Instructions

CDBG Project Status Report

As of February 24, 2005

The form has twelve (12) sections, grantees are to complete all sections.

Project Status Reports are to be submitted within ten (10) days after each 6-month reporting period. The uniform 6-month reporting period ending dates of June 30 and December 31 will be used for all projects. DED reserves the right to not process any request for funds for projects that do not have status reports into DED by the uniform due dates of July 10 and January 10. Submit all project status reports to:

Attn: (Project’s Program Rep)

Nebraska Department of Economic Development

Community and Rural Development Division

PO Box 94666

Lincoln, NE 68509

Distribute a signed copy of the report to the Chief Elected Official of the grantee.

The information collected enables the DED to satisfy record keeping and reporting requirements of the United States Department of Housing and Urban Development (HUD).

Instructions are provided for each item in the twelve (12) sections (refer to the Grantee Implementation Schedule to complete sections X and XI). If there is need for additional information or clarification, please contact your DED Program Representative.

SECTION I – Grantee Data

(1)CDBG Grant number.

(2)Grantee - Official name of CDBG grant recipient.

(3)Federal Tax Identification Number.

(4)Mailing address for official correspondence.

(5)Person from local government responsible for day-to-day administration.

(6)Telephone number of person identified on line 5.

SECTION II – CDBG Certified Administrator

NAME: Identify the CDBG Certified Administrator who prepared and can answer any questions concerning this Project Status Report.

TELEPHONE: Provide the telephone number where the CDBG Certified Administrator can be reached between 8:00 a.m. and 5:00 p.m. CT Monday through Friday.

DED Program Representative: Identify the DED program representative assigned to the project.

SECTION III – Signature of CDBG Certified Administrator is required.

Include date of signing.

SECTION IV – Proposed Beneficiaries

Enter the proposed beneficiaries for the project, these must correspond to the proposed beneficiaries that were detailed in the awarded application, contract or MOU for the project (in most cases this number will not change during the life of the project). Beneficiaries are tabulated by counting the individual persons benefited from the project, except in the case of housing grants. Beneficiaries for housing grants are tabulated by counting the number of households that benefited from the grant.

SECTION V – Actual Beneficiaries

Enter the actual beneficiaries for the project as of the date of the report (some projects may not have any actual beneficiaries until the project is complete). Enter the number of those beneficiaries that are LMI, the percent of the beneficiaries that are LMI and the number that are female head of households.

SECTION VI – Race and Ethnicity of Actual Beneficiaries

Enter the race of the actual beneficiaries for the project and whether or not they are of Hispanic ethnicity. As of the 2000 Census, the US Census Bureau no longer categorizes Hispanic as a race. The Census now categorizes Hispanic as an ethnicity. The total of the racial breakdown of actual beneficiaries must equal the total actual beneficiaries reported in Section V of the Project Status report.

SECTION VII – Housing Applicants

This section is required to be completed for all CDBG housing projects and only for CDBG housing projects.

Enter the total number of housing applicants as of the end of the reporting period, include applicants selected and not selected. Applicants are tabulated by household, not individual persons. Enter the number of total applicants that are LMI, the percent of the applicants that are LMI and the number that are female head of households.

SECTION VIII – Race and Ethnicity of Housing Applicants

This section is required to be completed for all CDBG housing projects and only for CDBG housing projects.

Enter the race of the housing applicants for the project and whether or not they are of Hispanic ethnicity. As of the 2000 Census, the US Census Bureau no longer categorizes Hispanic as a race. The Census now categorizes Hispanic as an ethnicity. The total of the racial breakdown of housing applicants must equal the total housing applicants reported in Section VII of the Project Status report.

SECTION IX – Activity Accomplishments

(1) TOTAL PROJECT GOAL: Indicate the quantitative accomplishments expected by the completion of each approved activity. In most cases this should not change throughout the life of the project.

(2) THIS REPORTING PERIOD (ACTUAL): Enter the number of these accomplishments actually completed during the reporting period.

(3) TO DATE (ACTUAL): Enter the cumulative number of these accomplishments actually completed as of the end of the reporting period.

*Please note that the units that activity accomplishments are measured in are provided in each column.

SECTION X – Progress of Activities During this Reporting Period in Accordance with Grantee Implementation

Schedule

Provide a brief narrative describing the progress of the activities that were undertaken during the reporting period. Include whether the project is on schedule or behind, if behind explain why. Also include if the project has any amendments or extensions. Complete even if narrative states that no activities were done during the reporting period and explain why. Reference the Grantee Implementation Schedule and report by progress toward project and activity milestones.

SECTION XI – Planned Activities for Next Reporting Period / Technical Assistance Needs

Provide a brief narrative describing activities that are planned for the project and also notify us of any technical assistance needs that you may have. If project is behind schedule address the strategy to be taken to get back on schedule.

SECTION XII – Contractual Obligations (This section is to be filled out only for contractual obligations with Minority Business Enterprise (MBE)/Women Business Enterprise (WBE)/ Sec 3 contractors) 1

(1) CONTRACTOR/SUBCONTRACTOR NAME & ADDRESS: Name of company or individual with whom a contract was entered. Include, as noted, the complete address. (i.e. street address, city, state and zip code)

(2) TAX ID NUMBER: Enter the Federal Identification Number, or if not applicable, the Social Security Number of the contractor or subcontractor. Identify the Federal Tax Identification Number or Social Security Number for each contractor/subcontractor listed.

(3) TYPE OF TRADE CODE: Enter the numeric codes which best indicates the contractor’s/subcontractor’s service.

(4) CONTRACTOR OR SUBCONTRACTOR BUSINESS RACIAL/ETHNIC CODE: Enter the numeric code, which indicates the racial/ethnic character of the owner(s) and controller(s) of 51% of the business. When 51% is not owned and controlled by any single racial/ethnic category, enter the code, which seems most appropriate.

(5) WOMAN OWNED BUSINESS: Please answer yes or no

(6) AMOUNT OF CONTRACT/SUBCONTRACT: Enter the dollar amount

rounded to the nearest dollar

(7) SECTION 3: Answer Yes or No if the contractor is with a Section 3 business as defined by the Housing and Urban Development Act of 1968.2

1Please do not include contracts that have been reported in previous Project Status Reports

2Section 3 of the HUD Act of 1968 requires that recipients of HUD funds (and their contractors and subcontractors) provide jobs and other economic opportunities to low-income persons. Through recruiting in a project’s area, such fund recipients can make residents and businesses aware of the opportunities available. Section 3 residents are low-income persons who live in the area in which a HUD-assisted project is located. A Section 3 business is owned by section 3 residents or employs section 3 residents in full-time positions or subcontracts with businesses which provide economic opportunities to low income persons.

Nebraska Department Of Economic Development – CDBG Project Status Report

Project Status Report as of ______ / Project National Objective ______
I. GRANTEE DATA / II. Name of CDBG Certified Administrator / III. Certification: I certify to the best of my knowledge and belief that the information in this report is true and correct.
1. CDBG Grant # ______/ Name: ______
2. Grantee ______/ Organization: ______/
Signed: CDBG Certified Administrator
3. Federal Tax ID Number
______/ Telephone: ( )______/ Date: ______
4. Address ______
______
DED Program Representative / DED USE ONLY
5. Contact ______
6. Telephone ( ) ______/ ______/ Date Approved: ______Approved By: ______
IV. Proposed Beneficiaries
/
V. Actual Beneficiaries
TOTAL / Number LMI / % LMI / *TOTAL / Number LMI / % LMI / # of Female Head of Household

VI. Race and Ethnicity of Actual Beneficiaries

Total / # Hispanic
White:
Black/African American:
Asian:
American Indian/Alaskan Native:
Native Hawaiian/Other Pacific Islander:
American Indian/Alaskan Native & White:
Asian & White:
Black/African American & White:
American Indian/Alaskan Native & Black African American:
Other Multi-Racial:
*Total:
(Actual Beneficiaries, must match total in table V.)

(Housing activities count by households, all other activities count by persons)

CDBG Housing Activities Applicants

(For housing activities only)

VII. Housing Applicants
(including those not selected)
*TOTAL / Number LMI / % LMI / # of Female Head of Household

Count by households, not individual persons

VIII. Race and Ethnicity of Housing Applicants

Total / # Hispanic
White:
Black/African American:
Asian:
American Indian/Alaskan Native:
Native Hawaiian/Other Pacific Islander:
American Indian/Alaskan Native & White:
Asian & White:
Black/African American & White:
American Indian/Alaskan Native & Black African American:
Other Multi-Racial:
*Total:
(Housing applicants, must match total in table VII.)

L:/CRD Web Forms/CDBG Forms/Project Status Report 2/24/2005

IX. ACTIVITY

CODE / ACTIVITY / ACCOMPLISHMENTS
(1) TOTAL PROJECT GOAL / (2) THIS REPORTING PERIOD (ACTUAL) / (3) TOTAL TO DATE (ACTUAL)
tbd / 0010 / Acquisition/Easements / Parcels / Parcels / Parcels
tbd / 0030 / Clearance/Demolition / Units / Units / Units
tbd / 0050 / Disposition of Acquired Assets / Parcels/Units / Parcels/Units / Parcels/Units
1/11 / 0070 / Public Facilities & Improvements / Lineal Feet (LF) or # of / Lineal Feet (LF) or # of / Lineal Feet (LF) or # of
11 / 0081 / Day Care Center / # of / # of / # of
11 / 0082 / Health Care Center / # of / # of / # of
11 / 0090 / Community Center / # of / # of / # of
11 / 0091 / Senior Center / # of / # of / # of
11 / 0092 / Public Library / # of / # of / # of
11 / 0093 / Fire Station/Equipment / # of / # of / # of
1 / 0230 / Streets / Lineal Feet (LF) / Lineal Feet (LF) / Lineal Feet (LF)
1 / 0250 / Storm Sewers / LF / LF / LF
1 / 0270 / Sanitary Sewers / LF / LF / LF
1 / 0290 / Sewage Treatment / # of tanks or lagoons / # of tanks or lagoons / # of tanks or lagoons
1 / 0300 / Water/Sewer Improvements
1 / 0310 / Water Source/Well / # of wells / # of wells / # of wells
1 / 0330 / Water Distribution/Transmission / LF / LF / LF
1 / 0350 / Water Storage / # of tanks / # of tanks / # of tanks
1 / 0370 / Flood & Drainage Facility / LF / LF / LF
10 / 0450 / Relocation/Reasonable Benefits / Households / Households / Households
10 / 0520 / Property Acquisition / Units / Units / Units
10 / 0530 / Housing Rehabilitation / Units / Units / Units
10 / 0541 / SF Housing – Rental Rehab. / Units / Units / Units
10 / 0542 / SF Housing – New Construction / Units / Units / Units
10 / 0543 / SF Housing – Public Service / Units / Units / Units
10 / 0561 / MF Housing – Rehab / Units / Units / Units
10 / 0562 / MF Housing – New Construction / Units / Units / Units
10 / 0580 / Housing Management / Units / Units / Units
13 / 0600 / ED Infrastructure Development / Jobs added/retained / Jobs added/retained / Jobs added/retained
1 / 0630 / Planning / # of plans / # of plans / # of plans
10 / 0650 / Code Enforcement / Housing Units / Housing Units / Housing Units
13 / 0690 / Fixed Assets/Land & Building / Jobs added/retained / Jobs added/retained / Jobs added/retained
13 / 0700 / Direct Fin. Assist. to for-Profit / Jobs added/retained / Jobs added/retained / Jobs added/retained
13 / 0710 / Job Training / Positions to be Trained / Positions to be Trained / Positions to be Trained
13 / 0730 / Working Capital / Jobs added/retained / Jobs added/retained / Jobs added/retained
13 / 0750 / Fixed Assets/Machinery & Equipment / Jobs added/retained / Jobs added/retained / Jobs added/retained
13 / 0770 / Fixed Assets/Leasehold Improvements / Jobs added/retained / Jobs added/retained / Jobs added/retained
8 / 0791 / Microenterprise Lending / Bus. Assisted / Bus. Assisted / Bus. Assisted
8 / 0792 / Business Incubators / Bus. Assisted / Bus. Assisted / Bus. Assisted
8 / 0793 / Technology Centers / users / users / users
8 / 0798 / Commercial/Service/Retail / Bus. Assisted / Bus. Assisted / Bus. Assisted
X. Physical Impact/Outputs of Work Completed this Reporting Period in reference to Grantee Implementation Schedule
(Assess whether or not project is on schedule and include any amendments or extensions that have been granted for the project) / XI. Planned Activities for Next Reporting Period / Technical Assistance Needs (Narrative must reference Grantee Implementation Schedule’s project activities and milestones.)
XII. CONTRACTUAL OBLIGATIONS TO DATE (COMPLETE THIS TABLE FOR CONTRACTS WITH MBE/WBE/ SEC 3 ONLY)1
(1) CONTRACTOR/SUBCONTRACTOR NAME & ADDRESS
/ (2)
Contractor/ Subcontractor Federal Tax ID Number / (3)
Type of Trade Code
(See Below) / (4)
Contractor or Subcontractor Business Racial/Ethnic
Code
(See Below) / (5) Woman Owned Business
(Yes/No) / (6)
Amount of Contract/ Subcontract /
(7)
Section 3
(Yes/ No)
Name / Street / City / State / Zip
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Type of Trade Codes: / Business Racial Ethnic Information:
CPD: / Housing: / 1 – White American
1 – New Construction / 1 – New Construction / 6 – Professional / 2 – Black American
2 – Education/Training / 2 – Substantial Rehab / 7 – Tenant Services / 3 – Native American
3 – Other / 3 – Repair / 8 – Education Training / 4 – Hispanic American
4 – Service / 9 – Arch./Engrg. Appraisal / 5 – Asian/Pacific American
5 – Project Management / 0 - Other

Attach additional sheets as necessary.

1Please do not include contracts that have been reported in previous Project Status Reports

CDBG Project Status Report 2/24/2005