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TOTAL ESTIMATED PROJECT COST (MUST BE VERIFIED BY BIDS): <br />TOTAL ESTIMATED AMOUNT REIMBURSED BY GRANT: <br />TOTAL ESTIMATED AMOUNT OF REHAB LOAN REQUEST: <br />PROPOSED START DATE: PROPOSED COMPLETION DATE: <br />INCOME VERIFICATION: <br />A.HOW WILL THE FUNDING OF THIS PROJECT PRINCIPALLY BENEFIT LOW AND MODERATE INCOME* RESIDENTS OF <br />ROSEVILLE? (Briefly describe in space below; provide more detail in the narrative description of the project.) <br />1.How many persons/households are expected to benefit from the project? <br />2.How many low and moderate income persons/households will benefit? <br />_____@ <80% of AMI ____ @ <60% of AMI ____ @ <50% of AMI ____ @ <30% of AMI <br />3.How many units are at or below the fair market rent limits? (Refer to attached summary sheet chart) <br />_____ 0 bedroom ____ 1 bedroom ____ 2 bedroom ____ 3 bedroom ____ 4 bedroom <br />B.Will the client/participant base be based on: <br />Income verified by a survey of tenants? (HRA has a sample survey form available for applicant use) <br />Special Needs populations presumed to be principally low and moderate income? <br />Residents are currently part of a complex where income has been previously verified as part of other financing <br />which used Federal Housing & Urban Development (HUD) funds? <br />Other, please explain <br />2 <br /> <br />