Area Office and Recipient Information

Date of Request:	Click here to enter a date.
Area Office:	Select Area Office	Area Office POC:	Enter Area Office POC
Tribe/Village:	Enter Name of your Tribe	TDHE:	Enter Name of TDHE, if applicable
Tribe City/State:	Click here to enter Tribe’s City and State.
Tribe/Village POC:	Enter Name, Phone, and e-Mail of Entity’s POC
Has the Tribe/Village been made aware of this request?	Choose an item.

Recipient Technical Assistance Background

1. Has the recipient organization received technical assistance from HUD in the past three years?	Choose an item.
If yes:	Name of consultant(s), organizations(s), or HUD Office that provided the previous technical assistance.	Click here to enter text.
Briefly describe the type of technical assistance provided (such as in-person, virtual or remote, helpdesk) and the topic on which technical assistance was provided (such as the specific HUD programs, policies, or requirements).	Click here to enter text.
If the previous technical assistance was for a topic or issue that relates to your current request, please describe the continuing need for technical assistance on this issue.	Click here to enter text.
2. Has the recipient organization reviewed any HUD resources, guidebooks, or other information on this topic or taken any online courses related to this topic?	Choose an item.
If yes:	Materials reviewed or courses taken:	List any materials reviewed or courses taken.
3. Is the recipient organization currently receiving technical assistance from another federal agency, a consultant hired by the recipient, or another entity?	Choose an item.
If yes:	Please describe the technical assistance being provided:	Click here to enter text.

Technical Assistance Topics

4. Please list the topic(s) for which the recipient organization needs assistance.	Click here to enter text.

Technical Assistance Request Details

5. Subject of your request.	Enter technical assistance title.
6. Please provide details about the problem or challenge to be addressed through technical assistance and the factors that led to the problem or challenge.	Enter text here.
7. Please describe the assistance needed from HUD to address the problem described above.	Enter text here.
8. Please describe timeframes for the assistance. If applicable, identify any critical deadlines or timing considerations related to this request.	Enter text here.
9. Please describe the intended result of the technical assistance. What is the organization hoping to achieve with the help of technical assistance?	Enter text here.

Please provide any relevant documents (i.e., audits, assessments, reports). List any documents that are included with the request.