HUD-50075.2 Annual Statement/Performance and Evaluation Report Capit

Capital Fund Program—Five-Year Action Plan U.S. Department of Housing and Urban Development

Office of Public and Indian Housing

OMB No. 2577-0226

Expires 4/30/20011

Part I: Summary
PHA Name/Number		Locality (City/County & State) Original 5-Year Plan Revision No:
	Development Number and Name	Work Statement Work Statement for Year 2 for Year 1 FFY	Work Statement for Year 3 FFY	Work Statement for Year 4 FFY	Work Statement for Year 5 FFY
		FFY _______
	Physical Improvements Subtotal	Annual Statement
	Management Improvements
	PHA-Wide Non-dwelling Structures and Equipment
	Administration
	Other
	Operations
	Demolition
	Development
	Capital Fund Financing – Debt Service
	Total CFP Funds
	Total Non-CFP Funds
	Grand Total

Part I: Summary (Continuation)
PHA Name/Number Locality (City/county & State) Original 5-Year Plan Revision No:
	Development Number Work Work Statement for Year 2 and Name Statement for FFY	Work Statement for Year 3 FFY	Work Statement for Year 4 FFY	Work Statement for Year 5 FFY
	Year 1 FFY _______
	Annual Statement

P art II: Supporting Pages – Physical Needs Work Statement(s)
Work Statement for Year 1 FFY ______	Work Statement for Year FFY			Work Statement for FFY	Year:
	Development Number/Name General Description of Major Work Categories	Quantity	Estimated Cost	Development Number/Name General Description of Major Work Categories	Quantity	Estimated Cost
See
Annual
Statement
Subtotal of Estimated Cost			$	Subtotal of Estimated Cost		$

P art II: Supporting Pages – Physical Needs Work Statement(s)
Work Statement for Year 1 FFY ______	Work Statement for Year			Work Statement for Year:
	FFY			FFY
	Development Number/Name General Description of Major Work Categories	Quantity	Estimated Cost	Development Number/Name General Description of Major Work Categories	Quantity	Estimated Cost
See
Annual
Statement
Subtotal of Estimated Cost			$	Subtotal of Estimated Cost		$

P art III: Supporting Pages – Management Needs Work Statement(s)
Work Statement for Year 1 FFY ______	Work Statement for Year		Work Statement for Year:
	FFY		FFY
	Development Number/Name General Description of Major Work Categories	Estimated Cost	Development Number/Name General Description of Major Work Categories	Estimated Cost
See
Annual
Statement
Subtotal of Estimated Cost		$	Subtotal of Estimated Cost	$

P art III: Supporting Pages – Management Needs Work Statement(s)
Work Statement for Year 1 FFY ______	Work Statement for Year		Work Statement for Year:
	FFY		FFY
	Development Number/Name General Description of Major Work Categories	Estimated Cost	Development Number/Name General Description of Major Work Categories	Estimated Cost
See
Annual
Statement
Subtotal of Estimated Cost		$	Subtotal of Estimated Cost	$

Page 0 of 6 form HUD-50075.2 (4/2008)