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

Chapter 4- HESWAP

 

Forms for Lead-Safe Home Remediation Grant Program

Chapter 1 - Lead Pamphlet [pdf 45kB]

Chapter 1 - Right of Entry Form [pdf 83kB]

Chapter 1 - Affidavit of no income for applicant  [pdf 47kB]

Chapter 1 - Affidavit of no income for member of household [pdf 47kB]

Chapter 1 - Certification of no income for applicant [pdf 47kB] 

Chapter 1 - Certification of no income for member of household [pdf 47kB]

Chapter 1 - Owner’s Permission for Lead Remediation [pdf 70kB]

Chapter 1 - Landlord Tenant Lead-Safe Remediation Agreement [pdf 69kB]

Chapter 1 - Certification of No Social Security Number [pdf 112KB]

 

Chapter 2 - Responsible Contractor Certification [pdf 302kB]

Chapter 2 - Bid Review Checklist [pdf 276kB]

Chapter 2 - Justification of Selection of Contractor [pdf 78kB]

Chapter 2 - Non-Collusion Affidavit of Prime Bidder [pdf 72kB]

Chapter 2 - Contractor Registration Application [pdf 92kB]

Chapter 2 - Affirmative Action Affidavit [pdf 72kB]

 

Chapter 3 - File Content and Compliance Checklist [pdf 39kB]

Chapter 3 - Rework Approval Form [pdf 59kB]

Chapter 3 - Approval to Exceed Maximum Allowable Cost Per Unit [pdf 174kB]

 

State Monitor Forms

State Monitor Final Inspection Form [103kB]