HUD 40107 Annual Performance Report

U.S. Department of Housing
and Urban Development
Office of Community Planning
and Development

Annual Performance Report
HOME Program

OMB Approval No. 2506-0171
(exp. 8/31/2009)

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)
Starting
Ending

Submit this form on or before December 31.
Send one copy to the appropriate HUD Field Office and one copy to:

Date Submitted

(mm/dd/yyyy)

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
of Reporting Period

2. Amount received during
Reporting Period

3. Total amount expended
during Reporting Period

4. Amount expended for TenantBased Rental Assistance

5. Balance on hand at end of
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.
a. Total

b. Alaskan Native or
American Indian

a. Total

b. Women Business
Enterprises (WBE)

Minority Business Enterprises (MBE)
c. Asian or
d. Black
Pacific Islander
Non-Hispanic

e. Hispanic

f. White
Non-Hispanic

A. Contracts
1. Number
2. Dollar Amount
B. Sub-Contracts
1. Number
2. Dollar Amount
c. Male

C. Contracts
1. Number
2. Dollar Amount
D. Sub-Contracts
1. Number
2. Dollar Amounts

page 1 of 2

form HUD-40107 (11/92)

Part IV Minority Owners of Rental Property
In the table below, indicate the number of HOME assisted rental property owners and the total dollar amount of HOME funds in these rental properties assisted
during the reporting period.
a. Total

b. Alaskan Native or
American Indian

Minority Property Owners
c. Asian or
d. Black
Pacific Islander
Non-Hispanic

e. Hispanic

f. White
Non-Hispanic

1. Number
2. Dollar Amount

Part V Relocation and Real Property Acquisition
Indicate the number of persons displaced, the cost of relocation payments, the number of parcels acquired, and the cost of acquisition. The data
provided should reflect only displacements and acquisitions occurring during the reporting period.
a. Number

b. Cost

1. Parcels Acquired
2. Businesses Displaced
3. Nonprofit Organizations Displaced
4. Households Temporarily Relocated, not Displaced

Households Displaced

a. Total

b. Alaskan Native or
American Indian

Minority Business Enterprises (MBE)
c. Asian or
d. Black
Pacific Islander
Non-Hispanic

e. Hispanic

f. White
Non-Hispanic

5. Households Displaced - Number
6. Households Displaced - Cost

page 2 of 2

form HUD-40107 (11/92)