Form HUD 96010 HUD 96010 FSS

---

Overview

Instructions
Coversheet
Worksheet
Reporting
GoalsPriorities
Needs
Services
Outcomes
Tools

---

Sheet 1: Instructions

---

Sheet 2: Coversheet

2014 eLogic Model® Information Coversheet
				Instructions
		When completing this section, there are "mandatory" fields that must be completed. These fields are highlighted in yellow. The required data must be entered correctly to complete an eLogic Model®. Applicant Legal Name must match box 8a in the SF-424 in your application. Enter the legal name by which you are incorporated and pay taxes. Only complete the CCR Doing Business As Name field if your registration at CCR includes an entry in Doing Business as: (DBA). Enter the DUNS # as entered into box 8c of the SF-424 Application for Federal Assistance form. Enter the City where your organization is located. This information must match the SF-424 data in your application. Use the dropdown to enter the State where your organization is located. This information must match the SF-424 data in your application. Enter the Grantee Contact Name and the Grantee email address in the fields provided. Enter the eLogic Model® Contact Name and their email address in the fields provided. When completing the Project Information Section, applicants except Indian Tribes must enter their Project Name, Project Location City/County/Parish, and State. If there are multiple locations, enter the location where the majority of the work will be done. Indian tribes, including multi-state tribes should enter the City or County associated with their business address location. For Indian Tribes, enter the state applicable to the business address of the Tribal entity.
				Program Information
				HUD Program	FSS
				Program CFDA #	14.896
				Grantee Information
				Applicant Legal Name	Applicant Legal Name: Applicant Legal name must Match Box 8a in the SF-424 in your application. Enter the legal name by which you are incorporated and pay taxes.
				SAM.GOV Doing Business As Name	CCR Doing Business As Name: CCR Doing Business as is new for 2010. Only complete this field if your registration at CCR includes an entry in Doing Business as: (dba).
				DUNS Number	DUNS Number: Enter the DUNS # as entered into box 8c of the SF-424 Application for Federal Assistance form.
				City	City: Enter the City where your organization is located, this information must match the SF-424 data in your application
				State	State: Use the dropdown to enter the State where your organization is located, this information must match the SF-424 data in your application.
				Zip Code	Zip Code Enter the first 5 digits of your 9 digit zip code here.	­	Zip Code: Enter the last 4 digits of your 9 digit zip code here.
				Grantee Contact Name
				Grantee Contact email
				Logic Model Contact Name
				Logic Model Contact email
				Project Information
				Project Name	Project Name: Use exactly the same name as you did on box 15 of the form SF-424. If you are submitting multiple applications under the same applicant name for the same HUD program, you must include a project name that can distinguish between the two applications and logic models submitted, e.g., HBCU_DillardAffordableHousing15, HBCU_DillardAffordableHousing16. If the project name is not known at time of application, then insert TBD1, TBD2, etc., e.g., HBCU_DillardTBD1, HBCU_DillardTBD2.
				Project Location City/County/Parish	Project Location City/County/Parish: Applicants, except Indian Tribes, will enter the city, township, County/Parish, where the project will be located. If there are multiple locations, enter the location where the majority of the work will be done. Indian Tribes, including multi-state tribes, should enter the city or county associated with their business address location.
				Project Location State	Project Location State: Use the dropdown menu to select the location of your project. The data field label, “Project Location State” includes all fifty states and American Samoa, District of Columbia, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, and, Virgin Islands. In the case of multi-state, or regional entities, enter the State location where the majority of activities are to occur. For Indian Tribes, enter the state applicable to the business address of the Tribal entity.
				Zip Code	Zip Code Enter the first 5 digits of your 9 digit zip code here.	­	Zip Code: Enter the last 4 digits of your 9 digit zip code here.
				Additional Information for Reporting (Leave Blank At the Time of Application)
				HUD Award Number	HUD Award Number: When you submit your report enter your HUD Award Number here.

---

Sheet 3: Worksheet

eLogic Model®

Worksheet

OMB Approval 2535-0114 exp. 08/31/2014

Applicant Legal Name

0

CCR Doing Business As Name

0

HUD Program

FSS

Reporting Period

Projection

Reporting Start Date

DUNS No.

0

Project Name

0

Reporting End Date

FY 2014

HUD Goals

Policy Priority

Needs

Services/Activities

Measures

Outcomes

Measures

Evaluation Tools

1

2

3

4

5

6

7

Policy

Planning

Programming

Projection

Annual

Extension

Impact

Projection

Annual

Extension

Accountability

3c

1a 1b 1c 4c 5a 5c

There is a need to link new FSS program participants to services and economic opportunities that will lead to employment and economic self-sufficiency. There is a need to maintain on-going linkages to services and economic opportunities for existing FSS program participants in order to support their transition to employment and economic self-sufficiency.

Child Care-Families linked to Child Care Services

Households

Persons

Education-Associates degree obtained

A. Tools for Measurement

Education-Participation in Adult Basic Education

Persons

Persons

Education-Bachelors degree obtained

Education-Participation in ESL classes

Persons

Persons

Education-Adult Basic Education-Completed

Education-Participation in High School/GED program

Persons

Persons

The Extension field is only to be used if given an extension from HUD. Report only new activity defined as activity that begins and ends with the dates of the extension. Do not add activity reported in Annual.

Education-Certification from technical school

B. Where Data Maintained

Education-Participation in Post secondary classes

Persons

Persons

Education-ESL-Completed

Employment-Job retention activities

Persons

Persons

Education-GED/High School diploma obtained

Financial Literacy-Escrow accounts established

Persons

Persons

Employment-Employment obtained (including apprenticeship)

C. Source of Data

Financial Literacy-Tax Preparation assistance provided

Persons

Persons

Employment-Employment increased from part-time to full-time (32+ hours)

Financial Literacy-IDA accounts (not escrow) established

Persons

Persons

Employment-Promotion/new job resulting in increased hourly wage

Financial Literacy-Individualized Counseling

Persons

Persons

Employment-Maintain employment greater than one year

D. Frequency of Collection

Financial Literacy-Classroom Setting Financial Education (participation)

Persons

Persons

Employment-Employer-Provided health benefits obtained

Health-Referral for health care services (physical/dental)

Persons

Households

Financial Literacy-EITC received

Health-Referral for mental health services

Persons

Households

Housing-Increased earned income results in no longer needing rental assistance

E. Processing of Data

Health-Referral for substance abuse services

Persons

Households

Housing-Purchased home with HCV Homeownership Assistance

Housing-Homeownership counseling

Persons

Households

Housing-Purchased home without HCV Homeownership Assistance

Service Coordination-New families enrolled (new CoPs)

Households

Service Coordination-Families continuing to receive service coordination

Households

Service Coordination-Families graduated

Households

Service Coordination-Individuals served (unduplicated count)

Persons

Training-Job Preparation/Counseling (soft skills)-Enrolled

Persons

Training-Job Preparation/Counseling (soft skills)-Completed

Persons

Training-Job Training (for specific job/type of job)-Enrolled

Persons

Training-Job Training (for specific job/type of job)-Completed

Persons

Training-Parenting/Household Skills/Life Skills (non-job training)-Enrolled

Persons

Training-Parenting/Household Skills/Life Skills (non-job training)-Completed

Persons

Transportation-Transportation services to enable service provision/employment

Persons

---

Sheet 4: Reporting

	Carter-Richmond Methodology
	The Management Questions developed for your program are based on the Carter-Richmond Methodology.* A description of the Carter-Richmond Methodology appears in the General Section of the NOFA.
	* © The Accountable Agency – How to Evaluate the Effectiveness of Public and Private Programs,” Reginald Carter, ISBN Number 9780978724924
	Response to Management Questions	Measure	Answer
1	How many households were under Contracts of Participation (unduplicated count)?	Households
2	How many persons received services (unduplicated count)?	Persons
3	How many partners are providing services (unduplicated count)?	Partners
4	How many households successfully completed their Contract of Participation/Graduated?	Households
5	What is the value of the dollars and services leveraged by this grant?	Dollars	$0.00
	Please work with your service partners to determine a dollar value for each service provided. For example, if the cost of a GED class is $300 and three FSS participants attend, the reported value would be $900. Repeat this for any services provided by your partners and add the total. If the grant was also used to leverage cash, please add this to the total. If you would like to provide any additional details on the value of leveraged services and funds, please use the blank text box below the field labeled, Explanation of Any Deviations from the Approved eLogic Model®
6	How many persons receiving services are under the age of 6?	Persons
7	How many persons receiving services are ages 6-17?	Persons
8	How many persons receiving services are ages 18-30?	Persons
9	How many persons receiving services are ages 31-50?	Persons
10	How many persons receiving services are ages 51-61?	Persons
11	How many persons receiving services are over 62 years of age?	Persons
	(The total number of persons reported in questions 6-11 should equal the total number of unduplicated individuals reported in question 2 above).
	ALABAMA
	ALASKA
	AMERICAN SAMOA
	ARIZONA
	ARKANSAS
	CALIFORNIA
	COLORADO
	CONNECTICUT
	DELAWARE
	DISTRICT OF COLUMBIA
	FEDERATED STATES OF MICRONESIA
	FLORIDA
	GEORGIA
	GUAM
	HAWAII
	IDAHO
	ILLINOIS
	INDIANA
	IOWA
	KANSAS
	KENTUCKY
	LOUISIANA
	MAINE
	MARSHALL ISLANDS
	MARYLAND
	MASSACHUSETTS
	MICHIGAN
	MINNESOTA
	MISSISSIPPI
	MISSOURI
	MONTANA
	NEBRASKA
	NEVADA
	NEW HAMPSHIRE
	NEW JERSEY
	NEW MEXICO
	NEW YORK
	NORTH CAROLINA
	NORTH DAKOTA
	NORTHERN MARIANA ISLANDS
	OHIO
	OKLAHOMA
	OREGON
	PALAU
	PENNSYLVANIA
	PUERTO RICO
	RHODE ISLAND
	SOUTH CAROLINA
	SOUTH DAKOTA
	TENNESSEE
	TEXAS
	UTAH
	VERMONT
	VIRGIN ISLANDS
	VIRGINIA
	WASHINGTON
	WEST VIRGINIA
	WISCONSIN
	WYOMING

---

Sheet 5: GoalsPriorities

	HUD Goals			HUD Priorities
1A	Strengthen the Nation’s Housing Market to Bolster the Economy and Protect Consumers (1A) Stem the foreclosure crisis.		1a	Job Creation/Employment (1a) Improving access to job opportunities through information sharing, coordination with federal, state, and local entities, and other means.
1B	Strengthen the Nation’s Housing Market to Bolster the Economy and Protect Consumer (1B) Protect and educate consumers when they buy, refinance or rent a home.		1b	Job Creation/Employment (1b) Increasing access to job training, career services, and work, supports through coordination with federal, state, and local entities.
1C	Strengthen the Nation’s Housing Market to Bolster the Economy and Protect Consumers (1C) Create financially sustainable homeownership opportunities.		1c	Job Creation/Employment (1c) Expanding economic and job creation opportunities for low-income residents and creating better transportation access to those jobs and other economic opportunities by partnering with federal and nonprofit agencies, private industry, and planning and economic development organizations and by leveraging federal and private resources.
1D	Strengthen the Nation’s Housing Market to Bolster the Economy and Protect Consumers (1D) Establish an accountable and sustainable housing finance system.		2a	Sustainability (2a) Promote and preserve community assets including small businesses, fresh food markets, parks, hospitals, and quality schools by incentivizing comprehensive and inclusive local economic development planning.
2A	Meet the Need for Quality Affordable Rental Homes (2A) End homelessness and substantially reduce the number of families and individuals with severe housing needs.		2b	Sustainability (2b) Give consumers more information about the true cost of living by incorporating both housing and transportation costs into measures of affordability.
2B	Meet the Need for Quality Affordable Rental Homes (2B) Expand the supply of affordable rental homes where most needed.		2c	Sustainability (2c) Improve residents’ health and safety, particularly that of children and other vulnerable populations, by promoting green and healthy design, construction, rehabilitation, and maintenance of housing and communities.
2C	Meet the Need for Quality Affordable Rental Homes (2C) Preserve the affordability and improve the quality of federally assisted and private unassisted affordable rental homes.		2d	Sustainability (2d) Support and promote an energy-efficient, green, and healthy housing market by retrofitting existing housing, supporting energy-efficient new construction, improving home energy labeling, and promoting financing products that reduce the carbon footprint of non-HUD-supported residential buildings.
2D	Meet the Need for Quality Affordable Rental Homes (2D) Expand families' choices of affordable rental homes located in a broad range of communities.		2e	Sustainability (2e) Reduce energy consumption and incorporate green building practices in the design and operation of HUD-supported affordable housing.
3A	Utilize Housing as a Platform for Improving Quality of Life (3A) Utilize HUD assistance to improve educational outcomes and early learning and development.		2f	Sustainability (2f) Promote coordinated planning, integrating federal resources, and targeting technical assistance at the local, state, and regional levels for sustainable housing and communities.
3B	Utilize Housing as a Platform for Improving Quality of Life (3B) Utilize HUD assistance to improve health outcomes.		2g	Sustainability (2g) Promote the design and construction of buildings and communities that are accessible and visitable by people with disabilities.
3C	Utilize Housing as a Platform for Improving Quality of Life (3C) Utilize HUD assistance to increase economic security and self-sufficiency.		2h	Sustainability (2h) Promote the use of climate-resilient and disaster-resistant building design, construction and siting.
3D	Utilize Housing as a Platform for Improving Quality of Life (3D) Utilize HUD assistance to improve housing stability through supportive services for vulnerable populations including the elderly, people with disabilities, homeless people, and those individuals and families at risk of becoming homeless.		2i	Sustainability (2i) Encourage metropolitan and regional focus in planning and community development.
3E	Utilize Housing as a Platform for Improving Quality of Life (3E) Utilize HUD assistance to improve public safety.		3a	Affirmatively Furthering Fair Housing (3a) Regional coordination of affirmatively furthering fair housing plans, including such activities as developing regional analyses of impediments.
4A	Build Inclusive and Sustainable Communities Free from Discrimination (4A) Catalyze economic development and job creation, while enhancing and preserving community assets.		3b	Affirmatively Furthering Fair Housing (3b) Regional strategies to reduce racially segregated living patterns and other effects of formely de jure segregated public or assisted housing in metropolitan areas with a year 2000 dissimilarity index of 70 or higher and where the minority population is at least 20,000 or 3 percent of the total population in the Core Based Statistical Area (CBSA), whichever is greater.
4B	Build Inclusive and Sustainable Communities Free from Discrimination (4B) Promote energy efficient buildings and location efficient communities that are healthy, affordable and diverse.		3c	Affirmatively Furthering Fair Housing (3c) Decreasing the concentration of poverty and racial segregation in neighborhoods and communities through strategic targeting of resources.
4C	Build Inclusive and Sustainable Communities Free from Discrimination (4C) Ensure open, diverse, and equitable communities.		3d	Affirmatively Furthering Fair Housing (3d) Promoting visitability for persons with disabilities in single-family housing.
4D	Build Inclusive and Sustainable Communities Free from Discrimination (4D) Facilitate disaster preparedness, recovery and resiliency.		4a	Capacity Building and Knowledge Sharing (4a) Develop, target and deliver technical assistance for increasing affordability in areas experiencing increased rental costs due to development.
4E	Build Inclusive and Sustainable Communities Free from Discrimination (4E) Build the capacity of local, state and regional public and private organizations.		4b	Capacity Building and Knowledge Sharing (4b) Strengthen the capacity of state and local partners, including governments and nonprofit organizations, to implement HUD programs, participate in decision making and planning processes, and coordinate on cross-programmatic, place-based approaches through grantmaking and technical assistance.
5A	Transform the Way HUD Does Business (5A) Build Capacity: Create a flexible and high performing learning organization with a motivated, skilled workforce.		4c	Capacity Building and Knowledge Sharing (4c) Support knowledge sharing and innovation by disseminating best practices, encouraging peer learning, publishing data analysis and research, and helping to incubate and test new ideas.
5B	Transform the Way HUD Does Business (5B) Focus on Results: Create an empowered organization that is customer-centered, place based, collaborative, and responsive to employee feedback and focused on results.		5a	Using Housing as a Platform for Improving Other Outcomes (5a) Increasing access to high quality early learning programs and services through coordination with local programs.
5C	Transform the Way HUD Does Business (5C) Bureaucracy Busting: Create flexible, modern rules and systems that promote responsiveness, openness and transparency.		5b	Using Housing as a Platform for Improving Other Outcomes (5b) Providing physical space to co-locate healthcare and wellness services with housing (e.g., on-site health clinics).
5D	Transform the Way HUD Does Business (5D) Culture Change: Create a healthy, open, flexible work environment that reflects the values of HUD’s mission.		5c	Using Housing as a Platform for Improving Other Outcomes (5c) Increasing access to public benefits (such as Temporary Assistance to Needy Families and Supplemental Security Income) through outreach and other means.
			5d	Using Housing as a Platform for Improving Other Outcomes (5d) Maintaining or improving the physical environment and design of HUD-assisted residences, giving attention to physical safety and crime prevention.
			5e	Using Housing as a Platform for Improving Other Outcomes (5e) Providing mobility counseling to increase access to neighborhoods of opportunity.
			6a	Expand Cross-Cutting Policy Knowledge (6a) Support knowledge sharing and innovation by disseminating best practices, encouraging peer learning, publishing data analysis and research, and helping to incubate and test new ideas.

---

Sheet 6: Needs

CAMP eLogic Model®

Column 2

NEEDS

There is a need to link new FSS program participants to services and economic opportunities that will lead to employment and economic self-sufficiency.

There is a need to maintain on-going linkages to services and economic opportunities for existing FSS program participants in order to support their transition to employment and economic self-sufficiency.

---

Sheet 7: Services

CAMP eLogic Model®
Column 3
SERVICES/ACTIVITIES	UNITS
Child Care-Families linked to Child Care Services	Households
Education-Participation in Adult Basic Education	Persons
Education-Participation in ESL classes	Persons
Education-Participation in High School/GED program	Persons
Education-Participation in Post secondary classes	Persons
Employment-Job retention activities	Persons
Financial Literacy-Escrow accounts established	Persons
Financial Literacy-Tax Preparation assistance provided	Persons
Financial Literacy-IDA accounts (not escrow) established	Persons
Financial Literacy-Individualized Counseling	Persons
Financial Literacy-Classroom Setting Financial Education (participation)	Persons
Health-Referral for health care services (physical/dental)	Persons
Health-Referral for mental health services	Persons
Health-Referral for substance abuse services	Persons
Housing-Homeownership counseling	Persons
Service Coordination-New families enrolled (new CoPs)	Households
Service Coordination-Families continuing to receive service coordination	Households
Service Coordination-Families graduated	Households
Service Coordination-Individuals served (unduplicated count)	Persons
Training-Job Preparation/Counseling (soft skills)-Enrolled	Persons
Training-Job Preparation/Counseling (soft skills)-Completed	Persons
Training-Job Training (for specific job/type of job)-Enrolled	Persons
Training-Job Training (for specific job/type of job)-Completed	Persons
Training-Parenting/Household Skills/Life Skills (non-job training)-Enrolled	Persons
Training-Parenting/Household Skills/Life Skills (non-job training)-Completed	Persons
Transportation-Transportation services to enable service provision/employment	Persons

---

Sheet 8: Outcomes

CAMP eLogic Model®
Column 5
OUTCOMES	UNITS
Education-Associates degree obtained	Persons
Education-Bachelors degree obtained	Persons
Education-Adult Basic Education-Completed	Persons
Education-Certification from technical school	Persons
Education-ESL-Completed	Persons
Education-GED/High School diploma obtained	Persons
Employment-Employment obtained (including apprenticeship)	Persons
Employment-Employment increased from part-time to full-time (32+ hours)	Persons
Employment-Promotion/new job resulting in increased hourly wage	Persons
Employment-Maintain employment greater than one year	Persons
Employment-Employer-Provided health benefits obtained	Persons
Financial Literacy-EITC received	Persons
Housing-Increased earned income results in no longer needing rental assistance	Households
Housing-Purchased home with HCV Homeownership Assistance	Households
Housing-Purchased home without HCV Homeownership Assistance	Households

---

Sheet 9: Tools

CAMP eLogic Model®

A. Tools For Measurement

Bank accounts

Construction log

Database

Enforcement log

Financial aid log

Intake log

Interviews

Mgt. Info. System-automated

Mgt. Info. System-manual

Outcome scale(s)

Phone log

Plans

Pre-post tests

Post tests

Program specific form(s)

Questionnaire

Recruitment log

Survey

Technical assistance log

Time sheets

B. Where Data Maintained

Agency database

Centralized database

Individual case records

Local precinct

Public database

School

Specialized database

Tax Assessor database

Training center

C. Source of Data

Audit report

Business licenses

Certificate of Occupancy

Code violation reports

Counseling reports

Employment records

Engineering reports

Environmental reports

Escrow accounts

Financial reports

GED certification/diploma

Health records

HMIS

Inspection results

Lease agreements

Legal documents

Loan monitoring reports

Mortgage documents

Payment vouchers

Permits issued

Placements

Progress reports

Referrals

Sale documents

Site reports

Statistics

Tax assessments

Testing results

Waiting lists

Work plan reports

D. Frequency of Collection

Daily

Weekly

Monthly

Quarterly

Biannually

Annually

Upon incident

E. Processing of Data

Computer spreadsheets

Flat file database

Manual tallies

Relational database

Statistical database