CNA Questionnaire
Please fill out this form so that we can provide you with your CNA Proposal.
Name of Company:
*
Street Address of Company
*
Street Address Line 2
City
*
State
*
Zip
*
Management Company Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Person's Name
*
Contact Person's Email
*
example@example.com
Contact Person's Title or Position
*
Who will be the end user/reviewer of this CNA?
*
USDA- RD
HUD
Internal Users
Is the HUD e-Tool Needed?
*
Yes
No
Is the current Section 504 Accessibility Self-Evaluation/Transition Plan less than three (3) years old?
*
Yes
No
Will the current Section 504 Accessibility Self-Evaluation/Transition Plan expire in less than six (6)months?
*
Yes
No
Expiration Date of Current 504 Accessibility Self-Evaluation/Transition Plan
-
Month
-
Day
Year
Date
Name, Location, Number of Units for the property or properties in need of a CNA
*
Rows
Property Name
Location/Address
Number of Units
Property 1
Property 2
Property 3
Property 4
Property 5
Property 6
Property 7
Property 8
Property 9
Property 10
If you have more than 10 Properties for this proposal, please provide the above information about each property in a spreadsheet and upload it below:
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Checking AGREE below indicates that you have proofread the information that has been entered and that you verify that all of the information is complete and accurate. Any errors or omissions may incur additional charges.
*
AGREE
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