HUD-92456 Semi-annual Performance Report

Semi-Annual Performance Report
Multifamily Housing
Service Coordinator Program

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

OMB Approval No. 2502-0447
(exp. 09/30/2013)

Federal Housing Commissioner

Public reporting burden for this collection of information is estimated to average X 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 collect this
information and you are not required to complete this form, unless it displays a currently valid control number.
existing
data sources,See
gathering
and
the data
needed, and completing and reviewing the collection of information. This agency may not collect this
Instructions:
pages
3 -maintaining
5tofor
detailed
information,
and you are not
required
complete
thisinstructions.
form, unless it displays a currently valid control number.

2. Service Coordinator Information
Email address:
Name:
Number of weekly hrs at project:
Phone w/ area code:

1. Reporting Period
Oct. 1 - Mar 1, 20___
Apr. 1 - Sept. 30, 20___

Hire date: _____/_____/__________

3. Source of funds for Service Coordinator (check all that apply)

Debit Service Savings

Residual Receipts

Project Rental Assistance Project (PRAC)

Grant­ Provide no.

Section 236 Excess Income

Section 8 Operating Funds

4. Project Information
Project Name

Street Name, City, State, and Zip code

# of Units

# of Residents

__

5. Neighbors Served. Number of low­income elderly or people with disabilities who live in the neighborhood and whom you assisted
durng the reporting period.

a. Resident Age Ranges

Age 18­61 (i.e., non­elderly people w/disabilities)

b. Residents Functional Status
Number of Project Residents
Type

Age 62­80

% of Total

Age 81­95

Over 96

Total

Number of SC Assisted During
Reporting Period

Frail Elders
At Risk Elders
(ADL)) (ADLs))
Non-elders
All others
Total
c. Neighbors Served
Number of low­income elderly or people with disabilites who live in the neighborhood and whom you assisted during the
reporting the period.

d. First Timers
Number of individuals whom you assisted for the first time during this reporting period.
Neighborhood residents
New move ins

All other project residents

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Form HUD 92456

6. Type of Service Coordination Performed
(For each service, provide the number of project and neighborhood residents whom you assisted and number of contacts you made.
Count the individuals only once, but provide the total numer of contacts for each individual.

residents only once

Service/Activities

# Contacts

# Individuals

Service/Activities

Advocacy

Legal Assistance

Assessments

Lease Education

# Individuals

# Contacts

Meals

Benefits/Entitlements

Mental Health Services

Case Management

Monitoring Services

Conflict Resolution

Outreach

Crisis Intervention/
Support Counseling
Education/Employment
Fair housing and Civil
Rights assistance

Resident Councils

Substance Abuse
Tax preparation services
Transfer to Alternative
Housing
Translation/Interpretation
Transportation

Family Support
General Info/Referral

Health
Care Services
Tax
Assistance
Home Management
Translation/Interpretation

Other (specify)

Homemaker
Isolation Intervention

7. Aging in Place Statistics for Residents Who Moved Out of the Project During the Reporting Period.
Move-Out Reasons

This Reporting Period

Last Reporting Period

Number of residents who died
.

Number of residents who moved to a higher level
of care

Number
of residents
residents who moved in with family
Number of
Number of residents evicted
Other
Other
l 100%)

Total number of move-outs

Contact with outside service providers

%(List approximate % of time per month you perform these tasks. Sum of all should
% equa
Meetings with management staff
%

Documentation of resident files

%

%

%

%

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Form HUD 92456

8. Time Allocation of Monthly Tasks (List approximate % of time per month you performed these tasks. Sum of all should equal 100%)
Contact with outside service provides

%

%

Direct contact with project and neighborhood residents
Documentation of resident files

Other

Paperwork not related to residents

%

Researching available spaces

%

%
Meetings with property management staff

%

%
Total 100%

Please respond to the following items 9­14 by attaching additional pages.
9. Professional Training Duration (hours or days)

List the training programs you attended during this reporting period. Provide the name of the training provider and program, its location,
number of hours, and the number of continuing education hours earned.
10. Educational / Preventative Health Programs
List the programs you implemented for project and/or neighborhood residents during this reporting period.

11. Fundraising
Fundraising activities are optional, but if you have engaged in any activities during the reporting period, please list them.
12. Community Engagement

List meetings or visits with community partners and attendance at or planning of community events that encourage interaction between the
community and project residents.
13. Resident Problems / Issues

Provide anecdotes (no more than two paragraphs each) describing two resident issues with which you were involved during this reportting
period.

14. Additional Information
Provide any other information relevant to the administration and performance of the Service Coordinator Program. Provide any
recommended "Best Practices" you have found to be effective in providing service coordination and promoting independent living for residents.

Date

Service Coordinator's Name

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Form HUD 92456

Instructions for Completing Form HUD-92456 General:
Service Cordinators whose positions are paid by any of the funding sources listed in item #3 must submit this Report.
Service Coordinators must fill out the form; respond to all questions on the report, provide their name and the date the
report is completed at the end of the form.
Multiple Service Coordinators, Projects, and Grants
* If one project has multiple Service Coordinators, each Service Coordinator should submit his/her own report.
* If one Service Coordinator serves multiple projects, submit one report per project. You may submit one form per project,
providing data for items1 through 8. You may attach just one text document responding to items 9 through 14.
* If one Service Coordinator position is supported by two or more grants at one project, submit one report and include
all grant numbers in item 3.
* If a Service Coordinator leaves his/her job during a reporting period, he or she must, to the extent possible, complete a
performance report for the time worked during that reporting period. If a new Service Coordinator starts during the same
reporting period, he or she should similarly complete a report for the time worked during that reporting period. The Service
Coordinator who finishes out the reporting period must send both reports to HUD, to provide data for the entire reporting period.
Method of Submission
It is preferred that you complete items 1 through 8 on the form on your computer and create a text file that contains brief responses
to items 9 through 14. Email both files together in one email to your representative in the HUD field office that services your project.
If you are unable to create or email electronic files, you may complete and submit a hard paper copy to your local HUD representative.
Specific Instructions for Each Item:
1. Reporting Period: All Service Coordinators must submit this Report according to the Federal Fiscal Year dates. The reporting
periods are October 1 through March 31 and April 1 through September 30. Your Report is due to your local Field Office 30 days
after the end of the reporting period, i.e. April 30 and October 30, respectively. Fill in the two-digit year on March 31 or September 30.
2. Service Coordinators Information. Enter your name, phone number, and email address. Provide the month and year you started
in this position. Indicate the number of hours you work each week at the project listed in item #4.
3. Source of Funds for the Service Coordinator.
Indicate all sources of HUD funding that are used to pay for your position. Many projects do use a combination of sources.
* If your position is supported by a HUD grant, check the "Grant" box and provide the grant number(s). The middle
four digits of this number must begin with: "C93", "C94", "CS", OR "HS". An example is OK56HS02002.
Do not provide your project's Section 8 number (e.g. OK56H789021).
* Check "Debt Service Savings", "Residual Receipts", or "Section 236 Excess Income if your local HUD office has approved
the use of thses funds for the Service Coordinator program.
* Check "Section 8 or Section 202 PRAC operating funds" if your local HUD office has approved the Service
Coordinator as an on­going permanent expense in your project's operating budget.
* Check multiple boxes if you use two or more HUD sources of funds to pay for your program. For example, many
programs are supported by a combination of grant funds and residual receipts or grant funds and Section 8 funds.
4. Project Information. Provide the name and address of the property where you work. Give the total number of units (i.e. apartments)
in the project and the total number of residents. Remember that if you serve two or more projects you must complete a separate
report for each project.
5. People Served
5a. Resident Age Ranges. Provide number of residents in each age category. The total of the four categories should match the
number of residents provided in item #4.
5b. Residents' Functional Status. Provide the estimated number of frail, at­risk, and well elderly (aged 62+) and the number of
non­elderly people with disabilities. (aged 18­61). The "All others" line refers to the "Well" elderly.
Indicate the number of residents in each category whom you assisted in any way duirng the reporting period. Do not count residents
twice. Regardless of the amount of time spent assisting one resident, only count that individual once. The total of the four categories in
the "Number of Project Residents" column should match the number of resident provided in tem #4.
A "Frail" elder is someone who has difficulty performing three or more Activities of Daily Living (ADLs). An "At­risk" elder is
one who has difficulty performing one or two ADLs. ADL deficiencies do not appy to non­elderly people with disabilities.
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Form HUD 92456

HUD's definition of ADLs includes eating, dressing, bathing, grooming, and transferring, as further described below:
(1) Eating--may need assistance with cooking, preparing, or serving food, but must be able to feed self;
(2) Bathing--may need assistance in getting in and out of the shower or tub, but must be able to wash self;
(3) Grooming--may need assistance in washing hair, but must be able to take care of personal appearance;
(4) Dressing--must be able to dress self, but may need occasional assistance;
(5) Transferring---actions such as going from a seated to standing position, getting in and out of bed, and using the toilet.
5c. Neighobors Servied. Provide the number of low-income elderly or people with disabilities who live in the neighborhood whom
you assisted during the reporting period (if any). Working with neighborhood residents is optional. HUD is interested in knowing how
many Service Coordinators serve the greater community and how many individuals are covered.
5d. First Timers. Provide the number of project residents and neighbors whom you assisted for the first time during the reporting period.
Make a distinction between those who moved in within the last six months ("New move-ins") and those who have lived in the
project or neighborhood longer, but only started coming to you for assistance during this reporting period.
6. Type of Service Coordination Performed. For each of the listed services, provide the sum of project residents and neighbors
( in the "Number of Individuals" column) who received that service during the reporting period. Provide the number of contacts
with all individual related to those services. Choose only the category you feel most appropriately represents the service you coordinated.
Count individuals once but report each contact with that one person. For example, you assisted three project residents in
obtaining transportation services during the reporting period. To do this you had to meet with one resident three times, another
resident five times and the third resident three times. So the number of individuals is three and the number of contacts is 11.
If you additionally helped one neighborhood resident obtain transportation services and if you met with that person three times
during the reporting period, then the number of individuals will be 4 and the number of contacts will be 14. Refer to the Glossary
of Service Types (HUD­92456­G) for explanations and examples of services.

7. Aging in Place Statistics. Provide the number of project residents who left the project during the reporting period.
Residents counted in this section must have been residents of the project at the time of their departure. Do not count
neighborhood residents. Provide the reason and number for each move-out. Add other reasons on the "Other" line if relevant.
HUD wants to know how the Service Coordinator program affects aging-in-place over time. Include the numbers from the last
report as a comparison. You'll do this on each subsequent report. If you are a new Service Coordinator and don't have a previous
report or access to previous data, indicate "No Data" in the revelant box.

8. Time Allocation of Monthly Tasks. List the approximate or average % of time per month you spent performing the listed tasks.
Add others if appropriate. Sum of all should equal 100% of your average time each month.
* Contact with outside service providers. Includes any activity related to obtaining information about or advocating for
affordable supportive services or assistance for residents. Such activity may include telephone conversations, face-to-face
meetings, coalition or task force meetings, or working groups.
* Direct contact with project and neighborhood residents. This is the time you spend with your residents, for example in
one­on­one meetings, informal conversation, while conducting needs screening, or at educational program gatherings.

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Form HUD 92456

* Documentation of resident files. Includes any notes you make, forms completed, or other information entered in
resident files.
* Meetings with property management staff. Includes meetings with site manager or administrator, supervisor,
other property management staff, or any other related meeting.
* Paperwork not related to a resident. Includes any reports written for management staff, supervisors, or peers.
Also revelant is paperwork related to registering for training, arranging travel, or purchasing supplies or equipment.
* Researching available services. Includes time spent searching for program information on the Internet, by phone,
reading literature, and meeting with knowledgeable professionals.
* Others. If you perform other work on a monthly basis, please list function and percentage of time.
Please attach a Microsoft Word (or other text file) that contains brief responses to items 9-14. Your report is not
complete without this additional document and adequate responses to each item.
Check the check-box on the form to indicate that you are attaching this document.

9. Professional Training Duration (hours or days)*. List the eligible training programs you attended during this
reporting period. Provide the following information for each program you attended:
* Name of the training program
* Name of sponsoring organization that planned and executed the training (i.e. training provider)
* Location
* Duradation (hours or days)
* Number of training hours completed

*Training pursuant to guidance in HUD's Management Agent Handbook 4381.5 REV­2 CHG­2, Chapter 8.9.
First time Service Coordinators must complete 36 hours in the first year of employment as a Service Coordinator,
unless they have received recent revelant training. All other Service Coordinators must complete 12 hours of eligible
training each year.

10. Educational and Preventative Health Programs. List the programs you developed and/or implemented for
project and/or neighborhood residents during this reporting period. Provide the name or topic of each program only and
give the approximate number of individuals who attended. Indicate whether events were one time only or ongoing programs.
Examples of such programs are talks on osteoporosis, nutrition, or accessibility issues for people with disabilities,
“brown bag” medication meetings with pharmacists, or remembrance groups.

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Form HUD 92456

11. Fundraising. List optional fundraising activities, if any, completed during this reporting period. Provide the name
or brief description of each activity, the amount of funds raised, and the intended use of these funds. Please note that
fundraising activities must relate to assisting the residents to age in place.

Examples of items that you might assist in fundraising include but are not limited to:
Another part-time Service Coordinator or aide position
Exercise equipment
Blood pressure machine for health clinic use
Ramp to make the project or immediate area more accessible
Purchase or lease of a van
Creation of computer Center and purchase of computer equipment
Examples of items that you should not directly engage in fundraising activities for include:
Holiday parties
Large screen TVs for community rooms
DVD players
Pianos and organs
Bingo sets

12. Community Engagement. List meetings with service providers and local area partners and attendance at or
planning of local events that encourage interaction between the greater community and project residents.
Community engagement is defined as follows:
* Visits or meetings with new service providers and/or local vendors, churches, schools, etc.
* Attendance at community organization events that would make the greater community aware of your property
and the needs of your residents.
* Planning events that encourage the greater community to visit and interact with project residents.

13. Resident Problems/Issues. Provide anecdotes (no more than two paragraphs each) describing two resident
issues with which you were involved during the reporting period. Indicate whether or not the issue was resolved during the
reporting period. Describe positive and/or negative outcomes. The objective of this item is to give readers of the report
a description of your work and the types of issues dealt with on a daily basis. Unresolved situations will be viewed as
examples of difficult problems or circumstances and not as a negative reflection on your efforts. Please be candid in
your account, in order to give the reader an accurate description of your work. Do not provide any personal identifiable
information.

14. Additional Information. Provide any other information relevant to the administration and performance of the Service
Coordinator Program. Provide any recommended "Best Practices" you have found to be effective in providing service
coordination and promoting independent living for the residents. Examples of your "Best Practices" will be essential in
helping others develop effective Service Coordinator programs and obtaining needed resources.

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Form HUD 92456