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["Work Site Description "]
["(A WorkSite Description is required for each property)"]
["YouthBuild (YB) GRANT"]
["ATTACHMENT 1 ",{"$nulls":6},"OMB No.","1205-0464"]
["ETA - 9143",{"$nulls":6},"Expires:","04/30/2014"]
["APPLICANT IDENTIFYING INFORMATION (Complete All Sections) "]
["Applicant Name:"]
["Program/Project Name & Address:"]
[]
[" ",null,null," "," ",null,null," "]
["1. Work Site Identification (Address/Parcel #)) "]
[]
["2.  Number of Housing Units Planned to be Produced: "]
[]
["3.  Type of housing to be produced (Check all that apply)  "]
[" ¨ Residential/rental   ¨ Homeownership  ¨  Transitional housing for the homeless"]
["4  Individual Housing Project Site Estimate and Documentation of Resources:  Complete the Attachment 1A for each housing project site to be used in conjunction with the YouthBuild implementation program.  Attach documentation of resources behind each Attachment 1A."]
["5.  Homeless Housing:  For housing that will be transitional housing for the homeless, attach a description of the plan for outreach and placement of homeless families or individuals (1 page).  Please label this Attachment 1B"]
[]
["6.  Will all housing produced be provided for homeless, low-income, or very-low income persons?  "]
["¨  Yes  ¨  No"]
["6. a.  If no for question 5, please explain what other populations will be targeted and why?"]
[]
[]
["7.  The on-site training site consists of (Check all that apply) :  ¨  New Construction     ¨  Rehabilitation "]
["8.  Are any of the units currently occupied?  ¨  Yes ¨  No  (If yes, attach a relocation narrative that identifies the number of persons, the business or others occupying the property on the date of submission of this application, the number of displaced, the number to be temporarily relocated but not displaced, the estimated cost of relocation services payments and services, the source of funds for relocation, and the organization that will provide relocation assistance to occupants and the contact person's name and phone number.  Label this Attachment 1C.)"]
["9.  Name of the current owner:  "]
["10.  Documentation of Access:  Attach required evidence of site access (Letter from the owner identified in No. 9).  Label this Attachment 1D."]
["11.  Describe the applicant role and responsibilities for the on-site housing construction or rehabilitation work.  Label this Attachment 1E."]
["12.  Name of entity which will own and manage the property after the construction or rehabilitation work is completed:"]
["13.  A Model Lease is Attached   ¨ Yes    ¨ No"]
["OMB No.: 1205-0464   Average Response Time: 30 minutes  \nThis reporting requirement is approved under the Paperwork Reduction Act of 1995.  Persons are not required to respond to this collection of information unless it displays a currently valid OMB number.  Public reporting burden for this collection of information includes time for reviewing instructions, searching existing data sources, gathering and reviewing the collection of information.  Respondent’s obligation to reply to this collection of information, which is for general program oversight, evaluation, and performance assessment, is required to maintain benefits [PL 109-281 Sec 173(A)(c)(3)].  Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to the U. S. Department of Labor, Employment and Training Administration, Youth Office, Room N4459, 200 Constitution Avenue, NW, Washington, D.C. 20210.\n\n\n \n\n"]
["Signature of Authorized Certifying Official of:  _______ Applicant   _____ Rightful Owner"]
["Printed Name: ",null,null,null,"Signature: "]
["Title: __________________________________________________ Date: _____________"]
["Organization: ______________________________________________________________"]

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["Individual Housing Project Site Estimate"]
["YouthBuild (YB) GRANT"]
["ATTACHMENT 1B",{"$nulls":5},"OMB No."]
["ETA - XXXX",{"$nulls":5},"Expires:"]
["APPLICANT IDENTIFYING INFORMATION"]
["Applicant Name:"]
["Address of the Property (include city, state, and zip code):"]
[]
[" ",null,null," "," ",null,null," "]
["Grant Activities",null,"Resources"]
[null,null,"YouthBuild","Other Federal ","State","Local","Private","Total "]
["1.  Acquisition"]
["2.  Architecture &      Engineering"]
["3.  Housing Construction"]
["4. Housing Rehabilitation"]
["5.  Total Housing Project Costs for Site "]
[]
["Note 1:  Include both cash and in-kind contributions. "]
[]
["Note 2: When paid, in whole or in part, with YouthBuild program funds, the activities will trigger applicable YouthBuild project-related restrictions contained in regulations XXXXXXX.  Applicants who propose to use YouthBuild funds for one or more of these activities are required to complete the appropriate certifications. "]
[]
["Documentation of Housing Resources"]
["Attach a letter of commitment from each source of funding.  These letters will not count towards your total page count"]
["Name of Provider (Donor)",null,null,"Cash or In-Kind",null,"Dollar Value Provided",null,"Page # of Letter"]
{"$rows_empty":7}
["OMB No.: 1205-0464 Public Burden Hours 30 minutes. These reporting instructions have been approved under the Paperwork Reduction Act of 1995.   Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.  Information is collected from eligible applicants for a competition to determine which entities will receive grant funds.  Public reporting burden for this collection of information includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Submission is required to obtain benefits (YouthBuild Transfer Act, PL 109-281).  The information will be used for the YouthBuild grant and response to this request for information is required in order to receive the benefits to be derived.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Workforce Security, Room S-4231, 200 Constitution Ave., NW, Washington, DC, 20210. "]

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