HUD 4134 Experience Chart Excel Template

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Overview

Instructions
Experience

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Sheet 1: Instructions

INSTRUCTIONS

Applicants may complete and submit this template, including all fillable fields within each spreadsheet (tab), in response to section IV.B.1.a of HUD's Notice of Funding Availability (NOFA) for its Community Compass Technical Assistance and Capacity Building (Community Compass) Program. The following instructions are outlined by spreadsheet (tab). These instructions are provided, in addition to the direction in the NOFA.

The completed template must be submitted timely and with the application in grants.gov, unless the applicant has received a written waiver (see IV.A. of the NOFA). The completed template does not count towards the 50-page limit for an applicant’s response to Rating Factors 1-3 of the NOFA.

Experience (for Staff/Contractors/Consultants)

To complete the Experience spreadsheet (tab), use the following instructions:

List the staff persons, along with consultant and contractor persons with whom the applicant organization has entered a formal agreement to participate in an award under this NOFA. For each person identify the: name (first and last); organization name, city, state, zip, and DUNS; role (in relation to the applicant); and qualifications. For the qualifications narrative, provide a summary of the individual’s experience, expertise, and other qualifications relevant to the activities included in the Community Compass NOFA.

For each person listed, to add years of experience by HUD Office, use the '+' links above the column headers. This will expand and show the relevant programs/topics under that Office. To hide those programs/topics, use the '-' links.

Within each HUD Office, indicate the number of years of experience relevant to each program/topic. Include only whole numbers; do not include text or decimals. For this chart, one year means “10 months or more.” For instance, if a staff member has nine months of experience, that staff person would be considered to have zero years of experience; a contractor with 5 years 11 months of experience would be considered to have six years of experience; and a consultant with 3 years 4 months experience would be considered to have 3 years of experience.

OMB Approval No. 2506-0197

(exp. 3/31/2023)

form HUD 4134

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Sheet 2: Experience

EXPERIENCE OF STAFF, CONTRACTORS, AND CONSULTANTS
Enter the name, organization, and qualifications for each staff person, contractor, and consultant. Then, expand each HUD Office and enter each person's years of experience by program/topc. Enter the years in whole numbers.
Certification: “I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802).” Public reporting burden for this collection of information is estimated to average 8.0 hours. This includes the time for collecting, reviewing, and reporting the data. The information is being collected for HUD's Community Compass Technical Assistance and Capacity Building Program Notice of Funding Availability (NOFA) and will be used for application review . Response to this request for information is required in order to receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number. No confidentiality is assured.” Send comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to the Reports Management Officer, Office of Policy Development and Research, REE, Department of Housing and Urban Development, 451 7th St SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2506-0197.											- to close	- to close	- to close	- to close	- to close	- to close	- to close
Applicant Name		#REF!								+ to expand	+ to expand	+ to expand	+ to expand	+ to expand	+ to expand	+ to expand
Staff, consultant, and contractor persons and qualifications										EXPERIENCE	EXPERIENCE	EXPERIENCE	EXPERIENCE	EXPERIENCE	EXPERIENCE	EXPERIENCE
#	Person's First Name	Person's Last Name	Organization Name	Role	Organization City	Organization State Abbrev	Organization Zip	Organization DUNS #	Qualifications Narrative (include experience with Systems	OFFICE OF COMMUNITY PLANNING AND DEVELOPMENT	PUBLIC AND INDIAN HOUSING	OFFICE OF HOUSING	OFFICE OF POLICY DEVELOPMENT AND RESEARCH	OFFICE OF FAIR HOUSING AND EQUAL OPPORTUNITY	CROSS-OFFICE: ENERGY, ENVIRONMENT, RELOCATION, REAL ESTATE, AND OTHER CROSS-OFFICE REQUIREMENTS	ADDITIONAL	Systems (like DRGR)	Cetifications (like AICP)
1										0	0	0	0	0	0	0
2										0	0	0	0	0	0	0
3										0	0	0	0	0	0	0
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11										0	0	0	0	0	0	0
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