TRA Assistance ............................................................................................ 4

Relocation Advisory Services ................................................................................................. 5

Housing Referrals and Inspections ........................................................................................ 6

Moving Expenses ................................................................................................................... 7

Claim Forms for Assistance ................................................................................................... 7

Requesting Payments from NCORR ...................................................................................... 7

Return Notice ......................................................................................................................... 8

Owner Acknowledgement of TRA Payments ......................................................................... 8

TRA Appeals .......................................................................................................................... 8

3. Tenant Relocation under URA ............................................................................................................ 9

3.1 Displaced Tenants .................................................................................................................. 9

3.2 Non-Displaced Tenants ........................................................................................................ 10

3.3 Section 414 Displaced Tenants ........................................................................................... 10

3.4 Relocation Assistance Not Applicable .................................................................................. 10

4. Temporary Relocation - Tenant Occupied Units ............................................................................... 11

4.1 Eligibility Requirements ........................................................................................................ 11

4.2 Tenant Intake ....................................................................................................................... 11

4.3 Eligible Expenses ................................................................................................................. 12

4.4 Ineligible Expenses .............................................................................................................. 14

4.5 URA Notifications ................................................................................................................. 14

4.6 Coordination of Temporary Relocation ................................................................................ 15

4.7 Timeframe for Temporary Relocation .................................................................................. 15

4.8 Relocation Advisory Services ............................................................................................... 16

4.9 Housing Referrals and Inspections ...................................................................................... 16

4.10 Moving Expenses ................................................................................................................. 17

4.11 Claim Forms for Assistance ................................................................................................. 17

4.12 Requesting Payments from NCORR .................................................................................... 18

NCORR CDBG-DR URA Relocation Procedures 2-iii

4.13 Return Notices and Post-Relocation Lease ......................................................................... 19

4.14 Tenant Acknowledgement of Relocation Payments ............................................................ 19

4.15 Tenant Opt-Out Process ...................................................................................................... 20

4.16 Tenant Appeals .................................................................................................................... 20

5. Permanent Relocation for Tenants ................................................................................................... 21

5.1 Definition of a Displaced Person .......................................................................................... 21

5.2 Eligibility Requirements ........................................................................................................ 21

5.3 Tenant Intake ....................................................................................................................... 21

5.4 Notice of Eligibility & Move Notices ...................................................................................... 23

5.5 Summary of Relocation Assistance to be provided: ............................................................ 23

5.6 Eligible Expenses ................................................................................................................. 23

5.7 Ineligible Expenses .............................................................................................................. 24

5.8 Required Tenant Documentation ......................................................................................... 24

5.9 Relocation Advisory Services ............................................................................................... 24

5.10 Housing Referrals and Inspections ...................................................................................... 25

5.11 Calculation of permanent Replacement Housing Payments (RHP) .................................... 26

5.12 Moving Expenses ................................................................................................................. 26

5.13 Claim Forms for Assistance ................................................................................................. 26

5.14 Requesting Payments from NCORR .................................................................................... 27

5.15 Tenant Acknowledgement of Relocation Payments ............................................................ 28

5.16 Tenant Opt-Out Process ...................................................................................................... 28

5.17 Tenant Appeals .................................................................................................................... 28

6. Protocols for Locating Displaced Households ................................................................................... 29

7. Tenant Assistance Policy .................................................................................................................. 31

8. Move-In Notices ................................................................................................................................ 32

9. Fair Housing ...................................................................................................................................... 33

10. Reasonable Accommodations........................................................................................................... 34

11. Definitions .......................................................................................................................................... 35

12. Grievance Procedures ....................................................................................................................... 37

NCORR CDBG-DR URA Relocation Procedures

1

1. Standard Operating Procedures for URA Compliance

North Carolina Office of Recovery and Resiliency (NCORR) and its Subrecipients are currently

undertaking CDBG-DR funded Homeowner Recovery Programs that may involve temporary or

permanent relocation of program applicants and tenants In order to achieve compliance with the

Uniform Relocation and Real Property Acquisition Policies Act of 1970 (URA), as amended,

NCORR has adopted URA Standard Operating Procedures (SOPs) to include an Optional

Relocation Policy covering all probable types of relocation that may be necessary in

accomplishing CDBG-DR related activities.

The overall goal during the implementation of NCORR Homeowner Recovery Programs is to

minimize the displacement of owners and tenants residing in properties assisted by program-

sponsored rehabilitation, elevation, or reconstruction projects affected by Hurricane Matthew. In

addition, the purpose of the URA SOPs and Optional Relocation Policy is to provide program staff

and contractors with specific guidance for the implementation of the program activities in

compliance with URA and NCORR’s Optional Relocation Policy. It is important to note that

this policy does not include provisions for the implementation of the state’s voluntary

Acquisition or Buyout programs.

A copy of the NCORR Residential Anti-Displacement and Relocation Assistance Plan is included

as Appendix 38.

NCORR CDBG-DR URA Relocation Procedures 2

2. Temporary Relocation Assistance (TRA) – Optional Relocation

Policy for Owner-Occupied Units

Program activities shall be planned and carried out in a manner that minimizes hardships and

displacement of owner-occupants of storm damaged residences to be rehabilitated, elevated, or

reconstructed in accordance with NCORR’s Homeowner Recovery Program Policies and

Procedures. Due to the voluntary nature of NCORR’s Homeowner Recovery Programs, it is within

NCORR’s discretion whether to adopt an optional or temporary relocation policy for owner-

occupied units. In order to reduce the burden on affected homeowners, NCORR has made the

decision to provide Temporary Relocation Assistance (TRA) to owner-occupants when

rehabilitation, elevation, reconstruction, or environmental remediation activities cause the

temporary relocation of the owner-occupant of the property.

The purpose of the Optional Relocation Policy is to establish guidance for the implementation of

NCORR’s Temporary Relocation Assistance (TRA) program for owner-occupants as outlined in

the approved Action Plan.

TRA Eligibility Requirements

In order to be eligible for TRA assistance:

• The owner-occupant must have applied for and be eligible for assistance in one of

NCORR’s Housing Recovery Programs.

• One or more of the owner-occupants must be lawfully present in the United States

occupying the residence to be rehabilitated, elevated, or reconstructed.

• The owner-occupant must be required by the program to temporarily relocate to complete

the rehabilitation, elevation, reconstruction or environmental remediation of the damaged

structure assisted with CDBG-DR funding.

Lawful Presence

One of the owner applicants must be a citizen or be lawfully present in the United States. Before any assistance can be provided, a Declaration of Lawful Presence Form must be completed by the individual or household to be assisted.

Eligible TRA Expenses

All TRA assistance must be determined to be necessary and reasonable according to the

following policies. TRA assistance will be paid directly to the landlord of the temporarily

displaced household.

The total amount of TRA assistance to be provided to owner-occupants cannot exceed

$12,000. Recipients of TRA assistance are responsible for providing NCORR or its

Subrecipient with all documentation related to eligible expenses to include rental or storage

leases, bills, paid invoices, cleared checks, etc. Undocumented expenses will not be

reimbursed by NCORR or the Subrecipient. In addition, all anticipated expenses must

be approved in writing in advance of the applicant incurring the expense.


Eligible expenses, up to $12,000, include the following:

Moving Expenses: Moving expenses can be paid according to the Federal Highway

Administration’s Fixed Residential Moving Cost Schedule (based upon the number of rooms

of furniture to be moved) for the State of North Carolina (see Appendix 25) or

https://www.federalregister.gov/articles/2015/07/24/2015-18159/uniform-relocation-andreal-

property-acquisition-for-federal-and-federally-assisted-programs-fixed

One half the moving expenses will be paid when the displaced household moves into the

temporary unit with the remaining half being paid upon re-occupancy of the original unit. TRA

recipients are not required to submit receipts or paid invoices for fixed moving

payments.

Monthly Rent: Rent for the temporary unit will be paid on a monthly basis for the timeframe

approved by NCORR or their Subrecipient. Temporarily displaced households are

encouraged to stay with friends or relatives if the temporary relocation is for a short period of

time. If the displaced household chooses to live with family or friends during temporary

relocation, the rent must be reasonable and cannot exceed one half of HUD Fair Market Rent

for the county in which the unit is located. All rental agreements must be in writing and

approved by the Program in advance to ensure that the terms and conditions of the lease

agreement are necessary, reasonable, and consistent with the anticipated length of time

necessary for the construction activity outlined in the applicant’s scope of work. This includes

agreements to compensate friends or family members who house temporarily displaced

households.

Hotel Expenses: For short-term temporary relocation when staying with family/friends or

entering into a lease is not feasible, the program may reimburse hotel expenses if they are

necessary and reasonable. Program staff will obtain 3 quotes for hotels in the local area, the

lowest of which will establish the ceiling for hotel expenses to be reimbursed to the applicant.

Paid invoices for all hotel expenses must be documented and submitted to the Program.

Storage Unit: Every attempt will be made to locate an unfurnished rental unit which is

comparable in size so that the cost of a storage unit is unnecessary. If this is not possible or

if there are extenuating circumstances, the monthly costs of storage unit or on-site storage

container can be provided. All rental agreements for storage units must be in writing and

approved by the Program in advance

Ineligible TRA Expenses

Temporary Relocation Assistance that is duplicative to other sources.

Temporary Relocation Expenses Not Pre-Approved in Writing: Temporary relocation

expenses beyond the parameters outlined in this policy must be pre-approved by the Program

prior to the temporarily displaced household incurring the cost. TRA recipients will be

responsible to bear any cost not approved by the Program in advance.


Temporary Relocation Expenses Beyond Date of Re-Occupancy: Temporary relocation

expenses incurred beyond the agreed-upon relocation timeframe will not be reimbursed by

the Program. In no case shall TRA recipients be provided temporary relocation assistance

beyond thirty (30) days after construction activities triggering temporary relocation are

complete.

Undocumented Relocation Expenses: Claims for temporary relocation expenses submitted

without applicable source documentation are ineligible for payment or reimbursement.

Duplicative assistance Any assistance received by the applicant for the purpose of temporary relocation for

rehabilitation, elevation, or reconstruction activities funded by the NCORR Homeowner

Recovery Programs must be disclosed to NCORR or the Subrecipient during the TRA

application process. Applicants will be required to sign a TRA Subrogation and Disclosure

Agreement (Appendix 19) prior to receiving Temporary Rental Assistance (TRA) so that

Duplication of Benefits (DOB) calculations can be made and the appropriate level of

assistance, if any, may be determined. If it is determined that duplicative assistance has

been received by the applicant, TRA assistance may be terminated and/or repaid.

Application for TRA Assistance

All inquiries for Temporary Rental Assistance for owner-occupants will be handled by NCORR or

Subrecipient Case Managers who will coordinate the intake process and obtain all required

information.

During the intake process, Case Managers will review the following with the applicant:

• HUD Brochure “The Lead Safe Guide to Renovate Right” (Appendix 5)

• NCORR or Subrecipient Appeal Procedures (Appendix 7)

• Subrogation Disclosure and Assignment Agreement (Appendix 19)

• TRA Optional Relocation Policies and Procedures

Case Managers will also collect and complete the following documents from the applicant during their

intake appointment:

• Owner Identification (current driver’s license, passport, or other government photo

identification) and certification of lawful presence.

• Household Case Record Form (Appendix 3)

• CDBG Demographic and Income Certification Form (Appendix 4)

• Applicant Voluntary TRA Participation Acknowledgement Form (Appendix 36)

Coordination of TRA Assistance

Owner-occupants who are eligible for TRA will be notified in writing and provided at least

thirty (30) days (see 30 Day Notice in Appendix 17), unless another mutually agreed upon


timeframe is approved, to relocate from their property prior to the initiation of construction

and/or environmental remediation activities necessitating temporary relocation.

The goal of this program is to provide moving and temporary rental assistance, not to exceed twelve (12) months, to displaced owner-occupied households. Applicants who are undertaking elevation or reconstruction activities may be provided an extension of time and increase in cap as necessary and reasonable. In no case shall TRA assistance exceed twenty-four (24) months.

All temporarily relocated households will be notified in writing once the unit is confirmed to

have passed a NCORR or Subrecipient final inspection for the rehabilitated, elevated, or

reconstructed unit. Once final inspection has been passed, the Case Manager will notify the

applicant that they can return home with a “Return Home Notice” (see Appendix 31) giving

the displaced household a reasonable timeframe to move and re-occupy the

rehabilitated/reconstructed unit. This timeframe will generally coincide with the terms of the

lease at the temporary unit. However, in no case shall the timeframe for return to the original

unit exceed 30 days unless there are extenuating circumstances approved by the program in

advance.

In addition, it is the responsibility of the applicant to move within the allotted timeframes, clean

the temporary unit, and return all keys to the landlord. The program will not be responsible

for additional rental payments if the applicant fails to vacate the rental property in the

time allotted. If the timeframe for temporary relocation is extended due to the failure of the

contractor to complete the work within the prescribed timeframe, the program will work with

the landlord at the temporary unit to extend the lease or rental agreement and pay for

additional costs.

Relocation Advisory Services

In addition to the coordination of construction activities with the applicant, it is important that

the assigned Case Manager provides adequate advisory services to properly manage TRA

costs and effectively minimize displacement of program applicants. As part of the case

management process, case managers will:

• Meet with applicants to establish a Household Case Record which assesses and

documents their relocation needs.

• Work with applicants to identify available and affordable housing units meeting the needs

of the household.

• Review and pre-approve all temporary relocation expenses to ensure that all relocation

claims are necessary and reasonable.

• Provide assistance filling out all necessary claim forms so that they are complete,

accurate, and documented in Salesforce.

• Collect all necessary source documentation needed to support each relocation claim.

• Coordinate relocation activities and timeframes with temporarily displaced households to

ensure that temporary relocation payments or reimbursements are provided in a timely

manner.


• Collect and review lease information and beneficiary data upon re-occupancy of the

original unit for upload into Salesforce.

It is important to note that all forms of relocation advisory services, including but not

limited to, phone calls, attempted phone calls, emails, letters, notifications, personal

interviews, site visits, inspections, etc. must be logged and documented in Salesforce

with sufficient and appropriate detail.

Housing Referrals and Inspections

Based upon the temporary relocation needs of the applicant, the Case Manager should pro-

actively identify rental units that are available in the applicant’s local community if possible to

minimize disruption to the tenant’s daily activities. Comparable units should be evaluated on

using the “Selection of Most Representative Comparable Replacement Dwelling” form (see

HUD-40061 Form in Appendix 21) form that compares the pre-relocation unit to other

comparable units. Available units should be inspected to ensure that they meet Housing

Quality Standards (HQS) using the “HUD Inspection Checklist” (see HUD-52580 Form in

Appendix 26) prior to their referral to the temporarily displaced household. In addition, several

comparable units should be provided to the household to establish the payment limit for the

monthly rent and ensure the amount of the rent is necessary and reasonable. Copies of the

“HUD Inspection Checklist” should be uploaded in the Salesforce for each comparable unit

provided to the tenant. The temporary unit referred to the owner, at a minimum, should be:

o “Equivalently functional” to their current dwelling (to include ADA accessibility),

o Sized appropriately for the household (i.e. enough bedrooms to avoid overcrowding-see

Section 12 for definitions)

o Decent, safe, and sanitary (as evidenced by the HUD Inspection Checklist in Appendix

26).

o Available at the time of the referral to the tenant.

o Available for the length of the time necessary for the temporary relocation (i.e.

tenants should not be referred to a unit which is only available for a 12-month lease when

the time period for the temporary relocation is only 4 months).

In the event that the applicant identifies their own temporary unit, the Case Manager should

request an inspection of the unit to ensure that it meets HQS standards using the “HUD

Inspection Checklist” (Appendix 26) and ensure that the rent is reasonable (i.e. consistent

with the comparable provided). If the rent of the unit is unreasonable or the unit is not decent,

safe, and sanitary, the tenant must be told that it is ineligible as a temporary unit. As previously

stated, copies of the “HUD Inspection Checklist” should be uploaded in the URA Checklist

screen in Salesforce if the applicant choses to live in the unit that they selected.

If the timeframe for temporary relocation is for a short term, applicants are encouraged to

temporarily relocate with friends or family if this is an option available to them. If the applicant

elects this option, payments will be capped at one half of Fair Market Rent (FMR) and will be

provided to the friends and family who agree to house temporarily displaced households to

offset any costs that they may have due to increased usage of electricity, water, etc. A signed

agreement between the applicant and the friends/family providing housing must be submitted


to the program for this arrangement to be eligible for payment. These units do not have to

be inspected by the program.

Moving Expenses

Applicants will be provided the option of receiving a fixed moving expense payment that is

based upon the number of rooms that must be moved by the tenant and the most recent

Federal Highway Administration’s fixed moving expense chart (see Appendix 25).

Any moving or relocation cost incurred by the applicant must be approved in advance

by the program or the tenant may not receive reimbursement.

Claim Forms for Assistance

Based upon documentation provided by the applicant, the Case Manager should prepare the

following claim forms for assistance on behalf of the owner.

o “Claim for Temporary Relocation Expenses” (see HUD-40030 Form in Appendix 22)

Supplemental to the claim forms for assistance, the following additional forms must be

prepared and obtained by the Case Manager:

o “ACH Transfer Form” for the applicant (see Appendix 27)

o “ACH Transfer Form” for the landlord (if applicable).

All supporting documents used to complete the claim form must be submitted as part

of the request for payment.

Requesting Payments from NCORR

In order to request a payment from NCORR, an “NCORR or Subrecipient Transmittal Memo”

(see Appendix 29) must be developed by the Case Manager to summarize the reason for and

amount of the payment to the applicant and/or landlord. In addition to the Transmittal Memo,

an “NCORR or Subrecipient Recovery Program Claim Payment Request” (see Appendix 30)

must be prepared by filling out the approved amount for each cost category and listing the

appropriate payees. Next the Case Manager should attach all completed and signed claim

forms for assistance. Claim forms for assistance must be accompanied by all required

documentation and submitted in the order listed below.

o “NCORR or Subrecipient Transmittal Memo” (Appendix 29)

o “NCORR or Subrecipient Recovery Program Claim Payment Request” (Appendix 30)

o Signed HUD Claim Form 40030 (Appendix 22)

o All source documentation related to the claim (lease agreement, inspection form, etc.)

o ACH transmittal Form (s) (Appendix 27)

o Subrogation Disclosure and Assignment Agreement (Appendix 19)

Once this documentation is submitted and the expenses are paid, the Case Manager should

enter the actual payment information into Salesforce and upload the packet of documents


listed above. As ACH payments are made, all cost details should be entered into Salesforce

to include the number of the draw request, method of payment, total payment, and period of

assistance.

Return Notice

Once a completion date for the pre-relocation dwelling has been established, the Case

Manager will draft a “Return Home Notice” (see Appendix 31) for the owner notifying them

that they will be able to return home (specifying the date of their return) and termination date

of the temporary relocation lease.

Owner Acknowledgement of TRA Payments

Once the “Return Home Notice” has been acknowledged by the owner, the Case Manager

should prepare a “TRA Acknowledgement Form” (Appendix 32) that lists all relocation

expense payments (including final moving expenses) and the total of those payments. This

form shall be presented to the applicant and signed at the same time that the applicant signs

the “Residential Claim for Moving and Related Expenses” (Appendix 24). The “Residential

Claim for Moving and Related Expenses” should not be submitted to NCORR for payment

until the following documents have been received, reviewed, and acknowledged by the

applicant:

o “Return Home Notice” (Appendix 31)

o “TRA Acknowledgement Form” (Appendix 32)

Once properly executed and acknowledged, all notices, forms, and signed receipts shall be

uploaded into Salesforce.

TRA Appeals

The Case Manager is responsible for informing all applicants about the appeals process and

obtaining a signed acknowledgement form from the applicant. In addition, the Case Manager

will be responsible for reviewing the appeal, collecting all necessary documentation, and

making a written recommendation to NCORR or Subrecipient regarding the applicant appeal.

NCORR or the Subrecipient will be responsible for responding to the applicant appeal within

fifteen (15) days as prescribed in the NCORR or Subrecipient Appeals/Grievance

procedures.


3. Tenant Relocation under URA As a first step, the Program must determine whether a tenant(s) may be a “displaced” person or

household. As a second step, the Program must determine whether the tenant must be displaced

temporarily or permanently. Tenants qualifying as displaced must be provided with relocation

assistance with a goal towards minimizing permanent displacement. Tenants who must move

temporarily due to program-sponsored activities must be provided temporary relocation

assistance to ensure that they do not become permanently displaced by the Program. In addition,

there are tenants who were displaced by the storms who are eligible for relocation assistance

under Section 414 of the Robert T. Stafford Act (unless a waiver is obtained by the grantee).

Tenant definitions are as follows:

3.1 Displaced Tenants

The Program considers the following to be displaced tenants:

o Tenants who moved permanently from the damaged rental unit after the applicant applied to

the NCORR Homeowner Recovery Program, and did not receive a notice of impending

program-sponsored work (“Move-In Notice”).

o Tenants who moved permanently from the damaged rental unit due to incorrect URA

eligibility determination.

o Tenants who moved permanently from the damaged rental unit due to misinformation

regarding the availability temporary relocation assistance or lack of relocation advisory

services.

o Tenants who moved permanently from the damaged rental unit due to lack of receiving

adequate relocation information.

o Tenants who moved permanently from the damaged rental unit due to a landlord eviction

which does not meet HUD requirements related to a documented court order (where

feasible) and pre-existing lease violations not related to NCORR Homeowner Recovery

Program projects.

o Tenants who permanently relocate due to an unreasonable increase in post-relocation rent

at the damaged address or unreasonable terms of their new rental agreement as evidenced

by the comparison of the terms of the pre-relocation and post-relocation leases at the

NCORR-assisted rental unit. It should be noted “unreasonable terms” of their new rental

agreement may include harassment or aggressive actions taken by the landlord/applicant

seeking to coerce or discourage the tenant from returning to the unit and/or receiving

relocation assistance. These types of cases should be referred to NCORR for further review

and possible applicant sanctions.

o Tenants whose pre-relocation dwelling is converted to another use (examples: conversion

from a two-family to a one-family unit due to the rehabilitation, change in residential use,

etc.)

o Tenant’s temporary relocation from the damaged address has exceeded 12 months and

they do not wish to return to the pre-relocation unit. See Appendix 37 Tenant URA Option

Form.


3.2 Non-Displaced Tenants

o Tenants who are not temporarily or permanently relocated due to Program-funded activity.

o Tenants who are temporarily relocated and return to the pre-relocation/damaged residence

after completion of the NCORR Homeowner Recovery project at a cost-reasonable rent.

o Tenants who signed a receipt for all required URA notices and voluntarily agree to “Opt-Out”

of relocation benefits (as evidenced by a signed “Opt-Out” notice fully describing relocation

benefits).

o Tenants who have been temporarily relocated over 12 months who elect to return to the

NCORR- or Subrecipient- assisted property based upon receipt of information regarding the

availability of the unit and guaranteed return. See Appendix 37 Tenant URA Option Form.

o Tenants who are evicted from the damaged rental unit due to pre-existing violations of their

lease (i.e. eviction evidenced by a court order).

o Tenants who received a “Move-In” Notice prior to signing their lease which explains that

they may be relocated and will not be eligible for URA benefits.

o Tenants were/are not lawfully present in the United States unless such ineligibility would

result in an exceptional hardship to a qualifying spouse, parent, or child.

3.3 Section 414 Displaced Tenants

o Tenants who were in legal occupancy at the time of a Covered Storm at a damaged unit

which will or has received assistance from the Program.

3.4 Relocation Assistance Not Applicable

Relocation Assistance is not available in the following scenarios:

o Documentation in the file shows that there were/are no tenants occupying the damaged

residence:

1. at the time of the storm (Hurricane Matthew October 8, 2016); AND

2. after the application for assistance is submitted to NCORR

o Damaged property was incorrectly identified as having a rental unit in Salesforce.

o Applicants who were issued a “Move In” Notice prior to signing their lease.


4. Temporary Relocation - Tenant Occupied Units

Tenants residing in NCORR- or Subrecipient- assisted properties are eligible for temporary

relocation benefits if they must move temporarily during the applicant’s project. In these cases,

program activities shall be planned and carried out in a manner that minimizes hardships and

displacement of tenants of storm-damaged residences to be rehabilitated, elevated, or

reconstructed in accordance with the Program. To ensure that tenants are provided with all

necessary assistance, URA case managers must assess the household needs of those being

temporarily displaced to include relocation advisory assistance, timely program notifications, and

necessary referrals to available rental units which are comparable in nature and decent, safe, and

sanitary.

4.1 Eligibility Requirements

In order to be eligible for temporary relocation benefits:

• The tenant’s landlord must have applied for and be eligible to receive assistance from one

of the Programs.

• The tenant must temporarily relocate to complete the rehabilitation/reconstruction,

elevation, or environmental remediation of the damaged structure assisted with CDBG-

DR funding.

• The tenant must be a US Citizen or qualified alien occupying the residence to be

rehabilitated or reconstructed.

4.2 Tenant Intake

Within ten (10) calendar days of referral, the URA case manager must contact the tenant to

make an appointment or begin the intake process and create a hard-copy file (in addition to upload

of information in Salesforce). To properly assess the temporary housing needs of program

tenants, the URA case manager must work with the tenant to collect all information necessary to

establish a Household Case Record for the tenant (see Appendix 3). As part of the tenant data-

collection process, it is also important that the tenant completes and self-certifies the “URA Tenant

Demographic Information Certification” form (see Appendix 4). Completion of this form is

necessary for DRGR reporting purposes and selection of the correct CDBG National Objective.

In addition, the HUD brochure “The Lead Safe Certified Guide to Renovate Right” (Appendix 5)

should be provided to the tenant to advise them about the potential effects of lead hazards in

residential dwellings, and a copy of the NCORR or Subrecipient Appeals/Grievance Procedures

(Appendix 7) should be distributed to the tenant.

The URA case manager must also collect all necessary information on the characteristics of the

pre-relocation dwelling to complete the “Comparable Replacement Dwelling” form (see HUD Form

40061 in Appendix 21) and determine the number of rooms of furniture that will have to be moved.

To accurately complete this task, it is recommended that the ECR drawing be reviewed with the

tenant at intake to determine the square footage of the areas occupied by the tenant. In addition,

to this information, the URA case manager should also obtain the tenant’s pre-relocation lease

and utility information for their unit (12-month average). This information will be necessary to

complete the “Claim for Temporary Relocation Expenses” form (see HUD-40030 Form in


Appendix 22), which requires the calculation of the difference in rent and utilities at the pre-

location dwelling in comparison to the temporary unit.

The following documents comprise the non-displaced tenant’s temporary relocation package that

should be reviewed with the tenant at intake:

o HUD Brochure “The Lead Safe Certified Guide to Renovate Right” (Appendix 5)

o NCORR Appeals/Grievance Procedures and program contact information

(Appendix 7)

o General Information Notice (GIN) (Appendix 8)

o Applicant and Landlord Certifications (Appendix 2). NOTE: This form should be

signed by applicant in advance of the intake meeting with the tenant, if possible.

In addition to the required tenant notifications, the URA case manager should obtain the

following information and signed documents at intake.

o Tenant Identification (current driver’s license, passport, or other government

photo identification).

o Household Case Record (Appendix 3)

o “URA Tenant Demographic Information Form” (Appendix 4)

o “Release Form for Pre-Relocation Utility Information” (Appendix 18)

o “Subrogation Disclosure and Assignment Agreement” (Appendix 19)

o “Right-of-Entry” Form, if applicable (Appendix 20)

o “Tenant Acknowledgement Form” (Appendix 11) for HUD and program required

notifications as applicable. NOTE: The number and type of notices can vary

based upon status of the tenant relocation and paperwork that has been

previously received by the tenant.

An acknowledgement of receipt for each document should be signed by the tenant and

uploaded into Salesforce using the correct naming conventions of the documents (See

Appendix 1 for appropriate naming conventions for each document).

4.3 Eligible Expenses

In conjunction with reviewing the tenant’s household information at intake, the tenant should be

made aware of all NCORR or Subrecipient assistance that is available to them for their temporary

relocation. In addition, the tenant should be informed that all temporary relocation expenses

should be approved by the program in advance of incurring that expense to ensure that the

expense is necessary and reasonable in accordance with HUD guidelines. All payments, except

for a security deposit and rent, will be paid to the displaced household. In limited cases, payments

may be made on behalf of the tenant as determined necessary on a case-by-case basis. Eligible

expenses include the following:

Moving Expenses: Fixed moving expenses are paid out according to the Federal Highway

Administration’s Fixed Residential Moving Cost Schedule for the State of North Carolina, found

in Appendix 25 or online as shown below:


https://www.federalregister.gov/articles/2015/07/24/2015-18159/uniform-relocation-andreal-

property-acquisition-for-federal-and-federally-assisted-programs-fixed

Tenants may also elect to receive reimbursement of actual moving costs. These requests must

be made in advance for pre-approval and will be based on the lowest of three (3) quotes

from moving companies.

Security Deposit: Security deposits for the temporary unit will be paid for under the condition

that the landlord of the temporary unit and the tenant attach the program “Lease Rider” to the

temporary lease. This rider states that the security deposit will be returned directly to NCORR or

Subrecipient at the end of the temporary relocation. The amount of any security deposit shall

not exceed one month’s rent.

Monthly Rent: Rent for the temporary unit will be paid on a monthly basis for the timeframe

approved by NCORR or their Subrecipient. Temporarily displaced households are encouraged

to stay with friends or relatives if the temporary relocation is for a short period of time. If the

displaced household chooses to live with family or friends during temporary relocation, the rent

must be reasonable and cannot exceed one half of HUD Fair Market Rent for the county in which

the unit is located. All rental agreements must be in writing and approved by the Program

in advance to ensure that the terms and conditions of the lease agreement are necessary,

reasonable, and consistent with the anticipated length of time necessary for the construction

activity outlined in the applicant’s scope of work. This includes agreements to compensate friends

or family members who house displaced households.

Hotel Expenses: For short-term temporary relocation when family stays or entering into a lease

is not feasible, the program may reimburse hotel expenses if they are necessary and reasonable.

Program staff will obtain 3 quotes for hotels in the local area, the lowest of which will establish

the ceiling for hotel expenses to be reimbursed to the applicant. Paid invoices for all hotel

expenses must be documented and submitted to the Program.

Storage Unit: Every attempt will be made to locate an unfurnished rental unit which is

comparable in size so that the cost of a storage unit is unnecessary. If this is not possible or if

there are extenuating circumstances, the monthly costs of a storage unit or an on-site storage

container can be provided. All rental agreements for storage units must be in writing and

approved by the Program in advance

To determine the appropriate size of the rental unit, the number of bedrooms allowable is based

upon the number of bedrooms that the displaced household currently occupies in comparison to

the number of bedrooms needed for members of the household who are temporarily displaced.

However, if a displaced household rents a unit smaller than their existing unit, the household will

only qualify for the rent for the temporary unit. The definitions for “Household” and “Unit” can be

found in Section 11.0 of this SOP.

The monthly rent for the temporary unit will be based upon comparable units available at the time

of temporary relocation and must be decent, safe, and sanitary.


4.4 Ineligible Expenses

Lost Rental Income: Owners of rental properties with temporarily displaced tenants will not be

provided compensation for lost rental income during the time that the renter is relocated.

Temporary Relocation Expenses Not Pre-Approved in Writing: Temporary relocation

expenses beyond the parameters outlined in this policy must be pre-approved by the Program

prior to the temporarily displaced household incurring the cost. Tenants will be responsible to

bear any cost not approved by the Program in advance.

Temporary Relocation Expenses Beyond Date of Re-Occupancy: Temporary relocation

expenses incurred beyond the agreed-upon relocation timeframe will not be reimbursed by the

Program. In no case shall tenants be provided temporary relocation assistance beyond thirty

(30) days after construction activities triggering temporary relocation are complete.

Undocumented Relocation Expenses: Claims for temporary relocation expenses submitted

without applicable source documentation are ineligible for payment or reimbursement.

4.5 URA Notifications

In order to meet HUD Uniform Relocation Act (URA) requirements, program notifications should

be made at critical points during the construction and temporary relocation process. Prior to

initiating program activities, the URA case manager will provide a General Information Notice

(GIN) to inform owners and tenants regarding URA requirements and rights. This notice is of

critical importance and will be provided early in the process so that tenants do not become

permanently displaced as a result of rehabilitation/reconstruction, elevation or environmental

remediation activities. Proof that the notice was received by the tenant will also be documented

in Salesforce to demonstrate that this information has been provided in a timely manner. In

addition, the tenant will be provided with the HUD brochure, “The Lead Safe Certified Guide to

Renovate Right” (Appendix 5) and a copy of the NCORR or Subrecipient Appeals/Grievance

Procedures (Appendix 7).

In addition to these notices, tenants must also be provided a “Notice of Non-Displacement-

Temporary Relocation Required” (Appendix 12) stating whether they will be temporarily relocated

or not. If a tenant must be temporarily relocated, providing this notice and documenting receipt of

this notice demonstrates that the program informed the tenant of their rights, including the

guarantee that tenants can return to the unit under reasonable terms and the availability of eligible

relocation costs.

Supplemental to the “Notice of Non-Displacement-Temporary Relocation Required)” (see

Appendix 12), the tenant should also be provided with a minimum of thirty (30) days’ notification

(see “30 Day Notice” in Appendix 17) to move and as much as 90 days, if feasible (see “90 Day

Notice” in Appendix 16). This notice should explain the reason for the move and provide the

estimated timeframe for temporary relocation, the availability of Relocation Advisory Services,

and a of list eligible expenses. Documentation that the program provided this notice to displaced

households is important to ensure that proper notice was provided, to establish the eligibility date

to incur temporary relocation costs, and to provide a date by which to monitor progress of the

project to ensure that the time for displacement of the household does not exceed one year.


Tenants who, after receiving a General Information Notice (GIN), do not have to temporarily

relocate for program activities will be issued a “Notice of Non-Displacement-Temporary

Relocation Not Required” (Appendix 13).

All notices provided to the tenant must be accompanied by a signed or certified mail

receipt and uploaded into Salesforce.

4.6 Coordination of Temporary Relocation

URA case managers must ensure that construction start dates are carefully coordinated with the

tenant and that the tenant has received the following notices at a minimum of thirty (30) days in

advance of the tenant’s scheduled move date:

o “Notice of Non-Displacement-Temporary Relocation Required” (Appendix 12)

o “Notice of Eligibility for Temporary Relocation Assistance” (Appendix 14)

o “30 Day Move Notice” (Appendix 17)

As previously stated, a signed tenant acknowledgement or certified mail receipt should be

uploaded into Salesforce for each notice.

4.7 Timeframe for Temporary Relocation

Eligible tenants will be given a minimum of 30 days (and 90 days in advance when feasible) to

relocate prior to the contractor initiating rehabilitation work. The length of time for temporary

relocation will be determined by the scope of work and will be communicated to the tenant for

planning purposes and coordination of their move. If a tenant’s temporary relocation exceeds 12

months, the URA case manager will contact the tenant to assess whether the anticipated

timeframe for return to the pre-relocation dwelling is acceptable and/or offer permanent relocation

assistance.

All displaced households will be notified in writing once the unit is confirmed to have passed a

NCORR final inspection for the rehabilitated or reconstructed unit. Once final inspection has been

passed, the URA case manager will notify the tenant that they can return home with a “Return

Home Notice” (see Appendix 31) giving the displaced household a reasonable timeframe to move

and re-occupy the rehabilitated/reconstructed unit. This timeframe will generally coincide with the

terms of the lease at the temporary unit. However, in no case shall the timeframe for return to the

rehabilitated/reconstructed unit exceed 30 days unless there are extenuating circumstances

approved by the program in advance. In addition, it is the responsibility of the displaced tenant to

move within the allotted timeframes, clean the temporary unit, and return all keys to the landlord.

The program will not be responsible for additional rental payments if the displaced tenant

fails to vacate the rental property in the time allotted. If the timeframe for temporary relocation

is extended due to the failure of the contractor to complete the work within the prescribed

timeframe, the program will work with the landlord at the temporary unit to extend the lease or

rental agreement and pay for additional costs.


4.8 Relocation Advisory Services

In addition to the coordination of construction activities with the applicant, it is important that the

assigned URA case manager provides adequate advisory services to households to effectively

minimize displacement of tenants. As part of the case management process, URA case

managers will:

• Meet with tenants to establish a Household Case Record (Appendix 3) which assesses

and documents their relocation needs.

• Ensure that all required notices (“GIN,” “Notice of Non-Displacement,” “30 Day Move Out

Notice,” etc.) have been provided and that receipt of these notices are adequately

documented and uploaded to Salesforce.

• Work with temporarily displaced tenants to identify available and affordable housing units

to meet the needs of the household.

• Review and pre-approve all temporary relocation expenses to ensure that all relocation





• Coordinate relocation activities and timeframes with temporarily displaced households to

ensure that temporary relocation payments or reimbursements are provided in a timely

manner.

• Collect and review lease information and beneficiary data upon re-occupancy of the

original unit for upload into Salesforce.

It is important to note that all forms of relocation advisory services including but not

limited to phone calls, attempted phone calls, emails, letters, notifications, personal

interviews, site visits, inspections, etc. must be logged and documented in Salesforce with

sufficient and appropriate detail.

4.9 Housing Referrals and Inspections

Based upon the temporary relocation needs of the tenant, the URA case manager should pro-

actively identify rental units that are available in the tenant’s local community, if possible to

minimize disruption to the tenant’s daily activities. Comparable units should be evaluated on

using the “Selection of Most Representative Comparable Replacement Dwelling” (see HUD-

40061 Form in Appendix 21) which compares the pre-relocation unit to other comparable units.

Available units should be inspected to ensure that they meet Housing Quality Standards (HQS)

using the “HUD Inspection Checklist” (see HUD-52580 Form in Appendix 26) prior to referring

them to the temporarily displaced household. In addition, several comparable units should be

provided to the household to establish the payment limit for the monthly rent and ensure that

amount of the rent is necessary and reasonable. Copies of the “HUD Inspection Checklist” (see

Appendix 26) should be uploaded in the URA Checklist into Salesforce for each comparable

provided to the tenant. The temporary unit referred to the tenant, at a minimum, should be:


o “Equivalently functional” to their current dwelling (to include ADA accessibility),



o Decent, safe, and sanitary (as evidenced by the HUD Inspection Form-Appendix 26).


o Available for the length of the time necessary for the temporary relocation (i.e.

tenants should not be referred to a unit which is only available for a 12-month lease when

the time period for the temporary relocation is only 4 months).

In the event that the tenant identifies their own temporary unit, the URA case manager should

request an inspection of the unit to ensure that it meets HQS standards using the “HUD Inspection

Checklist” and ensure that the rent is reasonable (i.e. consistent with the comparable provided).

If the rent of the unit is unreasonable or the unit is not decent, safe, and sanitary, the tenant must

be told that it is ineligible as a temporary unit. As previously stated, copies of the “HUD Inspection

Checklist” should be uploaded in the into Salesforce if the tenant choses to live in the unit that

they selected.

If the timeframe for temporary relocation is short term, tenants should be encouraged to

temporarily relocate with friends or family if this is an option available to them. If the tenant elects

this option, payments will be capped at one half of Fair Market Rent (FMR) and will be provided

to the friends and family who agree to house temporarily displaced households to offset any costs

that they may have due to increased usage of electricity, water, etc. A signed agreement between

the tenant and the household must be submitted to the program for this arrangement to be eligible

for payment. These units do not have to be inspected by the program.

4.10 Moving Expenses

Tenants will be provided the option of receiving a fixed moving expense payment or actual moving

expenses. If the tenant selects a fixed moving expense payment, the payment is based upon the

number of rooms that must be moved by the tenant and the most recent Federal Highway

Administration’s fixed moving expense chart (see Appendix 25).

If the tenant elects to receive reimbursement of actual moving expenses, then the URA case

manager will obtain three (3) quotes from moving companies. The lowest quote establishes the

maximum amount that the program will pay for the move. The reimbursed amount of the actual

moving expense is either the 1) lowest quote obtained by the URA case manager, or 2) actual

reimbursable moving expense; whichever is less.

Any moving or relocation cost incurred by the tenant must be approved in advance by the

program or the tenant may not receive reimbursement.

4.11 Claim Forms for Assistance

Based upon documentation provided by the tenant, the URA case manager should prepare the

claim form for assistance on behalf of the tenant.

o “Claim for Temporary Relocation Expenses” (see HUD-40030 Form in Appendix 22). This

form includes a tenant’s claim for rental and moving expenses).


Supplemental to the claim forms for assistance, the following additional forms must be prepared

and obtained by the URA case manager:

o “ACH Transfer Form” for the tenant (Appendix 27)

o “ACH Transfer Form” for the landlord (if applicable)

o “Lease Rider” if the landlord of the temporary unit is requiring a security deposit (Appendix

28)

The “Claim for Temporary Relocation Expenses” must be accompanied by copies of the pre-

relocation and temporary relocation leases. In addition, print outs regarding the average

monthly utilities for each unit must also be attached as these costs are the basis for the calculation

of the tenant’s temporary relocation payment (i.e. the difference between rent and utilities at the

pre-relocation unit and the temporary unit).

The “Residential Claim for Moving and Related Expenses” (Appendix 24), if based upon actual

expenses, should be accompanied by three (3) quotes from moving companies, proof of the

actual expenses incurred by the tenants (bill from the moving company), and paid invoice or

cancelled check.

These forms shall be filled out and signed by the tenant as soon as possible so that the program

can provide payment or reimbursement of the expense in a reasonable timeframe.

In addition to the claim forms for assistance, the tenant will also need to complete and sign the

ACH form for NCORR or the Subrecipient to directly deposit the relocation funds into the tenant’s

account. If applicable, this form should also be filled out by the landlord of the temporary unit so

that rental payments can be directly deposited into the landlord’s account. If a landlord requires

the submittal of a security deposit at the temporary unit, the URA case manager must ensure that

the “Lease Rider” (Appendix 28) form is signed by the landlord and is properly executed prior to

requesting the payment.

All documents used to complete the claim form must be submitted as part of the request

for payment.

4.12 Requesting Payments from NCORR

In order to request a payment from NCORR, a “NCORR or Subrecipient Transmittal Memo”

(Appendix 29) must be developed by the URA case manager to summarize the reason for and

amount of the payment to the tenant and/or landlord. In addition to the “NCORR or Subrecipient

Transmittal Memo”, a “NCORR or Subrecipient Recovery Program Claim Payment Request” (see

Appendix 30) must be prepared by filling out the approved amount for each cost category and

listing the appropriate payees. Next, the URA case manager should attach all completed and

signed claim forms for assistance. Claim forms for assistance must be accompanied by all

required documentation and submitted in the order listed below.

o “NCORR or Subrecipient Transmittal Memo” (Appendix 29),



o Tenant signed “Claim form for Temporary Relocation Expenses” (Appendix 22)

o Fully executed Lease Rider (if a security deposit for the temporary unit is required)

(Appendix 28).

o All source documentation related to the claim (pre-relocation lease, temporary relocation

lease, moving expense receipts, if applicable).



Once submitted and paid, the URA case manager should enter the actual payment information

into Salesforce and upload the packet of documents listed above.

As ACH payments are made, the relocation payment details should be entered into Salesforce to

include the number of the draw request, method of payment, total payment, and period of

assistance.

4.13 Return Notices and Post-Relocation Lease

Once a completion date for the pre-relocation dwelling has been established, the URA case

manager will draft a “Return Home Notice” (Appendix 31) for the tenant notifying them that they

will be able to return to the unit (specifying the date of their return) and termination date of the

temporary relocation lease. In addition, the URA case manager will contact the landlord of the

unit and request the submittal of a post-relocation lease for review and distribution to the tenant.

If possible, the “Return Home Notice” and “Post-Relocation Lease” will be provided at the same

time to the tenant. The tenant should sign a receipt for the notice and post-relocation lease.

Prior to providing the “Post Relocation Lease” to the tenant, the URA case manager must compare

the pre-relocation lease with the post-relocation lease to ensure that the terms are consistent,

and rent was not unreasonably increased. Once reviewed and properly executed (signed), the

“Return Home Notice”, “Post Relocation Lease”, and tenant acknowledgement of these

documents should be uploaded into Salesforce.

It should be noted that a tenant’s final moving expense payment will be held until a

properly executed “Post-Relocation Lease” is reviewed and submitted to the program.

4.14 Tenant Acknowledgement of Relocation Payments

Once the “Return Home Notice” and “Post-Relocation Lease” has been acknowledged by the

tenant, the URA case manager should prepare a “Relocation Assistance Acknowledgement

Form” (Appendix 32) that lists all relocation expense payments (including final moving expenses)

and the total of those payments. This form shall be presented to the tenant and signed at the

same time that the tenant signs the “Residential Claim for Moving and Related Expenses”

(Appendix 24). The “Residential Claim for Moving and Related Expenses” should not be

submitted to NCORR for payment until the following documents have been received, reviewed,

and acknowledged by the tenant:

o “Return Home Notice” (Appendix 31)

o “Post-Relocation Lease”

o “Relocation Assistance Acknowledgement Form” (Appendix 32)


Once properly executed and acknowledged, all notices, forms and signed receipts shall be

uploaded into Salesforce.

4.15 Tenant Opt-Out Process

Tenants who are not interested in receiving temporary relocation benefits or those who do not

wish to return to the pre-relocation unit can elect to “Opt-Out” of the program using the NCORR

approved “Opt-Out” form (Appendix 33). However, for the tenant to select this option the tenant

must:

o Acknowledge receipt of the “GIN” and “Notice of Non-Displacement – Temporary

Relocation Required”,

o Fully understand the timeframe for temporary relocation, and the amount and type of

temporary relocation benefits they are entitled to receive.

o Acknowledge that the pre-relocation dwelling would be made available to them once

construction is complete under reasonable conditions and rent.

4.16 Tenant Appeals

The URA case manager is responsible for informing all tenants about the appeals process and

obtaining a signed acknowledgement form from the tenant. In addition, the URA case manager

will be responsible for reviewing the appeal, collecting all necessary documentation, and making

a written recommendation to NCORR or Subrecipient regarding the tenant appeal. NCORR or

the Subrecipient will be responsible for responding to the tenant appeal within the timeframe

prescribed in the NCORR or Subrecipient Appeals/Grievance procedures (Appendix 7).


5. Permanent Relocation for Tenants

5.1 Definition of a Displaced Person

All persons, families, or businesses permanently displaced resulting from non-voluntary

acquisition, rehabilitation, or demolition, in whole or in part, shall be provided with relocation

assistance and compensation as authorized by the Uniform Relocation Act. Procedures and

forms shall be in accordance with URA regulations and HUD Relocation Handbook 1378, as

revised. Tenants meeting the definition of a “Displaced Person” should be offered permanent

relocation benefits if they meet the eligibility requirement listed below.

5.2 Eligibility Requirements

In order to be eligible for permanent relocation benefits under URA:

• Permanently displaced tenants must have documentation that they were in legal

occupancy of a residential dwelling assisted by the NCORR or Subrecipient Homeowner

Recovery Program at the time of application (if no “Move In” Notice was received) and/or

program assisted construction activities. Tenants displaced by the Hurricane Matthew

who are covered by Section 414 of the Stafford Act (unless waived) must have

documentation that they were in legal occupancy of a NCORR or Subrecipient assisted

dwelling at the time of the storm (October 8, 2016).

• The tenant’s dwelling unit must be eligible and must have been acquired, rehabilitated,

and/or demolished as part of the NCORR or Subrecipient Homeowner Recovery Program.

• Tenants must relocate or have relocated into a decent, safe, and sanitary dwelling unit

and provide the program with a right-of-entry into their current dwelling so that it can be

inspected.

• Calculation of URA relocation benefits must exceed the amount of any duplicative

assistance received from other sources.

• Tenant must be lawfully present in the United States at the time of assistance. Tenants

who were displaced by the storm must also have been lawfully present in the United States

at the time of displacement.

5.3 Tenant Intake

Upon identification of a tenant who has been or will be permanently displaced, the URA case

manager must contact the tenant to make an appointment or begin the intake process and create

a hard copy file (in addition to upload of information in Salesforce). To properly assess the

permanent housing needs of program tenants, the URA case manager must work with the tenant

to collect all information necessary to establish a “Household Case Record” (see Appendix 3) and

documenting this information in Salesforce. As part of the tenant data collection process it is also

important that the tenant completes and self-certifies the “URA Tenant Demographic Information

Certification” form (see Appendix 4). Completion of this form is necessary for DRGR reporting

purposes and selection of the correct CDBG National Objective. In addition, the HUD brochure

“The Lead Safe Certified Guide to Renovate Right” (see Appendix 5) should be provided to the

tenant to advise them about the potential effects of lead hazards in residential dwellings as well

as the HUD brochure “Relocation Assistance for Tenants Displaced from their Homes” (see


Appendix 6). In addition, a copy of the NCORR or Subrecipient Appeals/Grievance Procedures

(see Appendix 7) should be distributed to the tenant.

The URA case manager must also collect all necessary information to define characteristics of

the pre-relocation dwelling to complete the “Selection of Most Representative Comparable

Replacement Dwelling” form (see HUD Form 40061 in Appendix 21) and determine the number

of rooms of furniture that will have to be or has been moved. To accurately complete this task, it

is recommended that the inspections drawings in the ECR be reviewed with the tenant at intake

to determine the square footage of the areas occupied by the tenant. Supplemental to this

information the URA case manager should also obtain the tenant’s pre-relocation lease and utility

information for their unit (12-month average). This information will be necessary to complete the

“Claim for Rental and Down Payment Assistance” form (see HUD Form-40058 in Appendix 23)

which requires the calculation of the difference in rent and utilities at the pre-location dwelling in

comparison to the comparable unit.

The following documents comprise the displaced tenant’s permanent relocation package that

should be reviewed with the tenant at intake:

o HUD Brochure “The Lead Safe Certified Guide to Renovate Right” (Appendix 5).

o HUD Brochure “Relocation Assistance for Tenants Displaced from Their Homes”

(Appendix 6)

o NCORR or Subrecipient Appeals/Grievance Procedures (Appendix 7)

o General Information Notice (GIN) (Appendix 8)

o Notice of Eligibility for Relocation Assistance, if applicable at intake (Appendix

15)

o “Tenant Acknowledgement Form” (Appendix 11) listing the above documents

NOTE: The number and type of notices can vary based upon status of the

tenant relocation and paperwork that has been previously received by the tenant.

o

In addition to the required tenant notifications, URA case manager should obtain the following

information and signed documents at intake.

o Tenant Identification (current driver’s license, passport, or other government

photo identification).

o “Household Case Record” (Appendix 3)

o “URA Tenant Demographic Information Form” (Appendix 4)

o “Release Form for Pre- / Post- Relocation Utility Information” (Appendix 18)


o “Right-of-Entry” Form, if applicable (Appendix 20)

An acknowledgement of receipt for each document should be signed by the tenant and

uploaded to into Salesforce using the correct naming conventions of the documents (See

Appendix 1 for appropriate naming conventions).


5.4 Notice of Eligibility & Move Notices

Once a tenant has been determined to be eligible for permanent relocation benefits, the URA

case manager must also provide them with a “Notice of Eligibility for Relocation Assistance”

(Appendix 15) which must be accompanied by a signed or certified mail receipt.

If applicable, tenants who have not already moved from the Program-funded property must also

be provided at least ninety (90) day’s notice (see “90 Day Notice” in Appendix 16) in advance of

their relocation date followed up by a thirty (30) day notification to move (see “30 Day Notice” in

Appendix 17). URA case managers must ensure that construction start dates are carefully

coordinated with the tenant, and that the tenant has received the following notices at a minimum

of thirty (30) days in advance of the tenant’s scheduled move date:

o “Notice of Eligibility for Relocation Benefits” (Appendix 15)



A signed tenant acknowledgement or certified mail receipt should be uploaded into Salesforce for

each notice.

5.5 Summary of Relocation Assistance to be provided:

Upon making a determination of eligibility, the URA case manager must offer tenants the following

advisory services and financial assistance.

• Advisory services including timely URA notifications, referral to comparable and suitable

replacement homes, inspection of replacement housing to ensure it meets decent, safe,

and sanitary standards, assistance in completing claim forms for assistance, and other

required services to assist the displaced household as necessary.

• Replacement Housing Payment (RHP) in the form of rental or down-payment

assistance.

• Payment for moving and other out-of-pocket expenses. Eligible tenants may receive

either a:

o Payment for Actual Reasonable Moving and Related Expenses, or

o Fixed Moving Expense, or

o Combination of both, based upon circumstances.

5.6 Eligible Expenses

• Actual or fixed moving expenses based upon the Federal Highway Administration Fixed

Payment for Moving Expenses.

• Replacement Housing Payment (RHP)

• Other reasonable out-of-pocket expenses related to the following:

o Transportation of the tenant and tenant’s family.

o Packing, moving, and unpacking of household goods.

o Disconnecting and reconnecting household appliances and other personal

property (e.g. electricity, cable, internet, and phone).


o Storage of household goods.

5.7 Ineligible Expenses

• Expenses related to the loss of personal property resulting from the storm.

• Duplicative assistance from other programs (FEMA, DRAP, non-profits, etc.).

5.8 Required Tenant Documentation

At intake, the URA case manager should request that the tenant bring in the following information,

which will be necessary to calculate their permanent relocation benefits and fill out required claim

forms.

• Tenant Identification (current driver’s license, passport, or other government photo

identification).

• Copy of executed lease valid at the time of the storm (or other acceptable program

documentation), landlord application to the NCORR or Subrecipient Homeowner

Recovery Program, and/or displacement from the rental unit assisted by NCORR or

Subrecipient.

• Proof of occupancy (Copy of driver’s license, utility, cable, or other bills) listing the tenant

and the dwelling unit at the time of the storm, landlord application, and/or displacement

from the rental unit.

• Documentation of all assistance previously received for relocation and moving expenses

and/or self-certification regarding the level of assistance provided (Note: All tenants

will be required to sign a subrogation agreement for all duplicative assistance

provided.)

If the tenant has previously relocated, the following should also be provided to the URA case

manager in addition to the above documents:

• Documentation of actual moving expenses from the pre-storm dwelling/assisted unit or

the number rooms of furniture moved, if any, at the time of displacement and/or affidavit

from the landlord regarding the number of rooms occupied at the time of the storm.

• Copy of current lease or purchase agreement for their post-relocation dwelling.

• Copy of current utility bills (12-month average) for their post-relocation dwelling.

5.9 Relocation Advisory Services

It is important that assigned URA case managers provide adequate advisory services to displaced

tenants. As part of the case management process, URA case managers must:

• Meet with tenants to establish a Household Case Record (Site Survey) which assesses

and documents their relocation needs.

• Ensure that all required notices (GIN, Notice of Non-Displacement, 30 Day Move Out

Notice, etc.) have been provided and that receipt of these notices are adequately

documented and uploaded to Salesforce.

• Work with displaced tenants to identify available, comparable, and affordable housing

units meeting the needs of the household.


• Review and pre-approve all permanent relocation expenses to ensure that all relocation





• Coordinate relocation activities and timeframes with displaced households to ensure that

relocation payments or reimbursements are provided in a timely manner.

• Collect and review lease information and beneficiary data.

It is important to note that all forms of relocation advisory services including but not

limited to phone calls, attempted phone calls, emails, letters, notifications, personal

interviews, site visits, inspections, etc. must be logged and documented in Salesforce with

sufficient detail.

5.10 Housing Referrals and Inspections

Based upon the permanent relocation needs of the tenant, the URA case manager should pro-

actively identify rental units that are available in the tenant’s neighborhood or local community if

possible to minimize disruption to the household’s daily activities. Comparable units should be

evaluated on using the “Selection of Most Representative Comparable Replacement Dwelling”

(see HUD Form-40061 in Appendix 21) Form which compares the pre-relocation unit to other

comparable units. In addition, available units should be inspected to ensure that they meet

Housing Quality Standards (HQS) using the “HUD Inspection Checklist” (see HUD-52580 Form

in Appendix 26) prior to referring them to the displaced household. In addition, at least three (3)

comparable units should be provided to the household to establish the payment threshold for

the tenant’s Replacement Housing Payment (RHP). Copies of the “Selection of Most

Representative Comparable Replacement Dwelling” form and “HUD Inspection Checklist” should

be uploaded into Salesforce for each comparable provided to the tenant. All comparable units

referred to the tenant should be:

o Selected from the neighborhood in which the displacement dwelling is located or in nearby similar neighborhoods where housing costs are generally the same or higher. An obviously overpriced dwelling (e.g., luxury housing, if the displacement dwelling is non-luxury housing) may be ignored.

o “Equivalently functional” with similar structural characteristics to their current dwelling

(to include ADA accessibility),



o Decent, safe, and sanitary (as evidenced by an inspection).


o Affordable to the tenant being displaced (if the unit is not affordable, a last resort

housing adjustment may be considered).

In the event that the tenant identifies their own unit or has already relocated to another unit, the

URA case manager should request an inspection of the unit to ensure that it meets HQS

standards using the “HUD Inspection Checklist” (Appendix 26). If the unit is not decent, safe, and

sanitary, the tenant must be told that it is an ineligible unit. If the tenant has permanently relocated


to an ineligible unit, the URA case manager must inform them in writing that they are ineligible for

relocation benefits and provide the tenant with the following options:

o A list of repairs that must be made for the unit to pass inspection.

o Offer of relocation to a comparable unit.

o One-year timeframe in which to move to a unit that will pass inspection.

Copies of all “HUD Inspection Checklists” should be uploaded into Salesforce.

5.11 Calculation of permanent Replacement Housing Payments (RHP)

Eligible tenants may receive rental assistance for a 42-month period to be computed in the

following manner:

The assistance needed for one month is determined by subtracting the “base monthly rent” from

the pre-storm dwelling unit from the costs of rent and utilities for the post-relocation dwelling (or

comparable replacement home, if that cost is lower). That monthly need, if there is a difference,

is multiplied by 42 months to determine the total amount that the tenant will receive by the

program. The replacement housing payment is this amount or $7,200 whichever is less unless

last resort housing is required. It should be noted that it is likely last resort housing may be

necessary. All payments above HUD’s cap of $7,200 must be reviewed and approved by

NCORR program staff.

To qualify for a replacement housing payment, the tenant must rent and occupy a decent, safe,

and sanitary dwelling within one year of the date of their claim for assistance with the program.

5.12 Moving Expenses

Tenants will be provided the option of receiving a fixed moving expense payment or actual moving

expenses. If the tenant selects a fixed moving expense payment, the payment is based upon the

number of rooms that must be moved or has been moved by the tenant and the most recent

Federal Highway Administration’s fixed moving expense chart (see Appendix 25).

If the tenant elects to receive reimbursement of actual moving expenses, then the URA case

manager will obtain three (3) quotes from moving companies. The lowest quote establishes the

maximum amount that the program will pay for the move. The reimbursed amount of the actual

moving expense is either the 1) lowest quote obtained by the URA case manager, or 2) actual

reimbursable moving expense; whichever is less.

ALL moving or relocation costs incurred by the tenant must be approved in advance by

the program or the tenant may not receive reimbursement.

5.13 Claim Forms for Assistance

Based upon documentation provided by the tenant, the URA case manager should prepare the

following claim forms for assistance on behalf of the tenant.


o “Claim for Rental Assistance or Down-payment Assistance” (Appendix 23)

o “Residential Claim for Moving and Related Expenses” (Appendix 24)

Supplemental to the claim forms for assistance, the following additional forms must be prepared

and obtained by the URA case manager:

o “ACH Transfer Form” for the tenant (Appendix 27)

o “ACH Transfer Form” for the landlord (if applicable)


The “Claim for Rental Assistance or Down Payment Assistance” (Appendix 23) must be

accompanied by copies of the pre-relocation lease and one of following: 1) a lease for the tenant’s

post-relocation unit, or 2) HUD-1 form showing the purchase price of the replacement dwelling,

3) Sales contract for a replacement dwelling. In addition, print outs showing the average monthly

utilities for each unit must also be attached as these costs are the basis for the calculation of the

tenant’s Replacement Housing Payment (RHP) (i.e. the difference between rent and utilities at

the pre-relocation unit and the temporary unit).

The “Residential Claim for Moving and Related Expenses” (Appendix 24), if based upon actual

expenses, should be accompanied by three (3) quotes from moving companies, proof of the

actual expenses incurred by the tenants (bill from the moving company), and paid invoice or

cancelled check. If the tenant was displaced by the storm, the URA case manager will review

paid invoices/cancelled checks for moving costs incurred to determine costs reasonableness.

In addition, to the claim forms for assistance, the tenant will also need to complete and sign the

ACH Form (Appendix 27) for NCORR or Subrecipient to directly deposit the relocation funds into

the tenant’s account. If applicable, this form should also be filled out by the landlord of the post-

relocation unit so that NCORR or Subrecipient rental payments can be directly deposited into their

account.

All documents used to complete the claim form must be submitted as part of the request

for payment.

5.14 Requesting Payments from NCORR

In order to request a payment from NCORR, a “NCORR or Subrecipient Transmittal Memo”

(Appendix 29) must be developed by the URA case manager to summarize the reason and

amount of the payment to the tenant and/or landlord. In addition to the “NCORR or Subrecipient

Transmittal Memo” and “NCORR or Subrecipient Recovery Program Claim Payment Request”

(Appendix 30) must be prepared by filling out the approved amount for each cost category and

listing the appropriate payees. Next the URA case manager should attach all completed and

signed claim forms for assistance. Claim forms for assistance must be accompanied by all

required documentation and submitted in the order listed below.

o “NCORR or Subrecipient Transmittal Memo” (Appendix 29)



o Signed HUD Claim Form (s) “Claim for Rental or Down Payment Assistance” and “Claim

Form for Moving and Related Expenses” (Appendices 23 and 24).

o All source documentation related to the claim (pre-relocation lease, temporary relocation

lease, moving expense receipts, if applicable).



Once submitted and paid, the URA case manager should enter the actual payment information

into the into Salesforce and upload the packet listed above. As ACH payments are made, the

relocation payment details should be entered into Salesforce to include the number of the draw

request, method of payment, total payment, and period of assistance.

5.15 Tenant Acknowledgement of Relocation Payments

Once the final payment request has been submitted, the URA case manager should prepare a

“Relocation Assistance Acknowledgement Form” (Appendix 32) that lists all relocation expense

payments and the total of those payments. The signed form should be uploaded into Salesforce.

5.16 Tenant Opt-Out Process

Tenants who are not interested in permanent relocation benefits can elect to “Opt-Out” of the

program using the NCORR approved “Opt-Out” form (Appendix 33). However, in order for the

tenant to select this option the tenant must:

o Acknowledge receipt of the 1) “GIN”, 2) “Notice of Eligibility for Relocation Assistance”,

and HUD Brochure “Relocation Assistance to Tenants Displaced From Their Homes”.

o Fully understand the amount and type of temporary relocation benefits they are entitled to

receive.

5.17 Tenant Appeals

The URA case manager is responsible for informing all tenants regarding the appeals process

and obtaining a signed acknowledgement form from the tenant. In addition, the URA case

manager will be responsible for reviewing the appeal, collecting all necessary documentation, and

making a written recommendation to NCORR or Subrecipient regarding the tenant appeal.

NCORR or Subrecipient will be responsible for responding to the tenant appeal in writing within

fifteen (15) days.


6. Protocols for Locating Displaced Households

If tenants are identified as being displaced or potentially displaced by a NCORR or Subrecipient

Homeowner Recovery Program, URA case managers must proactively address non-compliance

as soon as possible and fully document program files for:

o Tenants identified as residing in a NCORR or Subrecipient assisted unit where temporary

relocation was required and did not occur due to the tenant moving out.

o Tenants identified as not returning to a rehabilitated unit after the NCORR or Subrecipient

work was completed.

o Tenants who did not receive the URA benefits that they were entitled to receive or were

underpaid and moved permanently from the unit.

o Tenants who were evicted for the landlord to initiate construction work.

o Tenants who did not return to the NCORR or Subrecipient unit due to increases in rent or

other unreasonable conditions.

o Tenants who have been identified as “Opting Out” of program benefits if they 1) did not

sign an “Opt-Out” form, 2) did not receive URA notifications, 3) weren’t fully informed

regarding the benefits they were entitled to receive.

All files identified as having displaced tenants or potentially displaced tenants should be reviewed

in detail by the URA case manager to understand the cause for the displacement, locate the

tenant, and make a URA eligibility determination. Once a tenant is located it will be necessary

for the URA case manager to ensure that all notification requirements are met and that all tenants

have been offered the appropriate amount of advisory services and assistance in accordance with

the URA SOPs and the Uniform Relocation Act (URA) to the greatest extent possible. In order to

document the file and assist displaced tenants, the following steps should be undertaken by the

URA case manager in order to locate a displaced, or potentially displaced, tenant:

Step 1

All files with identified deficiencies should be assigned to URA case managers who will attempt

to contact the tenant based upon information documented in the applicant’s file. All attempts to

locate the tenant will be documented in detail in Salesforce to include dates, times, methods of

contact and outcomes. If tenant contact information is available, standard protocols for contact

are at least three phone calls and follow up correspondence sent via regular and certified

mail. If tenants are located, URA case managers will work with the tenant to gather all required

household information, provide required notifications, document the receipt of those notifications,

make eligibility determinations, referrals, and provide temporary or permanent relocation

assistance as necessary in accordance with the URA SOPs. Comparable units will be inspected

for compliance with Housing Quality Standards (HQS) prior to providing them to the tenant to

ensure that the dwellings are currently available and decent, safe, and sanitary. In addition, all

comparable units must be available at the time referral to the tenant. All documentation related to

tenant contact and/or documentation shall be uploaded to the system of record within 24 hours.

NOTE: While it is important to document each attempt to contact the tenant and outcome of the

contact, it is important to remember that the tenant communication log in Salesforce is viewable

by all program staff and HUD during monitoring. For this reason, it is important that notes entered


into Salesforce are concise and do not contain personal observations, opinions, conjecture, or

other inappropriate language.

Step 2

If tenant contact information is not available or the tenant cannot be located, URA case managers

should contact the applicant (landlord) to attempt to obtain additional contact information.

Standard protocols for contact with the applicant (landlord and tenant) are at least three phone

calls and follow up correspondence sent via regular and certified mail. Even if additional

contact information cannot be obtained, the URA case manager will work with the applicant

(landlord) to gather as much information as possible related to the tenant to include rent and utility

costs at the assisted rental unit so that permanent relocation payments can be calculated and

budgeted. All attempts to locate the tenant and/or applicant (landlord) will be documented in

Salesforce to include dates, times, methods of contact and outcomes.

If tenants are located, the URA case manager will work with the tenant and/or applicant (landlord)

to gather all required household information, provide required notifications, document the receipt

of those notifications, make eligibility determinations, referrals, and provide temporary or

permanent relocation assistance as necessary in accordance with URA requirements.

Comparable units must be inspected for compliance with Housing Quality Standards (HQS) prior

to providing them to the tenant to ensure that the dwellings are decent, safe, and sanitary. In

addition, all comparable units must be available at the time referral to the tenant. A record of

tenant contacts (“Household Case Record”) and/or documentation shall be uploaded to the

system of record within 24 hours.

Step 3

In the case that no contact information can be found and/or contact has been unsuccessful with

tenants and applicants (landlord), URA case managers will utilize the skip-tracing software in

attempt to obtain tenant contact information. If the search does not return new contact information,

the skip-tracing team will forward the best available contact information (name and NCORR or

Subrecipient address) to the URA publication team.

In the event that new information is returned as a result of the skip trace search, URA case

managers will use the new contact information to locate tenants and document these efforts in

accordance with protocols outlined in Steps 1 and 2 above. If URA case managers are not

successful utilizing skip trace information, the best available tenant contact information (name

and NCORR or Subrecipient address) will be forwarded to the URA publication team who will

publish tenant lists in the local newspaper of greatest circulation in the area in which the tenant

resided prior to being displaced. The notice will be published for a minimum of 30 days.

Once the 30 days expires, proof of the public notices for the required duration shall be

uploaded in each tenant/applicant file within 3 business days.

Step 4

In addition to the public notices in the newspaper, a listing of tenants will also be posted to the

NCORR CDBG-DR Website until each tenant is located and/or provided assistance or the

program is closed out.


7. Tenant Assistance Policy

The goal of NCORR or Subrecipient Homeowner Recovery Programs is to minimize the

temporary and permanent displacement of tenants. For this reason, rental property owners

participating in NCORR or Subrecipient Homeowner Recovery Programs cannot permanently

displace tenants residing in their rental units. Tenants who are permanently displaced as a result

of a NCORR or Subrecipient Homeowner Recovery Programs are eligible for URA benefits. If

permanent displacement is unavoidable and URA Payments to the tenant are required, the

property owner may be held responsible for the cost of relocation benefits if it is determined that

the property owner knowingly violated program rules and purposefully caused the displacement.

It should be noted that tenants will not be responsible for making their regular rental payments to

the owners while they are temporarily relocated. Landlords who violate URA requirements will be

issued a “Notice of Landlord Default and Request to Cure” (see Appendix 35). Tenants who

violate the terms of their lease agreement which may cause eviction will be issued a “Modified

General Information Notice” (GIN) (see Appendix 10) to notify the tenant to cure their lease

violation.

At a minimum, tenants will be provided housing advisory services to assess temporary or

permanent relocation needs/levels of assistance, provide opportunities to select replacement

dwellings from a full range of neighborhoods within the total housing market, describe individual

rights under the Fair Housing Law, and methods in which to locate suitable replacement housing.

In addition, tenants will be provided a listing of available and affordable units that are comparable

in size and nature to the dwelling the household was displaced from, which also meet the current

needs of the households. For temporary displacement, tenants will also be provided with

assurances that the rehabilitated/reconstructed rental unit will be available at affordable rates for

a minimum of one year upon their return.

If an eligible tenant was relocated prior to the program providing URA assistance, the tenant will

be contacted to determine the reasons and circumstances for the displacement. If a tenant has

since returned to the rehabilitated/reconstructed unit, then tenant documentation of temporary

relocation expenses will be collected and reviewed to reimburse the tenant all eligible temporary

relocation costs. If the tenant has become permanently displaced, the Program will evaluate the

case and provide relocation benefits in accordance with URA requirements.

Finally, no person displaced by rental rehabilitation activities will be discriminated against. All

displaced persons shall be equally provided information, counseling, referrals, and relocation

services. In addition, no person shall be displaced or discriminated against because of age, race,

color, religion, sex, handicap, familial status, or national origin.


8. Move-In Notices

The URA case manager will assist in the identification and notification of prospective tenants

considering the lease of NCORR or Subrecipient assisted properties. All landlords and

prospective tenants will be provided “Move-In Notices” (see Appendix 34) prior to signing a lease.

The “Move In” Notice will inform the landlord and tenant that an application for assistance has

been submitted to the NCORR or Subrecipient Program, relocation for the project may be

required, and that relocation assistance will not be provided. A copy of the “Move In” Notice and

signed receipts from the landlord and tenants will be uploaded into Salesforce.


9. Fair Housing

NCORR and Subrecipient Homeowner Recovery Programs must fully comply with all U.S.

Department of Housing and Urban Development (HUD) regulations governing Fair Housing and

Equal Opportunity. No person shall, on the grounds of race, color, sex, religion, national or ethnic

origin, familial status, or disability shall be excluded from participation in, be denied benefits of, or

otherwise be subjected to discrimination during the implementation of a NCORR or Subrecipient

Homeowner Recovery Program.

The URA case manager will assist all relocated households who believe that they have suffered

illegal discrimination and will contact NCORR or the Subrecipient immediately for review and

assistance in filing a complaint with the HUD Office of Fair Housing and Equal Opportunity.

Section 12.0 outlines the NCORR’s or Subrecipient CDBG-DR Tenant Appeals/Grievance

Procedures.


10. Reasonable Accommodations

In certain circumstances, displaced households may require a reasonable accommodation to fully

benefit from temporary or permanent relocation activities undertaken in conjunction with NCORR

or Subrecipient Programs. Applicants who require a reasonable accommodation should contact

the NCORR Section 504 coordinator.

All forms, written materials and verbal messages used to communicate with displaced households

will be made available in the household’s primary language should the household indicate that

they have a Limited English Proficiency (LEP).


11. Definitions

Household: A household is comprised of all persons who occupy a dwelling unit. The

household may consist of a single family, one person living alone, two or more families living

together, live-in aides, or any other group of related or unrelated persons who share living

arrangements. Upon application for temporary or permanent relocation assistance, all

persons who reside in the household must be identified so that appropriate relocation

resources and assistance can be provided. Changes in household composition must be

reported to the Program within 10 days of the change.

Live-in Aide: A live-in aide is a person who resides with an elderly, handicapped or disabled

person who is:

• essential to the care and well-being of the person, and

• not obligated for the financial support of the person, and

• only living in the unit to provide necessary supportive services

Unit Size:

• The following factors will be considered in determining the unit size:

• Number of persons

• Relationship of persons

• Gender and age of persons

• Need to avoid overcrowding, maximize the use of space, and minimize the subsidy

costs

Generally, no more than two persons are required to occupy a bedroom. Children may share a

bedroom with a parent, if the parent so wishes. The decision is made by the parent.

All children expected to reside in the unit must be counted (e.g. unborn children, children in the

process of being adopted, foster children, children wo are subject to a joint custody agreement

and live in the unit at least 50% of the time). In addition, the following situations will be considered:

• Live-in attendants, foster children, and children who are temporarily absent due to

placement in a foster home are also counted when determining unit size

• Children who are away at school, who live with the family when school recesses, may be

counted

• Adult children on active military duty and permanently institutionalized family members are

no included in the bedroom count.

The maximum number of bedrooms used to provide temporary rental assistance is as follows:

• 1 BR for head of household/spouse/partner

• 1 BR for every two children of the same gender

• 1 BR for an only child

• 1 BR for multi-generational member or other adult

• 1 BR for approved live-in aides


Tenants may request to be assigned a larger unit as a reasonable accommodation. Such

requests must be made in writing to the Program. In all cases, local, state, or federal rules,

regulations, or ordinance will take precedence over the above stated policies should a conflict

arise.


12. Grievance Procedures

Both owner and tenant households shall be provided a copy of the NCORR or Subrecipient

Appeals Procedures during intake and/or prior to being provided relocation assistance (see

Appendix 7). Receipt of these procedures shall be documented and uploaded to the applicant’s

file in Salesforce.

All tenants have the right to appeal NCORR or Subrecipient action of the program on the

following grounds:

1. Failure to properly determine eligibility for, or the amount of, a relocation or other

payment due to them under the Uniform Act;

2. Refusal to waive the time limit for filing a claim or the one-year purchase and

occupancy requirement;

3. Failure to properly inspect the replacement dwelling;

4. Failure to comply with a requirement of 24 CFR 42.209 (Availability of Comparable

Replacement Dwellings Prior to Displacement); and

5. Failure to comply with a requirement of 24 CFR 42.207 (Notice of Right to Continue

in Occupancy).

The tenant’s acceptance of the amount offered to them by the program does not limit their

right to appeal the program determination regarding the amount of relocation assistance.

i

Uniform Relocation Act (URA)

Standard Operating Procedures

APPENDICES

ii

APPENDIX 1 Uniform Relocation Act (URA) List of Documents and Salesforce Naming Conventions

Appendix URA Document

Naming Convention Non-Displaced Tenants

(Temporary Relocation)

Permanently Displaced Tenants

2 Applicant and Tenant URA Certifications

Document:

APPID_URA_ATCert X X

3 Household Case Record

Document:

APPID_URA_HCR_LastNameFirstName X X

4 URA Tenant Demographic Information Certification

Document:

APPID_URA_TDIC_LastNameFirstInitial

X X

5 HUD Brochure “The Lead Safe Certified Guide to Renovate Right”

Document:

APPID_URA_LeadSafe_LastNameFirstInitial

X X

6 HUD Brochure “Relocation Assistance for Tenants Displaced From their Home”

Document:

APPID_URA_HUDRelo_LastNameFirstInitial

X

7 NCORR Appeals/Grievance Procedures

Tenant Document:

APPID_URA_TN_AppealProcedure_LastNameFirstInitial

X X

8 General Information Notice (GIN)-Tenant

Document:

APPID_URA_GIN_LastNameFirstInitial Certified Mail Return Receipt:

APPID_URA_CMRR_GIN_LastNameFirstInitial

X X

iii





9 General Information Notice (GIN) – Applicant

Document:

APPID_URA_GIN_LastNameFirstInitial Certified Mail Return Receipt:

APPID_URA_CMRR_GIN_LastNameFirstInitial

X X

10 Modified General Information Notice (GIN) – For eviction or other landlord/tenant issues

Document:

APPID_URA_TN_MGIN_LastNameFirstInitial Certified Mail Return Receipt:

APPID_URA_TN_CMRR_MGIN_LastNameFirstInitial

X X

11 URA Notice Tenant Acknowledgement Form

Document:

APPID_URA_NTD_LastNameFirstInitial

X X

12 Notice of Non-Displacement – Temporary Relocation Required

Document:

APPID_URA_TN_CMRR_ TRR_LastNameFirstInitial Certified Mail Receipt:

APPID_URA_TN_CMRR_TRR_LastNameFirstInitial

X

13 Notice of Non-Displacement – Temporary Relocation is not Required

Document:

APPID_URA_TN_TRNR_LastNameFirstInitial Certified Mail Receipt:

APPID_URA_TN_CMRR_TRNR_LastNameFirstInitial

X

14

Notice of Eligibility for Temporary Relocation Assistance

Document:

APPID_URA_TN_NOE_LastNameFirstInitial Certified Mail Receipt:

APPID_URA_TN_CMRR_NOE_LastNameFirstInitial

X

iv





15 Notice of Eligibility for Permanent Relocation Assistance

Document:

APPID_URA_TN_NOEPR_LastNameFirstInitial Certified Mail Receipt:

APPID_URA_TN_CMRR_NOEPR_LastNameFirstInitial

X

16 90 Day Notice Document:

APPID_URA_TN_90D_LastNameFirstInitial Certified Mail Receipt:

APPID_URA_TN_CMRR_90D_LastNameFirstIntial

X

17 30 Day Notice Document:

APPID_URA_30D_LastNameFirstInitial Certified Mail Receipt:

APPID_URA_CMRR_30D_LastNameFirstInitial

X X

18 Tenant Release and Consent Form for Utility Information

Document:

APPID_URA_TN_CRU_Freeform **Each utility can be named as freeform

X X

19 Tenant Subrogation Disclosure and Assignment Agreement

Document:

APPID_URA_SUB_LastNameFirstInitial X X

20 Right-of-Entry Form

Document:

APPID_URA_TN_ROE_LastNameFirstInitial

X X

v





21 “Selection of Most Comparable Replacement Dwelling”

Document:

APPID_URA_MCRD_LastNameFirstInitial

X X

22 “Claim Form for Temporary Relocation Expenses” (HUD Form-40030)

Document:

APPID_URA_ClaimTRE_LastNameFirstInitial

NOTE: All source documentation must be attached to the claim form and uploaded as a package.

X

23 “Claim Form for Rental or Downpayment Assistance” (HUD Form-40058)

Document:

APPID_URA_TN_ClaimFormRD_LastNameFirstInitial


X

24 “Claim Form for Moving and Related Expenses” (HUD Form-40054).

Tenant Document:

APPID_URA_TN_ClaimMRE_LastNameFirstInitial


X

25 FHA Fixed Moving Expense Schedule (if applicable)

N/A Attach schedule to “Claim Form for Moving and Related Expenses.

X X

vi





26 “HUD Inspection Checklist” (HUD Form 52580)

Document:

APPID_URA_HUDInsp_LastNameFirstInitial X X

27 ACH Transfer Form

Document:

APPID_URA_ACH_LastNameFirstInitial_MonthYear

X X

28 Landlord Cover Letter and Lease Rider

Document:

APPID_URA_TN_LeaseRider_LastNameFirstInitial X

29 NCORR Transmittal Memo

Document:

APPID_URA_NCEMMemo_MonthYear X X

30 NCORR Recovery Program Claim Payment Request

Document:

APPID_URA_NCEM_RPCPR_MonthYear X X

31 “Return Home Notice”

Document:

APPID_URA_ReturnHome_LastNameFirstInitial

X

32 “Tenant Relocation Assistance Acknowledgement Form”

Document:

APPID_URA_TRAA_LastNameFirstInitial X

X

vii





33 Tenant Opt-Out Form

Document:

APPID_URA_TN_OptOut_LastNameFirstInitial

X X

34 “Move-In Notice” (for prospective tenant only)

Document:

APPID_URA_TN_MoveIn_LastNameFirstInitial N/A N/A

35 “Notice of Landlord Default and Request to Cure”

Document:

APPID_URA_LDR_LastNameFirstInitial X X

36 Applicant Acknowledgement of Voluntary TRA Assistance

Document:

APPID_TRA_ACK_LastNameFirstInitial

37 Tenant URA Option Form

Document:

APPID_URA_OPTION_LastNameFirstInitial X

38 Residential Anti-Displacement Plan

N/A

39 URA Process Flow N/A

APPENDIX 2

1

APPLICANT AND TENANT URA CERTIFICATIONS

For Agency Use Only: Program Registration ID #: Applicant ID#:

Applicant Last Name: Damaged Property Address: Unit#:

Applicant/Authorized Representative Contact Information:

First Name: Last Name: Middle Initial:

Current Mailing Address:

City: State: Zip Code:

Cell Phone Number: Daytime Phone: Evening Phone:

Email:

Tenant Contact Information:

First Name: Last Name: Middle Initial:




Email:

For Applicants and tenants receiving assistance from the ReBuild NC Program pursuant to the Uniform Relocation Act:

2

I. The applicant and tenant self-certify that they have been provided with and understand the Program’s General Information Notice (GIN) for rental property located at _________________________________________ (APP#________________) (UNIT#__________________)

[TENANT INITIALS: ____ APPLICANT INITIALS: ____ ]

II. The applicant will not require or otherwise cause the tenant to move out of the unit until the Program has provided the tenant with a Notice of Non-Displacement-Temporary Relocation Required and/or Notice of Eligibility for Relocation Assistance and a 30-Day Move Notice. The applicant acknowledges that any tenant violation with the terms of their lease must be reported to the Program prior to taking legal action against the tenant. Tenants must notify the program if they want to relocate from the rental unit or if they do not intend to return to the rental unit. [TENANT INITIALS: ____ APPLICANT INITIALS: ____ ]

III. The applicant and tenant understand that rental payments to the applicant will be suspended during the period of temporary displacement (if applicable) but will resume upon the tenant’s re-occupancy of the rental unit.


IV. The applicant will provide the Program and tenant with a minimum of thirty (30) days notice prior to

commencement of program construction activities.


V. The applicant will notify the Program if construction activities or unforeseen circumstances will cause the

permanent displacement of the tenant prior to initiating construction, if possible (i.e. removal of all or a portion of the rental unit).


VI. The applicant will complete all construction on the home in less than twelve (12) months as stipulated in the grant agreement with the Program so that the tenant does not become permanently displaced. In addition, the applicant will coordinate construction activities with the Program and tenant to minimize the length of time that the tenant is temporarily relocated, if applicable.


VII. The applicant and the tenant self-certify that the rent of the pre-relocation unit is $ _________ at the time of

temporary displacement. In addition, the applicant and tenant self-certify that the tenant will return to the rental unit once construction is complete. The post-relocation rent of the unit will be $___________ with the same lease conditions applying at the time of the tenant’s displacement. The applicant and tenant will be responsible for providing the Program with a post-relocation lease within ten (10) days of the tenants return to the unit.


3

VIII. The applicant and tenant self-certify that they are fully aware that violations of URA requirements and Applicant and Tenant URA Certifications may result in Program sanctions to include a determination of ineligibility for program assistance, repayment of all or a portion of ReBuild NC funding, or reimbursement to the program for temporary and/or permanent relocation benefits. Tenants who do not intend to return to the rental unit should notify the program prior to receiving temporary relocation assistance. Tenant failure to notify the program may result in the repayment of a portion or all of the temporary relocation assistance.


IX. In the event of a conflict between the terms of these Certifications and the terms of the Lease Agreement, the provisions of these Certifications will take precedence.


Your signature below indicates that you have read, initialed, and understand the terms above.

(Applicant’s Signature) (Tenant’s Signature)

(Date) (Date)

APPENDIX 3

HOUSEHOLD CASE RECORD

DATE OF ORIGINAL INTERVIEW: _________________ NAME OF INTERVIEWER: ________________________

HOUSEHOLD SURVEY Name of Relocatee (s) : Racial/Ethnic Classification: See attached Relocatee Applicant ID: ______________ Tenant ID:_______________ Demographic Information Form Address: Contact in Case of Emergency: Name: Email: Address: Phone: Day Night Phone: Date of Original Occupancy: Relationship: CHARACTERISTICS OF CURRENT UNIT HOUSING COSTS OF CURRENT UNIT Type of Unit: SF Home Duplex Multi-Family # of Rooms: TENANT ONLY Is there a written lease? # of Bedrooms: Yes or No # of Bathrooms: Rent: $_________ Approximate Square Footage: Accessibility to Shopping: Is the rent subsidized? Medical: Avg. Utilities: $_________ Yes or No Public Transit: Other Services: Total Monthly Are utilities included in Number of cars in family: ______ Housing Cost: $__________ rent? Number of bathrooms: ___________________________ Yes or No Rooms of furniture: Living Room ____ Dining Room____ Kitchen ____ Office____ Basement _____ Other_____ Total Monthly Housing Costs: $_______ HOUSEHOLD CHARACTERISTICS

Name Age Sex

Relationship With

Household Head

Gross Monthly Income

Employer/Source of Income

Amount Source of Income Phone

Date/Initials of Person Verifying

Data

of 5

REPLACEMENT HOUSING PREFERENCES REPLACEMENT HOUSING NEEDS Tenure: Own: Rent: Subsidized: # of Rooms: # of Bedrooms: Other (Specify): # of Bathrooms: Location of Neighborhood: Approximate Square Footage: ________________________________________________ Maximum Monthly Housing Cost: $ Pets, Garage, etc: Preferred Maximum Monthly Housing Cost:$ SPECIAL NEEDS: _____School Age Children _____Disabled (Specify):_____________________ _____Other (Specify):___________________________ MOVING PREFERENCES Relocatee prefers: _____Fixed Moving Payment _____Reimbursement for Actual Moving Costs (Must be based on 3 quotes and approved in advance) Is there a need for a storage unit during relocation? Yes or No If yes, what size storage unit is needed? ___________ square feet If yes, does the storage unit need to be climate controlled? Yes or No HOUSING REFERRALS

Date Address Type of Unit Size of Unit Monthly

Rent/Sales Price

Date Available

Low Income or Minority

Area

Action on Referral/Reason

for Rejection

Relocatee Initials Rental Sales Subsi-

dized # of

Rooms # of

Bedrooms

of 5

SERVICES AND ASSISTANCE PROVIDED

Date Nature of Contact Assistance Provided Person Providing Service Results of Assistance or

Contact

REPLACEMENT UNIT Date of Move:__________________________ Address:____________________________________________________ INSPECTION MONTHLY HOUSING COSTS Date Inspected:____________________________ RENTAL SALES

Rent: $_________ Mortgage Payment: $_______ Decent, Safe and Sanitary: _____Yes _____No Estimated

Utilities: $_________ Real Property Tax: $_______ Date of Re-Inspection:______________________

Total Monthly Housing Cost: $_________ Estimated Utilities: $_______ # of Rooms:______________________________ #of Bedrooms:____________________________ Total Monthly Housing Costs: $_______ Accessibility to Services:___________________ Sales Price: $_______ TEMPORARY RELOCATION

Date Reason Address Rental

$

$

$

of 5

RELOCATION PAYMENTS

Type Paid Date and Amount Receipt Acknowledged

Moving: Fixed

Actual

Housing: Rental

Down Payment

Rent Other Total

APPEALS APPEAL FILED TYPE OF APPEAL Yes______ Payments_______ No_______ Housing________ Other__________

of 5

RECORD OF ADVISORY ASSISTANCE AND OTHER CONTACTS NAME OF RELOCATEE

Page of

NAME OF AGENCY REP AND DATE OF CONTACT

COMMENTS

APPENDIX 4

For

URA Tenant Demographic Information Form

Name _________________________________ Number of Persons in Household _____ Address ________________________________ Number of Household Members 62 or Older _____ Phone ________________________________ Number of Disabled in Household _____

Household Information --Total number of persons in household by: 1. Race White ____ American Indian/Alaskan Native & Other ____

Black/African American ____ Asian & White _____ Asian ____ Black/African American & White_____ American Indian/Alaskan Native____ Other Multi-Racial ______ Native Hawaiian/Other Pacific Islander_____ American Indian/Alaskan Native & Black/African American _______

2. Ethnicity Non-Hispanic______ Hispanic______ 3. Head of Household: Male _____ Female _____ 4. Age of Head of Household: ______ Residential Households (1) Individual (2) Family

I certify that I am (check one): I certify that there are ______ persons _____ a citizen or national of the United States in my household and that ______ are _____ an alien lawfully present in the United States citizens or nationals of the United States and _______ are aliens lawfully present in the United States

Total Gross Annual Household Income: In the column showing the number of people in your household, circle (only one) income range that totals the gross annual household income. 1 person 2 person 3 person 4 person 5 person 6 person 7 person 8 person $0-$23,300 $0-$26,600 $0-$29,950 $0-$33,250 $0-$35,950 $0-$38,600 $0-$41,250 $0-$43,900 $23,301-$38,800 $26,601-$44,350 $29,951-$49,900 $33,251-$55,400 $35,951-$51,550 $38,601-$64,300 $41,251-$68,700 $43,901-$73,150 $38,801-$56,700 $44,351-$64,800 $49,901-$72,900 $55,401-$81,000 $51,551-$87,500 $64,301-$94,000 $68,701-$100,450 $73,151-$106,950 Above $56,700 Above $64,800 Above $72,900 Above $81,000 Above $87,500 Above $94,000 Above $100,450 Above $106,950

For Official Use Over :_________ LMI:__________ VL:___________ XL:

I hereby certify that the above information is true and accurate to the best of my knowledge and fully understand that this information is subject to verification by NCORR or HUD upon their request. Falsifying this information can result in the repayment of CDBG funds. ____________________________________ ________________________________________ Signature Date Interviewer

APPENDIX 5

THE LEAD-SAFE CERTIFIED GUIDE TO

RENOVATE

RIGHT

1-800-424-LEAD (5323) epa.gov/getleadsafe

EPA-740-K-10-001 Revised September 2011

This document may be purchased through the U.S. Government Printing Office online at

-1800. -free ): 1- 866- 512

bookstor e.gpo. gov or by phone (toll

Important lead hazard information for

families, child care providers and schools.

- SA AD

E F

L E E M

C IR

RTIFIEDF

http://www.epa.gov/getleadsafe

http://bookstore.gpo.gov/

IT’S THE LAW!

Federal law requires contractors that disturb painted surfaces

in homes, child care facilities and schools built before 1978 to

be certified and follow specific work practices to prevent lead

contamination. Always ask to see your contractor’s certification.

Federal law requires that individuals receive certain information

before renovating more than six square feet of painted surfaces

in a room for interior projects or more than twenty square feet

of painted surfaces for exterior projects or window replacement

or demolition in housing, child care facilities and schools built

before 1978.

• Homeowners and tenants: renovators must give you

this pamphlet before starting work.

• Child care facilities, including preschools and kindergarten

classrooms, and the families of children under six years of age

that attend those facilities: renovators must provide a copy of

this pamphlet to child care facilities and general renovation

information to families whose children attend those facilities.

WHO SHOULD READ THIS PAMPHLET?

This pamphlet is for you if you:

• Reside in a home built before 1978.

• Own or operate a child care facility, including preschools and

kindergarten classrooms, built before 1978, or

• Have a child under six years of age who attends a child care facility built before 1978.

You will learn:

• Basic facts about lead and your health.

• How to choose a contractor, if you are a property owner.

• What tenants, and parents/guardians of a child in a child care facility or

school should consider.

• How to prepare for the renovation or repair job.

• What to look for during the job and after the job is done.

• Where to get more information about lead.

This pamphlet is not for:

• Abatement projects. Abatement is a set of activities aimed specifically at eliminating lead

or lead hazards. EPA has regulations for certification and training of abatement

professionals. If your goal is to eliminate lead or lead hazards, contact the National Lead Information Center at 1-800-424-LEAD (5323) for more information.

• “Do-it-yourself” projects. If you plan to do renovation work yourself, this

document is a good start, but you will need more information to complete the

work safely. Call the National Lead Information Center at 1-800-424-LEAD

(5323) and ask for more information on how to work safely

in a home with lead-based paint.

• Contractor education. Contractors

who want information about working

safely with lead should contact the National Lead Information Center at 1-800-424-LEAD (5323) for

information about courses and

resources on lead-safe work practices.

1

RENOVATING, REPAIRING, OR PAINTING?

• Is your home, your building, or the child care

facility or school your children attend being

renovated, repaired, or painted?

• Was your home, your building, or the child care

facility or school where your children under six

years of age attend built before 1978? If the answer to these questions is YES, there

are a few important things you need to know

about lead-based paint.

This pamphlet provides basic facts about lead and

information about lead safety when work is being

done in your home, your building or the child care

facility or school your children attend.

The Facts About Lead

• Lead can affect children’s brains and developing nervous systems, causing reduced IQ,

learning disabilities, and behavioral problems. Lead is also harmful to adults.

• Lead in dust is the most common way people are exposed to lead. People can also get

lead in their bodies from lead in soil or paint chips. Lead dust is often invisible.

• Lead-based paint was used in more than 38 million homes until it was

banned for residential use in 1978.

• Projects that disturb painted surfaces can create dust and endanger you and

your family. Don’t let this happen to you. Follow the practices described in this

pamphlet to protect you and your family.

LEAD AND YOUR HEALTH

Lead is especially dangerous to

children under six years of age. Lead can affect children’s brains and

developing nervous systems, causing: • Reduced IQ and learning disabilities. • Behavior problems.

Even children who appear healthy can have

dangerous levels of lead in their bodies. Lead is also harmful to adults. In adults, low

levels of lead can pose many dangers, including: • High blood pressure and hypertension. • Pregnant women exposed to lead can transfer lead to their fetuses. Lead

gets into the body when it is swallowed or inhaled. • People, especially children, can swallow lead dust as they eat, play, and do

other normal hand-to-mouth activities. • People may also breathe in lead dust or fumes if they disturb lead-based

paint. People who sand, scrape, burn, brush, blast or otherwise disturb

lead-based paint risk unsafe exposure to lead.

What should I do if I am concerned about my family’s exposure to lead? • A blood test is the only way to find out if you or a family member already has lead

poisoning. Call your doctor or local health department to arrange for a blood test. • Call your local health department for advice on reducing and eliminating

exposures to lead inside and outside your home, child care facility or school. • Always use lead-safe work practices when renovation or repair will

disturb painted surfaces.

For more information about the health effects of exposure to lead, visit the EPA

lead website at epa.gov/lead/pubs/leadinfo or call 1-800-424-LEAD (5323). There are other things you can do to protect your family every day. • Regularly clean floors, window sills, and other surfaces. • Wash children’s hands, bottles, pacifiers, and toys often. • Make sure children eat a healthy, nutritious diet consistent with the USDA's

dietary guidelines, that helps protect children from the effects of lead. • Wipe off shoes before entering the house.

2 3

http://www.epa.gov/lead/pubs/leadinfo.htm

WHERE DOES THE LEAD COME FROM?

Dust is the main problem. The most common way to get lead in the body is from dust. Lead dust comes from

deteriorating lead-based paint and lead-contaminated soil that gets tracked into

your home. This dust may accumulate to unsafe levels. Then, normal hand to-

mouth activities, like playing and eating (especially in young children), move that

dust from surfaces like floors and window sills into the body.

Home renovation creates dust. Common renovation activities like sanding, cutting, and demolition can

create hazardous lead dust and chips.

Proper work practices protect you from the dust. The key to protecting yourself and your family during a renovation, repair or

painting job is to use lead-safe work practices such as containing dust inside the

work area, using dust-minimizing work methods, and conducting a careful

cleanup, as described in this pamphlet.

Other sources of lead. Remember, lead can also come from outside soil, your water, or household items (such

as lead-glazed pottery and lead crystal). Contact the National Lead Information Center at

1-800-424-LEAD (5323) for more information on these sources.

CHECKING YOUR HOME FOR LEAD-BASED PAINT

Older homes, child care facilities, and schools are more likely to contain lead-based paint. Homes may be single-family homes or apartments. They may be private,

government-assisted, or public housing. Schools are preschools and

kindergarten classrooms. They may be urban, suburban, or rural.

You have the following options: You may decide to assume your home, child care facility, or school

contains lead. Especially in older homes and buildings, you may simply want

to assume lead-based paint is present and follow the lead-safe work practices

described in this brochure during the renovation, repair, or painting job. You can hire a certified professional to check for lead-based paint. These professionals are certified risk assessors or inspectors, and can

determine if your home has lead or lead hazards. • A certified inspector or risk assessor can conduct an inspection telling you whether your

home, or a portion of your home, has lead-based paint and where it is located. This will

tell you the areas in your home where lead-safe work practices are needed. • A certified risk assessor can conduct a risk assessment telling you if your

home currently has any lead hazards from lead in paint, dust, or soil. The risk

assessor can also tell you what actions to take to address any hazards. • For help finding a certified risk assessor or inspector, call the National

Lead Information Center at 1-800-424-LEAD (5323). You may also have a certified renovator test the surfaces or components being

disturbed for lead by using a lead test kit or by taking paint chip samples and sending

them to an EPA-recognized testing laboratory. Test kits must be EPA-recognized and

are available at hardware stores. They include detailed instructions for their use.

4 5

FOR PROPERTY OWNERS

You have the ultimate responsibility for the safety of your family, tenants, or children in your care. This means properly preparing for the renovation and keeping persons out of the work

area (see p. 8). It also means ensuring the contractor uses lead-safe work practices.

Federal law requires that contractors performing renovation, repair and painting projects that

disturb painted surfaces in homes, child care facilities, and schools built before 1978 be

certified and follow specific work practices to prevent lead contamination.

Make sure your contractor is certified, and can explain clearly the details of the

job and how the contractor will minimize lead hazards during the work. • You can verify that a contractor is certified by checking EPA’s website at

epa.gov/getleadsafe or by calling the National Lead Information Center at 1-800-424-LEAD (5323). You can also ask to see a copy of the

contractor’s firm certification.

• Ask if the contractor is trained to perform lead-safe work practices and to

see a copy of their training certificate.

• Ask them what lead-safe methods they will use to set up and perform the job in

your home, child care facility or school.

• Ask for references from at least three recent jobs involving homes built before

1978, and speak to each personally. Always make sure the contract is clear about how the work will be

set up, performed, and cleaned. • Share the results of any previous lead tests with the contractor.

• You should specify in the contract that they follow the work practices

described on pages 9 and 10 of this brochure.

• The contract should specify which parts of your home are part of the work area

and specify which lead-safe work practices will be used in those areas.

Remember, your contractor should confine dust and debris to the work area

and should minimize spreading that dust to other areas of the home.

• The contract should also specify that the contractor will clean the work area,

verify that it was cleaned adequately, and re-clean it if necessary.

If you think a worker is not doing what he is supposed to do or is doing something that is unsafe, you should: • Direct the contractor to comply with regulatory and contract requirements.

• Call your local health or building department, or

• Call EPA's hotline 1-800-424-LEAD (5323).

If your property receives housing assistance from HUD (or a state or local

agency that uses HUD funds), you must follow the requirements of HUD’s Lead-

Safe Housing Rule and the ones described in this pamphlet.

FOR TENANTS AND FAMILIES OF CHILDREN UNDER SIX

YEARS OF AGE IN CHILD CARE FACILITIES AND SCHOOLS

You play an important role ensuring

the ultimate safety of your family. This means properly preparing for the renovation

and staying out of the work area (see p. 8). Federal law requires that contractors performing

renovation, repair and painting projects that

disturb painted surfaces in homes built before

1978 and in child care facilities and schools built

before 1978, that a child under six years of age

visits regularly, to be certified and follow specific

work practices to prevent lead contamination. The law requires anyone hired to renovate, repair, or

do painting preparation work on a property built before

1978 to follow the steps described on pages 9 and 10 unless the area where

the work will be done contains no lead-based paint.

If you think a worker is not doing what he is supposed to do or is doing something that is unsafe, you should: • Contact your landlord. • Call your local health or building department, or • Call EPA's hotline 1-800-424-LEAD (5323). If you are concerned about lead hazards left behind after the job is over,

you can check the work yourself (see page 10).

6 7

http://www.epa.gov/getleadsafe

PREPARING FOR A RENOVATION

The work areas should not be accessible to occupants while the work occurs.

The rooms or areas where work is being done may need to be blocked off or sealed

with plastic sheeting to contain any dust that is generated. Therefore, the contained

area may not be available to you until the work in that room or area is complete,

cleaned thoroughly, and the containment has been removed. Because you may not

have access to some areas during the renovation, you should plan accordingly.

You may need: • Alternative bedroom, bathroom, and kitchen arrangements if work is

occurring in those areas of your home.

• A safe place for pets because they too can be poisoned by lead and can

track lead dust into other areas of the home.

• A separate pathway for the contractor from the work area to the outside in

order to bring materials in and out of the home. Ideally, it should not be

through the same entrance that your family uses.

• A place to store your furniture. All furniture and belongings may have to be

moved from the work area while the work is being done. Items that can’t be

moved, such as cabinets, should be wrapped in plastic.

• To turn off forced-air heating and air conditioning systems while the work is being

done. This prevents dust from spreading through vents from the work area to the

rest of your home. Consider how this may affect your living arrangements.

You may even want to move out of your home temporarily while all or

part of the work is being done.

Child care facilities and schools may want to consider alternative

accommodations for children and access to necessary facilities.

DURING THE WORK

Federal law requires contractors that are hired to perform renovation, repair and painting

projects in homes, child care facilities, and schools built before 1978 that disturb painted

surfaces to be certified and follow specific work practices to prevent lead contamination. The work practices the contractor must follow include these three simple

procedures, described below: 1. Contain the work area. The area must be contained so that dust and debris do

not escape from that area. Warning signs must be put up and plastic or other

impermeable material and tape must be used as appropriate to:

• Cover the floors and any furniture that cannot be moved.

• Seal off doors and heating and cooling system vents.

• For exterior renovations, cover the ground and, in some instances, erect vertical

containment or equivalent extra precautions in containing the work area. These work practices will help prevent dust or debris from getting outside the work area. 2. Avoid renovation methods that generate large amounts of lead-

contaminated dust. Some methods generate so much lead-contaminated dust

that their use is prohibited. They are:

• Open flame burning or torching.

• Sanding, grinding, planing, needle

gunning, or blasting with power tools

and equipment not equipped with a

shroud and HEPA vacuum attachment.

• Using a heat gun at temperatures

greater than 1100°F. There is no way to eliminate dust, but some renovation methods make less dust than others.

Contractors may choose to use various methods to minimize dust generation, including using

water to mist areas before sanding or scraping; scoring paint before separating components;

and prying and pulling apart components instead of breaking them. 3. Clean up thoroughly. The work area should be cleaned up daily to keep it as

clean as possible. When all the work is done, the area must be cleaned up using

special cleaning methods before taking down any plastic that isolates the work

area from the rest of the home. The special cleaning methods should include:

• Using a HEPA vacuum to clean up dust and debris on all surfaces, followed by

• Wet wiping and wet mopping with plenty of rinse water. When the final cleaning is done, look around. There should be no dust, paint chips, or debris in

the work area. If you see any dust, paint chips, or debris, the area must be re-cleaned.

8 9

FOR PROPERTY OWNERS: AFTER THE WORK IS DONE

When all the work is finished, you will want to know if your home, child care

facility, or school where children under six attend has been cleaned up properly.

EPA Requires Cleaning Verification. In addition to using allowable work practices and working in a lead-safe manner,

EPA’s RRP rule requires contractors to follow a specific cleaning protocol. The

protocol requires the contractor to use disposable cleaning cloths to wipe the floor

and other surfaces of the work area and compare these cloths to an EPA-provided

cleaning verification card to determine if the work area was adequately cleaned. EPA

research has shown that following the use of lead-safe work practices with the

cleaning verification protocol will effectively reduce lead-dust hazards.

Lead-Dust Testing. EPA believes that if you use a certified and trained renovation contractor who

follows the LRRP rule by using lead-safe work practices and the cleaning

protocol after the job is finished, lead-dust hazards will be effectively reduced. If,

however, you are interested in having lead-dust testing done at the completion

of your job, outlined below is some helpful information.

What is a lead-dust test? • Lead-dust tests are wipe samples sent to a laboratory for analysis. You will

get a report specifying the levels of lead found after your specific job.

How and when should I ask my contractor about lead-dust testing? • Contractors are not required by EPA to conduct lead-dust testing. However, if

you want testing, EPA recommends testing be conducted by a lead professional.

To locate a lead professional who will perform an evaluation near you, visit EPA’s

website at epa.gov/lead/pubs/locate or contact the National Lead Information

Center at 1-800-424-LEAD (5323).

• If you decide that you want lead-dust testing, it is a good idea to specify in your

contract, before the start of the job, that a lead-dust test is to be done for your

job and who will do the testing, as well as whether re-cleaning will be required

based on the results of the test.

• You may do the testing yourself. If you choose to do the testing,

some EPA-recognized lead

laboratories will send you a kit

that allows you to collect samples

and send them back to the

laboratory for analysis. Contact

the National Lead Information

Center for lists of EPA-

recognized testing laboratories.

FOR ADDITIONAL INFORMATION

You may need additional information on how to protect yourself and your children

while a job is going on in your home, your building, or child care facility. The National Lead Information Center at 1-800-424-LEAD (5323) or

epa.gov/lead/nlic can tell you how to contact your state, local, and/or tribal

programs or get general information about lead poisoning prevention. • State and tribal lead poisoning prevention or environmental protection

programs can provide information about lead regulations and potential sources of financial aid for reducing

lead hazards. If your state or local government has

requirements more stringent than those described in

this pamphlet, you must follow those requirements. • Local building code officials can tell you the

regulations that apply to the renovation work that

you are planning. • State, county, and local health departments can

provide information about local programs, including

assistance for lead-poisoned children and advice on

ways to get your home checked for lead. The National Lead Information Center can also

provide a variety of resource materials, including

the following guides to lead-safe work practices.

Many of these materials are also available at

epa.gov/lead/pubs/brochure • Steps to Lead Safe Renovation, Repair and Painting. • Protect Your Family from Lead in Your Home • Lead in Your Home: A Parent’s Reference Guide

For the hearing impaired, call the Federal Information Relay Service at 1-800-

877-8339 to access any of the phone numbers in this brochure.

10 11

http://www.epa.gov/lead/pubs/locate.htm

http://www.epa.gov/lead/nlic.htm

http://www.epa.gov/lead/pubs/brochure.htm

EPA CONTACTS OTHER FEDERAL AGENCIES

EPA Regional Offices EPA addresses residential lead hazards through several different regulations. EPA requires training and certification for conducting abatement and renovations,

education about hazards associated with renovations, disclosure about known lead

paint and lead hazards in housing, and sets lead-paint hazard standards.

Your Regional EPA Office can provide further information regarding lead

safety and lead protection programs at epa.gov/lead.

Region 1 Region 4 Region 7 (Connecticut, Massachusetts, (Alabama, Florida, Georgia, (Iowa, Kansas, Missouri, Maine, New Hampshire, Kentucky, Mississippi, North Nebraska) Rhode Island, Vermont) Carolina, South Carolina, Regional Lead Contact Regional Lead Contact Tennessee) U.S. EPA Region 7 U.S. EPA Region 1 Regional Lead Contact 901 N. 5th Street Suite 1100 U.S. EPA Region 4 Kansas City, KS 66101 One Congress Street 61 Forsyth Street, SW (913) 551-7003 Boston, MA 02114-2023 Atlanta, GA 30303-8960

Region 8 (888) 372-7341 (404) 562-9900

Region 2 Region 5 (Colorado, Montana, North Dakota, South Dakota,

(New Jersey, New York, (Illinois, Indiana, Michigan, Utah, Wyoming) Puerto Rico, Virgin Islands) Minnesota, Ohio, Wisconsin) Regional Lead Contact Regional Lead Contact Regional Lead Contact U.S. EPA Region 8 U.S. EPA Region 2 U.S. EPA Region 5 1595 Wynkoop Street 2890 Woodbridge Avenue 77 West Jackson Boulevard Denver, CO 80202 Building 205, Mail Stop 225 Chicago, IL 60604-3507 (303) 312-6312 Edison, NJ 08837-3679 (312) 886-6003

Region 9 (732) 321-6671 Region 6

Region 3 (Arizona, California, Hawaii,

(Arkansas, Louisiana, New Nevada) (Delaware, Maryland, Mexico, Oklahoma, Texas) Regional Lead Contact Pennsylvania, Virginia, Regional Lead Contact U.S. Region 9 Washington, DC, West U.S. EPA Region 6 75 Hawthorne Street Virginia) 1445 Ross Avenue, San Francisco, CA 94105 Regional Lead Contact 12th Floor (415) 947-8021 U.S. EPA Region 3 Dallas, TX 75202-2733

Region 10 1650 Arch Street (214) 665-7577 Philadelphia, PA (Alaska, Idaho, 19103-2029 Oregon, Washington) (215) 814-5000 Regional Lead Contact U.S. EPA Region 10 1200 Sixth Avenue Seattle, WA 98101-1128 (206) 553-1200

CPSC The Consumer Product Safety

Commission (CPSC) protects the public

from the unreasonable risk of injury or

death from 15,000 types of consumer

products under the agency’s jurisdiction.

CPSC warns the public and private

sectors to reduce exposure to lead and

increase consumer awareness. Contact

CPSC for further information regarding

regulations and consumer product safety.

CPSC 4330 East West Highway Bethesda, MD 20814 Hotline 1-(800) 638-2772 cpsc.gov

CDC Childhood Lead

Poisoning Prevention Branch The Centers for Disease Control and

Prevention (CDC) assists state and local

childhood lead poisoning prevention

programs to provide a scientific basis for

policy decisions, and to ensure that health

issues are addressed in decisions about

housing and the environment. Contact

CDC Childhood Lead Poisoning

Prevention Program for additional

materials and links on the topic of lead.

CDC Childhood Lead

Poisoning Prevention Branch 4770 Buford Highway, MS

F-40 Atlanta, GA 30341 (770) 488-3300

cdc.gov/nceh/lead

HUD Office of Healthy Homes

and Lead Hazard Control The Department of Housing and Urban

Development (HUD) provides funds to

state and local governments to develop

cost-effective ways to reduce lead-based

paint hazards in America’s privately-

owned low-income housing. In addition,

the office enforces the rule on disclosure

of known lead paint and lead hazards in

housing, and HUD’s lead safety

regulations in HUD-assisted housing,

provides public outreach and technical

assistance, and conducts technical

studies to help protect children and their

families from health and safety hazards in

the home. Contact the HUD Office of

Healthy Homes and Lead Hazard Control

for information on lead regulations,

outreach efforts, and lead hazard control

research and outreach grant programs.

U.S. Department of Housing and

Urban Development

Office of Healthy Homes and Lead Hazard Control 451 Seventh Street, SW, Room 8236 Washington, DC 20410-3000 HUD’s Lead Regulations Hotline (202) 402-7698

hud.gov/offices/lead/

12 13

http://www.epa.gov/lead

http://www.cpsc.gov/

http://www.cdc.gov/nceh/lead

http://www.hud.gov/offices/lead/

PRE-RENOVATION FORM This form may be used by renovation firms to document compliance with the Federal pre-renovation education and renovation, repair, and painting regulations.

Occupant Confirmation Pamphlet Receipt q I have received a copy of the lead hazard information pamphlet informing me of the

potential risk of the lead hazard exposure from renovation activity to be performed

in my dwelling unit. I received this pamphlet before the work began.

Printed Name of Owner-occupant

Signature of Owner-occupant Signature Date

Renovator’s Self Certification Option (for tenant-occupied dwellings only) Instructions to Renovator: If the lead hazard information pamphlet was delivered but a

tenant signature was not obtainable, you may check the appropriate box below.

q Declined – I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant.

q Unavailable for signature – I certify that I have made a good faith effort to deliver the

lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant

was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the

pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left).

Printed Name of Person Certifying Delivery Attempted Delivery Date

Signature of Person Certifying Lead Pamphlet Delivery

Unit Address

Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by a certificate of mailing from the post office.

APPENDIX 6

RELOCATION ASSISTANCE U.S. Department of Housing TO TENANTS DISPLACED and Urban Development FROM THEIR HOMES Office of Community Planning and Development www.hud.gov/relocation

Previous Edition Obsolete 1 HUD-1042-CPD

(3/2005)

Introduction This booklet describes the relocation payments and other relocation assistance provided under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (URA) to tenants displaced from their homes. This includes any family or individual that must move as a direct result of rehabilitation, demolition or acquisition for a project in which Federal funds are used. If you are notified that you will be displaced, it is important that you do not move before you learn what you must do to receive the relocation payments and other assistance to which you are entitled. Pursuant to Public Law 105-117, aliens not lawfully present in the United States are not eligible for relocation assistance, unless such ineligibility would result in exceptional hardship to a qualifying spouse, parent, or child. All persons seeking relocation assistance will be required to certify that they are a United States citizen or national, or an alien lawfully present in the United States. This booklet may not answer all of your questions. If you have more questions about your relocation, contact the Agency responsible for the project. (Check the back of this booklet for the name of the person to contact at the Agency.) Ask your questions before you move. Afterwards, it may be too late. Summary of Relocation Assistance As an eligible tenant displaced from your home, you will be offered the following advisory and financial assistance: • Advisory Services. This includes referrals to comparable and suitable replacement

homes, the inspection of replacement housing to ensure that it meets established standards, help in preparing claim forms for relocation payments and other assistance to minimize the impact of the move.

• Payment for Moving Expenses. You may choose either a:

∗ Payment for Your Actual Reasonable Moving and Related Expenses, or ∗ Fixed Moving Expense and Dislocation Allowance, or ∗ A combination of both, based on circumstances.

• Replacement Housing Assistance. To enable you to rent, or if you prefer, buy a comparable or suitable replacement home, you may choose either:


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∗ Rental Assistance, or ∗ Purchase Assistance.

If you disagree with the Agency's decision as to the relocation assistance for which you are eligible, you may appeal that decision. General Questions How Will I Know I Am Eligible For Relocation Assistance? You should receive a written notice explaining your eligibility for relocation assistance. You should not move before receiving that notice. If you do, you may not receive relocation assistance. How Will The Agency Know How Much Help I Need? You will be contacted at an early date and personally interviewed by a representative of the Agency to determine your relocation needs and preferences for replacement housing and advisory services. The interviewer will ask certain questions about you and other members of your household, including questions about your income. It is to your advantage to provide the information so that the Agency can assist you in moving with a minimum of hardship. The information you give will be kept in confidence. How Soon Will I Have To Move? If possible, a mutually agreeable date for the move will be worked out. You will be given enough time to make plans for moving. Unless there is a health or safety emergency, you will not be required to move without at least 90 days advance written notice of (1) at least one "comparable replacement home" that is available to you and (2) the earliest date by which you must move. What Is A Comparable Replacement Home? A comparable replacement home is: • Decent, safe, and sanitary. • Functionally equivalent to (and equal or better than) your present home. • Actually available for you to rent. • Affordable. • Reasonably accessible to your place of employment. • Generally as well located with respect to public and commercial facilities, such as

schools and shopping, as your present home. • Not subject to unreasonable adverse environmental conditions. • Available to all persons regardless of race, color, religion, sex, or national origin.


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What is Decent, Safe, and Sanitary Housing? Decent, safe, and sanitary housing is housing that: • Meets applicable housing and occupancy requirements. • Is structurally sound, weathertight, and in good repair. • Contains a safe, adequate electrical wiring system. • Has adequate living space for the occupants. • Has a kitchen with a sink, hot and cold running water, and connections for a stove

and refrigerator (if you were displaced from a housekeeping unit). • Has a separate, complete bathroom with hot and cold running water. • Has heating as required by climatic conditions. • Has an unobstructed exit to safe, open space at ground level. • Meets standards protecting occupants from lead-based paint hazards. • If you are person with a physical disability, is free of any barriers which would

preclude your reasonable use of the unit. Will The Agency Help Me Find A Replacement Home? Yes. You will be provided with referrals to housing that has been inspected to ensure that it meets established standards. If possible, you will be referred to at least three comparable replacement homes. The maximum financial assistance for which you may qualify will be based on the cost of the most representative comparable replacement home that is available to you. Promptly after you become eligible for relocation assistance, the Agency will inform you of such unit and the maximum payment available. Once the Agency representative has a clear understanding of your needs and preferences, he or she will work with you to assure that you are given the best possible choice of housing. The Agency will offer you appropriate transportation to inspect these units. If you would like to move to government-owned housing or obtain a Housing Choice Voucher (HCV) let the Agency representative know of your interest. Generally, an eligible displaced person receives preference for such long term housing assistance. You will be given assistance in completing any required application forms. What If I Find My Own Replacement Housing? You have every right to find your own replacement housing. However, before you rent or buy, ask the Agency to inspect the unit to make sure that it is decent, safe, and sanitary. If the housing unit is not decent, safe, and sanitary, you will not receive a replacement housing payment. What If I Encounter A Problem In Obtaining Housing Of My Choice?


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If you encounter a problem in buying or renting housing of your choice, notify the Agency immediately. The Agency will look into the matter and try to resolve it. You will receive this help whether you were referred to the housing unit or found it yourself. If you are unable to buy or rent a housing unit because of discriminatory practices on the part of a real estate broker, rental agent, lender, or a property owner, the Agency will help you file a formal housing discrimination complaint with the U.S. Department of Housing and Urban Development or the appropriate State or local fair housing agency. What Other Services Will I Receive? In addition to help in obtaining a comparable replacement home, other assistance, as necessary, will be provided in order to minimize the impact of your move. This assistance may include referral to appropriate public and private agencies that provide services concerning housing financing, employment, health, welfare, or legal assistance. The range of services depends on the needs of the person being displaced. You should ask the Agency representative to tell you about the specific services that will be available to help you and your family. What Is a Payment For Actual Reasonable Moving and Related Expenses? You may choose to receive a relocation payment to cover the reasonable cost of your move. If you choose a Payment For Actual Reasonable Moving And Related Expenses, you may include in your claim the reasonable and necessary costs for: • Transportation for you and your family. • Packing, moving and unpacking your household goods. • Disconnecting and reconnecting household appliances and other personal property

(e.g., telephone and cable TV). • Storage of household goods, as may be necessary. • Insurance for the replacement value of your property during the move and necessary

storage. • The replacement value of property lost, stolen or damaged in the move (but not

through your neglect) if insurance is not reasonably available.

The Agency will explain all eligible moving costs, as well as those which are not eligible. You must be able to account for any costs that you incur, so keep all your receipts. Select your mover with care. The Agency can help you select a reliable and reputable mover.

You may elect to pay your moving costs yourself and be repaid by the Agency or, if you prefer, you may have the Agency pay the mover. In either case, let the Agency know before you move. What Is A Fixed Moving Expense And Dislocation Allowance? If you choose a Fixed Moving Expense and Dislocation Allowance, you will receive an allowance which is based on the number of rooms in your home or the number of rooms


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of furniture you will be moving, as shown on a schedule. The Agency has a copy of the schedule and will help you decide whether choosing this allowance is in your best interest. If you do not have a large amount of personal property to move, this payment should be more advantageous. No special documentation is required to support your claim. You need only move your personal property and complete the appropriate claim form in order to receive your payment. How Much Rental Assistance Will I Receive? You may be eligible to receive Rental Assistance for a 42-month period. The assistance is computed in the following manner: The assistance needed for one month is determined by subtracting the "base monthly rent" for your present home from the cost of rent and utilities for your new home (or a comparable replacement home, if that cost is lower). That monthly need, if any, is multiplied by 42, to determine the total amount that you will receive. This amount will be paid directly to you. The Agency must provide the assistance in monthly installments or other periodic payments. Generally, the base monthly rent for your present home is the lesser of: (1) the monthly rent and average monthly cost for utilities, or (2) thirty (30) percent of your average monthly gross household income, if you are low-income based on HUD income limits. Examples: Let's say that the monthly rent and average cost for utilities for your present home are $250; the monthly rent and estimated average utility costs for a comparable replacement home are $350; and your monthly gross income is $700. In this case your "base monthly rent" would be $210 because you are low-income and that amount (30 percent of your income) is less than the monthly cost of rent and utilities at your present home ($250).

• If you rent a replacement home for $360 per month, including estimated average monthly utility charges, you will receive $5,880. That amount is 42 times $140 (the difference between the "base monthly rent" for your present home ($210) and the cost for a comparable replacement home ($350)).

• If you rent a replacement home for $310, including estimated average monthly

utility charges, you will receive $4,200. That amount is 42 times $100 (the difference between the "base monthly rent" for your present home ($210) and the actual cost of your new home ($310)).

To qualify for rental assistance, you must rent and occupy a decent, safe, and sanitary home within one year after the date you move. However, the Agency will extend this period for good cause. If I Decide to Buy, Rather Than Rent, How Much Assistance Will I Receive? If you buy a replacement home, you may be eligible for assistance to make a down


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payment equal to the amount you would receive if you rented a comparable replacement home (i.e., 42 times the amount obtained by subtracting the "base monthly rent" for your present home from the monthly rent and estimated average monthly utility costs for a comparable replacement home). A down payment assistance payment will be paid in a lump sum. Example: Assuming the information in the prior examples, the downpayment assistance payment would be $5,880. That amount is 42 times $140 (the difference between the "base monthly rent" for your present home ($210) and the monthly rent and estimated average monthly utilities cost for a comparable replacement home ($350). The full amount of the payment must be applied to the purchase of the replacement dwelling. Must I File A Claim To Obtain A Relocation Payment? Yes. You must file a claim for each relocation payment. The Agency will, however, provide you with the required claim form, help you to complete it, and explain the type of documentation, if any, that you must submit in order to receive the payment. If you must pay any relocation expenses before you move (e.g., a security deposit when you sign a lease for your new home), discuss your financial needs with the Agency. While refundable deposits are not covered by URA payments, you may be able to obtain an advance payment to meet these costs. An advance payment may be placed in "escrow" or paid directly to a contractor to ensure that the move will be completed on a timely basis. You must file your claim within 18 months after the date you move. However, it is to your advantage to file as soon as possible after you move. The sooner you submit your claim, the sooner it can be processed and paid. If you are unable to file your claim within 18 months, ask the Agency to extend this period. Be careful not to confuse this 18-month period with the 12-month period within which you must rent (or buy) and occupy a replacement dwelling in order to be eligible for a replacement housing payment. You will be paid promptly after you file an acceptable claim. If there is any question regarding your right to a relocation payment or the amount of the payment, you will be notified, in writing, of the problem and the action you may take to resolve the matter. Will I Have To Pay Rent To The Agency Before I Move? If the Agency acquires the property in which you live, you may be required to pay a fair rent to the Agency for the period between the acquisition of the property and the date that you move. Such rent will not exceed the market rent for comparable properties in the area. Do I Have To Pay Federal Income Taxes On My Relocation Payments? No. Section 216 of the URA states that you need not report relocation payments as part of your gross income for Federal tax purposes. For information on State or local income taxes, you should check with the State or local income tax office in your area or with your personal


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tax advisor. What If I Don't Receive The Required Assistance. Can I Appeal? If you disagree with the Agency's decision as to your right to relocation assistance or the amount of a payment, or the adequacy of the housing to which you have been referred, you may appeal the decision to the Agency. The Agency will inform you of its appeal procedures. At a minimum, you will have 60 days to file your appeal with the Agency after you receive written notification of the Agency's determination on your claim. Your appeal must be in writing. However, if you need help, the Agency will assist you in preparing your appeal. If you are a low- or moderate-income person and are dissatisfied with the Agency's determination on your appeal, you may have an additional right to request administrative review of that decision (e.g., by HUD or the State). You can expect a fair decision on any appeal. However, if you are not satisfied with the final administrative decision on your appeal, you may seek review of the matter by the courts. I Have More Questions. Who Will Answer Them? If you have further questions after reading this booklet, contact the Agency and discuss your concerns with an Agency representative. Agency : Address:

Office Hours: Telephone No.: Person to Contact:

APPENDIX 7

NORTH CAROLINA EMERGENCY MANAGEMENT HOMEOWNER RECOVERY PROGRAM

APPEAL PROCEDURES

Grounds

You have the right to appeal any decision of the Project Manager and/or the North Carolina

Office of Recovery and Resiliency (NCORR) concerning the implementation of the North

Carolina Homeowner Recovery Program.

Methods and Time Limits for Initiating an Appeal

A written appeal must be submitted to the Project Manager within thirty (30) days of the

program determination using the attached “Request for Appeal” Form. The Project Manager

has fifteen (15) calendar days from the receipt of the written appeal to provide a written

response. If the appeal is legitimate given the federal regulations and Housing Manual Policies

and Procedures, the Project Manager will work to resolve the situation. All appeals (except for

Robeson County residents) should be submitted in writing to:

Rebuild NC Appeals Team North Carolina Office of Recovery and Resiliency

4236 Mail Service Center Raleigh, NC 27699-4236

ATTN: NCORR CDBG-DR Email: [email protected]

* Robeson County residents should appeal at: Rebuild NC Robeson Appeals Process

405 Dunn Road Lumberton, NC 28358

mailto:[email protected]

Appeal to the North Carolina Office of Recovery and Resiliency

If you are not satisfied with the written response from the Project Manager, a second written

appeal can be made to NCORR at:

CDBG-DR Housing Manager North Carolina Office of Recovery and Resiliency

4238 Mail Service Center Raleigh, NC 27699-4236

ATTN: NCORR CDBG-DR This second written appeal must be made within thirty (30) days after you receive the written

response from the Project Manager. NCORR as fifteen (15) calendar days from the receipt of the

written appeal to respond.

If, in the unlikely event, the appeal cannot be resolved at the state level, the Owner or

Contractor may choose to file at the Greensboro HUD Office. If you have any questions

concerning these procedures, do not hesitate to contact 2-1-1 for additional information.

NORTH CAROLINA OFFICE OF RECOVERY AND RESILIENCY

HOMEOWNER RECOVERY PROGRAM

REQUEST FOR APPEAL FORM

Applicant ID #

Property Owner Name

Damaged Property Street Address

City, State, Zip Code

Mailing Address (if Different)


Phone Number

Email Address

Appeal Request: Please accept my request for appeal to the North Carolina Homeowner Recovery Program. I would like the Project Manager to review my case regarding the following: Denial of my application based on eligibility requirements Denial of my application based on my structure type The amount of my award for reimbursement, rehabilitation, elevation, or reconstruction of

my home Requirement to rebuild my home Other Attached are the following documents (if applicable): __________________________________ Homeowner/Participant Printed Name Homeowner/Participant Signature __________________________ Date

NORTH CAROLINA OFFICE OF RECOVERY AND

RESILIENCY HOMEOWNER RECOVERY PROGRAM

APPEAL PROCEDURES

RECEIPT

Applicant ID #

Property Owner Name

Damaged Property Street Address


Mailing Address (If Different)


Phone Number

Email Address

I, _________________________________ (Last, First Name), certify that I have received a copy of

the NCORR Homeowner Recovery Program Appeal Procedures related to the reimbursement,

rehabilitation, elevation, or reconstruction of my home located at

__________________________________________ (List Address).

_______________________________ ______________________________ Applicant Name (Printed Last, First) Homeowner Signature ______________________________ ______________________ Date

APPENDIX 8

TENANT GENERAL INFORMATION NOTICE (GIN)

[Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] GENERAL INFORMATION NOTICE: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: ReBuild NC – General Information Notice

Dear [TENANT NAME]:

The ReBuild NC is providing assistance to support the rehabilitation or reconstruction of the property you currently occupy as a tenant at [damaged property address]. The purpose of this Program is to enable rental housing providers to rehabilitate or reconstruct their residential properties in the wake of damage resulting from Hurricane Matthew. Funding for this Program is provided by the U.S. Department of Housing and Urban Development (HUD) and must comply with the Uniform Relocation Assistance and Real Property Acquisition Act (URA) of 1970, as amended. The purpose of this notice is to inform you that you may be temporarily relocated a result of the proposed project. This notice also serves to inform you of your potential rights as a displaced person under a federal law known as the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA). You may be eligible for relocation assistance and payments under the URA if the proposed project receives HUD funding assistance and if you are become permanently displaced as a result of acquisition, rehabilitation or demolition for the project.

• This is not a notice to vacate the premises.

• This is not a notice of relocation eligibility.

In the event you are required to temporarily (or permanently) relocate to complete program activities, a Relocation Specialist will be assigned to you to determine your eligibility and provide the following assistance:

• Relocation advisory services. • Rental Assistance or Replacement Housing Payments • Payment for moving and other out of pocket expenses to include transportation costs,

packing/unpacking of household goods, disconnecting and reconnecting household appliances or services, and storage of household goods.

You will not be required to relocate without at least thirty (30) days advance written notice of the date you will be required to move. In addition, you also have the right to appeal then Program’s determination regarding relocation assistance.

Please be advised that you should continue to pay your rent and meet any other obligations as specified in your rental/lease agreement. Failure to do so may be cause for eviction. If you choose to move or if you are evicted prior to receiving a formal notice of relocation eligibility you will not be eligible to receive relocation assistance. It is important for you to contact us before making any moving plans.

Again, this is not a notice to vacate the premises and does not establish your eligibility for relocation payments or assistance at this time. If you are required to vacate the premises in the future, you will be informed in writing. In the event the proposed project does not proceed or if you are determined not to be displaced, you will also be notified in writing.

You will be contacted soon so that we can collect your household information and provide you with more information about the status of the project. If you have any questions about this notice or the proposed project, please contact [LIST NAME] at (000) 000-0000 or email [LIST EMAIL]

Thank You,

ReBuild NC

APPENDIX 9

APPLICANT GENERAL INFORMATION NOTICE (GIN)

[Date] VIA Certified Mail [First Name] [Last Name] [Mailing Address] [City, State, Zip] GENERAL INFORMATION NOTICE: [Applicant Name] [APP ID] [Owner ID] [Damaged Property Address] [City], [State] [Zip] Re: ReBuild NC – General Information Notice to Property Owners

Dear [Applicant Name]:

Attached for your information is a sample copy of the General Information Notice (GIN) mailed to all known tenant(s) residing in units at the property referenced above at the time of your application to the ReBuild NC Program. This GIN Notice is required to comply with the rules of the Uniform Relocation Assistance and Real Property Acquisition Act of 1970 (URA), as amended. As you are aware, all program applicants must comply with URA regulations to participate in the program with the goal of minimizing the displacement of tenants. In the event temporary (or permanent) relocation of tenants is required to complete program activities, a Relocation Specialist will be assigned to your tenant (s) to determine their eligibility and provide the following assistance:

• Relocation advisory services. • Rental or Replacement Housing Payments • Payment for moving and other out of pocket expenses to include transportation costs,


If you have any questions regarding this notice or the requirements of URA, please call the [LIST NAME] at (000) 000-0000 or email [LIST EMAIL]

Thank You,

ReBuild NC

APPENDIX 10

TENANT GENERAL INFORMATION NOTICE (GIN)

NOTICE TO CURE LEASE VIOLATION

Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] NOTICE TO CURE LEASE VIOLATION: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: ReBuild NC – General Information Notice Notice to Cure

Dear [TENANT NAME]:

As stated in the General Information Notice that you received, the ReBuild NC Program is providing assistance to support the rehabilitation or reconstruction of the property you currently occupy as a tenant at [damaged property address]. The purpose of this Program is to enable rental housing providers to rehabilitate or reconstruct their residential properties in the wake of damage resulting from Hurricane Matthew. Funding for this Program is provided by the U.S. Department of Housing and Urban Development (HUD) and must comply with the Uniform Relocation Assistance and Real Property Acquisition Act (URA) of 1970, as amended. To be eligible for relocation assistance, you must remain compliant with the terms of your current lease agreement. At this time, it has come to our attention that you are in default of your lease agreement for the following reasons. INSERT REASONS You have 30 days to correct this issue with your landlord or you may not be eligible for relocation assistance. Please note that:

• This is not a notice to vacate the premises.

• This is not a notice of relocation eligibility.

In the event you are required to temporarily (or permanently) relocate to complete program activities, a Relocation Specialist will be assigned to you to determine your eligibility and provide the following assistance:

• Relocation advisory services. • Rental Assistance or Replacement Housing Payments • Payment for moving and other out of pocket expenses to include transportation costs,


You will not be required to relocate without at least thirty (30) days advance written notice of the date you will be required to move. In addition, you also have the right to appeal the Program’s determination regarding relocation assistance.

Please be advised that you should continue to pay your rent and meet any other obligations as specified in your rental/lease agreement. Failure to do so may be cause for eviction. If you choose to move or if you are evicted prior to receiving a formal notice of relocation eligibility you will not be eligible to receive relocation assistance. It is important for you to contact us before making any moving plans.

Again, this is not a notice to vacate the premises and does not establish your eligibility for relocation payments or assistance at this time. If you are required to vacate the premises in the future, you will be informed in writing. In the event the proposed project does not proceed or if you are determined not to be displaced, you will also be notified in writing.

You will be contacted soon so that we can collect your household information and provide you with more information about the status of the project. If you have any questions about this notice or the proposed project, please contact [LIST NAME] at (000) 000-0000 or email [LIST EMAIL]

Thank You,

ReBuild NC

APPENDIX 11

1

Tenant Acknowledgement of ReBuild NC Program Notifications

For Agency Use Only: Program Registration ID #: Applicant ID#:

Applicant Last Name: Damaged Property Address: Unit#:

Tenant Name: First Name Last Name Middle Initial




Email

I/We, __________________________ , certify that I/we are currently residing at the following

damaged address: _______________________________________________, Unit __________

and acknowledge the receipt of the following:

Initials

________ HUD Brochure “The Lead Safe Certified Guide to Renovate Right”

________ NCORR Appeals/Grievance Procedures

________ General Information Notice (GIN)

________ Landlord and Tenant Responsibilities Certification ________________________________ ________________________________ Signature Signature _________________ _________________ Date Date

APPENDIX 12

NOTICE OF NON-DISPLACEMENT

TEMPORARY RELOCATION REQUIRED

Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] NOTICE OF NON-DISPLACEMENT: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: Notice of Non-Displacement: Temporary Relocation Required

Dear [Tenant Name]:

On [Date of GIN], the ReBuild NC Program notified you that the Program may provide assistance to rehabilitate or reconstruct the property you currently occupy at [Damaged Property Address]. The purpose of the Program is to enable property owners to rehabilitate or reconstruct their homes damaged by Hurricane Matthew. Funding for the Program was provided by U.S. Department of Housing and Urban Development (HUD) under the Community Development Block Grant (CDBG) Disaster Recovery Program.

This letter is to notify you that funding for the rehabilitation or reconstruction of the property you currently occupy was approved and repairs are expected to begin/resume soon. Because federal funding is involved in this project, you are protected by the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 as amended (the URA).

This is a Notice of Non-Displacement. You will NOT be required to permanently relocate as a result of the rehabilitation or reconstruction. However, you will be required to relocate temporarily to facilitate construction on your current unit. The Program will work with you to help you with this relocation. Please be aware that this is not a notice to vacate the premises and this is not a notice of relocation eligibility.

This notice guarantees you the following:

1. Upon completion of the rehabilitation, you will be able to lease and occupy your present dwelling unit under reasonable terms and conditions.

2. Because you must move temporarily so that the rehabilitation can be completed, you will be reimbursed for all reasonable expenses related to the relocation, including the cost of moving to and from temporary housing and any increased interim housing costs if the cost of your temporary housing exceeds the cost of your current unit. The temporary unit will meet HQS standards, and all other conditions of your temporary move will be reasonable.

A representative from the Program will be reaching out to you to coordinate your temporary relocation. Consequently, we urge you not to move away from your unit until you have had the opportunity to meet with the program staff as all temporary relocation expenses must be approved in advance. Also, as with all tenants, you must continue to comply with the terms and conditions of your lease as long as you reside in your current unit.

If you disagree with this determination or decision as to your right to relocation assistance, you may appeal the decision to the Program. You will have 30 days to file an appeal with the Program after receiving this written notification of non-displacement. All appeals must be in writing following the procedures previously provided.

If you have any questions, please contact a [List Relocation Specialist] at [(XXX) XXX-XXXX]. This letter is important to you and should be retained.

Sincerely,

ReBuild NC

APPENDIX 13

NOTICE OF NON-DISPLACEMENT

TEMPORARY RELOCATION NOT REQUIRED

Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] NOTICE OF NON-DISPLACEMENT: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: Notice of Non-Displacement: Temporary Relocation Not Required

Dear [Tenant Name]:


This letter is to notify you that funding for the rehabilitation of the property you currently occupy was approved and repairs are expected to begin/resume soon. Because federal funding is involved in this project, you are protected by the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 as amended (the URA).

This is a Notice of Non-Displacement. You will NOT be required to move permanently as a result of the rehabilitation of your unit nor will you be required to move temporarily in order for this project to be completed. Specifically, this Notice guarantees that you will be able to continue to lease and occupy your present apartment under reasonable terms and conditions. Consequently, we urge you not to move away from your unit, unless you want to do so for your own reasons not related to this project and the rehabilitation assistance that was provided.

As with all tenants, you must continue to comply with the terms and conditions of your lease as long as you reside in the unit or you may be subject to legal actions from your owner. Please note that if you do choose to move for your own reasons, you will not be considered displaced and you will not be eligible for any relocation assistance in your new home.

If you disagree with this determination or decision as to your right to relocation assistance, you may appeal the decision to the Program. You will have 30 days to file an appeal with the Program after receiving this

written notification of non-displacement. All appeals must be in writing following the procedures previously provided.


Sincerely,

ReBuild NC

APPENDIX 14

NOTICE OF TEMPORARY RELOCATION ELIGIBILITY

Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] NOTICE OF TEMPORARY RELOCATION ELIGIBILITY: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: Notice of Temporary Relocation Eligibility

Dear [Tenant Name]:



It has been determined that you will need to relocate temporarily during construction on your unit. Since you are being temporarily relocated in connection with this federally funded project, you will be eligible for relocation assistance and payments under the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA).

• This is your Notice of Eligibility for Temporary Relocation assistance, effective as of the date of

this notice.

(NOTE: Pursuant to Public Law 105-117, aliens not lawfully present in the United States are not eligible for relocation assistance, unless such ineligibility would result in exceptional hardship to a qualifying spouse, parent, or child. All persons seeking relocation assistance will be required to certify that they are a United States citizen or national, or an alien lawfully present in the United States.) Based on the information we have about the rent and utilities you now pay, you will receive monthly assistance from ReBuild NC to cover the difference between your current rent and the rent of the temporary housing unit, for the length of your relocation. Please note that all replacement housing must be inspected and meet decent, safe and sanitary standards before any temporary housing payments are made. Attached is a housing form with several rental units that are currently available in your area. Based upon your household survey and the rental units identified on the form, we have determined that the maximum amount of monthly housing assistance and other expenses you are eligible to receive assistance for are as follows:

• Monthly Housing Assistance: $__________. This amount represents the difference between rent and utilities at your current unit and the unit selected as the most comparable on the attached form. This is the maximum amount of monthly assistance that can be provided. Your monthly housing assistance will be disbursed to your landlord prior to the 1st of each month of your temporary relocation. You will be responsible for paying the landlord the difference.

• Payment for Moving Expenses: $__________ is the amount of the fixed moving payment. Moving expenses are determined by a fixed cost moving schedule that assesses the funding you are eligible for based on the number of rooms of furniture you currently occupy unless you choose to obtain three quotes for actual moving expenses.

• Storage Costs (if applicable): $__________ is the amount of storage costs should your temporary unit not facilitate the storage of all of your belongings.

• Security Deposit: $_________. The security deposit must be returned by your temporary landlord directly to ReBuild NC at the end of your tenancy in the temporary apartment. In order for the program to pay for your deposit, the landlord must agree to sign a “Lease Rider”.

• Meal Allowance (if applicable): $___________. This funding is only provided in the event that you do not have access to a kitchen during your relocation.

Please note that the expenses listed above establish the not-to-exceed amount for each eligible expense. Payments or reimbursements will be based upon the amount listed above or actual expenses whichever is less.

A representative from the Program will be reaching out to you to coordinate your temporary relocation. Consequently, we urge you not to move away from your unit until you have had the opportunity to meet with the program staff as all temporary relocation expenses must be approved in advance. Also, as with all tenants, you must continue to comply with the terms and conditions of your lease as long as you reside in your current unit.

If you disagree with this determination or decision as to your right to relocation assistance, you may appeal the decision to the Program. You will have 30 days to file an appeal with the Program after receiving this written notice of eligibility for temporary relocation. All appeals must be in writing following the

procedures previously provided.


Sincerely,

ReBuild NC

Attachment: HUD Form 40061

APPENDIX 15

NOTICE OF PERMANENT RELOCATION ELIGIBILITY

Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] NOTICE OF PERMANENT RELOCATION ELIGIBLILITY: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip]

Re: Notice of Permanent Relocation Eligibility

Dear [Tenant Name]:


Due to [Insert URA reason], it has been determined that you [will be/have been] permanently displaced by the project. Since [you will be/have been] displaced in connection with this federally funded project, you are eligible for relocation assistance and payments under the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA).

• This is your Notice of Eligibility for Permanent Relocation assistance, effective as of the date of

this notice. (NOTE: Pursuant to Public Law 105-117, aliens not lawfully present in the United States are not eligible for relocation assistance, unless such ineligibility would result in exceptional hardship to a qualifying spouse, parent, or child. All persons seeking relocation assistance will be required to certify that they are a United States citizen or national, or an alien lawfully present in the United States.)

As an eligible tenant displaced from your home, you will be offered the following advisory and financial assistance: • Advisory Services. This includes referrals to comparable and suitable replacement homes,

the inspection of replacement housing to ensure that it meets established standards, help in preparing claim forms for relocation payments and other assistance to minimize the impact of the move.

• Payment for Moving Expenses. You may choose either a:

∗ Payment for Your Actual Reasonable Moving and Related Expenses, or ∗ Fixed Moving Expense and Dislocation Allowance, or ∗ A combination of both, based on circumstances.

• Replacement Housing Assistance. To enable you to rent, or if you prefer, buy a

comparable or suitable replacement home, you may choose either:

∗ Rental Assistance, or ∗ Purchase Assistance.

A Relocation Specialist from the Program will be reaching out to you to coordinate your claim for relocation assistance. If you disagree with this determination or decision as to your right to relocation assistance, you may appeal the decision to the Program. You will have 30 days to file an appeal with the Program after receiving this written notice of eligibility for permanent relocation. All appeals must be in writing following the procedures previously provided.


Sincerely,

ReBuild NC

APPENDIX 16

90-DAY NOTICE TO VACATE

[Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Mailing Address] [City], [State] [Zip] 90 DAY NOTICE: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: 90-Day Notice to Vacate

Dear [Tenant First Name] [Tenant Last Name]:


The work on the property you currently occupy is expected to commence within 90 days of the date on this letter. As you are aware, we have been in contact with you since (Date) to help you locate and move into suitable [temporary or permanent] replacement housing. The rental unit that you are currently occupying must be vacated in 90 days, by [Date]. We will send you a second notice 30 days before you must vacate.

If you have any questions or need additional assistance in planning or completing your move, please contact a [List Relocation Specialist] at [(XXX) XXX-XXXX]. This letter is important to you and should be retained. Sincerely,

ReBuild NC

APPENDIX 17

TENANT 30-DAY NOTICE TO VACATE

[Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] 30 DAY NOTICE: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: 30-Day Notice to Vacate



The work on the property you currently occupy is expected to commence within 30 days of the date on this letter. As you are aware, we have been in contact with you since [Date] to help you locate and move into suitable [temporary or permanent] replacement housing. The rental unit that you are currently occupying must be vacated in 30 days, by [Date].


ReBuild NC

OWNER 30-DAY NOTICE TO VACATE

[Date] VIA Certified Mail [First Name] [Last Name] [Mailing Address] [City], [State] [Zip] 30 DAY NOTICE: [First Name] [Last Name] [APP ID] [Damaged Property Address] [Mailing Address] [City], [State] [Zip] Re: 30-Day Notice to Vacate


The work on the property you currently occupy is expected to commence within 30 days of the date on this letter. As you are aware, we have been in contact with you since [Date] to help you locate and move into suitable temporary housing. The home that you are currently occupying must be vacated in 30 days, by [Date].


ReBuild NC

APPENDIX 18

TENANT RELEASE AND CONSENT FORM-UTILITY USAGE

Applicant ID: ____________________________ Tenant ID: ______________________________

I /We , the undersigned hereby authorize all persons or

companies in the categories listed below to release without liability, information regarding my utility usage for the

rental unit located at ____________________________________ for the purposes of verifying this information on

my/our behalf for the purposes of ReBuild NC-URA Relocation Assistance.

Authorized ReBuild Agent

Authorized ReBuild Agent’s Return Address

__________________________________

___________________________________

CONDITIONS

I/We agree that a photocopy of this authorization may be used for the purposes stated above. The

original of this authorization is on file and will stay in effect for eighteen (18) months from the date signed.

SIGNATURES

Tenant Print Name Date

Co-Tenant Print Name Date

Adult Household Member Print Name Date

Adult Household Member Print Name Date

Utility Account Information

Data Release Authorization Form

Requestor:

ReBuild NC Program [ReBuild NC Authorized Agent’s Name] [ReBuild NC Authorized Agent’s Address Line 1] [ReBuild NC Authorized Agent’s Address Line 2] [ReBuild NC Authorized Agent’s Email Address] [ReBuild NC Authorized Agent’s Phone Number]

Tenant Contact Information:

Applicant ID number: _______________________

Tenant Name: _______________________

Tenant ID number: _______________________

Address/Physical location of Utility: ______________________________

______________________________

________________________________

Billing Address: ________________________________

________________________________

Electricity:

Check one: Included in Rent Not included in Rent

Name of utility provider: ______________________________

Name listed on utility bill: _____________________________

Account Number: __________________________

Estimated 12-Month Average Utility Bill: $ __________________

Natural Gas:




Account Number: __________________________


Water




Account Number: __________________________


Sewer




Account Number: __________________________


Other Utility




Account Number: __________________________


AUTHORIZATION TO REVIEW UTILITY ACCOUNT HISTORY:

I/We hereby authorize ReBuild NC and/or their designated representatives to obtain records on demand documenting the average consumption of energy or natural resources for the accounts listed on this form

in order to determine my/our eligibility for relocation benefits from the Program.

Typed Name: ____________________ Typed Name: ____________________

Signature: ______________________ Signature: ______________________

Date: ____________________ Date: ____________________

APPENDIX 19

1

TENANT SUBROGATION DISCLOSURE AND ASSIGNMENT AGREEMENT

This Tenant Disclosure and Subrogation Assignment was made this ______ day of

______ 20___ by ____________________ and ___________________ currently

residing at the address of __________________________ herein referred to as the

“Tenant”.

I/we disclose to the program all forms of relocation assistance provided to our household

as shown below:

Temporary Relocation Assistance

Amount of Relocation Assistance Provided

Dates of Assistance

Permanent Relocation Assistance


Dates of Assistance

List Source $ List Source $




Total $ Total $

1. Subrogation and Assignment Relating to Funds Received for Hurricane

Matthew and Florence, if applicable.

(a) Tenant enters this Agreement in consideration of the evaluation by North

Carolina Office of Recovery and Resiliency ("NCORR") for eligibility to obtain relocation

assistance using disaster assistance funds, monies, or other benefits ("Benefits") or its

receipt of Benefits under the ReBuild NC Program ("Program").

2

(b) Tenant acknowledges that the Program is subject to the provisions of the Robert

T. Stafford Disaster Relief and Emergency Assistance Act, as amended, 42 U.S.C. §§

5121-5207, (the "Stafford Act"). Under the Stafford Act, Tenant may receive assistance only

to the extent that it has a disaster recovery need that is not fully met by insurance or other

disaster assistance. Tenant further acknowledges that this Agreement is intended to

ensure that it does not receive Benefits that duplicate benefits available for the same

purposes from another source. Tenant promises to reimburse NCORR for the full amount

of any Benefits that Tenant previously received, subsequently receives, or (or with

reasonable effort would be) eligible to receive for the same purposes for which the

Benefits are awarded.

(c) Tenant subrogates and assigns to NCORR all of its future rights to

reimbursement and all payments or proceeds determined to be a Duplication of Benefits

("DOB"), as provided in this Agreement. This includes payments or proceeds received from

any grant, subsidized loan, insurance policies of any type or coverage, or under any

reimbursement or relief program related to or administered by the Federal Emergency

Management Agency (" FEMA") or the Small Business Administration ("SBA") (each,

singularly, a "Disaster Program" and, collectively, the "Disaster Programs") to the extent

such payments and/or proceeds, in the sole discretion of NCORR or its designated agent,

constitute a DOB. Payments and proceeds referred to in this paragraph, regardless of DOB

or source, shall hereafter be referred to as "Proceeds," and any Proceeds that are a DOB

shall hereafter be referred to as " DOB Proceeds."

(d) Tenant agrees to immediately notify NCORR upon receiving any Proceeds not

previously disclosed in connection with their claim for relocation assistance. NCORR will

thereafter determine, in its sole discretion, whether any and all DOB proceeds to NCORR,

as provided in this Agreement.

3

2. Cooperation and Further Documentation.

(a) Tenant agrees to assist and cooperate with NCORR, if NCORR pursues any claims for

reimbursement Tenant has, or may have, against insurers. Tenant's assistance and

cooperation includes but is not limited to allowing suit to be brought in Tenant's name(s)

and providing any additional documentation with respect to such consent, giving

depositions, providing documents, producing records and other evidence, testifying at

trial, and any other form of assistance and cooperation NCORR reasonably requests.

Tenant also agrees to assist and cooperate with NCORR to attain and collect any DOB

Proceeds available to Tenant under any applicable Disaster Program.

(b) Tenant agrees to execute additional documents and instruments upon NCORR request

to further and better subrogate and assign to NCORR (to the extent of Program

Benefits Tenant received) any amounts received under the Disaster Programs that are

DOB Proceeds and any rights thereunder. Tenant further agrees to take all actions and

to do all things requested by NCORR to make this agreement effective.

(c) Tenant expressly authorizes each of its insurers; any entity to which Tenant applied for

storm recovery assistance or from which it received, is now receiving, or is eligible to

receive disaster recovery benefits, including FEMA, SBA, and any other entity, to

release upon NCORR request, any nonpublic or confidential information the NCORR

finds useful to effect the rights subrogated and assigned by Tenant.

3. Agreement to Turn Over Proceeds; Future Reassignment.

(a) If Tenant receives any Proceeds, or any notice that he/she is scheduled to receive

Proceeds, and such Proceeds have not been previously disclosed in connection with its

Application ("Subsequent Proceeds"), Tenant must immediately notify NCORR and

4

provide NCORR with copies of any communications concerning the Subsequent

Proceeds.

(b) Upon receipt of such notice from Tenant, NCORR will determine the amount of the

Subsequent Proceeds that constitute DOB Proceeds (the "Subsequent DOB Amount")

and thereafter provide Tenant with notice of its determination (the "DOB Notice").

Upon receipt of any such DOB Notice, Tenant hereby agrees to proceed as follows:

i. If Tenant has received all of the Subsequent Proceeds, Tenant must

surrender the Subsequent DOB Amount to NCORR, within three (3)

business days of Tenant's receipt of its DOB Notice.


(a) Tenant agrees to assist and cooperate with NCORR, if NCORR pursues any claims for

reimbursement Tenant has, or may have, against insurers. Tenant's assistance and

cooperation includes, but is not limited to allowing suit to be brought in Tenant's name(s)

and providing any additional documentation with respect to such consent, giving

depositions, providing documents, producing records and other evidence, testifying at trial,

and any other form of assistance and cooperation NCORR reasonably requests. Tenant

also agrees to assist and cooperate with NCORR to attain and collect any DOB Proceeds

available to Tenant under any applicable Disaster Program. Tenant agrees to execute

additional documents and instruments upon NCORR request.

(i) If Tenant has received only part of the Subsequent Proceeds,

but more than the Subsequent DOB Amount identified in the

DOB Notice, then Tenant shall surrender the Subsequent DOB

Amount to NCORR, within three (3) business days of Tenant' s

receipt of its DOB Notice.

5

(ii) If Tenant has received part of the Subsequent Proceeds, but

less than the Subsequent DOB Amount, Tenant shall surrender

to NCORR all of the Subsequent Proceeds it has received,

within three (3) business days of Tenant's receipt of its DOB

Notice. Upon Tenant's receipt of any further Subsequent

Proceeds, Tenant shall, within three (3) business days,

surrender to NCORR the outstanding balance of the Subsequent

DOB Amount.

(iii) If Tenant has not yet received any Subsequent Proceeds,

Tenant shall notify NCORR of this fact, within three (3) business

days of Tenant' s receipt of its DOB Notice. Thereafter, Tenant

shall notify NCORR within three (3) business days of its receipt

of any or all of the Subsequent Proceeds and proceed as

instructed by NCORR.

5. Miscellaneous

Tenant represents that all of their statements and representations are true and correct

as of the date of this agreement.

(a) In any proceeding to enforce this Agreement, NCORR shall be entitled to recover

all costs of enforcement, including actual attorney's fees.

(b) Tenant waives the right to have any judicial proceeding arising out of this

Agreement tried by a jury.

(c) This Agreement may be modified only by written amendment signed by Tenant

and agreed to by NCORR.

6

(d) Tenant makes this Agreement in and under the jurisdiction of the state of North

Carolina. Tenant agrees that any action must be brought in the State of North

Carolina and adjudicated pursuant to North Carolina law and any applicable

federal law without giving effect to conflict of law provisions.

By executing this Agreement, Tenant acknowledges and understands that the North

Carolina False Claims Act (N.C. Gen. Stat. 1-607) makes it unlawful for a person to

knowingly present or cause to be presented to the State a false or fraudulent claim for

payment or approval, or to knowingly make, use, or cause to be made or used, a false

record or statement material to a false or fraudulent claim on the State. Persons who

violate this statute are liable for three times the amount that the State is damaged by the

false claim, the costs incurred by the State in recovering damages, and a civil penalty of

between $5,500 and $11,000 for each violation.

IN WITNESS WHEREOF, Tenant has caused this Agreement to be duly executed as of the

day and year first above written.

By: ____________________________ By: ____________________________

Printed Name:_______________________ Printed Name:_______________________

Title:______________________________ Title:______________________________

Date: _________________ Date: _________________

STATE OF NORTH CAROLINA )

) ss.: COUNTY OF )

On the ________ day of __________ in the year 20_______ before me , the undersigned,

personally appeared ________________________personally known to me or proved to me

7

on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed

to the within instrument and acknowledged to me that he/she/they executed the same in

his/her/their capacity (ies), and that by his/her/their signature(s) on the instrument, the

individual(s), or the person upon behalf of which the individual(s) acted, executed

the instrument.


) ss.: COUNTY OF )







the instrument.

8

APPLICANT SUBROGATION DISCLOSURE AND ASSIGNMENT

AGREEMENT FOR TRA ASSISTANCE

This Disclosure and Subrogation Assignment was made this ______ day of ______

20___ by ____________________ and ___________________ currently residing at the

address of __________________________ herein referred to as the “Applicant”.

I/we disclose to the program all forms of relocation assistance provided to our household

as shown below:

Temporary Relocation Assistance


Dates of Assistance

Permanent Relocation Assistance


Dates of Assistance





Total $ Total $

6. Subrogation and Assignment Relating to Funds Received for Hurricane

Matthew and Florence, if applicable.

(e) Applicant enters this Agreement in consideration of the evaluation by North

Carolina Office of Recovery and Resiliency ("NCORR") for eligibility to obtain relocation

assistance using disaster assistance funds, monies, or other benefits ("Benefits") or its

9

receipt of Benefits under the ReBuild NC Program ("Program").

(f) Applicant acknowledges that the Program is subject to the provisions of the

Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, 42 U.S.C.

§§ 5121-5207, (the "Stafford Act"). Under the Stafford Act, Applicant may receive

assistance only to the extent that it has a disaster recovery need that is not fully met by

insurance or other disaster assistance. Applicant further acknowledges that this

Agreement is intended to ensure that it does not receive Benefits that duplicate benefits

available for the same purposes from another source. Applicant promises to reimburse

NCORR for the full amount of any Benefits that Applicant previously received,

subsequently receives, or (or with reasonable effort would be) eligible to receive for the

same purposes for which the Benefits are awarded.

(g) Applicant subrogates and assigns to NCORR all of its future rights to

reimbursement and all payments or proceeds determined to be a Duplication of Benefits

("DOB"), as provided in this Agreement. This includes payments or proceeds received from

any grant, subsidized loan, insurance policies of any type or coverage, or under any

reimbursement or relief program related to or administered by the Federal Emergency

Management Agency ("FEMA") or the Small Business Administration ("SBA") each,

singularly, a "Disaster Program" and, collectively, the "Disaster Programs" to the extent

such payments and/or proceeds, in the sole discretion of NCORR or its designated agent,

constitute a DOB. Payments and proceeds referred to in this paragraph, regardless of DOB

or source, shall hereafter be referred to as "Proceeds," and any Proceeds that are a DOB

shall hereafter be referred to as " DOB Proceeds."

(h) Applicant agrees to immediately notify NCORR upon receiving any Proceeds

not previously disclosed in connection with their claim for relocation assistance. NCORR

10

will thereafter determine, in its sole discretion, whether any and all DOB proceeds to

NCORR, as provided in this Agreement.


(d) Applicant agrees to assist and cooperate with NCORR, if NCORR pursues any claims

for reimbursement Applicant has, or may have, against insurers. Applicant's assistance

and cooperation includes but is not limited to allowing suit to be brought in Applicant's

name(s) and providing any additional documentation with respect to such consent,

giving depositions, providing documents, producing records and other evidence, testifying

at trial, and any other form of assistance and cooperation NCORR reasonably requests.

Applicant also agrees to assist and cooperate with NCORR to attain and collect any

DOB Proceeds available to Applicant under any applicable Disaster Program.

(e) Applicant agrees to execute additional documents and instruments upon NCORR

request to further and better subrogate and assign to NCORR (to the extent of Program

Benefits Applicant received) any amounts received under the Disaster Programs that

are DOB Proceeds and any rights thereunder. Applicant further agrees to take all

actions and to do all things requested by NCORR to make this agreement effective.

(f) Applicant expressly authorizes each of its insurers; any entity to which Applicant

applied for storm recovery assistance or from which it received, is now receiving, or is

eligible to receive disaster recovery benefits, including FEMA, SBA, and any other entity,

to release upon NCORR request, any nonpublic or confidential information the NCORR

finds useful to effect the rights subrogated and assigned by Applicant.

11

8. Agreement to Turn Over Proceeds; Future Reassignment.

(a) If Applicant receives any Proceeds, or any notice that he/she is scheduled to receive

Proceeds, and such Proceeds have not been previously disclosed in connection with its

Application ("Subsequent Proceeds"), Applicant must immediately notify NCORR and

provide NCORR with copies of any communications concerning the Subsequent

Proceeds.

(c) Upon receipt of such notice from Tenant, NCORR will determine the amount of the

Subsequent Proceeds that constitute DOB Proceeds (the "Subsequent DOB Amount")

and thereafter provide Applicant with notice of its determination (the "DOB Notice").

Upon receipt of any such DOB Notice, Applicant hereby agrees to proceed as follows:

i. If Applicant has received all of the Subsequent Proceeds, Applicant

must surrender the Subsequent DOB Amount to NCORR, within three

(3) business days of Applicant's receipt of its DOB Notice.


(b) Applicant agrees to assist and cooperate with NCORR, if NCORR pursues any claims

for reimbursement Applicant has, or may have, against insurers. Applicant's assistance

and cooperation includes, but is not limited to allowing suit to be brought in Applicant's

name(s) and providing any additional documentation with respect to such consent, giving

depositions, providing documents, producing records and other evidence, testifying at trial,

and any other form of assistance and cooperation NCORR reasonably requests.

Applicant also agrees to assist and cooperate with NCORR to attain and collect any DOB

Proceeds available to Applicant under any applicable Disaster Program. Applicant

agrees to execute additional documents and instruments upon NCORR request.

12

(i) If Applicant has received only part of the Subsequent Proceeds,

but more than the Subsequent DOB Amount identified in the

DOB Notice, then Applicant shall surrender the Subsequent

DOB Amount to NCORR, within three (3) business days of

Applicant’s receipt of its DOB Notice.

(ii) If Applicant has received part of the Subsequent Proceeds, but

less than the Subsequent DOB Amount, Applicant shall

surrender to NCORR all of the Subsequent Proceeds it has

received, within three (3) business days of Applicant's receipt of

its DOB Notice. Upon Applicant's receipt of any further

Subsequent Proceeds, Applicant shall, within three (3) business

days, surrender to NCORR the outstanding balance of the

Subsequent DOB Amount.

(iii) If Applicant has not yet received any Subsequent Proceeds,

Applicant shall notify NCORR of this fact, within three (3)

business days of Applicant' s receipt of its DOB Notice.

Thereafter, Applicant shall notify NCORR within three (3)

business days of its receipt of any or all of the Subsequent

Proceeds and proceed as instructed by NCORR.

10. Miscellaneous

Applicant represents that all of their statements and representations are true and

correct as of the date of this agreement.

(e) In any proceeding to enforce this Agreement, NCORR shall be entitled to recover

all costs of enforcement, including actual attorney's fees.

13

(f) Applicant waives the right to have any judicial proceeding arising out of this

Agreement tried by a jury.

(g) This Agreement may be modified only by written amendment signed by Applicant

and agreed to by NCORR.

(h) Applicant makes this Agreement in and under the jurisdiction of the state of North

Carolina. Applicant agrees that any action must be brought in the State of North

Carolina and adjudicated pursuant to North Carolina law and any applicable

federal law without giving effect to conflict of law provisions.

By executing this Agreement, Applicant acknowledges and understands that the

North Carolina False Claims Act (N.C. Gen. Stat. 1-607) makes it unlawful for a

person to knowingly present or cause to be presented to the State a false or

fraudulent claim for payment or approval, or to knowingly make, use, or cause to

be made or used, a false record or statement material to a false or fraudulent

claim on the State. Persons who violate this statute are liable for three times the

amount that the State is damaged by the false claim, the costs incurred by the

State in recovering damages, and a civil penalty of between $5,500 and $11,000

for each violation.

IN WITNESS WHEREOF, Applicant has caused this Agreement to be duly executed as of the

day and year first above written.

By: ____________________________ By: ____________________________

Printed Name:_______________________ Printed Name:_______________________

Title:______________________________ Title:______________________________

Date: _________________ Date: _________________

14


) ss.: COUNTY OF )







the instrument.


) ss.: COUNTY OF )







the instrument.

APPENDIX 20

North Carolina Housing Recovery Program

Right of Entry Permit

The undersigned (“Tenant”) hereby affirms occupancy of the rental unit located at:

Property Address and Unit # City, State, Zip

Tenant unconditionally authorizes the North Carolina Office of Recovery and Resiliency (NCORR) or the Unit of General Local Government (UGLG) and its assigns, employees, agents, and contractors (collectively, the “ReBuild NC Providers”) to have the right of access and to enter in and onto the rental unit described above for the purpose of performing inspections on the rental unit, and/or, after approval by the Tenant, for purposes of receiving relocation benefits from ReBuild NC.

It is fully understood that this Right of Entry (“ROE”) does not create any obligation on the part of the NCORR or UGLG, its officials, or the ReBuild NC Providers to perform inspections on the rental unit. Tenant understands that no benefits will be provided by the Program until this ROE is executed in full, and that there is no guarantee that Tenant will receive relocation benefits under the Program.

1. Time Period: The ROE shall expire 3 years after this form is signed, unless sooner cancelled or amended according to the terms herein.

2. Inspection/Construction Authorized: The ROE authorizes inspections of the tenant occupied rental unit. Tenant understands that the NCORR or UGLG and its ReBuild NC Providers shall determine the extent of the required services. If Tenant disagrees with the nature or extent of proposed actions, Tenant may refuse assistance and cancel this ROE at any time by notifying the Tenant’s Case Manager.

3. Duty to Protect, Duty to Inform of Unsafe Conditions: Tenant shall take all reasonable precautions to protect the rental unit and persons inhabiting the property from damage or injury, including but not limited to, removing or securing fragile or valuable personal property and complying with orders to vacate the property or portions of the property. Tenant shall give notice to

2

the NCORR or UGLG and ReBuild NC Providers of any unsafe conditions at the rental unit, of which Tenant is aware.

4. Miscellaneous: a. Tenant represents and warrants that Tenant has full power and authority to execute and fully perform Tenant’s obligations under this ROE. If Tenant is an entity, Tenant also represents and warrants that Tenant has such power and authority pursuant to its governing instruments, without the need for any further action, and that the person(s) executing this ROE on behalf of Tenant are the duly designated agent(s) of Tenant and are authorized to bind the entity according to its articles of incorporation. Tenant expressly represents and warrants that fee title to the Premises is vested solely in Tenant and/or that Tenant has the authority to act as the agent of any other property Tenants and to bind any such Tenants to the terms specified herein.

b. All tools, equipment, and other property owned or leased by the NCORR or UGLG and/or the ReBuild NC Providers taken upon or placed upon the property by the NCORR or UGLG and/or the ReBuild NC Providers shall remain the property of the ReBuild NC Providers and may be removed by the ReBuild NC Providers at any time within a reasonable period after the expiration of this ROE, if necessary.

c. Information is collected to make it possible for the North Carolina Office of Recovery and Resiliency or Unit of General Local Government or its ReBuild NC Providers, to enter your rental unit, conduct inspections, and/or undertake protective measures. Information submitted will be shared with other government agencies (Federal, State and Local), their contractors, subcontractors and employees, for official use only in accordance with the purposes outlined in this ROE.

For the considerations and purposes set forth herein, I/we hereby set my/our hand(s) and seal(s) this.

Tenant (Print Name) Signature Date

Additional Tenant (Print Name) Signature Date


3




APPENDIX 21

form HUD-40061 (04/2005)Page 1 of 2Previous editions are obsolete.

Address

Type of Unit

Stories / Style

Lot Size

Type of Construction

Age (in years)

Condition

Area of Living Space (sq. ft.)

No.Rooms/Bedrooms /Baths / / / / / / / /

Basement

Parking/No. of Cars

Type of Heating /Fuel / / / /

Type of Air Conditioning

Neighborhood

Transportation (distance)

Current Work (distance)

High School/Grade School (distance) / / / /

Neighborhood Shopping (distance)

Religious Facility (distance)

Sale Price or Rent/Utility Costs $ $ $ $

Other

Date of Inspection

Date Available

Most Representative Comparable Replacement Dwelling

(Check "Comparable no.1, 2, or 3" and complete Comments)

Prepared By Date (mm/dd/yyyy) Approved by Date (mm/dd/yyyy)

Factors (see back of page) Displacement Dwelling Comparable No.1 Comparable No.2 Comparable No.3

1. Agency 2. Project 3. Household 4. Select One 5.Case Number

Owner

Tenant

Privacy Act Notice: This information is needed to determine whether you are eligible to receive a payment to help you rent or buy a new home. You are notrequired by law to furnish this information, but if you do not provide it, you may not receive any payment for these expenses or it may take longer to pay you.This information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970. The informationmay be made available to a Federal agency for review.

Comments: Include appropriate analysis and correlation of data. If Agency makes adjustment to the asking price for a comparable replacement dwellingto reflect the anticipated sale price, indicate the basis for the adjustment. For rental units, indicate utilities included in rent and provide estimates for otherutility costs. Indicate availability of any housing subsidy. If condominium or cooperative, indicate required fees. (Continue on back of page)

Comments continued on back of page Yes No

Selection of Most RepresentativeComparable Replacement Dwellingfor Computing a Replacement Housing Payment

U.S. Department of Housingand Urban DevelopmentOffice of of Community Planningand Developmemt

OMB Approval No. 2506-0016(exp. 10/31/2011)

Public reporting burden for this collection of information is estimated to average 1.0 hour. This includes the time for collecting, reviewing, and reportingthe data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970,and implementing regulations at 49 CFR Part 24 and will be used for determining the most comparable and available replacement housing and its cost to beused by Agencies in computing a replacement housing payment for displaced persons. Response to this request for information is required in order toreceive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currentlyvalid OMB control number.

form HUD-40061 (04/2005)Page 2 of 2Previous editions are obsolete.

Factors Examples

Type of Unit Detached,Row, End Row, Townhouse, Highrise Apartment, Mobile Home (Indicate whether this is subsidized housing)

Stories 1, 11/2, 2, 21/2, Split Level, Split Foyer

Style Colonial, Cape, Ranch, Contemporary, Tudor, Mediterranean

Type of Frame, Masonry, Pre-Fab, Stone, Concrete Block, Concrete, Veneer (wood, brick, or aluminum siding)Construction

Condition Poor, Fair, Good, Very Good, Excellent

Basement Full, Partial (1/2), None; Finished or Unfinished

Parking Attached, Built-In, Detached, Carport Paved Open Area, Unpaved Open Area, None

Type of Forced Air, Hot Water, Electric, Heat Pump, Steam, Space Heater, Solar, NoneHeating

Type of Fuel Natural Gas, Propane Gas, Oil, Electric, Coal, Solar

Type of Air Central, Wall, Window, NoneConditioning

Neighborhood Poor, Fair, Good, Very Good, Excellent. (Based on characteristics such as vacancy levels, quality and maintenance of dwellings,landscaping, Street Maintenance, Trash Pickup, and Nonconforming land uses)

Other Swimming Pool, Fireplace, Patio, Porch, Greenhouse

Comments Continued:

Comments continued on a separate page Yes No

APPENDIX 22

of 4 Form HUD-40030 (06/2016)

Claim for Temporary Relocation U.S. Department of Housing and Urban Development OMB Approval No. 2506-0016

Expenses (Residential Moves) Office of Community Planning and Development (exp. 4/30/2018)

(Appendix A, 49 CFR 24.2(a)(9)(ii)(D)) See page 3 for Public Reporting Burden and Privacy Act Statements before completing this form For Agency Name of Agency Use Only

Project Name or Number Case Number

Instructions: This claim form is for the use of families and individuals applying for reimbursement of temporary relocation expenses. The Agency will assist you in completing the form. If the full amount of your claim is not approved, the Agency will provide you with a written explanation of the reason. If you are not satisfied with the Agency’s determination, you may appeal that determination. The Agency will explain how to make an appeal. The Department of Housing and Urban Development provides information on these requirements and other guidance materials on its website at www.hud.gov/relocation. 1a. Your Name(s) (You are the Claimant(s)) and Present Mailing Address

1b. Telephone Number(s)

2a. Have all members of the household moved to the same dwelling? □ Yes □ No (If “No,” list the names of all members and the addresses to which they moved in the Remarks Section.)

2b. Do you (or will you) receive a Federal, State, or local housing program subsidy at the dwelling you moved to? □ Yes □ No

Dwelling Address When Did You Rent This Unit?

When Did You Move to This Unit?

When Did You Move Out of This Unit?

3. Unit That You Moved From 4. Unit That You Moved To 5. Unit That You Returned To 6. CERTIFICATION OF LEGAL RESIDENCY IN THE UNITED STATES (Please read instructions below before completing this section.) Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, you must be a United States citizen or national, or an alien lawfully present in the United States. The certification below must be completed in order to receive any relocation assistance. (This certification may not have any standing with regard to applicable State laws providing relocation assistance.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) and (h) for hardship exceptions. Please address only the category (individual or family) that describes your occupancy status. For Line (2), please fill in the correct number of persons. RESIDENTIAL HOUSEHOLDS (1) Individual. (2) Family. I certify that I am: (check one) I certify that there are _____ persons in my household and that ______ are _____ a citizen or national of the United States citizens or nationals of the United States and _____ are aliens lawfully _____ an alien lawfully present in the United States present in the United States. 7. DETERMINATION OF MOVING EXPENSES – MOVE TO TEMPORARY UNIT Instructions: You may be eligible for reimbursement of actual and reasonable moving costs and related expenses in connection with your move to a temporary housing unit. The computation table below provides you with the ability to compute your payment.

Move to Temporary Unit

(1) Commercial Move

(Actual Costs)

Claimant Agency Use

(2) Self Move

(Actual Costs) (Not to exceed cost paid by a

commercial mover) Claimant Agency Use

(a) Moving Cost Expenses (49 CFR 24.301(g)(1-7)); see page 3 (Do not include storage costs listed separately below.)

$

$

$

$

(b) Storage cost (not to exceed 12 months) $ $ $ $ (c) Telephone re-connection $ $ $ $ (d) Cable/Internet re-connection $ $ $ $ (e) Other (Explain in Remarks Section) $ $ $ $ (f) Total (Lines 7(a) – 7(e)) $ $ $ $ (g) Amount Previously Received, if any $ $ $ $ (h) Amount Requested (Subtract Line 7(g) from Line 7(f) $ $ $ $ (i) Total Amount Approved by Agency (for move to temporary unit) $ $

TO BE COMPLETED BY AGENCY SUMMARY FOR MOVE TO TEMPORARY HOUSING UNIT Line No.: Amount Claimed: Amount Recommended: Date Paid: Payable To: (j) Line 7(i), Column (1) $ $ (k) Line 7(i), Column (2) $ $ (l) Total: $ $ Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy) (m) RECOMMENDED $ (n) APPROVED $ Remarks (Attach additional sheets, if necessary)

of 4 Form HUD-40030 (06/2016

8. DETERMINATION OF MOVING EXPENSES – MOVE TO PERMANENT UNIT Instructions: You may be eligible for reimbursement of actual and reasonable moving costs and related expenses in connection with your move to a permanent housing unit. The computation table below provides you with the ability to compute your payment.

Move to Permanent Unit

(1) Commercial Move

(Actual Costs)

Claimant Agency Use

(2) Self Move

(Actual Costs) (Not to exceed cost paid by a commercial

mover) Claimant Agency Use

(a) Moving Cost Expenses (49 CFR 24.301(g)(1-7)); see page 3 $ $ $ $ (b) Telephone re-connection $ $ $ $ (c) Cable/Internet re-connection $ $ $ $ (d) Other (Explain in Remarks Section) $ $ $ $ (e) Total (Lines 8(a) – 8(d)) $ $ $ $ (f) Amount Previously Received, if any $ $ $ $ (g) Amount Requested (Subtract Line 8(f) from Line 8(e) $ $ $ $ (h) Total Amount Approved by Agency (for move to permanent unit) $ $

TO BE COMPLETED BY AGENCY SUMMARY FOR MOVE TO PERMANENT UNIT Line No.: Amount Claimed: Amount Recommended: Date Paid: Payable To: (i) Line 8(h), Column (1) $ $ (j) Line 8(h), Column (2) $ $ (k) Total: $ $ Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy) (l) RECOMMENDED $ $ (m) APPROVED $ $ Remarks (Attach additional sheets, if necessary) 9. MONTHLY OUT-OF-POCKET COSTS FOR TEMPORARY RELOCATION Costs listed on this form are for the period beginning ____________ _______ and ending _____________ ________ TOTAL # OF MONTHS: _____ (Month/Day) (Year) (Month/Day) (Year) DETERMINATION OF RENT AND AVERAGE MONTHLY UTILITY COSTS Instructions: To compute the payment, entries on Line 9(i) must reflect all utility services. Therefore, identify on Lines 9(b) through 9(f) each utility necessary to provide electricity, gas, other heating/cooking fuels, water and sewer. In those cases where the utility service is covered by the monthly rent, enter “IMR” (In Monthly Rent). If a monthly housing program subsidy (e.g., Housing Choice Voucher/Section 8, other) has been provided, enter the applicable amount on Line 9(h). Monthly Temporary Relocation Cost (For temporary relocation that lasts more than one month, either complete a Continuation Form for each additional month of temporary relocation or enter total claimed on Line 9(p) and explain under “Remarks.”

Unit You Moved From

Unit You Moved To

Increase In Monthly Cost

Amount Approved

(1) Claimant

(2) For Agency Use Only

(3) Claimant



(6) To Be Provided by

Agency

(a) Rent (The monthly rental amount due under the terms and conditions of occupancy). Check appropriate box: □ All utilities included □ Utilities not included (list on Line 9(b) to 9(f) below)

$

$

$

$

$

$

(b) Electricity $ $ $ $ $ $ (c) Gas $ $ $ $ $ $ (d) Water/sewer $ $ $ $ $ $ (e) Sanitation $ $ $ $ $ $ (f) Other $ $ $ $ $ $ (g) Gross Monthly Rent and Utility Costs (add Lines 9(a) through 9(f))

$

$

$

$

$

$

(h) Monthly Housing Subsidy, if applicable (e.g., Housing Choice Voucher/Section 8, other)

$

$

$

$

$

$

(i) Net Monthly Rent and Utility Costs for Month of ________ (subtract Line 9(h) from Line 9(g) above)

$

$

$

$

$

$

OTHER REASONABLE OUT-OF-POCKET EXPENSES Instructions: You may be eligible for other reasonable out-of-pocket expenses as approved by the agency in connection with your temporary move. Monthly Cost For Month of: ____________________ _______ (Month) (Year)

(1) Claimant

(2) Agency Use

(j) Per Diem for unit without cooking facilities: $__________ per adult x ______ days in this month period $__________ per child under age 12 x ______ days in this month period

$

$

Other (e.g., increased transportation costs, boarding for pets, parking). Itemize. (k) $ $ (l) $ $ (m) $ $

of 4

Form HUD-40030 (06/2016)

(n) Total (add lines 9(j) through 9(m)) $ $

TO BE COMPLETED BY AGENCY

SUMMARY OF MONTHLY OUT-OF-POCKET COSTS FOR TEMPORARY RELOCATION Line No.: Amount Claimed: Amount Recommended: (o) Add Lines 9(i) Column 6 and Line 9(n) Column 2

$

$

(p) Multiply Line 9(o) by number of months of temporary relocation (# of months: ______) or enter total amount from all Continuation Sheets, Lines 10(i) Column 6 and 10(n) Column 2

$

$

Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy) (r) RECOMMENDED

$

(s)APPROVED

$

Remarks (Attach additional sheets, if necessary)

CERTIFICATION BY CLAIMANT(S): I certify that this claim and supporting information are true and complete and that I have not been paid for these expenses by any other source. I ask that the amounts on Line 7(n), Line 8(m) and Line 9(r), be paid to: □ me □ the contractor(s) (as specified in the Remarks Section). Signature(s) of Claimant(s): _________________________________________________________________________________ Date: _______________________ Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Eligible Actual Residential Moving Expenses (49 CFR 24.301(g)(1-7))

1) Transportation of the displaced person and personal property. Transportation costs for a distance beyond 50 miles are not eligible, unless the Agency determines that relocation beyond 50 miles is justified.

2) Packing, crating, unpacking and uncrating of the personal property. 3) Disconnecting, dismantling, removing, reassembling and reinstalling relocated household appliances and other personal property. 4) Storage of the personal property for a period not to exceed 12 months, unless the Agency determines that a longer period is necessary. 5) Insurance for the replacement value of the property in connection with the move and necessary storage. 6) The replacement value of property lost, stolen, or damaged in the process of moving (not through the fault or negligence of the displaced person, his or her

agent, or employee) where insurance covering such loss, theft, or damage is not reasonably available. 7) Other moving-related expenses that are not listed as ineligible under §24.301(h), as the Agency determines to be reasonable and necessary.

Public reporting burden for this collection of information is estimated to average 30 minutes per response. This includes the time for collecting, reviewing and reporting the data. The information is being collected under the authority of the Housing and Community Development Act of 1987, 42 U.S.C. 3543, the U.S. Housing Act of 1937, as amended, 42 U.S.C. 1437 et seq., and the Housing and Community Development Act of 1981, P.L. 97-35, 85 stat., 34, 408 to determine if you are eligible to receive a payment for temporary moving expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a valid OMB control number. Privacy Act Notice: This information is being used by an agency administering program services on behalf of HUD for certain HUD programs to determine whetheryou are eligible to receive a payment for temporary moving expenses. Periodically, HUD reviews a random sample of the agency files to ensure compliance withstatutory and regulatory requirements. The information requested is voluntary, you are not required by law to furnish this information, but if you do not provide it,you may not receive any payment for these expenses or it may take longer to pay you. This information is being collected under the authority of the Housing and Community Development Act of 1987, 42 U.S.C. 3543, the U.S. Housing Act of 1937, as amended, 42 U.S.C. 1437 et seq., and the Housing and Community Development Act of 1981, P.L. 9735, 85 stat., 34, 408. This information may be shared with Federal agencies and other agencies approved by HUD to administer or assist with servicesfor Uniform Relocation Assistance and Real Property Acquisition Policies Act obligations.

of 4 Form HUD-40030 (06/2016)

[CONTINUATION SHEET] Claim for Temporary Relocation U.S. Department of Housing and Urban Development

Expenses (Residential Moves) Office of Community Planning and Development

(Appendix A, 49 CFR 24.2(a)(9)(ii)(D)) 10. CONTINUATION SHEET FOR EACH ADDITIONAL MONTH OF TEMPORARY RELOCATION Costs listed on this form are for the period beginning ______________ _______ and ending ____________ ________ TOTAL # OF MONTHS: ______ (Month/Day) (Year) (Month/Day) (Year) DETERMINATION OF RENT AND AVERAGE MONTHLY UTILITY COSTS Instructions: To compute the payment, entries on Line (i) must reflect all utility services. Therefore, identify on Lines 10(b) through 10 (f) each utility necessary to provide electricity, gas, other heating/cooking fuels, water and sewer. In those cases where the utility service is covered by the monthly rent, enter “IMR” (In Monthly Rent). If a monthly housing program subsidy (e.g., Housing Choice Voucher/Section 8, other) has been provided, enter the applicable amount on Line 10(h). Temporary Relocation Cost for Periods That Exceed One Month (For temporary relocation that lasts more than one month, complete this Continuation Form for each additional month of temporary relocation.

Unit You Moved From

Unit You Moved To

Increase In Monthly Cost

Amount Approved

(1) Claimant


(3) Claimant



(6) To Be Provided by

Agency (a) Rent (The monthly rental amount due under the terms and conditions of occupancy). Check appropriate box: □ All utilities included □ Utilities not included (list on Lines 10 (b) to 10(f) below)

$

$

$

$

$

$

(b) Electricity $ $ $ $ $ $ (c) Gas $ $ $ $ $ $ (d) Water/sewer $ $ $ $ $ $ (e) Sanitation $ $ $ $ $ $ (f) Other $ $ $ $ $ $ (g) Gross Monthly Rent and Utility Costs (add Lines 10(a) through 10(f))

$

$

$

$

$

$

(h) Monthly Housing Subsidy, if applicable (e.g., Housing Choice Voucher/Section 8, other)

$

$

$

$

$

$

(i) Net Monthly Rent and Utility Costs for Month of ________ (subtract Line 20(h) from Line 10(g) above)

$

$

$

$

$

$

OTHER REASONABLE OUT-OF-POCKET EXPENSES Instructions: You may be eligible for other reasonable out-of-pocket expenses as approved by the agency in connection with your temporary move. Monthly Cost For Month of: ______________________ _______ (Month) (Year)

(1) Claimant

(2) Agency Use

(j) Per Diem for unit without cooking facilities: $__________ per adult x ______ days in this month period $__________ per child under age 12 x ______ days in this month period

$

$

Other (e.g., increased transportation costs, boarding for pets, parking). Itemize. (k) (l) $ $ (m) $ $ (n) Total (add lines 10(j) through 10(m)) $ $

APPENDIX 23

form HUD-40058 (06/2016)Page 1 of 3Previous editions are obsolete

For Agency Name of Agency Project Name or Number Case NumberUse Only

1a. Your Name(s) (You are the Claimant(s)) and Present Mailing Address 1b. Telephone Number(s)

3. Unit That You Moved From

4. Unit That You Moved To

When Did You When Did You Move When Did You MoveDwelling Address Rent/Buy This Unit? To This Unit? Out of This Unit?

Claim for Rental Assistance orDown Payment Assistance(49 CFR 24.402 and 24.401(f))

U.S. Department of Housingand Urban DevelopmentOffice of Community Planningand Development

OMB Approval No. 2506-0016 (exp. 04/30/2018)

2a. Have all members of the household moved to the same dwelling? Yes No (If “No”, list the names of all members and the addresses

to which they moved in the Remarks Section.)

See page 3 for Public Reporting Burden andPrivacy Act Statements before completing this form

2b. Do you (or will you) receive a Federal, State, or local housing program

subsidy at the dwelling you moved to? Yes No

Household Income

Claimant For Agency Use Only(a) (b)

(1) Total number of persons in the household (See item 5(1) or (2))

(2) Annual Gross House-hold Income. (49 CFR24.2(a)(14)). Entername of each house-hold member withincome (include theincome of persons notlawfully present in theU.S.)

(3) Total Gross Annual Income (Sum of entries in item 6(2)) $ $

(4) URA low income limit for number of persons in item 6(1). If item 6(3) is greater than

item 6(4) - Family is not low-income. See 49 CFR 24.402 (b)(2)(ii) $

(5) Gross Monthly Income (Divide item 6(3) by 12) $ $

(6) 30% of item 6(5) or "NA". (If gross annual income item 6(3) is greater than URA low income $ $ limit in item 6(4), enter "NA".)

$ $

Instructions: This claim form is for the use of families and individuals applying for rental or down payment assistance under the Uniform RelocationAssistance and Real Property Acquisition Policies Act of 1970 (URA) and may also be used by a 90-day homeowner-occupant who chooses to rentrather than buy a replacement home. The Agency will help you complete the form. HUD also provides information on these requirements and otherguidance materials on its website at www.hud.gov/relocation. If the full amount of your claim is not approved, the Agency will provide you with a writtenexplanation of the reason. If you are not satisfied with the Agency's determination, you may appeal that determination. The Agency will explain how tomake an appeal.Displaced persons must rent/purchase and occupy a decent, safe and sanitary replacement dwelling within one year from the date ofdisplacement for replacement housing payment eligibility (see 24.402(a)(2)). All claims for payments must be filed no later than 18 monthsfrom the date of displacement (see 24.207(d)).

5. Certification of Legal Residency in the United States (Please read instructions below before completing this section.)Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real PropertyAcquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the United States. The certificationbelow must be completed in order to receive any relocation benefits. (This certification may not have any standing with regard to applicable Statelaws providing relocation benefits.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.

Please address only the category (Individual or family) that describes your occupancy status. For item (2), please fill in the correct number of persons.

RESIDENTIAL HOUSEHOLDS(1) Individual. (2) Family. I certify that I am: (check one) I certify that there are ______ persons in my household and that _____ a citizen or national of the United States ______ are citizens or nationals of the United States and _____ are aliens lawfully _____ an alien lawfully present in the United States. present in the United States.

6. Determination of Person’s Financial Means (Not applicable to 90-day homeowner-occupants who choose to rent. Enter NA in Item 6(6).)

(Form has been revised. See last page.)

form HUD-40058 (06/2016)Page 2 of 3Previous editions are obsolete

(2)

(3)

(4)

(5)

(6) Gross Monthly Rent and Utility Costs $ $ $ $ $(add item 7(1) through (5))

(7) Monthly Housing Subsidy, if applicable $ $ $ $ $(e.g., Housing Choice Voucher/Section 8, other)

Monthly Cost

Unit That You Moved From Unit That You Moved To Comparable(For Homeowner-Occupant, rent (Do not complete if claim is for Replacementwill be determined by the agency.) down payment assistance.) Dwelling

(a) (b) (c) (d) (e)Claimant For Agency Claimant For Agency To Be Provided

Use Only Use Only By Agency(1) Rent (The monthly rental amount due under the terms $ $ $ $ $

and conditions of occupancy. If utilities are not included in rent, list in item 7(2) to (5))

(8) Net Monthly Rent and Utility Costs $ $ $ $ $(subtract item 7(7) from item 7(6)) (Enter these

amounts on the appropriate lines in Item 8.)

7. Determination of Rent and Average Monthly Utility Costs (See 49 CFR 24.402(b))Instructions: To compute the payment, entries on line (8) must reflect all utility services. Therefore, identify on lines (2) through (5) each utility necessary to provide electricity,gas, other heating/cooking fuels, water and sewer. In those cases where the utility service is not covered by the monthly rent, indicate the estimated out-of-pocket monthly cost.In those cases where the utility service is covered by the monthly rent, enter “IMR” (In Monthly Rent). Determine the estimated average monthly cost of a utility service by dividingthe reasonable estimated yearly cost by 12. If a monthly housing program subsidy (e.g., Housing Choice Voucher/Section 8, other) has been provided, enter the applicable amounton line (7).

8. Computation of Payment: If you are filing for down payment assistance, check this box and skip item 8(1).To Be Completed

By Claimant For Agency Use Only (a) (b)

(1) Monthly Rent and Average Monthly Utility Costs for Unit That You Moved To(From item 7(8), Column (c)) $ $

(2) Monthly Rent and Average Monthly Utility Costs for Comparable Replacement Dwelling(From item 7(8), Column (e)) (To be provided by the Agency)

(3) Lesser of item 8(1) or (2) (If claim is for down payment assistance, enter amount fromitem 8(2))

(4) Monthly Rent and Average Monthly Utility Costs for Unit That You Moved From (From item 7(8), Column (a)) (For Homeowner-Occupants who choose to rent, to be determined by the agency.)

(5) 30% of Average Gross Monthly Household Income (From item 6(6), Column (a)). If item 6(6) is "NA", enter "NA" here.

(6) Lesser of item 8(4) or 8(5)

(7) Monthly Need (Subtract item 8(6) from item 8(3))

(8) Amount of Payment Claim (Amount on item 8(7) multiplied by 42) (For a Homeowner-Occupant who elects to rent, this amount cannot exceed the difference between the aquisition cost of the displacement dwelling and the cost of a comparable replacement dwelling. See form HUD-40057, item 5(5).) $ $

(9) Amount Previously Received (if any)

(10) Amount Requested (Subtract item 8(9) from 8(8)) $ $

9. Certification By Claimant(s): I certify that the information on this claim form and supporting documentation is true and complete and that I have not been paid for these expenses by any other source.

Signature(s) of Claimant(s) & Date

X

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

form HUD-40058 (06/2016)Page 3 of 3

Remarks continued on a separate page? Yes No

14. Recommended $

15. Approved $

Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy)

10. Effective date (mm/dd/yyyy) 11. Date (mm/dd/yyyy) replacement 12. Date(mm/dd/yyyy)of eligibility for relocation dwelling inspected and found person occupied replacementassistance decent, safe and sanitary dwelling

To be Completedby the Agency

Remarks

13. Payment To Be Made In: Lump Sum Monthly Installments Other Installments

(only for down payment assistance) (specify in the Remarks Section)

(NOTE: Updated to incorporate MAP21 statutory changes to the URA effective on 10/01/2014. Please note the current URA regulations of 49 CFR part 24 will be revised in a future URA rule making to reflect MAP21 changes. For additional information on MAP21 changes to the URA for HUD programs and projects, refer to HUD Notice CPD1409 at the following website: http://portal.hud.gov/hudportal/documents/huddoc?id=1409pdn.pdf.)

APPENDIX 24

Previous versions obsolete.

3. Unit That YouMoved From

4. Unit That YouMoved To

Residential Claim for Movingand Related Expenses(49 CFR 24.301 and 24.302)

OMB Approval No. 2506-0016(exp. 4/30/2018)

1. Your Name(s) (You are the Claimant(s)) and Present Mailing Address 1a. Telephone Number(s)

2. Have All Members of the Household Moved to the Same Dwelling? Yes No(If “No,” list the names of all members and the addresses to which they moved in the Remarks Section.)

Number of Rooms Date DateDwelling Address (include Apartment No.) of Furniture? * Occupied Vacated

U.S. Department of Housingand Urban DevelopmentOffice of Community Planningand Development

For Agency Name of Agency Project Name or Number Case NumberUse Only

See page 3 for Public Reporting Burden andPrivacy Act Statements before completing this form

Instructions: This claim form is for the use of families and individuals applying for payment of residential moving and related expenses under the Uniform Relocation Assistanceand Real Property Acquisition Policies Act of 1970 (URA). You may be eligible to apply for either (1) a fixed payment (see 24.302), or (2) payment for actual reasonable movingcosts and related expenses (see 24.301), or (3) in some cases, a payment based on a combination of moving options (contact Agency). All claims for actual expenses mustbe supported by receipts or other acceptable evidence. The Agency will explain the differences between the types of moving options and will help you complete this form. HUDprovides information on these requirements and other guidance materials on its website at www.hud.gov/relocation. If the full amount of your claim is not approved, the Agencywill provide you with a written explanation of the reason. If you are not satisfied with the Agency's determination, you may appeal that determination. The Agency will explainhow to make an appeal. All claims for payments must be filed no later than 18 months from the date of displacement (see 24.207(d)).

5. Is This a Final Claim? Yes No

7a. Commercial Move 7b. Self Move 7c. Self Move

(Actual Costs) (Actual Costs) (Fixed Schedule) (Based on lower of 2 bids) (Not to exceed cost of (See 49 CFR 24.302) commerical move) Claimant Agency Use Claimant Agency Use Claimant Agency Use

7. Computation of Payment (See 49 CFR 24.301 and 24.302)Instructions: You may be eligible to apply for either (1) a fixed payment (see 24.302), or (2) payment for actual and reasonable moving costs and related expenses(see 24.301), or (3) in some cases, a payment based on a combination of moving options (see 24.301(b)). The computation table in this section provides you withthe ability to compute your payment based on one or a combination of moving options depending on your eligibility and your needs and desires.

A fixed payment is used to compute a payment based on the numbers of rooms of furniture within the displacement dwelling. The Residential Fixed Moving Cost Scheduleavailable at www.hud.gov/relocation, will provide the payment amount for the state in which the displacement occurred. (Note: for persons occupying a dormitory styleroom or where the move is performed by the Agency at no cost to the displaced person, the payment amount is limited to the amount specified for such moves on theFixed Moving Cost Schedule.) If you choose to claim a fixed payment, fill in the applicable schedule amount in column 7c Line (3). In some cases, persons who plansto claim only a fixed payment may also be eligible for additional moving options to move personal property located outside the dwelling and not considered in the FixedMoving Cost Schedule (jungle gym, hot tub, etc.) or for personal property requiring specialized moving assistance within the dwelling (piano, pool table, medical equipment,etc.). In these situations you may also be eligible for a payment based on actual costs for a commerical move and/or self move for these items. Contact the Agencyfor further assistance. If the Agency determines you are eligible for other moving options in addition to the fixed payment, fill in all applicable claim information requestedfor the type(s) of moving option specified in the table.

(1) Moving Cost Expenses (49 CFR 24.301(g)(1-7); see page 3)(Do not include storage costs listed separately below). [ForMobile Home Owner Occupants also include 24.301(g)(8-10),if applicable.](2) Storage Cost (Requires prior agency approval) (Not toexceed 12 months)(3) Fixed Moving Cost Schedule Amount (Based on number ofrooms of furniture in Item 3). For amount see Moving CostSchedule available at www.hud.gov/relocation.(4) Other (Explain in Remarks Section)(5) Total Amount of Claim.(6) Amount Previously Received, if any.(7) Amount Requested (Subtract line (6) from line (5)(8) Total Amount Requested - Combination Moves Only(add applicable columns 7(a)(7), 7(b)(7) and 7(c)(7))

6. Certification of Legal Residency in the United States (Please read instructions below before completing this section.)

Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real PropertyAcquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the United States. The certificationbelow must be completed in order to receive any relocation benefits. (This certification may not have any standing with regard to applicable Statelaws providing relocation benefits.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.

Please address only the category (Individual or family) that describes your occupancy status. For item (2), please fill in the correct number of persons.

RESIDENTIAL HOUSEHOLDS(1) Individual. (2) Family. I certify that I am: (check one) I certify that there are ______ persons in my household and that _____ a citizen or national of the United States ______ are citizens or nationals of the United States and _____ are aliens lawfully _____ an alien lawfully present in the United States. present in the United States.

* Excluding bathrooms, hallways and closets.

Page 1 of 3 HUD form 40054 (06/2016)

Previous versions obsolete.

Remarks (Attach additional sheets, if necessary)

Additional sheets attached? Yes No

9. Recommended $

10. Approved $

Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy)To Be Completed by the Agency

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

8. Certification By Claimant(s): I certify that this claim and supporting information are true and complete and that I have not been paidfor these expenses by any other source. I ask that the amount on line (7) of Item 7 or line (8) of Item 7 for combination moves bepaid to me the contractor(s) (as specified in the Remarks Section).

Signature(s) of Claimant(s) & Date:

X

Page 2 of 3 HUD form 40054 (06/2016)

Eligible Actual Residential Moving Expenses (49 CFR 24.301(g)(1-10)(1) Transportation of the displaced person and personal property. Transportation costs for a distance beyond 50 miles are not eligible, unless the Agency determines that relocation beyond 50 miles is justified.(2) Packing, crating, unpacking, and uncrating of the personal property.(3) Disconnecting, dismantling, removing, reassembling, and reinstalling relocated household appliances and other personal property. For businesses, farms or nonprofit organizations this includes machinery, equipment, substitute personal property, and connections to utilities available within the building; it also includes modifications to the personal property, including those mandated by Federal, State or local law, code or ordinance, necessary to adapt it to the replacement structure, the replacement site, or the utilities at the replacement site, and modifications necessary to adapt the utilities at the replacement site to the personal property.(4) Storage of the personal property for a period not to exceed l2 months, unless the Agency determines that a longer period is necessary.(5) Insurance for the replacement value of the property in connection with the move and necessary storage.(6) The replacement value of property lost, stolen, or damaged in the process of moving (not through the fault or negligence of the displaced person, his or her agent, or employee) where insurance covering such loss, theft, or damage is not reasonably available.(7) Other moving-related expenses that are not listed as ineligible under § 24.301(h), as the Agency determines to be reasonable and necessary.(8) The reasonable cost of disassembling, moving, and reassembling any appurtenances attached to a mobile home, such as porches, decks, skirting, and awnings, which were not acquired, anchoring of the unit, and utility “hookup” charges.(9) The reasonable cost of repairs and/or modifications so that a mobile home can be moved and/or made decent, safe, and sanitary.(10) The cost of a nonrefundable mobile home park entrance fee, to the extent it does not exceed the fee at a comparable mobile home park, if the person is displaced from a mobile home park or the Agency determines that payment of the fee is necessary to effect relocation.

Public reporting burden for this collection of information is estimated to average 30 minutes per response. This includes the time for collecting, reviewing,and reporting the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition PoliciesAct of 1970, and implementing regulations at 49 CFR Part 24 and will be used for determining whether you are eligible to receive a payment for moving andrelated expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. Thisagency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number.

Privacy Act Notice: This information is being used by an agency administering program services on behalf of HUD for certain HUD programs to determine whether you are eligible to receive a payment for moving and related expenses and the amount of any payment. Periodically, HUD reviews a random sample of theagency files to ensure compliance with statutory and regulatory requirements. The information requested is voluntary, you are not required by law to furnish this information, but if you do not provide it, you may not receive any payment for these expenses or it may take longer to pay you. This information is being collectedunder the authority of the Housing and Community Development Act of 1987, 42 U.S.C. 3543, the U.S.Housing Act of 1937, as amended, 42 U.S.C. 1437 et seq., andthe Housing and Community Development Act of 1981, P.L. 97-35, 85 stat., 34,408. This information may be shared with Federal agencies and other agenciesapproved by HUD to administer or assist with services forUniform Relocation Assistance and Real Property Acquisition Policies Act obligations.

Page 3 of 3 HUD form 40054 (06/2016)

APPENDIX 25

44182 Federal Register / Vol. 80, No. 142 / Friday, July 24, 2015 / Notices

received an application from Upland Pipeline, LLC (‘‘Upland’’) for a Presidential Permit authorizing the construction, connection, operation, and maintenance of pipeline facilities for the export of crude oil. If the application is approved, the proposed facilities will transport crude oil from the Williston

Dated: April 27, 2015. Chris Davy, Acting Director, Energy Resources Bureau, Energy Diplomacy (ENR/EDP/EWA), Bureau of Energy Resources, U.S. Department of State. [FR Doc. 2015–18208 Filed 7–23–15; 8:45 am] BILLING CODE 4710–07–P

Participants will be highly encouraged to introduce ideas of how they would incorporate SWIM data into their operation or application both before and after working with the data types provided. For more information or to register, visit www.faa.gov/nextgen/ swim.

Basin region in North Dakota across the U.S.-Canadian border near Burke

Space is limited so register early to secure a spot! Registration will close

County, North Dakota, for onward transportation to refineries in Canada and the eastern United States.

Upland is a limited liability corporation organized under the laws of the State of Delaware. The ultimate parent corporation of Upland is TransCanada Corporation (‘‘TransCanada’’). TransCanada is a major energy infrastructure firm whose assets include approximately 35,500 miles of natural gas pipelines and a 2,600-mile petroleum pipeline. Upland plans to enter into a development, management, and operations agreement with TransCanada Oil Pipeline Operations, Inc., a subsidiary of TransCanada, to provide operating services for the project.

Under E.O. 13337, the Secretary of State is designated and empowered to receive all applications for Presidential Permits for the construction, connection, operation, or maintenance, at the borders of the United States, of facilities for the exportation or

DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration

System Wide Information Management (SWIM) Interactive Developer Workshop; Meeting Announcement

AGENCY: Federal Aviation Administration (FAA), DOT. System Wide Information Management (SWIM) Interactive Developer Workshop; Meeting Announcement

Tuesday, September 22, 2015 to Thursday, September 24, 2015—From 8:00 a.m. to 4:30 p.m., FAA Florida NextGen Test Bed, 557 Innovation Way, Daytona Beach, FL 32114. Open Meeting—Interactive Workshop

The Federal Aviation Administration (FAA) invites all interested stakeholders with a background in software development to attend an interactive workshop on System Wide Information Management (SWIM) at the state of the art NextGen Test Bed in Daytona Beach, FL. Join fellow developers as the FAA

when all spots have been filled! About SWIM

System Wide Information Management (SWIM) is the FAA’s data distribution backbone of NextGen, the Next Generation Air Transportation System. SWIM utilizes a ‘‘one to many’’ data distribution model, allowing easier access to more data, providing it to the right person, at the right time, in the format they want. SWIM utilizes industry standard service oriented architecture (SOA) technology to be interoperable with many types of applications capable of web service and java based messaging. The FAA is also leading the use of standard data exchange models such as Aeronautical Information Exchange (AIXM) and Flight Information Exchange (FIXM). Paul Fontaine, Director, NextGen Portfolio Management and Technology Development, Federal Aviation Administration. [FR Doc. 2015–18213 Filed 7–23–15; 8:45 am] BILLING CODE P

importation of liquid petroleum, introduces and demonstrates current petroleum products, or other non- gaseous fuels to or from a foreign country. The Department of State has the responsibility to determine whether issuance of a new Presidential Permit for construction, connection, operation, and maintenance of the proposed Upland pipeline border facilities would serve the U.S. national interest.

The Department will conduct an environmental review consistent with the National Environmental Policy Act of 1969. The Department will provide more information on the review process in a future Federal Register notice.

Upland’s application is available at: http://www.state.gov/e/enr/applicant/ applicants/index.htm FOR FURTHER INFORMATION CONTACT: Acting Director, Energy Resources Bureau, Energy Diplomacy (ENR/EDP/ EWA) United States Department of State, 2201 C St. NW., Suite 4843, Washington, DC 20520.

and new data services being made available from the agency’s enterprise information gateway. Socializing new ideas on how to work with data from SWIM and what applications can be developed will be highly encouraged by the organizers.

Participants to the workshop who have an existing graphical user interface that visualizes data are encouraged to bring their application to use during the workshop. Participants that do not have an interface may be provided one at no cost. All participants must bring their own hardware (laptop preferred) to use during the event.

The FAA will be providing a connection to the Research & Development Data Domain allowing participants to engage and interact real time with data from SWIM in a non- operational environment. The following data types will be introduced and available to work with during the event: • Notices to Airmen (NOTAM) • Common Sourced Weather • Terminal Data Distribution Services • Flight Data Publication Services • Traffic Flow Management Publication

Services


Federal Highway Administration

Uniform Relocation and Real Property Acquisition for Federal and Federally- Assisted Programs; Fixed Payment for Moving Expenses; Residential Moves

AGENCY: Federal Highway Administration (FHWA), DOT. ACTION: Notice.

SUMMARY: The purpose of this notice is to publish changes in the Fixed Residential Moving Cost Schedule for the States and Territories of Alabama, California, Colorado, District of Columbia, Florida, Guam, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, North Dakota, Oklahoma, Puerto Rico, Rhode Island, South Carolina, Utah, Virginia, Wisconsin, and Wyoming as provided for by section 202(b) of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended. The schedule amounts for the States and Territories not listed above

http://www.faa.gov/nextgen/swim

http://www.faa.gov/nextgen/swim

http://www.state.gov/e/enr/applicant/applicants/index.htm

http://www.state.gov/e/enr/applicant/applicants/index.htm

Federal Register / Vol. 80, No. 142 / Friday, July 24, 2015 / Notices 44183

remain unchanged. The Uniform Act applies to all programs or projects undertaken by Federal agencies or with Federal financial assistance that cause the displacement of any person. DATES: The provisions of this notice are effective August 24, 2015, or on such earlier date as an agency elects to begin operating under this schedule. FOR FURTHER INFORMATION CONTACT: Mary Jane Daluge, Office of Real Estate Services, (202) 366–2035, email address: [email protected] ; Robert Black, Office of the Chief Counsel, (202) 366–1359, email address: Robert.Black@ dot.gov; Federal Highway Administration, 1200 New Jersey Avenue SE., Washington, DC 20590. Office hours are from 8:00 a.m. to 4:30 p.m., e.t., Monday through Friday, except Federal holidays. SUPPLEMENTARY INFORMATION:

Electronic Access Internet users may reach the Office of

the Federal Register’s home page at: http://www.archives.gov/ and the Government Printing Office’s database: http://www.fdsys.gov. Background

The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended, 42 U.S.C. 4601–4655 (Uniform Act), established a program, which includes the payment of moving and related expenses, to assist persons who move because of Federal or federally assisted projects. The FHWA is the lead agency for implementing the provisions of the Uniform Act, and has issued governmentwide implementing regulations at 49 CFR part 24.

The following 17 Federal departments and agencies have, by cross-reference,

adopted the governmentwide regulations: Department of Agriculture; Department of Commerce; Department of Defense; Department of Education; Department of Energy; Department of Homeland Security; Environmental Protection Agency; Federal Emergency Management Agency; General Services Administration; Department of Health and Human Services; Department of Housing and Urban Development; Department of the Interior; Department of Justice; Department of Labor; Department of Veterans Affairs; National Aeronautics and Space Administration; Tennessee Valley Authority.

Section 202(b) of the Uniform Act provides that as an alternative to being paid for actual residential moving and related expenses, a displaced individual or family may elect payment for moving expenses on the basis of a moving expense schedule established by the head of the lead agency. The governmentwide regulations at 49 CFR 24.302 provide that the FHWA will develop, approve, maintain, and update this schedule, as appropriate.

The purpose of this notice is to update the schedule published on May 23, 2012, at 77 FR 30586.

The schedule is being updated to reflect the increased costs associated with moving personal property and was developed from data provided by State highway agencies. This update increases the schedule amounts in the States and Territories of Alabama, California, Colorado, District of Columbia, Florida, Guam, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, North Dakota, Oklahoma, Puerto Rico, Rhode Island, South Carolina,

Utah, Virginia, Wisconsin, and Wyoming. The schedule amounts for the States and Territories not listed above remain unchanged. The payments listed in the table below apply on a State-by- State basis. Two exceptions and limitations apply to all States and Territories. Payment is limited to $100.00 if either of the following conditions applies:

(a) A person has minimal possessions and occupies a dormitory style room, or

(b) A person’s residential move is performed by an agency at no cost to the person.

The schedule continues to be based on the ‘‘number of rooms of furniture’’owned by a displaced individual or family. In the interest of fairness and accuracy, and to encourage the use of the schedule (and thereby simplify the computation and payment of moving expenses), an agency should increase the room count for the purpose of applying the schedule if the amount of possessions in a single room or space actually constitutes more than the normal contents of one room of furniture or other personal property. For example, a basement may count as two rooms if the equivalent of two rooms worth of possessions is located in the basement. In addition, an agency may elect to pay for items stored outside the dwelling unit by adding the appropriate number of rooms.

Authority: 42 U.S.C. 4622(b) and 4633(b); 49 CFR 1.85 and 24.302.

Issued on: July 17, 2015. Gregory G. Nadeau, Acting Administrator, Federal Highway Administration.

UNIFORM RELOCATION ASSISTANCE AND REAL PROPERTY ACQUISITION POLICIES ACT OF 1970, AS AMENDED FIXED

RESIDENTIAL MOVING COST SCHEDULE (2015)

State

Occupant owns furniture Occupant does not own furniture

Number of rooms of furniture

1 room/ no furn.

Addt’l room

no furn. 1

room 2

rooms 3

rooms 4

rooms 5

rooms 6

rooms 7

rooms 8

rooms Addt’l room

Alabama ..................... 600 800 1000 1200 1400 1600 1800 2000 200 400 50 Alaska ......................... 700 900 1125 1350 1550 1725 1900 2075 300 500 200 American Samoa ........ 282 395 508 621 706 790 875 960 85 226 28 Arizona ....................... 700 800 900 1000 1100 1200 1300 1400 100 395 60 Arkansas .................... 550 825 1100 1350 1600 1825 2050 2275 200 300 70 California .................... 725 930 1165 1375 1665 1925 2215 2505 265 475 90 Colorado ..................... 675 895 1115 1270 1425 1580 1735 1890 155 385 55 Connecticut ................ 620 810 1000 1180 1425 1670 1910 2150 150 225 60 Delaware .................... 500 710 880 1110 1260 1410 1560 1710 160 400 60 DC .............................. 800 1000 1200 1500 1700 1900 2100 2300 200 500 100 Florida ........................ 750 900 1075 1250 1400 1550 1600 1850 300 500 150 Georgia ....................... 600 975 1300 1600 1875 2125 2325 2525 200 375 100 Guam .......................... 600 950 1300 1600 1900 2150 2400 2650 200 300 150 Hawaii ......................... 600 950 1300 1600 1900 2150 2400 2650 200 300 150 Idaho .......................... 600 800 1000 1200 1400 1600 1800 2000 200 350 100




http://www.archives.gov/

http://www.fdsys.gov/

44184 Federal Register / Vol. 80, No. 142 / Friday, July 24, 2015 / Notices

UNIFORM RELOCATION ASSISTANCE AND REAL PROPERTY ACQUISITION POLICIES ACT OF 1970, AS AMENDED FIXED

RESIDENTIAL MOVING COST SCHEDULE (2015)—Continued

State

Occupant owns furniture Occupant does not own furniture

Number of rooms of furniture

1 room/ no furn.

Addt’l room

no furn. 1

room 2

rooms 3

rooms 4

rooms 5

rooms 6

rooms 7

rooms 8

rooms Addt’l room

Illinois ......................... 850 1000 1150 1250 1400 1600 1750 2050 450 650 150 Indiana ........................ 500 700 900 1100 1300 1500 1700 1900 200 400 100 Iowa ............................ 550 700 800 900 1000 1100 1225 1350 125 500 50 Kansas ....................... 400 600 800 1000 1200 1400 1600 1800 200 250 50 Kentucky ..................... 500 700 900 1100 1300 1500 1700 1900 200 350 50 Louisiana .................... 600 800 1000 1200 1300 1550 1700 1900 300 400 70 Maine .......................... 650 900 1150 1400 1650 1900 2150 2400 250 400 100 Maryland ..................... 700 900 1100 1300 1500 1700 1900 2100 200 500 100 Massachusetts ........... 700 850 1000 1200 1350 1500 1650 1800 250 450 150 Michigan ..................... 700 950 1150 1300 1450 1600 1750 1900 300 500 200 Minnesota ................... 575 725 925 1125 1325 1525 1725 1925 275 450 100 Mississippi .................. 750 850 1000 1200 1400 1550 1700 1850 300 400 100 Missouri ...................... 800 900 1000 1100 1200 1300 1400 1500 200 400 100 Montana ..................... 500 700 900 1100 1300 1500 1700 1900 200 350 100 Nebraska .................... 390 545 700 855 970 1075 1205 1325 120 310 40 Nevada ....................... 500 700 900 1100 1300 1500 1700 1900 200 350 60 New Hampshire .......... 500 700 900 1100 1300 1500 1700 1900 200 200 150 New Jersey ................ 650 750 850 1000 1150 1300 1400 1600 200 200 50 New Mexico ................ 650 850 1050 1250 1450 1650 1850 2050 200 400 60 New York .................... 600 800 1000 1200 1400 1600 1800 2000 200 350 100 North Carolina ............ 550 750 1050 1200 1350 1600 1700 1900 150 350 50 North Dakota .............. 495 715 900 1080 1265 1415 1510 1695 185 430 65 N. Mariana Is. ............. 282 395 508 621 706 790 875 960 85 226 28 Ohio ............................ 600 800 1000 1150 1300 1450 1600 1750 150 400 100 Oklahoma ................... 700 900 1100 1300 1500 1700 1850 2000 200 350 100 Oregon ....................... 600 800 1000 1200 1400 1600 1800 2000 200 350 100 Pennsylvania .............. 500 750 1000 1200 1400 1600 1800 2000 200 400 70 Puerto Rico ................ 350 550 700 850 1000 1100 1200 1300 100 300 50 Rhode Island .............. 600 850 1000 1200 1400 1600 1800 2000 150 300 100 South Carolina ........... 700 805 1095 1285 1575 1735 1890 2075 225 500 75 South Dakota ............. 500 650 800 950 1050 1200 1400 1600 200 300 40 Tennessee .................. 500 750 1000 1250 1500 1750 2000 2250 250 400 100 Texas .......................... 600 800 1000 1200 1400 1600 1750 1900 150 400 50 Utah ............................ 650 800 950 1100 1250 1400 1550 1700 150 500 100 Vermont ...................... 400 550 650 850 1000 1100 1200 1300 150 300 75 Virgin Islands .............. 500 700 850 950 1150 1300 1450 1600 150 425 100 Virginia ....................... 700 900 1100 1300 1500 1700 1900 2100 300 400 75 Washington ................ 600 800 1000 1200 1400 1600 1800 2000 200 300 50 West Virginia .............. 750 900 1050 1200 1350 1500 1650 1800 150 350 50 Wisconsin ................... 550 730 935 1140 1350 1560 1765 1975 260 440 105 Wyoming .................... 540 800 870 1020 1170 1325 1500 1670 200 370 60

Exceptions: 1. The payment to a person with minimal possession who is in occupancy of a dormitory style room or whose residential move is performed by an agency at no cost to the person is limited to $100.00.

2. An occupant will be paid on an actual cost basis for moving his or her mobile home from the displacement site. In addition, a reasonable payment to the occupant for packing and securing property for the move may be paid at the agency’s discretion.

[FR Doc. 2015–18159 Filed 7–23–15; 8:45 am] BILLING CODE 4910–22–P

environmental impact statement will be prepared for a proposed highway project

impact statement (EIS) on a proposal to improve the I–20/I–26/I–126 Corridor

in Lexington and Richland counties, South Carolina.

located in Lexington and Richland counties, South Carolina. To date, the


Federal Highway Administration

Environmental Impact Statement: Lexington and Richland Counties, South Carolina; Notice of Intent

AGENCY: Federal Highway Administration (FHWA), DOT. ACTION: Notice of intent.

FOR FURTHER INFORMATION CONTACT: Emily O. Lawton, Division Administrator, Federal Highway Administration, Strom Thurmond Federal Building, 1835 Assembly Street, Suite 1270, Columbia, South Carolina 29201, Telephone: (803) 765–5411, Email: [email protected]. SUPPLEMENTARY INFORMATION: The

project area has been defined as a mainline corridor including I–20 from the Saluda River to the Broad River, I– 26 from US 378 to Broad River Road, and I–126 from Colonial Life Boulevard to I–26.

The I–20/I–26/I–126 corridor is a vital link in South Carolina, serving residents, commuters, travelers, and

FHWA, in cooperation with the South commerce. Due to nearby residential SUMMARY: The FHWA is issuing this notice to advise the public that an

Carolina Department of Transportation (SCDOT), will prepare an environmental

and commercial development, proximity to downtown Columbia,


APPENDIX 26

Previous editions are obsolete Page 1 of 8 form HUD-52580 (4/2015)ref Handbook 7420.8

Inspection Checklist U.S. Department of Housing OMB Approval No. 2577-0169and Urban Development (Exp. 04/30/2018)

Housing Choice Voucher Program Office of Public and Indian Housing

Public reporting burden for this collection of information is estimated to average 0.50 hours per response, including the time for reviewing instructions,searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may notconduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number .

Assurances of confidentiality are not provided under this collection.

This collection of information is authorized under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The information is used to determineif a unit meets the housing quality standards of the section 8 rental assistance program.

Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form bySection 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f). Collection of the name and address of both family and the owner is mandatory. Theinformation is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. HUD may disclose this informationto Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed orreleased outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejection of family participation.

Name of Family Tenant ID Number Date of Request (mm/dd/yyyy)

Inspector Neighborhood/Census Tract Date of Inspection (mm/dd/yyyy)

Type of Inspection

Initial Special ReinspectionDate of Last Inspection (mm/dd/yyyy) PHA

A. General Information

Inspected Unit Year Constructed (yyyy) Housing Type (check as appropriate)

Single Family Detached

Duplex or Two Family

Row House or Town HouseLow Rise: 3, 4 Stories,Including Garden Apartment

High Rise; 5 or More StoriesManufactured HomeCongregateCooperativeIndependent GroupResidenceSingle Room Occupancy

Shared Housing

Other

Full Address (including Street, City, County, State, Zip)

Number of Children in Family Under 6

Owner

Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number

Address of Owner or Agent

B. Summary Decision On Unit (To be completed after form has been filled out

PassFailInconclusive

Number of Bedrooms for Purposesof the FMR or Payment Standard

Number of Sleeping Rooms

Inspection Checklist

ItemNo. 1. Living Room

YesPass

NoFail

In-Conc. Comment

Final ApprovalDate (mm/dd/yyyy)

1.1 Living Room Present

1.2 Electricity

1.3 Electrical Hazards

1.4 Security

1.5 Window Condition

1.6 Ceiling Condition

1.7 Wall Condition

1.8 Floor Condition


* Room Codes: 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room); 2 = Dining Room or Dining Area;3 = Second Living Room, Family Room, Den, Playroom, TV Room; 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 = Other

Item

No.1. Living Room (Continued) Yes

Pas

No

Fail

In-

Conc. Comment

Final Approval

Date (mm/dd/yyyy)

1.9 Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

Not Applicable

2. Ki tchen

2.1 Kitchen Area Present

2.2 Electricity


2.4 Security



2.7 Wall Condition

2.8 Floor Condition

2.9 Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

Not Applicable

2.10 Stove or Range with Oven

2.11 Refrigerator

2.12 Sink2.13 Space for Storage, Preparation, and Serving

of Food3. Bathroom

3.1 Bathroom Present

3.2 Electricity


3.4 Security



3.7 Wall Condition

3.8 Floor Condition

Flush Toilet in Enclosed Room in Unit

3.11 Fixed Wash Basin or Lavatory in Unit

3.12 Tub or Shower in Unit

3.13 Ventilation

Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

Not Applicable3.9

3.10

Item No. 4. Other Rooms Used For Living and HallsComment


4..1 Room Code* and (Circle One) (Circle One)Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.2 Electricity/Illumination4.3 Electrical Hazards

4.4 Security4.5 Window Condition

4.6 Ceiling Condition4.7 Wall Condition

4.8 Floor Condition4.9 Lead-Based Paint

Are all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

4.10 Smoke Detectors4.1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.9 Lead-Based Paint


4.10 Smoke Detectors

4.1 Room Code* andRoom Location

4.2 Electricity/Illumination




4.8 Floor Condition

4.9 Lead-Based Paint


In-Conc.

YesPass

NoFail

Right/Center/Left Front/Center/Rear ____Floor Level(Circle One) (Circle One)

Not Applicable

Not Applicable





4.8 Floor Condition

Not Applicable

Previous editions are obsolete Page 3 of 8 form HUD52580 (4/2015) ref Handbook 7420.8

Previous editions are obsolete Page 4 of 8 form HUD- 52580 (4/2015)ref Handbook 7420.8

ItemNo.

4. Other Rooms Used For Living and Halls YesPass

NoFail

In-Conc. Comment


4.1 (Circle One) (Circle One)Right/Center/Left Front/Center/Rear ____Floor Level

Room Location



4.4 Security



4.7 Wall Condition



Not Applicable

4.10 Smoke Detectors4.1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level4.2 Electricity/Illumination


4.4 Security



4.7 Wall Condition



Not Applicable

4.10 Smoke Detectors5. All Secondary Rooms

(Rooms not used for living)

5.1 None Go to Part 6

5.2 Security

5.3 Electrical Hazards5.4 Other Potentially Hazardous

Features in these Rooms

Room Code *and Room Location


Item 6. Building ExteriorNo.

6.1 Condition of Foundation

6.2 Condition of Stairs, Rails, and Porches

6.3 Condition of Roof/Gutters

6.4 Condition of Exterior Surfaces

6.5 Condition of Chimney

6.6 Lead Paint: Exterior SurfacesAre all painted surfaces free of deterioratedpaint?

If not, do deteriorated surfaces exceed 20square feet of total exterior surface area?

Not Applicable

6.7 Manufactured Home: Tie Downs

7. Heating and Plumbing

7.1 Adequacy of Heating Equipment

7.2 Safety of Heating Equipment

7.3 Ventilation/Cooling7.4 Water Heater

7.5 Approvable Water Supply

7.6 Plumbing

7.7 Sewer Connection8. General Health and Safety

8.4 Garbage and Debris

8.5 Refuse Disposal

8.6 Interior Stairs and Commom Halls

8.7 Other Interior Hazards

8.8 Elevators

8.9 Interior Air Quality

8.10 Site and Neighborhood Conditions

8.11 Lead-Based Paint: Owner's Certification Not Applicable

If the owner is required to correct any lead-based paint hazards at the property including deteriorated paint or other hazards identified by avisual assessor, a certified lead-based paint risk assessor, or certified lead-based paint inspector, the PHA must obtain certification that thework has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead -Based Paint Owner Certification must bereceived by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice.Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have beenmet and no re-inspection by the HQS inspector is required.

Comment

Yes

Pass

No

Fail

In -

Conc.Final Approval

Date (mm/dd/yyyy)

8.1 Access to Unit

8.2 Fire Exits

8.3 Evidence of Infestation

H15148

Line

H15148

Line

H15148

Line

H15148

Line

H15148

Line

H15148

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C. Special Amenities (Optional)This Section is for optional use of the HA. It is designed to collect additional information about other positive features of the unit that may be present.Although the features listed below are not included in the Housing Quality Standards, the tenant and HA may wish to take them into consideration indecisions about renting the unit and the reasonableness of the rent.Check/list any positive features found in relation to the unit.

D. Questions to ask the Tenant (Optional)1. Living Room

High quality floors or wall coveringsWorking fireplace or stove Balcony,patio, deck, porch Special windowsor doorsExceptional size relative to needs of familyOther: (Specify)

4. Bath

Special feature shower headBuilt-in heat lampLarge mirrorsGlass door on shower/tubSeparate dressing roomDouble sink or special lavatoryExceptional size relative to needs of familyOther: (Specify)

2. KitchenDishwasherSeparate freezerGarbage disposalEating counter/breakfast nookPantry or abundant shelving or cabinetsDouble oven/self cleaning oven, microwaveDouble sinkHigh quality cabinetsAbundant counter-top spaceModern appliance(s)Exceptional size relative to needs of familyOther: (Specify)

5. Overall Characteristics

Storm windows and doorsOther forms of weatherization (e.g., insulation, weatherstripping) Screen doors or windowsGood upkeep of grounds (i.e., site cleanliness, landscaping,condition of lawn)Garage or parking facilitiesDrivewayLarge yardGood maintenance of building exteriorOther: (Specify)

3. Other Rooms Used for Living

High quality floors or wall coveringsWorking fireplace or stove Balcony,patio, deck, porch Special windowsor doorsExceptional size relative to needs of familyOther: (Specify)

6. Disabled Accessibility

Unit is accessible to a particular disability.Disability

NoYes


1. Does the owner make repairs when asked? Yes No 2. How many people live there? _____

3. How much money do you pay to the owner/agent for rent? $ ____________

4. Do you pay for anything else? (specify) __________________________________________________________________

5. Who owns the range and refrigerator? (insert O = Owner or T = Tenant) Range ______ Refrigerator _____ Microwave __

6. Is there anything else you want to tell us? (specify) Yes No


E. Inspection Summary/Comments (Optional)Provide a summary description of each item which resulted in a rating of "Fail" or "Pass with Comments."Tenant ID Number Inspector Date of Inspection (mm/dd/yyyy) Address of Inspected Unit

Type of Inspection Initial Special Reinspection

Item Number Reason for "Fail" or "Pass with Comments" Rating

Continued on additional page Yes No

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APPENDIX 27

NCORR ACH TRANSFER FORM

NOTE: Please type or clearly print all requested information

PART 1: Payee Identification Payee Name

Project Number Contact Name

Payee Email Address Payee Phone Number (with area code)

Payee Street Address City State Zip Code

Payee Type

Owner Tenant Property Manager/Agent

PART 2: Financial Institution Information Name of Financial Institution Account Number

Name on Account Nine Digit Routing Number

Financial Institution Street Address City State Zip Code

Account Type

Individual/Consumer

Commercial (Corporation, Partnership,

etc.)

Gov’t

Other

PART 3: Authorization

I authorize NCORR to deposit payments by electronic funds transfer (ACH) into the above referenced account. I acknowledge that if I fail to provide complete and accurate information on this authorization form,

processing of this form and payments may be delayed. This authorization will remain in effect until written notice to terminate is received.

WARNING: Federal law prohibits NCORR from processing international ACH transactions (IAT). If any payment to you from NCORR will result in an IAT under National Automated Clearing House Association’s

operating rules or if you are unsure if the rules apply to you, DO NOT COMPLETE THIS FORM.

Please initial in the box to the right to indicate you have read the above warning.

If you fail to initial here, direct deposit will not be approved.

Authorized Signatory Date

Authorized Signatory Title

APPENDIX 28

LEASE RIDER

[Date] VIA U.S. Postal Service [Landlord First Name] [Landlord Last Name] [Mailing Address] [City], [State] [Zip] [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Temporary Relocation Address] [City], [State] [Zip] Re: ReBuild NC - Lease Rider for [List Tenant Name] at [List Rental Property Address]

Dear [Landlord First Name] [Landlord Last Name]:

ReBuild NC (the “Program”) is a housing recovery program administered by North Carolina Office of Recovery and Resiliency (“NCORR”). It is federally funded through the Community Development Block Grant – Disaster Recovery Program (“CDBG-DR”), which is administered by the U.S. Department of Housing and Urban Development (HUD). The goal of the Program is to assist homeowners and rental property owners to repair, reconstruct, and elevate their storm damaged properties.

In some cases, tenants located in Program-assisted properties are required to temporarily relocate due to work being completed on their rental unit. The Program is required by the Uniform Relocation Act (URA) to provide tenants with relocation advisory services and rental assistance for temporary housing. This assistance includes the payment of a security deposit to offset the costs of temporary relocation. To make this payment on behalf of the tenant, the Program must ensure that all security deposits are returned to the agency once the tenant returns to their pre-relocation dwelling unit.

The tenant listed above has requested that we provide you with a security deposit of $___________ as outlined in your rental agreement for [List Property Address]. In order to provide this payment on behalf of the tenant, the attached Rider to the Lease Agreement form must be signed and fully executed. This form outlines program requirements regarding the return of the security deposit once the lease is terminated.

We sincerely appreciate your cooperation with the temporary relocation of this tenant. Please contact [Relocation Specialist] at (XXX) XXX-XXXX if you have any questions about the Lease Rider Form.

Sincerely, ReBuild NC

RIDER TO LEASE AGREEMENT

For tenants receiving relocation assistance via the ReBuild NC Program as administered by North Carolina Office of Recovery and Resiliency (“NCORR”) pursuant to the Uniform Relocation Act:

Landlord: [Landlord First Name] [Landlord Last Name] [Mailing Address] [City], [State] [Zip] Tenant: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Temporary Relocation Address] [City], [State] [Zip]

I. A security deposit for [List Rental Property Address] shall be paid to the landlord in the amount

of: $________________ [TENANT INITIALS: ____ LANDLORD INITIALS: ____ ]

II. The landlord will comply with all legal requirements regarding the deposit of security, including but not limited to, notifying NCORR of the name and address of the bank where the security will be deposited during the term of the lease per the required ACH Transfer Form.

III. The security deposit will be refunded directly by the landlord to NCORR at conclusion of the lease agreement. The landlord will make returned security deposit checks payable to: NCORR.

IV. The tenant will not be entitled to reimbursement for any portion of the security deposit.

V. Upon conclusion of this lease agreement, the landlord will be entitled to withhold security deposit funds in the amount of damages caused by the tenant, not to exceed the total security deposit amount. Within a reasonable time from the conclusion of the tenancy, the landlord will provide both NCORR and the tenant with an itemized list of any damages to be deducted from the security deposit, detailing all resulting repair costs and accompanied by supporting documentation, such as photographs of damage or contractor repair estimates.

VI. Should the landlord properly withhold security deposit funds as described above, the tenant must repay the withheld amount to NCORR. NCORR shall enter into a binding repayment agreement with the tenant for any such properly withheld amounts.

VII. In the event of a conflict between the terms of this rider and the terms of the Lease Agreement, the provisions of this rider will take precedence.

Your signature below indicates that you have read and understand the terms above.

Landlord’s Signature Tenant’s Signature

Landlord’s Printed Name Tenant’s Printed Name

Date Date

APPENDIX 29

NCORR URA CLAIM TRANSMITTAL MEMO

TRANSMITTAL

DATE:

TO: CDBG-DR Housing Manager

North Carolina Office of Recovery and Resiliency (NCORR)

CF: Jamal “Jaye” Graham

Resiliency Finance Manager

FROM:

SUBJECT: Transmittal of Claims – Relocation Assistance Payment

PROGRAM: APPLICANT ID: TENANT ID: DISPLACEE NAME: DAMAGED PROPERTY ADDRESS:

Description of Payment Request:

List of Attachments/Claim Source Documentation:

______________________________________ ______________

CDBG-DR Housing Manager Date

Transmit Transmit with Changes Deny

Reason: __________________________________________________

APPENDIX 30

NCORR URA CLAIM PAYMENT REQUEST

DATE: CONTENT:

THE FOLLOWING CASE INFORMATION TO BE REFERENCED: Claimant:

Address:

App ID: Tenant ID:

ATTACHED DOCUMENTS SUPPORT THE FOLLOWING PAYMENT REQUEST(S):

RESIDENTIAL RELOCATION

Check all that apply

PAYMENT TYPE ADVANCE PAYMENT

FINAL PAYMENT

COMMENT

Rental Assistance Payment

Security Deposit Assistance

Moving Costs

Storage Costs

Other (Broker Fee)

Other (Food Costs)

Other

THE PAYMENT SHOULD BE MADE PAYABLE TO:

IN THE AMOUNT OF:

Special Instructions: PAYMENT TO BE MADE VIA ACH

TO: Jamal “Jaye” Graham Resiliency Finance Manager North Carolina Department of Public Safety 4238 MSC Raleigh, NC 27699-4238

FROM: CDBG-DR Housing Manager North Carolina Office of Recovery and Resiliency 4238 MSC Raleigh, NC 27699-4238

APPENDIX 31

TENANT RETURN HOME NOTICE

[Date] VIA Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] RETURN HOME NOTICE: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [City], [State] [Zip] Re: ReBuild NC - Return Home Notice


The ReBuild NC (the Program) is notifying you that the construction on the property you previously occupied at [List Damaged Property Address] will be completed on [Date]. Because federal funding is involved with this project, you continue to be protected by the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 as amended (the URA). This is a Notice to Return to your original unit within thirty (30) days on [Date]. We have notified the landlord of your temporary unit located at [List Address of Temporary Rental Unit] that your lease will be terminated on this date. The Program will work with you to assist with relocation back to your original unit. In addition, this notice guarantees you the following: 1. Upon completion of construction, you will be able to lease and occupy your original dwelling unit under previous terms and conditions. 2. Because you had to move temporarily so that the construction could be completed, you will be reimbursed for all reasonable expenses related to the relocation, including the cost of moving out of temporary housing and any reasonable out-of-pocket expenses incurred to return to the original unit. A representative from the Program will be reaching out to you to coordinate your relocation. Consequently, we urge you not to move from your unit until you have had the opportunity to speak with your relocation specialist. All moving and out-of-pocket expenses must be approved by the program in advance of incurring those costs. If you have any questions or need additional assistance in completing your move, please contact [Relocation Specialist] at (XXX) XXX-XXXX. This letter is important to you and should be retained. Sincerely, ReBuild NC

APPLICANT RETURN HOME NOTICE

[Date] VIA Certified Mail [Applicant First Name] [Applicant Last Name] [Mailing Address] [City], [State] [Zip] RETURN HOME NOTICE: [Applicant First Name] [Applicant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [City], [State] [Zip] Re: ReBuild NC - Return Home Notice

Dear [Applicant First Name] [Applicant Last Name]:

The ReBuild NC (the Program) is notifying you that the construction on your home located at [List Damaged Property Address] will be completed on [Date]. This is a Notice to Return to your home within thirty (30) days on [Date]. A representative from the Program will be reaching out to you to coordinate your relocation. All moving and out-of-pocket expenses must be approved by the program in advance of incurring those costs. If you have any questions or need additional assistance in completing your move, please contact [Relocation Specialist] at (XXX) XXX-XXXX. Sincerely, ReBuild NC

APPENDIX 32

TRA/URA PAYMENT ACKNOWLEDGEMENT FORM

RELOCATEE INFORMATION: Relocatee Name:

Damaged Address:

App ID: Tenant ID:

I CERTIFY THAT I HAVE RECEIVED THE FOLLOWING URA PAYMENTS: RESIDENTIAL RELOCATION

Check all

that apply

PAYMENT TYPE ADVANCE PAYMENT

FINAL PAYMENT

COMMENT

Rental Assistance Payment $ $

Security Deposit Assistance $ $

Moving Costs $ $

Storage Costs $ $

Other (List: ) $ $

Other (List: ) $ $

Other (List: ) $ $

TOTAL AMOUNT OF ASSISTANCE

DATE:

TO: ReBuild NC Program North Carolina Office of Recovery and Resiliency

(NCORR)

4236 Mail Service Center

Raleigh, NC 27699-4236

ATTN: NCORR CDBG-DR URA

SIGNATURES

Relocatee Print Name Date



APPENDIX 33

URA OPT-OUT AGREEMENT

[Date] VIA Hand Delivery with Signed Receipt or Certified Mail [Tenant First Name] [Tenant Last Name] [Mailing Address] [City], [State] [Zip] URA OPT OUT NOTICE: [Tenant First Name] [Tenant Last Name] [APP ID] [Tenant ID] [Damaged Property Address] [City], [State] [Zip]

Opt-Out Agreement for Uniform Relocation Act (URA) Assistance

As the displaced tenant of the damaged property located at ___________________________________, I, __________________________________, acknowledge that I have received a General Information Notice, Notice of Eligibility for Relocation Assistance, and have been fully informed of the amount and type of relocation assistance that is available to me as a tenant protected by the Uniform Relocation and Real Properties Acquisition Act of 1970.

In consideration of this information, I am declining to receive assistance and return to [List Damaged Address] once construction is complete, for the following reason (s):

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I also acknowledge that this decision impacts my eligibility for relocation and do not wish to receive relocation assistance which includes the following:

• Advisory Services. This includes referrals to comparable and suitable replacement homes, the inspection of replacement housing to ensure it meets HQS standards, help in preparing claim forms for relocation payments, and other assistance to minimize the impact of my move.

• Payment for Moving Expenses.

∗ Payment for Actual Reasonable Moving and Related Expenses, or ∗ Fixed Moving Expense, or ∗ A combination of both, based on circumstances.

• Temporary Relocation Assistance (if only relocating temporarily for construction work at

the rental unit) to include rental assistance at a temporary unit, security deposit, moving expenses, and other reasonable out-of-pocket expenses.

• Permanent Replacement Housing Assistance (if required to permanently relocate due to construction work at the rental unit) to include rental assistance for a period of 42 months or down-payment assistance, security deposit, moving expenses, and other reasonable out-of-pocket expenses.

Executed this ___ day of ____________, 20___.

Signatures of Tenant(s):

________________________________________

Tenant Signature

_________________________________________

Printed Tenant Name

________________________________________

Tenant Signature

_________________________________________

Printed Tenant Name

APPENDIX 34

URA MOVE-IN NOTICE

[Date] VIA Hand Delivery with Signed Receipt or Certified Mail [Prospective Tenant First Name] [Prospective Tenant Last Name] [Mailing Address] [City], [State] [Zip] URA MOVE-IN NOTICE: [Prospective Tenant First Name] [Prospective Tenant Last Name] [APP ID] [Damaged Property Address] [City], [State] [Zip] Dear Tenant:

On [Date],[Applicant Name] submitted an application to ReBuild NC for financial assistance [Acquire] [Rehabilitate] [Demolish] [Reconstruct] the rental unit located at [address]. Because Federal funds are being used in this project, the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA) of 1970, as amended, applies for tenants in residence at the time of application. However, as prospective (new) tenant, you will not be eligible for relocation benefits under the URA.

This notice is to inform you of the following information before you enter into any lease agreement and occupy a unit at the above address:

• You may be displaced by the project. • You may be required to relocate temporarily. • You may be subject to a rent increase. • You will not be entitled to any relocation benefits provided under the URA. If you have

to move or your rent is increased as a result of the above project, you will not be reimbursed for any such rent increase or for any costs or expenses incurred by you in connection with a move as a result of the project.

Please read this notification carefully prior to signing a rental agreement and moving into the rental unit. If you should have any questions about this notice, please contact [Relocation Specialist] at [(XXX) XXX-XXXX. Once you have read and have understood this notice, please sign the statement below if you still desire to lease the unit.

This letter is important to you and should be retained. If you have any questions, please contact [Relocation Specialist] at [(XXX) XXX-XXXX. Sincerely,

ReBuild NC

URA MOVE IN NOTICE RECEIPT

[Prospective Tenant First Name] [Prospective Tenant Last Name] [Mailing Address] [City], [State] [Zip] URA MOVE IN NOTICE RECEIPT: [Prospective Tenant First Name] [Prospective Tenant Last Name] [APP ID] [Damaged Property Address] [City], [State] [Zip]

I have read the URA Move-In Notice and understand that I will not be eligible for temporary and/or permanent relocation assistance if I become displaced by the construction on this rental unit.

Print Name of Tenant(s)

Signature Date

APPENDIX 35

LANDLORD NOTICE OF DEFAULT

[Date] VIA Certified Mail [Applicant First Name] [Applicant Last Name] [Mailing Address] [City, State, Zip] LANDLORD NOTICE OF DEFAULT: [Applicant First Name] [Applicant Last Name] [APP ID] [Damaged Property Address] [City], [State] [Zip] Re: ReBuild NC – Landlord Notice of Default

Dear [Applicant First Name] [Applicant Last Name]:

As you are aware, ReBuild NC (the “Program”) is a housing recovery program administered by North Carolina Office of Recovery and Resiliency (“NCORR”). It is federally funded through the Community Development Block Grant – Disaster Recovery Program (“CDBG-DR”), which is administered by the U.S. Department of Housing and Urban Development (HUD). The goal of the Program is to assist homeowners and rental property owners to rehabilitate, reconstruct, and/or elevate their storm damaged properties.

Due to the use of federal funds, the Program is obligated to meet the requirements of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (“URA”) in order to minimize the displacement of tenants residing in ReBuild NC assisted rental units. URA regulations require the Program to provide tenants with relocation advisory services, rental assistance for temporary housing, moving expenses, and other reasonable costs. In the event that a tenant becomes permanently displaced as a result of program activities, the program must provide a replacement housing payment. Applicants who are provided program funding for the rehabilitation, elevation, or reconstruction of rental units are also required to meet URA requirements as outlined in Section 24 of the Rehabilitation Grant Agreement or Section 26 of the Reconstruction Grant Agreement for Program benefits.

The purpose of this letter is to notify you that you may be in default of the above-referenced Grant Agreement, dated [Insert Date of Agreement], for the following reason (s):

[Insert All Reasons for Default e.g., eviction of the tenant in order commence construction work, failure to renew an existing lease in order to commence construction work, causing the tenant to move without proper URA notification, making structural changes to the unit which prevents the tenant from returning to the unit, unreasonably increasing the rent of the unit which makes it unaffordable for the tenant to return, verbal threats or coercion of the tenant causing them to move, creation of an unreasonable living environment or lease conditions that prevent (s) the tenant from returning to your rental unit ].

The alleged action (s), if substantiated, violate URA regulations and your Grant Agreement with the Program. In order to comply with your Grant Agreement you must cure this violation within ten (10) calendar days from the date on this notice. Failure to cure this violation may result in ineligibility for the ReBuild NC Program and/or repayment of funding.

Please contact [Relocation Specialist] at [(XXX) XXX-XXXX as soon as possible and/or provide a written response.

Thank You,

ReBuild NC

APPENDIX 36

Applicant Voluntary TRA Participation Acknowledgement Form

Single-Family Homeowner Program

REBUILD NC Version 1 | January 2019 Page 1 of 2

Applicant Name

ReBuild NC ID

Damaged Address

Grant Award Type (s)

☐Rehabilitation/Repairs Only

☐Rehabilitation/Repairs + Reimbursement

☐Reconstruction/Replacement

☐Flood Insurance Assistance (FIA)

☐Temporary Relocation Assistance (TRA)

Elevation Required ☐Yes ☐No

Owner-Occupant Notification:

• The ReBuild NC Single-Family Homeowner is a voluntary program for owner-occupants to receive assistance for rehabilitation/repair or reconstruction/replacement of their primary residence.

• Due to the voluntary nature of the ReBuild NCORR’s Homeowner Recovery Programs, it is within NCORR’s discretion whether to adopt an optional or temporary relocation policy for owner-occupied units.

• In order to reduce the burden on affected homeowners, NCORR has made the decision to provide Temporary Relocation Assistance (TRA) to owner-occupants when rehabilitation, elevation, reconstruction, or environmental remediation activities cause the temporary relocation of the owner-occupant of the property.

• In some cases, temporary relocation from owner-occupied units may exceed one-year. However, in no case will an owner-occupant become a displaced person (49 CFR 24.2 (a) (9)(ii)(h)) due to the following: -Owner-occupants will not be required to permanently relocate as a direct result of a ReBuild NC activity. -Owner-occupants will retain the right of use and occupancy of their assisted property as their primary residence once construction activities are completed.

• Owner-occupants voluntarily participating in the ReBuild Single-Family Program are not be eligible for permanent relocation benefits covered by the Uniform Relocation Act (URA) unless an unforeseen circumstance causes permanent displacement from the damaged address.

Applicant Voluntary TRA Participation Acknowledgement Form

Single-Family Homeowner Program


Owner-Occupant Acknowledgement

Applicant Response Applicant Initials

a. I/we have voluntarily applied to ReBuild NC for assistance to rehabilitate/repair or reconstruct/replace my storm damaged home.

☐ Yes ☐ No

b. In order to complete the work on my/our home, I/we have been notified that I/we will be required to temporarily relocate until it is safe to return home.

☐ Yes ☐ No

c. During all or a portion of my temporary displacement, I have elected to receive Temporary Relocation Assistance (TRA).

☐ Yes ☐ No

d. As an owner-occupant voluntarily participating in the ReBuild NC Program, I understand that I will not become permanently displaced by the Program or become eligible for relocation benefits covered by URA unless an unforeseen circumstance causes permanent displacement.

☐ Yes ☐ No

e. Once construction activities are complete, I/we intend to reoccupy the damaged address as my/our primary residence.

☐ Yes ☐ No

If “no”, please provide an explanation.

____________________________________ ____________________________________ Printed Name of Applicant Printed Name of Applicant ____________________________________ ____________________________________ Applicant Signature Applicant Signature _______________________ _______________________ Date Date

APPENDIX 37

Tenant URA Option Form Single-Family Homeowner Program


Tenant Name

Damaged Address and Unit Number

ReBuild NC ID

Applicant Name

Date of GIN Receipt / /

Notice of Non-Displacement (NND)

Temporary Relocation Required Temporary Relocation Not Required

Date of Receipt for NND / /

Date of Receipt for Notice of Eligibility for Relocation Assistance

/ /

Date of Receipt for HUD Brochure “Relocation Assistance to Tenants Displaced from their Homes”

/ /

Dates of Temporary Relocation

Start Date: End Date:

Tenant Notification: The Uniform Relocation and Real Property Acquisition Act of 1970 (URA) requires that any residential tenant who has been temporarily relocated for a period beyond one year must be contacted by the Agency and offered permanent relocation assistance. At this time, it has come to the Program’s attention that the timeframe for your temporary relocation has or will exceed the 12- month timeframe. For this reason, we have provided you with the following documents:

• Notice of Eligibility for Relocation Assistance

• HUD Brochure, “Relocation Assistance for Tenants Displaced from their Homes” At this time, it is anticipated that Program related construction activities will be complete at ______________________________________________________________________ on or list address before ___________________. Date For this reason, we are requesting you to select an relocation option. Please return this form to the following address within fifteen (15) calendar days.

Tenant Acknowledgement

Tenant Response Tenant Initials

a. I/we have received and understand the Notice of Relocation Eligibility . ☐ Yes ☐ No



I hereby select one of the following:

As the displaced tenant of the damaged property located at _____________________________________, I, __________________________________, acknowledge that I am aware that construction at my permanent address may take more than 12 months. I am also aware that if I am displaced for more than 12 months, I am entitled to permanent relocation compensation under the Uniform Relocation and Real Properties Acquisition Act of 1970. My intention to return to my permanent address will impact my eligibility to receive permanent relocation assistance.

Please initial to select one of the following two options regarding your intention to return to the permanent address:

OPTION 1

______ Yes, I intend to return to my permanent address after the completion of the construction project.

* I will be eligible for relocation assistance specific to the months of my displacement, which may include moving costs, rental assistance, storage and other reasonable costs associated with the displacement.

* I am aware that I may be displaced for more than 12 months.

OR

OPTION 2

______ No, I do not wish to return to my permanent address at the completion of construction project.

* I will be eligible for relocation assistance for up to 42 months, which may include moving costs, rental assistance and other reasonable costs associated with the displacement.

* By choosing not to return to your permanent property you are foregoing to right to reoccupy your permanent unit for 42 months. Reoccupying your permanent property within 42 months of your

b. I/we have received the HUD Brochure, “Relocation Assistance for Tenants Displaced from their homes”.

☐ Yes ☐ No

c. A URA Case Manager has met with me to provide relocation advisory services and outline the relocation options available to me.

☐ Yes ☐ No

If “no”, please provide an explanation.



displacement is prohibited and will be subject to partial or complete repayment of relocation assistance funds.

* If the construction project is completed within 12 months, I will be automatically considered a temporary displacement regardless of my intention to return to my original property and will not be not eligible for permanent relocation services.

____________________________________ ____________________________________ Printed Name of Tenant Printed Name of Tenant ____________________________________ ____________________________________ Tenant Signature Tenant Signature _______________________ _______________________ Date Date

APPENDIX 38

APPENDIX 39

URA Case ManagementIn

itia

tio

nIn

tak

eR

elo

cati

on

Ass

ista

nce

Pa

yme

nt

Phase

Review applicant’s file

to identify if there is/

was tenant on property

Tenant

identified?

Update Tenant

Information Page

with tenant contact

information

YES

NO

Update Site Survey

Tenant Type to “NA”

Create URA

Checklist page and

assign to the tenant

Send GIN to tenant

Schedule amd

conduct Intake

GIN Received?

YES

Is tenant

contact info

available?

YES

NO

Perform Skip-

Tracing

NO

Obtain CDBG

Information and

Upload to Tenant

Information Page

Fill out Household

Case Record and

Upload to Site

Survey Page

Identify Tenant Type

and Status on Site

Survey page

Update Checklist

Page GIN Status to

Fail

Update Checklist

Page GIN Status to

Pass

Obtain pre-, temp-,

and post-relocation

information and

Update Tenant

Information Page

Identify applicable

URA Notices on URA

Checklist Page

Upload

Acknowledgement

Receipts and Update

Doc Status on URA

Checklist Page

Distribute applicable

URA Notices and

Obtain

Acknowledgement

Receipts

URA Eligible?

Identify Comparable Units based on the

Household Case Record

Inspect Comparable Units to ensure DSS

and availability

Upload Comps documentation to Site

Survey Page

Finalize analysis of Comps and inform

tenant

Update Site Survey

Status to “Not Eligible”

and Notify tenant

NO

YES

NO

Create Site Survey

page

Update Site Survey

Tenant Status to

“Unable To Locate”

Update Site Survey

Tenant Status to

“Initial Review”

Update Site Survey page:

Type ”Displaced”

Status ”Perm Relocation Required”

Update Site Survey Status:

”Temp/Perm Housing Identified”

Section 414

Tenant?NO

Request

documentation to

perform eligibility

review

YES

Review and upload

documentation to

perform eligibility

review

Documentation

Sufficient?YES

NO

Issue Notice of Eligibility (NOE)

Reimbursement Temporary Relocation Permanent Relocation

Tenant Selects

Comp?

Inspect Tenant’s Unit

YESObtain signature on ACH and Lease

Rider

Passes

Inspection?

YES

Process Claim Forms

Monthly Draws Reconciliation or Actual

Costs – enter into IntelliGrants

Issue Return Home Notice

Obtain Post-Relocation Lease and

upload to IntelliGrants

Confirm return of Security Deposit

Reconcile in IntelliGrants

Update Site Survey Tenant Status to “Relocation Complete”


Type ”Non-Displaced”

Status ”Temp Relocation Required”

Down Payment

Assistance?

NO

Inspect Tenant’s Unit

YES

Obtain Contract of Sale

Obtain Closing

Statement

Process Claim Forms

Submit Draw

Confirm Closing

Obtain HUD Form

Obtain

Acknowledgement Form

Obtain Acknowledgement Form


Type ”Displaced”

Status ”414 Assistance Required”?

Collect Required Documentation

Complete Claim Form and ACH Form

Enter payments info in IntelliGrants and

Upload supporting documents

Submit Draw

Document Cost reasonableness

Relocation

Complete?

YES

NO