DOLA RROF Instructions

Instructions for Completing the Request for Release of Funds and Certification Exhibit IV-C and D / HUD-7015.15

Important Note to All non-local government grantees: DOLA’s Environmental Compliance Officer will complete and sign this form on your behalf.

Part 1. Program Description and Request for Release of Funds (to be completed by Responsible Entity)

1. Program Title(s): enter the HUD program name - e.g., Community Development Block Grant, HOME, etc.
2. HUD/State Identification Number: enter the letters/numbers assigned to your program/project by the State- e.g. Community Development Block Grant, CDBG 11-XXX; HOME 11-XXX; etc.
3. Recipient Identification Number: No response is necessary for this box.
4. OMB Catalog Number(s): complete as appropriate from below based on the information provided in your award letter. If your program is not listed here, contact DOLA for guidance.

5. Name and Address of Responsible Entity: enter the name and address of the unit of government or the State Agency/Department responsible for the environmental review of the activity(ies)/project(s). It may be the same as the grant recipient implementing the project.

6. For Information about this request, Contact (name & phone number): enter the name of person to contact concerning form RROF and the environmental review(s) for the activity(ies)/project(s) listed on this form. This may be the Environmental Preparer, the Certifying Officer of the Responsible Entity, or another person with knowledge regarding the environmental review of the project.
7. Name and Address of Recipient/Grantee (if different than Responsible Entity): No response is necessary for this box.
8. HUD or State Agency and Office Unit to Receive Request: enter the name and address of the HUD Office or State Agency where form RROF will be submitted.

9. Program Activity/Project Name: enter the activity(ies)/project name(s) for which this form RROF is submitted.
10. Location (Street address, city, county, and State): enter the location of the activity/project.
11. Program Activity/Project Description: enter a description of the activity/project for which this form RROF pertains, including estimated/approximate dollar amounts.

Part 2. Environmental Certification (to be completed by Responsible Entity)

1. Check the appropriate box.
2. Signature of Certifying Officer of the Responsible Entity: the Certifying Officer signs his/her name, title, and the date. The Certifying Officer is usually the chief elected official or a senior staff member of the local government grantee. The Certifying Officer may also be a Governor, or a State Agency official, formally and legally designated by the Governor. The Certifying Officer is attesting to the Responsible Entity’s compliance with HUD’s environmental review procedures (24 CFR Part 58) as set forth in points 1 - 8 in Part 2.

Local Government Grantees:
If the Responsible Entity is also the grant recipient, the completed form RROF, along with a copy of the posted or published environmental Notice(s), is/are submitted to DOLA’s Environmental Compliance Officer.

Non-Local Government Grantees:
This form will be completed and signed by DOLA’s Environmental Compliance Officer.

Part 3. To be completed when the Recipient is not the Responsible Entity

Signature of Authorized Officer of the Recipient: No signature is necessary for this section.

DOLA Grantees (CDBG, HOME, ESG, etc.)

James Spiers, CDBG Program Manager
Department of Local Affairs
1313 Sherman Street, Room 521
Denver, CO 80203
720-892-8307 or james.spiers@state.co.us