Form 52735-as Annual Performance Report

Annual Performance Report

These forms meet the minimum requirements for an Annual Performance Report (APR) required by the United States Department of Housing and Urban Development. In addition to these minimum requirements, a tribe/tribally designated housing entity (TDHE) may elect to prepare a more comprehensive APR. If a tribe/TDHE elects to prepare a more comprehensive report, the required elements of this APR must still be submitted on the prescribed HUD forms.

A nnual Performance Report

Under the Native American Housing Assistance and Self-Determination Act of 1996 (NAHASDA) (25 U.S.C. 4104 et seq.) HUD will provide grants, loan guarantees, and technical assistance to Indian tribes and Alaskan Native villages for the development and operation of low-income housing in Indian areas. Grants will be made to eligible recipients under the Indian Housing Block Grant Program. To be eligible for the grants, respondents must submit an Indian Housing Plan that meets the minimum requirements of the Act, consult with residents, prepare Title VI application/certification, submit performance reports, and maintain records for HUD monitoring and audit review.

Public reporting burden for this collection of information is estimated to average 120 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. Recipients of Indian Housing Block Grant (IHBG) program funds are required to submit an Annual Performance Report (APR) to HUD within 60 days of the end of their program year. Statutory reference is contained in the Native American Housing Assistance and Self-Determination Act (NAHASDA) of 1996, as amended, Sec. 404 Performance Reports. The regulatory reference is found at 24 CFR Part 1000, sections 512 through 521. Response to the Annual Performance Report is mandatory and is required by Sections 403 and 404 of NAHASDA and by the regulations at 24 CFR 1000.
The information requested does not lend itself to confidentiality.

This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

A nnual Performance Report

Recipients of NAHASDA funds are required to prepare and submit an Annual Performance Report (APR) within 60 days of the end of the program year. The APR shall contain the information required below and narrative statements as needed.

The Annual Performance Report consists of the following parts:

Cover sheet - General information on the tribe or TDHE

Part I - Reporting on the One-Year Indian Housing Plan

Table I - Sources of Funds

Table II - Uses of Funds

Part II - Reporting on Program Year Accomplishments

Section A - Monitoring

Table III - Inspection of Assisted Housing

Section B - Audits

Section C - Public Accountability

Section D - Jobs Created by NAHASDA

Part I (including Tables I and II) – One separate part must be submitted for each open grant.

Part II (including Sections A, B, C, and Table III) – This part is not grant specific. A single part is to be prepared and submitted at the end of each program year and will cover all open grants.

Part D (including Table IV) – This part is optional.

Annual Performance Report

Cover Sheet

1. APR is submitted by (mark one): tribe TDHE

2. Reporting period for which this APR is prepared: from: ________________ to: ____________________

^{(mm/dd/yy) (mm/dd/yy)}

3. Recipient Name and Address
4. Name of Contact Person	Title		Telephone no. (include Area Code)
If APR is submitted by the TDHE 5. Enter the name of each tribe included in this APR
6. Name of official authorized to submit APR		Title
Signature		Date
Certification: The information contained in this report is accurate and reflects the activities actually accomplished during the reporting period. Activities planned and accomplished are eligible under applicable statutes and regulations and were included in the applicable one year activities in the corresponding Indian Housing Plan. Warning: If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Title 18 of the United States Code. In addition, any person who knowingly and materially violates any required disclosure of information, including intentional disclosure, is subject to civil money penalty not to exceed $10,000 for each violation. For HUD use only
Date APR is received by HUD	Time		logged in by

PART I - REPORTING ON THE ONE-YEAR INDIAN HOUSING

PLAN (IHP)

One separate Part I (that includes Tables I and II) must be submitted for each open grant.

Grant Number:

Enter the date HUD notified you that your IHP was found in compliance:

____________ (mm/dd/yy)

Is this the final APR for this grant?

Check one:

yes

no

Each year, you develop goals and objectives and performance objectives in the IHP that describe the use of your IHBG funds. At the end of the program year, you report on the progress made towards achievement of them.

1. Please report on each of the one-year goals and objectives and report on each of the performance objectives identified in the IHP for this reporting period only in a format as follows:
   Note: Goals and Objectives should be reported from inception to the present while the performance objectives should be reported for the reporting period only.
   
   
   
   

GOAL # ____		Goal as identified in the IHP:
	Objective #_____	Objective as identified in the IHP:
	Performance Objective #_____	Performance objective relating to the above listed goal and its objective(s) as identified in the IHP:
	Accomplishment(s)	Progress made toward completion of the goal and objective(s) as they relate to this performance objective:
	No accomplishment	If no progress was made, explain why not and describe what you will do to complete the activities:

Repeat this format for each one year goal and objective(s) and performance objective(s) in the IHP for this grant.

2. Are you on schedule to complete the 5-year goals identified in your IHP?
   
   

Check one:

yes

no

3. If the answer to #2 is no, explain causes for delays and how you plan to modify your program to meet your 5-year goals and objectives.

4. How would you change your programs in general as a result of your experience with the implementation of NAHASDA?

Grant Number:

Table I - Sources of Funds

Sources of Funds for IHBG Activities	Planned Amount (from the IHP)	Amount Actually Awarded
(a)	(b)	(c)
1. HUD Resources
a. NAHASDA Block Grant
b. NAHASDA Program Income
c. NAHASDA Title VI (Federal Guarantee)
d. Section 184 Loan Guarantee
e. Indian Community Development Block Grant
f. Drug Elimination
g. Prior year funds
h. Other (explain in narrative)
2. Existing Program Resources
a. 1937 Housing Act Programs
b. Other HUD Programs
3. Other Federal or State Resources
a. BIA Home Improvement Program
b. Other (explain in narrative)
4. Private Resources
a. Tribe
b. Financial Institution
c. Other (explain in narrative)
5. Other (explain in narrative)
Total Resources

Narrative:

1. If column c is less than column b, explain why the planned funds were not realized.

Grant Number:

Table II - Uses of Funds

		Cumulative
Activity	Budgeted Amount (from the IHP)	Grant (IHBG) funds expended	Other funds expended	Total funds expended from all sources (c + d)	Percentage of IHBG Grant Amount Obligated
(a)	(b)	(c)	(d)	(e)	(f)
1. Indian Housing Assistance (1937 Housing Act units)
a. Modernization
b. Operating
2. Development
a. Rental
i. Construction of new units
ii. Acquisition
iii. Rehabilitation
b. Homeownership
i. Construction of new units
ii. Acquisition
iii. Rehabilitation
3. Housing Services
4. Housing management services
5. Crime Prevention & Safety
6. Model Activities
7. Planning & administration
8. Reserves
9. Other
Total

Table II (continued)

		Cumulative
Activity	Number of units planned (from the IHP)		Number of units completed	Number of units started not completed	Number of families assisted
(a)	(g)		(h)	(i)	low-income Indian families	non low-income Indian families	non-Native American
					(j)	(k)	(l)
Indian Housing Assistance (1937 Act units)
Modernization
Operating
Development
Rental
Construction of new units
Acquisition
Rehabilitation
Homeownership
Construction of new units
Acquisition
Rehabilitation
Housing Services
Housing Management Services
Crime Prevention & Safety
Model Activities
Planning & administration
Reserves
Other
Total

Narrative:

1. Column (a), line item #8, Reserves: Identify the purpose for the funds you placed in this category.

2. Explain any unexpected cost overruns associated with IHBG funds.

3. Investments: Date HUD approved: ________________

^(mm/dd/yy)

Amount approved for investment: $_______________

Amount of IHBG funds (principal only) invested as of this reporting period end date:

$ _______________

Part II - Reporting on Program Year Accomplishments

This Part is not grant specific. A single Part II consisting of Sections A through D (including Table III), is to be prepared and submitted at the end of each program year and will cover all open grants.

SECTION A - MONITORING

I. Self-Monitoring: Sec 403(b) of the NAHASDA statute and §1000.502 of the program regulations require that the recipient and the tribe are to be involved in monitoring activities. You are responsible for monitoring your grant activities to ensure compliance with NAHASDA and its implementing regulations, and for monitoring the performance goals included under the IHP. In addition, if you are the TDHE, the tribe is responsible for monitoring your programmatic performance for compliance with the IHP, its stated goals and objectives, and the NAHASDA statute and its implementing regulations.

If you are a tribe reporting as the recipient, answer questions 1, 2 and 5. If you are a TDHE, answer all of the questions in this part.

1. Briefly describe the self monitoring systems and internal control procedures you used and those you implemented during the past year to assure that program activities comply with NAHASDA and its program regulations.

2. If you are a tribe or a TDHE reporting as the recipient:

1. List the activities you monitored:

2. Describe the results of each monitoring activity:
   
   
   
   
   
   
   
   

3. Describe any required corrective action:
   
   
   
   
   

3. If you are a TDHE (in addition to answering #2):
   
   

4. Describe the procedures the tribe used to monitor your affordable housing activities:
   
   
   
   
   
   
   

5. List your activities the tribe monitored:
   
   
   
   
   
   
   

6. Describe the results of the activities the tribe monitored:
   
   
   
   
   
   
   

7. Describe any corrective action required:

4. If you are a TDHE, describe any issues regarding your program activities that were referred to the tribe by HUD, an auditor, etc. and your responses to them.

4. Describe any monitoring activities you conducted of your sub-recipients.

II. Inspection of Units: Per 403(b) of NAHASDA, a monitoring program must include an on-site inspection of all housing units assisted with NAHASDA funds and 1937 Housing Act funds. Use Table III to record the results of the assisted housing units inspected in this reporting period.

Table III - Inspection of Assisted Housing

			Units Inspected
Activity		Total number of units	Total number of units Inspected (total d through g)	Number of units in standard condition	Number of units needing rehabilitation (costing less than $20,000)	Number of units needing rehabilitation (more than $20,000)	Number of units needing to be replaced
(a)		b.	c.	d.	e.	f.	g.
1937 Housing Act funded units
Mutual Help
Low Rent
Turnkey III
Other
NAHASDA funded units
Owned or managed by recipient
Homeownership
Rental
Temporary housing
Other
Total

Narrative:

1. Describe your plan of action for complying with your inspection policy:

2. If applicable, explain why all units were not inspected:

3. Describe the process you use to perform inspections on units you do not own or manage which are assisted with IHBG funds:

SECTION B - AUDITS

Per 24 CFR 1000.544, IHBG recipients must comply with the requirements of the Single Audit Act and OMB Circular A-133 which require annual audits of recipients that expend Federal funds equal to or in excess of an amount specified by the U.S. Office of Management and Budget. (Currently set at $500,000). Audit reports are to be submitted to HUD within 30 days after receipt or nine months after the end of the audit period (whichever is soonest). Per 24 CFR 1000.548, if a copy of the audit has not already been submitted, it must be submitted with the APR.

1. For this program year, did you expend Federal funds equal to or more than $500,000?

Check one:

yes

no

2. If the audit is not submitted with this APR, the time period your last audit was covered is _______________ to _______________ ^(mm/dd/yy)

^(mm/dd/yy)

2. If you are a TDHE, will your housing activities be included in the tribe’s audit (in which case you will not be submitting an audit for this period)?

Check one:

yes

no

4. If the answer to #3 is no, have you submitted your latest audit report to the tribe in accordance with 24 CFR 1000.550?

Check one:

yes

no

SECTION C - Public Accountability:

1. Did you make this APR available to the citizens in your jurisdiction before it was submitted to HUD per 24 CFR 1000.518?

Check one:

yes

no

2. If you are a TDHE, did you submit this APR to the tribe per 24 CFR 1000.512?

Check one:

yes

no

N/A

3. If you answered no to question #1 and/or #2, provide an explanation as to why not and indicate when you will do so.

3. Summarize any comments received from citizens:

3. Summarize any comments received from the tribe if applicable:

SECTION D - Jobs Created by NAHASDA

Submission of this table is optional . The information provided in this table may be used to respond to inquiries from Congress, other Federal agencies, and the public regarding the impact of the IHBG Program.

Table IV - Jobs Created by NAHASDA

	Number of permanent positions created	Number of temporary positions created	Number of positions needed to implement NAHASDA
(a)	(b)	(c)	(d)
Indian Housing Block Grant Assistance

Narrative:

Previous editions are obsolete. Page 8 form HUD-52735-AS (01/2007)