FY2024 New & Expansion Housing Project Applicant Budget Form

FY2024 New & Expansion Housing Project Applicant Budget Form
Agency Name*
Project Name*
Name of Primary Contact*

First NameLast Name
Primary Contact Position Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address Listed on Application*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rental Assistance Budget

To learn more about Rental Assistance Budgets visit the HUD Exchange: https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-eligible-activities/coc-rental-assistance/budgets/
Total Annual Assistance Requested*
Total Number of Units Requested*
Total Number of FMR (Fair Market Rate) Areas to be Served *
Size of Units

Unit Size Budget Amount Requested*

	Number of Units	Total Requested Amount
Single Room Occupancy (SRO)
0 Bedroom
1 Bedroom
2 Bedroom
3Bedroom
4 Bedroom
5 Bedroom
6 Bedroom
7 Bedroom
8 Bedroom
9 Bedroom

Supportive Services Budget

HUD Exchange Supportive Services Budget Binder: https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-eligible-activities/supportive-services/ HUD exchange Operating Costs Binder: https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-eligible-activities/operating-costs/
Total Supportive Services Amount Requested*

Eligible Cost Budget Line Items Requested*

	Annual Assistance Requested	Quantity Requested
Assessment of Service Needs
Assistance with Moving Costs
Case Management
Child Care
Education Services
Employment Services
Food
Housing/Counseling
Legal Services
Life Skills
Mental Health Services
Outpatient Health Services
Substance Abuse Treatment Services
Transportation
Utility Deposits
Operating Costs

Examples of Supportive Services Description

Please be sure to familiarize yourself with the Supportive Services Budget Binder found on the HUD Exchange
- Assessment of Service Needs: .25 FTE at $49,500 including fringe benefits of $4,500
- Case Management: .75 FTE at $49,500 including fringe benefits of $4,500; Mileage
  paid at IRS reimbursement rate ($600/month); Cell phone
  ($160/month); Office supplies including laptop ($170/month); Case
  management will be partially supported with cash match.
- Transportation: Bus Tickets ($40/month)
Please Provide a Brief Quantity AND Description for Each Budget Line Item Requested*
VAWA Budget

VAWA Budget Line Item HUD Exchange Binder: https://www.hudexchange.info/resource/7025/implementing-eligible-costs-under-the-coc-program/
Estimated budget amount for VAWA Emergency Transfer Facilitation*
Estimated budget amount for VAWA Confidentiality Requirements: *
Rural Budget Form

HUD Interim Rule: https://www.hudexchange.info/resource/2033/hearth-coc-program-interim-rule/
Estimated Budget amount for Short-term emergency lodging to include housing in motels or shelters, either by providing direct funding or through vouchers.*
Estimated Budget amount for Repairs to housing units in where individuals and families experiencing homelessness will be housed, including housingunits currently not fit for human habitation.*
Estimated Budget amount for Staff Training to include professional development, skill development, and staff retention activities.*
Sources of Match

HUD Exchange Match Binder: https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-match/coc-match-overview/
Total Amount of Cash Commitments *
Total Amount of In-Kind Commitments*
Total Amount of All Commitments*
Before grant execution, services to be provided by a third party must be documented by a memorandum of understanding (MOU) between the recipient or subrecipient and the third party that will provide the services.
Upload ALL Documented Match Documentation as a Single PDF File*

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Budget Summary

The following information summarizes the funding request for the total term of the proposed project project.*

	Estimated Applicant CoC Program Costs
Leased Units
Leased Structures
Total Rental Assistance Requested
Total Supportive Services Requested
Total Operating Costs Requested
Total VAWA Budget Request
Total Rural Budget Request
Sub-total of CoC Program Costs
Admin
Total Documented Match
Total Budget for this Grant Application, including Match

Should be Empty:

FY2024 New & Expansion Housing Project Applicant Budget Form

Rental Assistance Budget

Size of Units

Supportive Services Budget

Examples of Supportive Services Description

VAWA Budget

Rural Budget Form

Sources of Match

Before grant execution, services to be provided by a third party must be documented by a memorandum of understanding (MOU) between the recipient or subrecipient and the third party that will provide the services.

Budget Summary