HUD 52842 Performance and Evaluation Report/Replacement Reserve

Annual Statement / Performance and
Evaluation Report on Replacement Reserve

U. S. Department of Housing
and Urban Development
Office of Public and Indian Housing

OMB Approval No. 2577-0157
(exp. 11/30/2008)

Comprehensive Grant Program (CGP)
See page 3 for Instructions and Public Reporting burden statement

Part I: Summary
HA Name

Submission (mark one)

Original Annual Statement
Revised Annual Statement / Revision No. ___________
Performance & Evaluation for Program Year Ending _____________
Section 1: Replacement Reserve Status Must be completed each year there is a balance in the replacement reserve.

Estimated

Actual

1. Replacement Reserve Interest Earned (account 6200/1420.7; equals line 17 of section 2, below)
2. Replacement Reserve Withdrawal (equals line 16 of section 2, below)
3. Net Impact on Replacement Reserve (line 1 minus line 2; equals line 18 of section 2, below)
4. Current FFY Funding for Replacement Reserve (line 15 of form HUD-52837)
5. Replacement Reserve Balance at End of Previous Program Year (account 2830)
6. Replacement Reserve Balance at End of Current Program Year (line 4 + line 5 + (or -) line 3) (account 2830)
Section 2: Replacement Reserve Withdrawal Report Complete this section if there is withdrawal/expenditure activity.
Summary by Account (6200 subaccount)
1.

Reserved

2.

1406 Operations

3.

1408 Management Improvements

4.

1410 Administration

5.

1415 Liquidated Damages

6.

1430 Fees and Costs

7.

1440 Site Acquisition

8.

1450 Sites Improvement

9.

1460 Dwelling Structures

Estimated Cost
Column 1 Original
Column 2 Revised

Actual Cost
Column 3 Expended

10. 1465 Dwelling Equipment -Nonexpendaable
11. 1470 Nondwelling Structures
12. 1475 Nondwelling Equipment
13. 1485 Demolition
14. 1495 Relocation Costs
15. 1498 Mod Used for Development
16. Replacement Reserve Withdrawal (sum of lines 2 thru 15)
17. 1420.7 Replacement Reserve Interest Income

(

) (

) (

)

18. Net Withdrawal from Replacement Reserve (line 16 minus line 17)
19. Amount of line 16 related to LBP Activities
20. Amount of line 16 related to Section 504 Compliance
21. Amount of line 16 related to Emergencies
Signature of the Executive Director

Date

Signature of the Field Office Manager

Date

form HUD-52842 (10/96)
ref. Handbook 7485.3

Annual Statement / Performance and
Evaluation Report on Replacement Reserve
Part II: Supporting Pages

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

Comprehensive Grant Program (CGP)
Development
Number/Name
HA-Wide
Activities

General Description of
Major Work Categories

1/ To be completed at the end of the program year.

Development
Account
Number

Total Estimated Cost
Original
Revised 1/

Page ___ of ___

Total Actual Cost
Funds Obligated 1/ Funds Expended 1/

Status of Proposed Work 1/

form HUD-52842 (10/96)
ref. Handbook 7485.3

Public reporting burden for this collection of information is estimated to average 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.
This collection of information requires that each eligible grantee submit information to HUD regarding use of all or a portion of its annual formula grant for a replacement reserve. This information will
be used by HUD to determine whether the replacement reserve established with CGP funds meets HUD requirements. Responses to the collection are required by Section 14(e)(3) and (4) of the U.S.
Housing Act of 1937, as amended. The information requested does not lend itself to confidentiality.

Instructions for completing form HUD-52842, Annual Statement/Performance and
Evaluation Report on Replacement Reserve
For the Performance and Evaluation Report:
The first report after a replacement reserve has been established is due by 9/30 of the FFY
following approval of the Annual Statement establishing the reserve. Mark the box,
Performance and Evaluation Report for Program Year Ending _________. Submit one form
HUD-52842 annually with form HUD-52837, Annual Statement/Performance and Evaluation Report, as long as the HA maintains a balance in the replacement reserve or has
withdrawal/expenditure activity from the replacement reserve. At the end of each program
year (6/30), complete Part I, Section 1; also, complete Part I, Section 2, and Part II if there
has been withdrawal/expenditure activity. Where the replacement reserve has been funded
from more than one grant, submit one combined form HUD-52842.
For the Annual Statement:
Submit form HUD-52482 with Section 2 of Part I and Part II completed, for prior HUD
approval where the HA plans to withdraw/expend funds from the replacement reserve.

Line 5 - Replacement Reserve Balance at End of Previous Program Year - Enter the
replacement reserve balance from the previous program year (Account 2830). This amount
will be the same for the "Estimated" and "Actual" columns.
Line 6 - Replacement Reserve Balance at End of Current Program Year - Enter the sum of
Lines 4 and 5, plus or minus Line 3. For the "Actual" column, the number entered must agree
with the program year end closing balance of the replacement reserve.
Section 2 - Replacement Reserve Withdrawal Report
Once the replacement reserve has been established, prepare form HUD-52842 when the
HA plans to withdraw funds from the reserve. Complete Section 2 of Part I and Part II and
submit to HUD for approval. Complete this section for the annual Performance and
Evaluation Report when the HA has withdrawn/expended funds from the reserve.
Line 1 - Reserved - Do not use at this time.

Part I: Summary

Lines 2 - 15 - Summary by Account

HA Name - Enter the HA's name.

Column 1 - Original Estimated Cost -

Type of Submission - Check the appropriate box to indicate whether the submission is the
Original Annual Statement, the Revised Annual Statement (and revision number), or the
Performance and Evaluation Report for Program Year Ending (enter date; e.g., 6/30/97).

For each line, enter the original current program year estimated cost for all work to be
undertaken in a particular development account as a result of the withdrawal of funds from
the replacement reserve.

Section 1 - Replacement Reserve Status:

Column 2 - Revised Estimated Cost -

Line 1 - Replacement Reserve Interest Earned (Account 6200/1420.7) - Enter the estimated
amount of interest that the HA should have earned on the replacement reserve during the
reporting period in the "Estimated" column. This amount should, at a minimum, equal
interest at or above the operating budget TII rate (average 91-day Treasury Bill rate) for the
reporting period (July 1 through June 30). If Section 2 is completed, this amount must equal
Line 17, Column 1 (or 2, if applicable) of Section 2. Enter the actual interest earned during
the reporting period in the "Actual" column. If Section 2 is completed, this amount must
equal Line 17, Column 3 of Section 2.

For each line, enter any cost decrease or increase after initial approval by HUD. When the
HA wishes to draw down additional funds from the reserve for expenditure activities, the HA
shall reflect the cumulative dollar amount estimated to be expended and submit the form to
HUD for approval. After HUD approves the revisions, the dollars in the revised column shall
be reflected in the original column when the next Performance and Evaluation Report is
submitted.

Line 2 - Replacement Reserve Withdrawal - Enter the amount that was estimated to be
withdrawn from the replacement reserve during the reporting period in the "Estimated"
column. If Section 2 is completed, this amount must equal Line 16, Column 1 (or 2, if
applicable) of Section 2. Enter the actual withdrawal amount in the "Actual" column. If
Section 2 is completed, this amount must equal Line 16, Column 3 of Section 2.

For each line, enter the actual amount of funds expended as of the end of the program year
(6/30). Mark the box Performance and Evaluation Report for Program Year Ending
_______ and submit to HUD by 9/30. Note: If the amount expended in Column 3 is less
than the budgeted amount in Column 1 (or 2, if applicable), then the HA shall include the
unexpended amount in the subsequent years estimate or provide an explanation of the
change from the estimate.

Line 3 - Net Impact on Replacement Reserve - Enter the amount of Line 1 minus Line 2. If
Section 2 is completed, this amount must equal Line 18, Column 3 of Section 2.
Line 4 - Current FFY Funding for Replacement Reserve - Enter the amount of the increase
to the replacement reserve in the appropriate column. This amount must equal Line 15 of
Part I of form HUD-52837 for the current FFY.

Column 3 - Expended Actual Cost -

Line 16 - Replacement Reserve Withdrawal - Enter the sum of lines 2 through 15. The
amount in Column 1 (or 2, if applicable) must equal the estimated amount entered on Line
2 of Section 1. The amount entered in Column 3 must equal the actual amount entered on
Line 2 of Section 1.
form HUD-52842 (10/96)
ref. Handbook 7485.3

Line 17 - Replacement Reserve Interest Income Enter the interest income earned on
the replacement reserve (bracketed). The amount entered in Column 1 (or 2, if applicable)
must equal the estimated amount entered on Line 1 of Section 1. The amount entered in
Column 3 must equal the actual amount entered on Line 1 of Section 1.
Line 18 - Net Withdrawal from Replacement Reserve Subtract from Line 16, the amount
inside the brackets on Line 17 and enter on Line 18. The amount in Column 1 (or 2, if
applicable) must equal the estimated amount of Line 3 of Section 1. The amount entered
in Column 3 must equal the actual amount entered on Line 3 of Section 1.
Sample:
Line 16 - Replacement Reserve Withdrawal. .............. $10,000
Line 17 - Replacement Reserve Interest Income .......... ( 500)
Line 18 - Net Withdrawal from Replacement Reserve. $ 9,500
Line 19 - Amount of Line 16 Related to Lead-Based Paint (LBP) Activities. - Enter the
amount of line 16 related to LBP activities in Column 1 (or 2, if applicable). At the end of
the program year, enter the actual amount in Column 3.
Line 20 - Amount of Line 16 Related to Section 504 Compliance - Enter the amount of line
16 related to Section 504 compliance in Column 1 (or 2, if applicable). At the end of the
program year, enter the actual amount in Column 3.
Line 21 - Amount of Line 16 Related to Emergencies - The HA shall exhaust its replacement
reserve before being eligible to apply for funding for emergencies from the $75 million
reserve. Where applicable, enter the amount of the replacement reserve to be used for
emergencies in Column 1 (or 2, if applicable). At the end of the program year, enter the
actual amount in Column 3.

Part II: Supporting Pages
Development Number/Name - Enter the abbreviated number (e.g., VA-36-1) and the
name, if any, of each development where a major work category will be undertaken. Enter
“HA-wide” for work categories that relate to a HA-wide activity (e.g., management improvements, administration, nondwelling equipment, operations).
General Description of Major Work Categories - For each development listed, enter a
general description of the major work categories (physical or management, as applicable)
that will be undertaken at that development, with replacement reserve funds, before listing
major work categories to be undertaken at other developments. After listing all major work
categories for all developments being funded from the replacement reserve, enter a general
description of HA-wide activities, such as management improvements, administrative
costs, equipment, etc. When a work category is subsequently deleted, draw a line through
the General Description, Development Account Number, and Estimated Cost. When a
major work category is subsequently added, enter the new work category under the
appropriate development number. Enter the quantity of the work as a percentage or whole
number. Do not specify the per unit cost or the quality of materials.
Development Account Number - For each major work category and HA-wide activity that
will be funded from replacement reserve funds, enter the appropriate development account
which corresponds to the major work categories described under the General Description
of Major Work Categories column. For appropriate development accounts, refer to CGP
Handbook 7485.3.
Total Estimated Cost - For each major work category and HA-wide activity, enter the
Original Estimated Cost. Then enter a subtotal for each development and a grand total.
Where the estimated cost is revised, enter a Revised Estimated Cost as appropriate.
Total Actual Cost - For each major work category and HA-wide activity, enter the
cumulative dollar amount of all funds obligated and all funds expended opposite the Original
Estimated Cost. Then enter subtotals for each development and a grand total.
Status of Proposed Work - At the end of each program year, complete this section and
submit to HUD for the Performance and Evaluation Report. For each work category listed,
prepare a brief description of the status of the item, e.g., work completed, contract awarded
on 5/2/96, etc. Explain the addition, deletion or modification of any work categories, such
as the addition of any emergency work.

form HUD-52842 (10/96)
ref. Handbook 7485.3