Application received on ______.

State ______ District Office ______.

If answer to any of the above is “no”, application is rejected and applicant so notified.

Selection Criteria:

Select the appropriate rating:

1. Points awarded based on the percentage of very-low income homeowners or families the applicant proposes to assist, using the following scale ______:

(a) More than 80%: 20 points.

(b) 61% to 80%: 15 points.

(c) 41% to 60%: 10 points.

(d) 20% to 40%: 5 points.

(e) Less than 20%: 0 points.

2. Points awarded based on the applicant's percentage of use of HPG funds to total cost of unit preservation. This percentage reflects maximum rehabilitation with the least possible HPG funds due to leveraging, innovative financial assistance, or other specified approaches. Points are based on the following percentage of HPG funds to total funds ______:

(a) 50% or less: 20 points.

(b) 51% to 65%: 15 points.

(c) 66% to 80%: 10 points.

(d) 81% to 95%: 5 points.

(e) 96% to 100%: 0 points.

3. The applicant has demonstrated its administrative capacity in assisting very low- and low-income families obtain adequate housing based on the following:

(a) The organization or a member of its staff has at least one or more years experience successfully managing and operating a rehabilitation or weatherization type program ______:

Yes—10 points.

No—0 points.

(b) The organization or a member of its staff has at least one or more years experience successfully managing and operating a program assisting very low- and low-income families obtain housing assistance ______:

Yes—10 points.

No—0 points.

(c) If the organization has administered grant programs, there are no outstanding or unresolved audit or investigative findings which might impair carrying out the proposal ______:

No findings: 10 points.

Outstanding findings: 0 points.

4. The proposed program will be undertaken entirely in rural areas outside Metropolitan Statistical Areas (MSAs) identified by FmHA or its successor agency under Public Law 103-354 as having populations below 10,000 or in remote parts of other rural areas (i.e., rural areas contained in MSAs with less than 5,000 population) ______:

Non-MSA area below 10,000 pop.: 10 points.

MSA area below 5,000 pop.: 10 points.

Neither: 0 points.

5. The program will use less than 20 percent of HPG funds for administration______:

Less than 20%: 5 points.

20%: 0 points.

6. The proposed program contains a component for alleviating overcrowding ______:

Has component: 5 points.

No component: 0 points.

7. The applicant is an existing grantee and meets the conditions of § 1944.686 of this subpart for additional points ______:

Meets conditions: 10 points.

Doesn't meet conditions: 0 points.

Total Points ______:

Ranking of This Applicant ________