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9 <br /> U.S.Department of Housing and Urban Development ATTACHMENT G <br /> Office of Community Planning and Development <br /> Homebuyer Set Up and Completion Form <br /> HOME Program (For single and multi-address activities) <br /> Check the appropriate box: Name and Phone Number of Person Completing Form: <br /> El Original Submission 0 Change Owner's Address <br /> 0 Ownership Transfer 0 Revision <br /> Set Up Activity: <br /> A. General Information <br /> 1.Name of Participant: 2.IDIS Activity ID Number: 3.Activity Name: <br /> B. CHDO Questions. (Only if applicable) <br /> 1.Is funding limited to CHDO Operating(CO)or 2.Will activity be funded with CR(Y/N) <br /> CHDO Capacity Building(CC)(Y/N)?: (If Yes, If Yes,CHCO Acting as(enter code) <br /> STOP. DO NOT FILL OUT THIS FORM) <br /> (1)Owner (2)Sponsor (3)Developer <br /> 3. Will initial funding be a CHDO Site Control 4.Is the activity going forward?(YIN): <br /> and/or Seed Money Loan(Y/N)?(Y/N) (If"Y",fill out the rest of the form. If"N',only the cost information is needed.) <br /> (If"Y" answer Item 4.) <br /> • <br /> C. Objective and Outcome. <br /> 1.Objective(enter code): 2.Outcome(enter code): <br /> (1)Create suitable living environment (1)Availability/accessibility <br /> (2)Provide decent affordable housing (2)Affordability <br /> (3)Create economic opportunities (3)Sustainability <br /> D. Special Characteristics. <br /> 1.Activity Location 2.Will this activity be <br /> Type"Y"next to any that apply carried out by a faith-based <br /> (1) CDBG Strategy Area (5) Brownfield redevelopment area organization(Y/N)? <br /> (2) Local target area (6) Conversion of nonresidential to <br /> (3) Presidentially declared major disaster area residential use <br /> (4) Historic preservation area (7) Colonia(For AZ,CA,NM,TX) <br /> E. Activity Information_. <br /> 1.Activity Type(enter code):_3_ <br /> (2)New Construction Only (4)Acquisition&Rehab <br /> (3)Acquisition Only (5)Acquisition&New Construction <br /> 2. Homebuyer's Name(option): 3. Street: <br /> Client ID#: <br /> 4. City: 5. State: 6.Zip Code: 7.County Code: Activity Estimates: <br /> 8.HOME Units: <br /> 9.HOME Cost: $ <br /> 10. Multi-Address(Y/N)? 11. Loan Guarantee(Y/N)? <br /> F. Developer. (For multi-address activities only) <br /> 1.Developer Type(Enter code): 2.Developer's Name: <br /> (1)Individual (4)Not-for-Profit 3.Developer's Street Address: <br /> (2)Partnership (5)Publicly Owned <br /> (3) Corporation (6)Other 4. City: 5. State: 6.Zip Code: <br /> 1 t <br /> r <br /> Page 1 of 6 1 171vised(8/06) <br />