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["Choice Neighborhoods ","U.S. Department of Housing",{"$nulls":7}," OMB Approval No.  2577-0269"]
["PLANNING GRANTS","and Urban Development",{"$nulls":7}," (exp. 2/28/2011)"]
["Key Eligibility Data Form","Office of Public and Indian Housing"]
[]
["               CHOICE NEIGHBORHOODS PLANNING GRANTS APPLICATION INFORMATION"]
[]
["ELIGIBLE APPLICANT"]
["You must provide the following information for the Lead Applicant and, if applicable, the Co-Applicant"]
["Lead Applicant: "]
[]
["Type of Eligible Applicant  ",null,"Public Housing Agency",{"$nulls":4},"Local Government"]
["(check one)",null,"PHA Code:"]
[]
[null,null,"Nonprofit",{"$nulls":4},"For profit developer applying jointly with a public entity"]
["Mailing Address: "]
["Executive Officer Name & Title:"]
["Telephone:",null,null,"Fax:",null,null,null,"Email:"]
["Primary Contact Name  & Title:"]
["Telephone:",null,null,"Fax:",null,null,null,"Email:"]
[]
["Co-Applicant (if any): "]
[]
["Type of Eligible Applicant  ",null,"Public Housing Agency",{"$nulls":4},"Local Government"]
["(check one)",null,"PHA Code:"]
[]
[null,null,"Nonprofit",{"$nulls":4},"For profit developer applying jointly with a public entity"]
["Mailing Address: "]
["Executive Officer Name & Title:"]
["Telephone:",null,null,"Fax:",null,null,null,"Email:"]
["Primary Contact Name  & Title:"]
["Telephone:",null,null,"Fax:",null,null,null,"Email:"]
[]
["If you have selected an outside Planning Coordinator, provide the following information:"]
["Planning Coordinator: "]
["Mailing Address: "]
["Executive Officer Name & Title:"]
["Telephone:",null,null,"Fax:",null,null,null,"Email:"]
["Primary Contact Name  & Title:"]
["Telephone:",null,null,"Fax:",null,null,null,"Email:"]
[{"$nulls":8},"                                            HUD Form 53152    (3/2011)"]

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["CHOICE NEIGHBORHOODS- Key Eligibility Data Form"]
[]
["ELIGIBLE TARGET HOUSING"]
["Your application must focus on severely distressed public and/or HUD-assisted housing.  See section I.C for defintions of \"public housing,\" \"assisted housing,\" and \"severely distressed housing.\"  "]
["Provide the following information for each target housing project.  List each site separately."]
[]
["Project #1"]
["Project Name:"]
["Type of Eligible Housing "]
["(check one)",null,null,"Public Housing (section 9)",null,null,"section 811"]
[]
[null,null,null,"Project-based section 8",null,null,"section 221(d)(3)"]
[]
[null,null,null,"section 202",null,null,"section 236"]
[]
[null,"If Public Housing",null,"PIC AMP Number:"]
[null,null,null,"\"old\" Project Number:"]
[]
[]
[null,"If Assisted Housing",null,"Contract Number:"]
[null,null,null,"REMS Number:"]
[null,null,null,"If FHA Insured, FHA #:"]
[]
[]
["Physical Street Address"]
["(include city, state and ZIP)"]
[]
["Unit Information as of Application Date"]
[null,null,null,"Total Number of Units in Project",{"$nulls":4},"Number Occupied"]
[null,null,null,"Number of Public and/or Assisted Units in Project",{"$nulls":4},"Number Vacant"]
[]
[]
["Project #2 (if applicable)"]
["Project Name:"]
["Type of Eligible Housing "]
["(check one)",null,null,"Public Housing (section 9)",null,null,"section 811"]
[]
[null,null,null,"Project-based section 8",null,null,"section 221(d)(3)"]
[]
[null,null,null,"section 202",null,null,"section 236"]
[]
[null,"If Public Housing",null,"PIC AMP Number:"]
[null,null,null,"\"old\" Project Number:"]
[]
[]
[null,"If Assisted Housing",null,"Contract Number:"]
[null,null,null,"REMS Number:"]
[null,null,null,"If FHA Insured, FHA #:"]
[]
[]
["Physical Street Address"]
["(include city, state and ZIP)"]
[]
["Unit Information as of Application Date"]
[null,null,null,"Total Number of Units in Project",{"$nulls":4},"Number Occupied"]
[null,null,null,"Number of Public and/or Assisted Units in Project",{"$nulls":4},"Number Vacant"]
[]
[]
["Project #3 (if aplicable)"]
["Project Name:"]
["Type of Eligible Housing "]
["(check one)",null,null,"Public Housing (section 9)",null,null,"section 811"]
[]
[null,null,null,"Project-based section 8",null,null,"section 221(d)(3)"]
[]
[null,null,null,"section 202",null,null,"section 236"]
[]
[null,"If Public Housing",null,"PIC AMP Number:"]
[null,null,null,"\"old\" Project Number:"]
[]
[]
[null,"If Assisted Housing",null,"Contract Number:"]
[null,null,null,"REMS Number:"]
[null,null,null,"If FHA Insured, FHA #:"]
[]
[]
["Physical Street Address"]
["(include city, state and ZIP)"]
[]
["Unit Information as of Application Date"]
[null,null,null,"Total Number of Units in Project",{"$nulls":4},"Number Occupied"]
[null,null,null,"Number of Public and/or Assisted Units in Project",{"$nulls":4},"Number Vacant"]
[]
[]
["Project #4 (if applicable)"]
["Project Name:"]
["Type of Eligible Housing "]
["(check one)",null,null,"Public Housing (section 9)",null,null,"section 811"]
[]
[null,null,null,"Project-based section 8",null,null,"section 221(d)(3)"]
[]
[null,null,null,"section 202",null,null,"section 236"]
[]
[null,"If Public Housing",null,"PIC AMP Number:"]
[null,null,null,"\"old\" Project Number:"]
[]
[]
[null,"If Assisted Housing",null,"Contract Number:"]
[null,null,null,"REMS Number:"]
[null,null,null,"If FHA Insured, FHA #:"]
[]
[]
["Physical Street Address"]
["(include city, state and ZIP)"]
[]
["Unit Information as of Application Date"]
[null,null,null,"Total Number of Units in Project",{"$nulls":4},"Number Occupied"]
[null,null,null,"Number of Public and/or Assisted Units in Project",{"$nulls":4},"Number Vacant"]

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