Form Hud-40118 - Annual Progress Report Page 4
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14Complete questions 11 - 15 for all participants who left during the operating year (from 2c, columns 1 and 2). The term participant means
single persons and adults in families. It does not include children or caregivers.
11. Amount and Source of Monthly Income at Entry and at Exit. Of those participants who left during the operating year, how many
participants were at each monthly income level and with each source of income?
A. Monthly Income at Entry
C. Income Sources at Entry
a.
No income
a.
Supplemental Security Income (SSI)
b.
$1-150
b.
Social Security Disability Income (SSDI)
c.
$151 - $250
c.
Social Security
d.
$251- $500
d.
General Public Assistance
e.
$501 - $1,000
e.
Temporary Aid to Needy Families (TANF)
f.
$1001- $1500
f.
Child Support
g.
$1501- $2000
g.
Veterans Benefits
h.
$2001 +
h.
Employment Income
i.
Unemployment Benefits
j.
Medicare
k.
Medicaid
l.
Food Stamps
m.
Other (please specify)
n.
No Financial Resources
B. Monthly Income at Exit
D. Income Sources at Exit
a.
No income
a.
Supplemental Security Income (SSI)
b.
$1-150
b.
Social Security Disability Income (SSDI)
c.
$151 - $250
c.
Social Security
d.
$251- $500
d.
General Public Assistance
e.
$501 - $1,000
e.
Temporary Aid to Needy Families (TANF)
f.
$1001- $1500
f.
Child Support
g.
$1501- $2000
g.
Veterans Benefits
h.
$2001 +
h.
Employment Income
i.
Unemployment Benefits
j.
Medicare
k.
Medicaid
l.
Food Stamps
m.
Other (please specify)
n.
No Financial Resources
7
HUD-40118 (11/00)
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