Rehabilitationl-1 Monitoringform

RehabilitationL-1 MonitoringForm

Thepurposeofrehabilitationis to takeanexistingunit and bringit up to therequired standards set by HUDandCA.TO qualifyasrehabilitation, partsoftheexisting house must beusedin theprocess.

(Bulletin10-2)

Grantee:

Grant Number:

Preparedby:

PreparedDate:

Beneficiary Name:

Beneficiary Address:

Details/Comments
1. / Isthereanapplicationforrehabilitation assistanceandconfirmedeligibility in the file? List date of application. / Yes / No
2. / Wasincome verified?Listdateofverification.
(24 CFR Part 570.483) / Yes / No
3. / HastheGrantee adoptedandmade public standardsfordeterminingaffordablerents?
{24 CFR Part 570.483 (b)(3)} / Yes / No / Attachback-up
documentationtoform.
4. / Doesthecasefile containawritten scopeof work? / Yes / No
5. / Isthereanexecutedcontractfor thescope of work? / Yes / No
6. / What type ofprocurementwasusedfor the rehabilitationcontractor? Are there any concernswiththe procurementmethod?
{24 CFR Part 85.36 (b)(3)}
7. / Wasavisitmade totherehabilitatedunit? / Yes / No
8. / Doesthecompletedworkconform tothe Scope ofWork?Ifnot, why not?Whatcorrective action isrequired? / Yes / No
9. / Doescasefilecontain:
a. Contractor’sCertificationofWork
Completion?
b. Homeowner’sAcceptanceofWork?
c.InvoicesGrantee’sCertification for payment?
d. Permits? / Yes / No
10. / Whatwasthe amountpaidtothe Contractor?
11. / Doestheamountmatchthe contractamountof
$5,000orless? / Yes / No
12. / Doestheamountmatchthe contractamountof more than $5,000? / Yes / No
LeadBasedPaint
13. / Wasthe dwelling constructedbefore 1978? / Yes / No
14. / Doany children 6 yearsoldor youngeroccupy structure? / Yes / No
InspectionandRisk Assessment
15. / IsthereaLeadbasedPaint Clearance Reportin the file?
(Attachcopytothischecklistforsubmittal) / Yes / No
N/A
16. / Isthe LeadBasedPaintChecklistsignedby the
Grantee’sdesignatedrepresentative?
(Attachcopytothischecklistforsubmittal) / Yes / No
N/A
Contracting andRecapture
17. / Whatisthe recaptureamount?
Whatisthe numberofyearsin the recapture period?
Date recorded? BookandPage? / NumberofYears: Date Recorded: Book:
Page
18. / Were thereany modifications? FinalBook andPage:
Any Additional? / YesNo
Date Recorded: Book:
Page:
Date Recorded: Book:
Page:
Date Recorded: Book:
Page:
19. / Didthehomeowner receive acopy ofthe Note and DeedofTrust? How isthatdocumented? / Yes / No
NOTES:

*List or attach supporting documentation or notate items reviewed to support work performed where deemed necessary for all questions listed on this monitoring checklist.

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Grantee Representative Date

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Grant Management Representative Date