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["Texas General Land Office\nCommunity Development and Revitalization\nDuplication Of Benefits (DOB) Calculation Form"]
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[]
[]
[]
[]
["The DOB Calculation Form must document the total DOB amount per household/property. All DOB calculated must follow the latest Clarification of Duplication of Benefits requirements under the Stafford Act for Community Development Block Grant (\"CDBG\") Disaster Recovery Grantees (71060 Federal Register/Vol. 76, No. 221/ Wednesday, November 16, 2011/Notices and 42 U.S.C. 5155 Section 312 of the Robert T. Stafford Disaster Assistance and Emergency Relief Act, as amended)."]
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["GLO's Designated Representative (\"GDR\") must first determine the applicant's total post-disaster recovery need (based on actual bid and program caps). Then the GDR must reduce the determined need by funding previously received for the same purposes. The applicant will need to pay back funds or take a reduction in scope to proceed with assistance."]
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["GLO’s Designated Representative (“GDR”) Name:"]
["Contract #:",null,"Applicant ID:"]
["Applicant Name:"]
["Co-Applicant Name:"]
["Applicant Address:"]
[]
["Calculation of Eligible Award"]
["1. Identify Applicant's Total Need Prior to Any Assistance (ex: Recon Cost, Acquisition payoff amount)",null,null,null,0]
["2. Identify All Potentially Duplicative Assistance"]
["       a. FEMA Housing Repair",null,null,null,0]
["       b. SBA",null,null,null,0]
["       c. Insurance",null,null,null,0]
["       d. Other (ex: nonprofit, charity, PREPS, etc.). Please provide funding source:",null,null,null,0]
["       Received Assistance Total",null,null,null,{"$f":"SUM(E20:E23)","v":0}]
["3. Expenditures (Receipts/Support Documentation)"]
["       a.Receipts or confirmation of repairs with Inspection Report",null,null,null,0]
["       b. Forced Mortgage Payoff",null,null,null,0]
["       c. Contractor Fraud",null,null,null,0]
["       Expenditure Total",null,null,null,{"$f":"SUM(E26:E28)","v":0}]
["4. Deduct Assistance Determined to be Duplicative (Received Assistance Total Minus Expenditure Total)",null,null,null,{"$f":"MAX(0,E24-E29)","v":0}]
["5. Funding Adjustments"]
["       a. Applicant Provided Funding",null,null,null,0]
["       Total Adjustments",null,null,null,{"$f":"SUM(E32:E32)","v":0}]
["6. Maximum Eligible Award (Item 1 minus Item 4 plus Item 5)",null,null,null,{"$f":"E18-E30+E33","v":0}]
[]
["Exception Acknowledgment"]
["Applicant owes funding or is taking a reduction in scope of work (YES/NO):",null,null,null,{"$f":"IF(E34<E18, \"Yes\", \"No\")","v":"No"}]
["The Stafford Act has been explained to me and I understand that a gap exists between funding sources I have received and the CDBG benefit that I would otherwise qualify for. To utilize multiple federal funding sources without resulting in a Duplication of Benefit, I understand an exception to the standard specifications will need to be made to the home in order to provide a solution while still maintaining a safe sanitary home. If an exception is needed the following items were lessened from the original scope of work."]
["Original Project Cost","Description of Change",null,null,"Cost"]
[null,null,null,null,0]
[null,null,null,null,0]
[null,null,null,null,0]
[null,null,null,null,0]
[null,null,null,null,0]
[null,null,null,null,0]
[null,null,null,"Total",{"$f":"SUM(E40:E45)","v":0}]
["I/We confirm I/we have no other option to pay the Gap owed and I/we are opting for a lesser option as described above. Please Initial (Applicant and Co-Applicant (if applicable)):"]
["Applicant:",null,"Co-Applicant (If Applicable):"]
[]
["Signatures"]
["Under penalties of perjury, I/we certify that the information presented in this document is true and accurate to the best of my knowledge and belief. I/We further understand that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in my ineligibility to participate in this program or any other programs that will accept this document Additionally, if I/we receive future funding for the same purpose of the CDBG-DR funds, I/we will agree to repay the assistance that was duplicated."]
["Warning: Any person who knowingly makes a false claim or statement to HUD may be subject to civil or criminal penalties under 18 U.S.C. 287, 1001 and 31 U.S.C. 3729."]
[]
["Printed Name of Applicant:",null,null,"Date:"]
["Signature of Applicant:"]
["Printed Name of Co-Applicant:",null,null,"Date:"]
["Signature of Co-Applicant:"]
["Printed Name of Builder:",null,null,"Date:"]
["Signature of Builder:"]
["Printed Name of GDR:",null,null,"Date:"]
["Signature of GDR:"]
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["Disclaimer: The Texas General Land Office has made every effort to ensure the information contained on this form is accurate and in compliance with the most up-to-date CDBG-DR and/or CDBG-MIT federal rules and regulations, as applicable. It should be noted that the Texas General Land Office assumes no liability or responsibility for any error or omission on this form that may result from the interim period between the publication of amended and/or revised federal rules and regulations and the Texas General Land Office's standard review and update schedule."]