NSP PI Form Instr 10.01.09 by tba32074

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									                                                      Neighborhood Stabilization Program (NSP)
                                             Quarterly Performance and Expenditure Report (QPER)
Instructions:
Grantee Information
1. Grantee Name: Input the name of your entity (City of, County of, Town of, etc...).
2. NSP Grant Number: Input the NSP grant/ contract number.
3. Date: Input the date this report was prepared in MM/DD/YYYY format.
4. QPER Interval: Please select the interval for this report from the dropdown menu.
5. Period Ending Date: Please select this report's ending date from the drop-down menu.
6. NSP Rep.: Please select the NSP Program Representative assigned to this grant from the dropdown menu.
7. Grantee Information: Input the name of your: entity, address, email address, and phone number.
8. Preparer Information: Input the preparer's: name, address, email address, and phone number.
Section I - Funds Status
9. Activity Code & Description: Input specific location (address, floor, room #, etc…) where this activity occurred.
10. Type of Act.: Select the appropriate activity type from the dropdown menu.
11. Budget: Please input the amount budgeted for each activity in this grant from Exhibit B.
12. Funds Requested - Requested This Quarter: Please input the amount currently being requested by activity.
12. Funds Requested - Total Requested Previously: Please input the amount previously requested by activity.
13. Balance: Auto fill
14. This Period - Obligated: Please indicate the amount of NSP grant funds obligated during this report's period.
14. This Period - Expended: Please indicate the amount of NSP grant funds expended during this report's period.
15. Cumulative Total - Obligated: Please indicate the total amount of NSP grant funds obligated.
15. Cumulative Total - Expended: Please indicate the total amount of NSP grant funds expended.
16. General Administration - 21A: Input the General Administration: budget, currently being requested, and the total requested for this NSP grant.
17. PI Obligated: Input the total NSP-related Program Income obligated during this report's period and total amount of NSP grant funds obligated.
18. Fund Status Comment(s): Please add brief comments/ clarifications regarding the Fund Status here.
Section II - Work in Progress
19. Project Name/ Site Description: Please provide specific site location and descriptions here - including county information.
20. Obligated This Quarter: Please provide the amount of NSP grant funds obligated to this project during this report's quarter.
21. Expended This Quarter: Please provide the amount of NSP grant funds expended to this project during this report's quarter.
22 Activity This Quarter?: Please select from the dropdown menu whether there was reportable activity for the project this quarter.
23. Activity(ies) performed on each property during THIS quarter: Select the performed activity(ies) from the dropdown menu.
24. Work in Progress - Comment(s): Please add brief comments/ clarifications regarding Work in Progress here.
Section III - Overall Grant Performance Measures
25. Project Name/ Site Description: Please provide specific site location and descriptions here - including county information.
26. Activity Code: Select the activity code from the dropdown menu.
27. # of Housing Units: The total # of housing units in this project/ at this site meeting the National Objective which benefit from NSP grant funds.
28. LMMH National Objective Breakdown - Households: This is the number of housing units in this project/ at this site benefiting from the NSP grant funds
under the categories: Low, Moderate, and Middle Income.
29. LMMA/ LMMC National Objective Breakdown: This is the number of all people served/ benefiting as well as the categories of 120% of AMI or less and
50% of AMI or less when this particular project is complete.
Section IV - Leverage Reporting
31. Leverage Reporting - Public Funds: Please input the amount of leverage from public source(s) expended during this report's quarter as well as the total
for this NSP grant.
32. Leverage Reporting - Private Funds: Please input the amount of leverage from private source(s) expended during this report's quarter as well as the total
for this NSP grant.
33. Source of Funds - This Quarter Only: Please provide information on the origin of leverage funds reported during this report's quarter.

Section V - Interest Revenue from Advances
Interest earned on NSP advances THIS quarter: Please provide the interest information
Advance funds on hand at the end of THIS quarter: Please provide the amount of advance funds remaining at the end of this report's quarter.
Were advance funds deposited to an interest-bearing account within three (3) days of receipt from HCD: Please select from the dropdown menu whether
advance funds were deposited withing three days of receipt from HCD.
34. General Comment(s): Please add brief comments/ clarifications regarding the QPER here.
Section VI - Certification
35. Certification: After verifying all information contained in this report is correct, the Authorized Signer must fill out this section and sign before submitting to
the State NSP team.



Revised 11.10.09

								
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