Form Hud-40107 - Annual Performance Report - U.s. Department Of Housing And Urban Development

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U.S. Department of Housing
Annual Performance Report
OMB Approval No. 2506-0171
(exp. 8/31/2009)
and Urban Development
HOME Program
Office of Community Planning
and Development
Public reporting burden for this collection of information is estimated to average 2.5 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not conduct
or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.
The HOME statute imposes a significant number of data collection and reporting requirements. This includes information on assisted properties, on the
owners or tenants of the properties, and on other programmatic areas. The information will be used: 1) to assist HOME participants in managing their
programs; 2) to track performance of participants in meeting fund commitment and expenditure deadlines; 3) to permit HUD to determine whether each
participant meets the HOME statutory income targeting and affordability requirements; and 4) to permit HUD to determine compliance with other statutory
and regulatory program requirements. This data collection is authorized under Title II of the Cranston-Gonzalez National Affordable Housing Act or related
authorities. Access to Federal grant funds is contingent on the reporting of certain project-specific data elements. Records of information collected will
be maintained by the recipients of the assistance. Information on activities and expenditures of grant funds is public information and is generally available
for disclosure. Recipients are responsible for ensuring confidentiality when public disclosure is not required.
This form is intended to collect numeric data to be aggregated nationally as a complement to data collected through the Cash and Management Information
(C/MI) System. Participants should enter the reporting period in the first block. The reporting period is October 1 to September 30. Instructions are included
for each section if further explanation is needed.
This report is for period (mm/dd/yyyy)
Date Submitted
Submit this form on or before December 31.
Send one copy to the appropriate HUD Field Office and one copy to:
HOME Program, Rm 7176, 451 7th Street, S.W., Washington D.C. 20410
Part I Participant Identification
1. Participant Number
2. Participant Name
3. Name of Person completing this report
4. Phone Number (Include Area Code)
5. Address
6. City
7. State
8. Zip Code
Part II Program Income
Enter the following program income amounts for the reporting period: in block 1, enter the balance on hand at the beginning; in block 2, enter the amount
generated; in block 3, enter the amount expended; and in block 4, enter the amount for Tenant-Based rental Assistance.
1. Balance on hand at Beginning 2. Amount received during
3. Total amount expended
4. Amount expended for Tenant-
5. Balance on hand at end of
of Reporting Period
Reporting Period
during Reporting Period
Based Rental Assistance
Reporting Period (1 + 2 - 3) = 5
Part III Minority Business Enterprises (MBE) and Women Business Enterprises (WBE)
In the table below, indicate the number and dollar value of contracts for HOME projects completed during the reporting period.
Minority Business Enterprises (MBE)
a. Total
b. Alaskan Native or
c. Asian or
d. Black
e. Hispanic
f. White
American Indian
Pacific Islander
A. Contracts
1. Number
2. Dollar Amount
B. Sub-Contracts
1. Number
2. Dollar Amount
a. Total
b. Women Business
c. Male
Enterprises (WBE)
C. Contracts
1. Number
2. Dollar Amount
D. Sub-Contracts
1. Number
2. Dollar Amounts
page 1 of 2
form HUD-40107 (11/92)


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