LMC
DEPARTMENT OF COMMUNITY DEVELOPMENT PUBLIC SERVICE ACTIVITIES LIMITED CLIENTELE PROGRAM ACCOMPLISHMENT REPORT
Date submitted: Payment Month: Payment Number: Check if Final
Agency Name: Contact Person (person completing form)
PROGRAM TYPE (e.g. Senior, Youth Services):
Project Number Phone Number
Matrix Code Fax Number
Contract Number E-mail Address
ACCOMPLISHMENTS/STATUS: Provide a concise description of the activity’s accomplishments reflecting the current amount of funds requested for reimbursement (expended). This narrative description of accomplishments should also identify any noteworthy issues that are relevant to the activity . DIRECT BENEFIT:
SERVICE AREA COMPLIANCE (unduplicated persons) Number of Persons Served This Report Number that Reside in Service Area SERVICE DELIVERY (may reflect duplicated persons) NUMBER OF PERSONS SERVED SERVICE CATEGORIES PLANNED ACTUAL This Report Total to Date PLANNED UNITS OF SERVICE ACTUAL This Report Total to Date Percent (%) that Reside in Service Area
Optional Comments (City Staff Only): Cite comments pertaining to the statement of accomplishments or the accuracy of data reported on this form.
WEB SITE: hhtp://cd.city.cleveland.oh.us
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Nov 2, 2006 LMC Activity Reporting Form
LMC
Total Number of Unduplicated Persons Assisted
This Reporting Period (New Clientele) Total to Date (Unduplicated) **
RACIAL / ETHNIC CHARACTERISTICS
Enter the total Number of unduplicated persons assisted by race and ethnicity.
C04ME07
NOTE: Ethnicity is a subset of race and is defined by HUD as having Hispanic or Latino origins. Hispanic or Latino is defined as a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
This Reporting Period RACE
(Note: the number in the Ethnicity column is a subset of the number in the total race column) White Black - African American Asian American Indian - Alaskan Native Native Hawaiian - Other Pacific Islander American Indian - Alaskan Native Asian & White Black - African American & White American Indian - Alaskan Native & Black Other Multi Racial The total number listed in the shaded areas on this page must be equal (New Clientele)
Year to Date Totals
(Unduplicated)
Total Race
ETHNICITY
Hispanic / Latino
Total Race
ETHNICITY
Hispanic / Latino
TOTAL
VERY LOW INCOME (0 to 30% of MFI)
*
**
Race only
This Report Year to Date
LOW INCOME (31 to 50% of MFI)
MODERATE INCOME (51 to 80% of MFI)
HIGHER INCOME (81%> of MFI)
GRAND TOTALS
* **
Public Services
Of the persons assisted, enter the number that:
Now have new access to this service or benefit (include existing services that have not changed in scope or location) Now have improved access to this service or benefit Now receive a service or benefit that is no longer substandard
CDBG17
This Reporting Period
Year to date
TOTAL Page 2 of 2
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**
Nov 2, 2006 LMC Activity Reporting Form