Official Site of The State of New Jersey
Program Policies and Procedures and Forms for Lead-Safe Home Remediation Grant Program
Lead-Safe Home Remediation Policy Appendix
The following Forms are DCA issued forms and are to be used by all participating Lead agencies. These documents are not to be altered and are required in all client files when applicable.
Policy and Procedures for Lead-Safe Home Remediation Grant Program
Chapter 1- Application Intake Process to Applicant Approval
Chapter 2- Procurement Process
Chapter 3 - Program Management and Operations
Lead Remediation and Abatement Program Workflow
Forms for Lead-Safe Home Remediation Grant Program
Chapter 1 - Lead Pamphlet
Chapter 1 - Right of Entry Form | Formulario para Permiso de Entrada
Chapter 1 - Tenant Lease Verification Form
Chapter 1 - Affidavit of no income for applicant | Declaración Jurada sobre Cero Ingresos
Chapter 1 - Affidavit of no income for member of household
Chapter 1 - Certification of no income for applicant
Chapter 1 - Certification of no income for member of household
Chapter 1 - Owner’s Permission for Lead Remediation | Autorización del Propietario para Remediación o Reducción del Plomo
Chapter 1 - Landlord Tenant Lead-Safe Remediation Agreement
Chapter 1 - Certification of No Social Security Number
Chapter 1- Lead Client Sign Off
Chapter 1- Lead Test Form
Chapter 2 - Responsible Contractor Certification
Chapter 2 - Bid Review Checklist
Chapter 2 - Justification of Selection of Contractor
Chapter 2 - Non-Collusion Affidavit of Prime Bidder
Chapter 2 - Contractor Registration Application
Chapter 2 - Affirmative Action Affidavit
Chapter 3 - File Content and Compliance Checklist
Chapter 3 - Rework Approval Form
Chapter 3 - Approval to Exceed Maximum Allowable Cost Per Unit
Top PageSelf Certification Forms
LRAP Income Self Certification Form | Certificación del solicitante para LRAP
Property Owner Self-Certification for Over-Expenditure Request
Vacant Unit Form
Vacant/Unoccupied Unit Certification
Agency Travel Reimbursement Form
State Monitor Forms
State Monitor Final Inspection Report
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