Form HUD-50900 Elements for the Annual Moving to work Plan and Annual M

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

FORM 50900: ELEMENTS FOR THE ANNUAL MOVING TO WORK PLAN
AND ANNUAL MOVING TO WORK REPORT
ATTACHMENT B
TO THE MOVING TO WORK AGREEMENT
BETWEEN THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
AND MOVING TO WORK AGENCIES
The information in this Form 50900 is being collected so that HUD can evaluate the impacts of Moving to Work
(MTW) activities; respond to congressional and other inquiries regarding outcome measures; and identify
promising practices learned through the MTW demonstration. The information collected through this Form
50900 is not confidential. MTW public housing agencies (MTW PHAs) will report outcome information on the
effects of MTW policy changes on residents, operations, and the local community. The estimated burden per
year, per MTW PHA, is 81 hours. Responses to this collection of information are required to obtain a benefit or
to retain a benefit. HUD may not conduct or sponsor, and MTW PHAs are not required to respond to, a
collection of information unless that collection displays a valid Office of Management and Budget (OMB)
control number. All current MTW PHAs as of the effective date of this Form 50900, will provide the following
required elements in the order and format given in this Form 50900 in Annual MTW Plans and Annual MTW
Reports, consistent with the requirements in Section VII of the Standard MTW Agreement (or applicable
successor section in future iterations of the MTW Agreement).

GENERAL INSTRUCTIONS
Section Numbering: The sections are as follows: (I) Introduction, (II) General Operating Information,
(III) Proposed MTW Activities, (IV) Approved MTW Activities, (V) Sources and Uses of MTW Funds, and
(VI) Administrative.
Inapplicable Fields and Sections: For those text fields in the tables provided in Sections (II) and (V) that are not
applicable, the MTW PHA should insert an “N/A.” For those numerical fields in the tables provided in Sections
(II) and (V) that are not applicable or have no value, the MTW PHA should insert a “0” (zero). Where a narrative
portion of Sections (I), (III), (IV) or (VI) is not applicable, the MTW PHA should include the sub-section number
and/or title and insert an “N/A.”
Plan Year: The “Plan Year” is defined as the MTW PHA’s fiscal year. The Plan Year is generally twelve months,
but may be longer or shorter if the MTW PHA is transitioning the start and end of its fiscal year to different
dates. The MTW PHA should discuss the impact of such transitioning on Annual MTW Plan/Report submissions
with HUD Headquarters and the applicable local HUD Field Office.
Format Requirements: MTW PHAs are required to provide information according to the order in this Form
50900. For Section (II) and Section (V), MTW PHAs must insert the tables as they appear in this Form 50900.
MTW PHAs must present the applicable Standard Metrics in Sections (III) and Section (IV) in the table format
given in the “Standard HUD Metrics” section of this Form 50900. HUD prefers that MTW PHAs also report
agency-developed metric information in a similar format. There is no prescribed format for presenting the
required information in Sections (I), (III), (IV) or (VI) of this Form 50900, but all required information must be
clearly provided. The submittal of separate Excel versions of Section (II) and Section (V) is not required.
Submission Requirements (dissemination): The MTW PHA shall follow the submission requirements as set
forth in its current MTW Agreement. All initial and revised submissions of the Annual MTW Plan and the
Annual MTW Report must be sent in an electronic format to HUD Headquarters and the applicable local HUD
HUD FORM 50900: Instructions

1

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

Field Office via email. The MTW Coordinator will send an email confirming receipt after the submission is
received.
Submission Requirements (file type): The electronic submission shall include a searchable PDF version (not a
scanned PDF) of the Annual MTW Plan/Report or a Microsoft Word document version of the Annual MTW
Plan/Report. The body of the Annual MTW Plan/Report shall be submitted as one file type and preferably in
one file. The body shall include the HUD-generated tables for Sections (II) and (V) and the applicable Standard
HUD Metrics tables incorporated into Sections (III) and (IV). Supplemental materials (e.g. Capital Fund forms,
signed Board Resolution, other appendix information) may be submitted in a different file type.
Submission Requirements (hard copy): A hard copy submission by the MTW PHA is only necessary at the
request of HUD.

SECTION-BY-SECTION INSTRUCTIONS
SECTION I: INTRODUCTION
Generally: MTW PHAs will include both short-term and long-term MTW goals and objectives in this section.
Section I.C: Affirmatively Furthering Fair Housing (AFFH)
Affirmatively Furthering Fair Housing (AFFH): Here, the MTW PHA must provide a statement of the MTW
PHA’s strategies and actions to achieve fair housing goals outlined in an approved Assessment of Fair Housing
(AFH) consistent with 24 CFR 5.154. The table format in this section should be used. Strategies and actions
must affirmatively further fair housing and may include, but are not limited to, enhancing mobility strategies
and encouraging development of new affordable housing in areas of opportunity, as well as place-based
strategies to encourage community revitalization, including preservation of existing affordable housing,
including HUD-assisted housing. (See 24 CFR 5.154(d)(5)). Until such a time that the MTW PHA is required to
submit an AFH and that AFH has been accepted by HUD, the statement must explain how the strategies and
actions will address impediments to fair housing choice in the Analysis of Impediments associated with the
applicable Consolidated Plan and Annual Action Plan.
SECTION II: GENERAL OPERATING INFORMATION
Generally: Pre-formatted tables have been provided in this Form 50900 for MTW PHAs to provide the required
housing stock, leasing and waiting list information in this section. These tables must be included in the Annual
MTW Plan/Report as provided. The MTW PHA may include clarifying text in addition to these tables in the
Annual MTW Plan/Report. An MTW PHA may also include updates to its historical housing stock or leasing
tables as an appendix to the Annual MTW Plan/Report. The MTW PHA may reference such an appendix in
Section (II) to direct readers to this information.
Section II.A: Housing Stock Information
General Description of All Planned Capital Fund Expenditures: MTW PHAs are required to provide a general
description of planned capital expenditures by development.
Section II.B: Leasing Information
Definition of MTW Households Served: "MTW Households Served" include all households that receive housing
assistance, directly or indirectly, using any amount of MTW funds. Housing assistance through local, nontraditional MTW programs is included, as long as the activity conforms to the requirements stipulated in the
Standard MTW Agreement and PIH Notice 2011-45 (or applicable successor MTW Agreement and/or PIH
Notice).
HUD FORM 50900: Instructions

2

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

Categories of MTW Households Served: “MTW Households Served” data will be reported in the categories
defined below. These categories are the only households that will be considered in the “Total Households
Served/Units Leased” calculation used to determine if the MTW PHA is continuing to assist substantially the
same total number of eligible low-income families as it would have, had the MTW PHA not combined its funds
(as set forth in PIH Notice 2013-2 or successor PIH Notice).
• MTW Public Housing Units Leased: Number of households that reside in any unit of housing authorized
and funded under an Annual Contributions Contract (ACC) between the MTW PHA and HUD pursuant to
the U.S. Housing Act of 1937.
• MTW Housing Choice Vouchers (HCVs) Utilized: Number of households that receive rental assistance
through Housing Assistance Payment (HAP) Contracts (pursuant to an ACC between HUD and the MTW
PHA) paid for with MTW funds at a location selected by the household and not tied to a specific location
OR households that receive rental assistance through HAP Contracts (pursuant to an ACC between HUD
and the PHA) paid for with MTW funds at a specific location that is not public housing.
• Local, Non-Traditional: Tenant-Based: Number of households that receive assistance through an MTW
tenant-based housing program outside of Sections 8 and 9 of the U.S. Housing Act of 1937. This includes
all households at or below 80% area median income (AMI) that receive tenant-based housing assistance
through MTW funds but not through traditional public housing or HCVs.
• Local, Non-Traditional: Property-Based: Number of households that receive assistance through an MTW
property-based or project-based housing program outside of Sections 8 and 9 of the U.S. Housing Act of
1937. This includes all households at or below 80% AMI that receive property-based or project-based
housing assistance through MTW funds but not through traditional public housing or HCVs.
• Local, Non-Traditional: Homeownership: Number of households that receive assistance through an MTW
homeownership housing program outside of Sections 8 and 9 of the U.S. Housing Act of 1937. This
includes all households at or below 80% AMI that receive homeownership housing assistance through
MTW funds but not through traditional public housing or HCVs.
Households Receiving Services Only: HUD will track “Households Receiving Services Only through MTWFunded Local, Non-Traditional Activities.” These households, however, will not be considered in the “Total
Households Served/Units Leased” calculation used to determine if the MTW PHA is continuing to assist
substantially the same total number of eligible low-income families as it would have had the MTW PHA not
combined its funds (as set forth in PIH Notice 2013-2 or successor PIH Notice). The definition for households
tracked in this category is:
• Households Receiving Services Only: Number of households at or below 80% AMI provided services
through MTW funds and not assisted through any type of housing assistance for the fiscal year and
over the course of the MTW PHA's participation in the demonstration. Households that are only
receiving services and are also on one of the MTW PHA's housing waiting lists should be included in this
category.
Section II.C: Waiting List Information
Waiting List Information Submittal: This section will include those waiting lists managed by the MTW PHA and
those managed by a third party. MTW PHAs should provide information only on those waiting lists that contain
households in the “MTW Households Served” categories defined above for Section II.B. Waiting lists for
households receiving services only and households in other non-MTW housing programs should not be
included.
SECTION III: PROPOSED MTW ACTIVITIES and SECTION IV: APPROVED MTW ACTIVITIES
Use of Standard HUD Metrics: MTW PHAs are required to track all applicable "Standard HUD Metrics" under
each implicated statutory objective for each MTW activity. Standard HUD Metrics must be given in the table
HUD FORM 50900: Instructions

3

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

format provided in the "Standard HUD Metrics" section of this Form 50900 in order to allow analysis and
aggregation across MTW PHAs for similar activities. When proposing an MTW activity, the MTW PHA should
provide the Standard HUD Metrics it deems applicable to that activity. After review of the proposed activity,
HUD will determine the Standard HUD Metrics that the MTW PHA must provide. After the activity has been
approved, HUD will advise the MTW PHA of any necessary changes to the applicable Standard HUD Metrics.
Additional Metrics: MTW PHAs may report on agency-developed and previously established metrics in addition
to the required Standard HUD Metrics.
SECTION IV: APPROVED MTW ACTIVITIES
Generally: This section includes four subsections: Implemented, Not Yet Implemented, On Hold, and Closed
Out. Once an activity is approved it must be placed in Section (IV) under one of these four subsections. These
subsections are defined below.
• Implemented Activities: MTW activities in which the MTW PHA is actively engaged.
• Not Yet Implemented Activities: MTW activities in which the MTW PHA is not actively engaged but is
preparing to implement in the future.
• On Hold Activities: MTW activities that were previously implemented, that the MTW PHA stopped
implementing, but that the MTW PHA plans to reactivate in the future.
• Closed Out Activities: MTW activities that: were MTW activities, but are now obsolete because they no
longer require MTW flexibility due to changes in regulation; were completed because the MTW PHA
accomplished its stated objectives and no longer requires the use of MTW flexibility; the MTW PHA has
decided to end before attaining the activity's objectives; the MTW PHA has never implemented and does
not plan to implement at any point in the future. In the year the activity is ended the MTW PHA is
required to provide information about the outcomes of the activity.
Use of Standard HUD Metrics: Standard HUD Metrics must be shown in the table format provided in the
"Standard HUD Metrics" section of this Form 50900 in order to allow analysis and aggregation across MTW
PHAs for similar activities. Standard HUD Metrics should appear in the Section (IV) subsections as follows:
• Implemented Activities: MTW PHAs are required to track all of the applicable Standard HUD Metrics
under each statutory objective implicated.
• Not Yet Implemented Activities: Since the MTW PHA would not currently be engaged in this category of
approved activities, it is not necessary to include applicable Standard HUD Metrics until implementation.
• On Hold Activities: Since the MTW PHA would not currently be engaged in this category of approved
activities, it is not necessary to include applicable Standard HUD Metrics until implementation.
• Closed Out Activities: MTW PHAs are required to provide final information on all of the applicable
Standard HUD Metrics under each statutory objective implicated for activities approved and
implemented after calendar year 2012.
Closing Out Activities: An approved activity must be closed out in an Annual MTW Report. If an Annual MTW
Plan is to be submitted after the MTW PHA has decided to close the activity but prior to the submission of an
Annual MTW Report, the to-be-closed activity should be listed in the “Not Yet Implemented Activities” or the
“Activities On Hold” subsection of the Annual MTW Plan as applicable. The associated discussion and timeline
should indicate that the MTW PHA will close out the activity in the next Annual MTW Report.
Significant Changes to Activities: HUD requires MTW PHAs to re-propose activities that require "significant
changes." A "significant change" occurs when the nature of the activity has changed such that an additional
MTW authorization is needed OR when an MTW PHA fundamentally changes the nature and scope of an
activity to the extent that there is the potential for a different impact on residents (e.g. changing the
calculation of rent). In these cases, the activity must undergo a new public process. HUD reserves the right to
HUD FORM 50900: Instructions

4

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

determine on a case-by-case basis if the change made to an activity crosses this threshold and therefore
requires the activity to be re-proposed.
SECTION V: SOURCES AND USES OF MTW FUNDS
Generally: Pre-formatted tables have been provided in this Form 50900 for MTW PHAs to provide the required
information in this section. These tables must be included in the Annual MTW Plan/Report as provided. The
MTW PHA may include clarifying text in addition to these tables in the Annual MTW Plan/Report.
SECTION VI: ADMINISTRATIVE
Board Resolution Submittal: There is no predetermined format for submission with the Annual MTW Plan of
the required resolution signed by the Board of Commissioners (or other authorized MTW PHA governing body)
adopting the Annual MTW Plan and the Annual MTW Plan Certifications of Compliance.
Certification of Meeting the MTW Statutory Requirements Submittal: There is no predetermined format for
submission with the Annual MTW Report of the required certification that the MTW PHA has met the three
MTW statutory requirements.
Certifications of Compliance Submittal: The format for submission with the Annual MTW Plan of the required
Certifications of Compliance is provided in this Form 50900. The preamble to the Certifications of Compliance
directs the MTW PHA to fill in the beginning of the fiscal year for which the certification is being made. This
should be provided as the first day of the fiscal year to be covered by the Annual MTW Plan (for example, for a
FY2016 Annual MTW Plan for an MTW PHA with a fiscal year of January 1 – December 31, this would be
January 1, 2016).
ADDITIONAL ITEMS
Appendix Information Submittal: The MTW PHA may submit additional appendix items as it deems
appropriate. Particular MTW PHAs may be required to submit additional appendix items depending on the
content of the particular MTW Agreement and Annual MTW Plan (examples include RHF Plan, Local Asset
Management Plan, RAD Significant Amendment, etc.) All appendices should be listed in the table of contents.
Submittal of Implementing Documents: As a part of the Annual MTW Plan and/or Annual MTW Report
submission, the MTW PHA may not submit to HUD for approval implementing documents (such as
Administrative Plans, ACOPs, etc.) or other materials that are superfluous to the items in this Form 50900. HUD
may request that the MTW PHA separate such items from the Annual MTW Plan to be approved and/or Annual
MTW Report to be accepted.

HUD FORM 50900: Instructions

5

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(I) INTRODUCTION
ANNUAL MTW PLAN

ANNUAL MTW REPORT

A. TABLE OF CONTENTS
Include all of the required elements of the
Annual MTW Plan (including appendices).
B. OVERVIEW OF SHORT-TERM AND LONG-TERM
MTW GOALS AND OBJECTIVES
Short-term goals and objectives include those
that the MTW PHA plans to accomplish within
the fiscal year. Long-term goals and objectives
include those that the MTW PHA plans to
accomplish beyond the current fiscal year. MTW
PHAs have the ability to define the level of
specificity in the short-term and long-term goals
and objectives. If the MTW PHA includes nonMTW components, the MTW PHA should clearly
delineate which are MTW and which are nonMTW goals and objectives. MTW PHAs have the
flexibility to include references to proposed and
ongoing activities in this section if it assists in
providing an explanation about short-term and
long-term goals and objectives. However, this is
not required.
C. AFFIRMATIVELY FUTHERING FAIR HOUSING
(AFFH)
Provide a statement of the MTW PHA’s
strategies and actions to achieve fair housing
goals outlined in an approved Assessment of
Fair Housing consistent with 24 CFR 5.154. The
format of this statement should be provided as
follows for each fair housing goal:

A. TABLE OF CONTENTS
Include all the required elements of the Annual
MTW Report (including appendices).
B. OVERVIEW OF SHORT-TERM AND LONG-TERM
MTW GOALS AND OBJECTIVES
The MTW PHA should include information about
whether the short-term goals and objectives
provided in the corresponding Annual MTW Plan
were accomplished. MTW PHAs should report
progress towards the long-term goals and
objectives provided in the corresponding Annual
MTW Plan.

Fair Housing Goal:
Explain Strategies and Actions

HUD FORM 50900: (I) Introduction

6

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(II) GENERAL OPERATING INFORMATION
ANNUAL MTW PLAN
A. HOUSING STOCK INFORMATION
i.

Planned New Public Housing Units
New public housing units that the MTW PHA anticipates will be added during the Plan Year.
AMP NAME AND
NUMBER
Name/Number
Name/Number
Name/Number

BEDROOM SIZE
0/1

2

3

4

5

6+

#
#
#

#
#
#

#
#
#

#
#
#

#
#
#

#
#
#

Total Public Housing Units to be Added in the Plan Year
*

TOTAL
UNITS

POPULATION
TYPE*

#
#
#

Type (below)
Type (below)
Type (below)

# of UFAS Units
Fully
Accessible

Adaptable

#
#
#

#
#
#

#

Select “Population Type” from: General, Elderly, Disabled, Elderly/Disabled, Other

If “Population Type” is “Other” please describe:
Description

ii.

Planned Public Housing Units to be Removed
Public housing units that the MTW PHA anticipates will be removed during the Plan Year.
AMP NAME AND
NUMBER

NUMBER OF
UNITS TO BE
REMOVED

EXPLANATION FOR REMOVAL

Name/Number
Name/Number
Name/Number

#
#
#

Explanation
Explanation
Explanation

#

Total Public Housing Units to be Removed in the Plan Year

iii. Planned New Project Based Vouchers
Tenant-based vouchers that the MTW PHA anticipates project-basing for the first time during the Plan Year.
These include only those in which a Housing Assistance Payment (HAP) Agreement will be in place by the end of
the Plan Year. Indicate whether the unit is included in the Rental Assistance Demonstration (RAD).
PROPERTY NAME

NUMBER OF
VOUCHERS TO BE
PROJECT-BASED

RAD?

DESCRIPTION OF PROJECT

Name
Name

#
#

Yes/No
Yes/No

Description
Description

#

Planned Total Vouchers to be Newly Project-Based

HUD FORM 50900: (II) General Operating Information

7

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

iv. Planned Existing Project Based Vouchers
Tenant-based vouchers that the MTW PHA is currently project-basing in the Plan Year. These include only those
in which a Housing Assistance Payment (HAP) Agreement is already in place at the beginning of the Plan Year.
Indicate whether the unit is included in RAD.
PROPERTY NAME

NUMBER OF
PROJECT-BASED
VOUCHERS

STATUS AT
END OF PLAN
YEAR*

RAD?

DESCRIPTION OF PROJECT

Name
Name

#
#

Status (below)
Status (below)

Yes/No
Yes/No

Description
Description

#
*

v.

Planned Total Existing Project-Based Vouchers

Select “Status at the End of Plan Year” from: Committed, Leased/Issued

Planned Other Changes to MTW Housing Stock Anticipated During the Plan Year
Examples of the types of other changes can include (but are not limited to): units held off-line due to relocation
or substantial rehabilitation, local, non-traditional units to be acquired/developed, etc.
PLANNED OTHER CHANGES TO MTW HOUSING STOCK ANTICIPATED IN THE PLAN YEAR
Description

vi. General Description of All Planned Capital Expenditures During the Plan Year
Narrative general description of all planned capital expenditures of MTW funds during the Plan Year.
GENERAL DESCRIPTION OF ALL PLANNED CAPITAL EXPENDITURES DURING THE PLAN YEAR
Description
B. LEASING INFORMATION
i.

Planned Number of Households Served
Snapshot and unit month information on the number of households the MTW PHA plans to serve at the end of
the Plan Year.
PLANNED NUMBER OF HOUSEHOLDS SERVED
THROUGH:

PLANNED NUMBER OF
UNIT MONTHS
OCCUPIED/LEASED*

PLANNED NUMBER OF
HOUSEHOLDS TO BE
SERVED**

MTW Public Housing Units Leased
MTW Housing Choice Vouchers (HCV) Utilized
Local, Non-Traditional: Tenant-Based^
Local, Non-Traditional: Property-Based^
Local, Non-Traditional: Homeownership^

#
#
#
#
#

#
#
#
#
#

#

#

Planned Total Households Served
*

“Planned Number of Unit Months Occupied/Leased” is the total number of months the MTW PHA plans to have
leased/occupied in each category throughout the full Plan Year.

** “Planned Number of Households to be Served” is calculated by dividing the “Planned Number of Unit Months
Occupied/Leased” by the number of months in the Plan Year.
^

In instances when a local, non-traditional program provides a certain subsidy level but does not specify a number of
units/households to be served, the MTW PHA should estimate the number of households to be served.

HUD FORM 50900: (II) General Operating Information

8

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

LOCAL, NONTRADITIONAL CATEGORY

MTW ACTIVITY NAME/NUMBER

PLANNED NUMBER
OF UNIT MONTHS
OCCUPIED/LEASED*

PLANNED NUMBER OF
HOUSEHOLDS TO BE
SERVED*

Tenant-Based
Property-Based
Homeownership

Name/#
Name/#
Name/#

#
#
#

#
#
#

*

ii.

C.

The sum of the figures provided should match the totals provided for each local, non-traditional categories in the previous
table. Multiple entries may be made for each category if applicable.

Discussion of Any Anticipated Issues/Possible Solutions Related to Leasing
Discussions of any anticipated issues and solutions in the MTW housing programs listed.
HOUSING PROGRAM

DESCRIPTION OF ANTICIPATED LEASING ISSUES AND POSSIBLE SOLUTIONS

MTW Public Housing
MTW Housing Choice Voucher
Local, Non-Traditional

Description
Description
Description

WAITING LIST INFORMATION
i. Waiting List Information Anticipated
Snapshot information of waiting list data as anticipated at the beginning of the Plan Year.

WAITING LIST NAME

DESCRIPTION

NUMBER OF
HOUSEHOLDS
ON WAITING
LIST

Name
Name
Name

Description
Description
Description

#
#
#

WAITING LIST OPEN,
PARTIALLY OPEN OR
CLOSED
Open/Partially Open/Closed
Open/Partially Open/Closed
Open/Partially Open/Closed

PLANS TO
OPEN THE
WAITING LIST
DURING THE
PLAN YEAR
Yes/No
Yes/No
Yes/No

Please describe any duplication of applicants across waiting lists:
Description

ii. Planned Changes to Waiting List in the Plan Year
Please describe any anticipated changes to the organizational structure or policies of the waiting list(s), including
any opening or closing of a waiting list, during the Plan Year.
WAITING LIST NAME

DESCRIPTION OF PLANNED CHANGES TO WAITING LIST

Name
Name

Description
Description

HUD FORM 50900: (II) General Operating Information

9

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(II) GENERAL OPERATING INFORMATION
ANNUAL MTW REPORT
A. HOUSING STOCK INFORMATION
i.

Actual New Project Based Vouchers
Tenant-based vouchers that the MTW PHA project-based for the first time during the Plan Year. These include
only those in which a Housing Assistance Payment (HAP) Agreement was in place by the end of the Plan Year.
Indicate whether the unit is included in the Rental Assistance Demonstration (RAD).

PROPERTY NAME

Name
Name

*

NUMBER OF
VOUCHERS NEWLY
PROJECT-BASED
Planned*

Actual

#
#

#
#

#

#

RAD?

DESCRIPTION OF PROJECT

Yes/No
Yes/No

Description
Description

Planned/Actual Total Vouchers Newly Project-Based

Figures in the “Planned” column should match the corresponding Annual MTW Plan.

Please describe differences between the Planned and Actual Number of Vouchers Newly Project-Based:
Description

ii.

Actual Existing Project Based Vouchers
Tenant-based vouchers that the MTW PHA is currently project-basing in the Plan Year. These include only those
in which a HAP Agreement was in place by the beginning of the Plan Year. Indicate whether the unit is included in
RAD.
PROPERTY NAME
Name
Name

*

NUMBER OF PROJECTBASED VOUCHERS **
Planned*

Actual

#
#

#
#

#

#

RAD?

DESCRIPTION OF PROJECT

Yes/No
Yes/No

Description
Description

Planned/Actual Total Existing Project-Based Vouchers

Figures and text in the “Planned” column should match the corresponding Annual MTW Plan.

** Select “Status at the End of Plan Year” from: Committed, Leased/Issued

Please describe differences between the Planned and Actual Number of Vouchers Project-Based:
Description

iii. Actual Other Changes to MTW Housing Stock in the Plan Year
Examples of the types of other changes can include (but are not limited to): units held off-line due to relocation
or substantial rehabilitation, local, non-traditional units to be acquired/developed, etc.
ACTUAL OTHER CHANGES TO MTW HOUSING STOCK IN THE PLAN YEAR
Description

HUD FORM 50900: (II) General Operating Information

10

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

iv. General Description of All Actual Capital Expenditures During the Plan Year
Narrative general description of all actual capital expenditures of MTW funds during the Plan Year.
GENERAL DESCRIPTION OF ALL ACTUAL CAPITAL EXPENDITURES DURING THE PLAN YEAR
Description
B. LEASING INFORMATION
i.

Actual Number of Households Served
Snapshot and unit month information on the number of households the MTW PHA actually served at the end of
the Plan Year.

NUMBER OF HOUSEHOLDS SERVED
THROUGH:

NUMBER OF UNIT MONTHS
OCCUPIED/LEASED*

NUMBER OF HOUSEHOLDS
SERVED**

Planned^^

Actual

Planned^^

Actual

#
#
#
#
#

#
#
#
#
#

#
#
#
#
#

#
#
#
#
#

#

#

MTW Public Housing Units Leased
MTW Housing Choice Vouchers (HCV) Utilized

Local, Non-Traditional: Tenant-Based^
Local, Non-Traditional: Property-Based^
Local, Non-Traditional: Homeownership^
Planned/Actual Totals
*

#

#

“Planned Number of Unit Months Occupied/Leased” is the total number of months the MTW PHA planned to have
leased/occupied in each category throughout the full Plan Year (as shown in the Annual MTW Plan).

** “Planned Number of Households to be Served” is calculated by dividing the “Planned Number of Unit Months
Occupied/Leased” by the number of months in the Plan Year (as shown in the Annual MTW Plan).
^

In instances when a local, non-traditional program provides a certain subsidy level but does not specify a number of
units/households to be served, the MTW PHA should estimate the number of households to be served.

^^ Figures and text in the “Planned” column should match the corresponding Annual MTW Plan.

Please describe any differences between the planned and actual households served:
Description

LOCAL, NONTRADITIONAL CATEGORY
Tenant-Based
Property-Based
Homeownership

MTW ACTIVITY
NAME/NUMBER
Name/#
Name/#
Name/#
Planned/Actual Totals

*

NUMBER OF UNIT
MONTHS
OCCUPIED/LEASED*

NUMBER OF
HOUSEHOLDS TO BE
SERVED*

Planned^^

Actual

Planned^^

Actual

#
#
#

#
#
#

#
#
#

#
#
#

#

#

#

#

The sum of the figures provided should match the totals provided for each Local, Non-Traditional category in the previous
table. Multiple entries may be made for each category if applicable.

^^ Figures and text in the “Planned” column should match the corresponding Annual MTW Plan.

HUD FORM 50900: (II) General Operating Information

11

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

ii.

C.

HOUSEHOLDS RECEIVING LOCAL, NON-TRADITIONAL SERVICES
ONLY

AVERAGE
NUMBER OF
HOUSEHOLDS PER
MONTH

TOTAL NUMBER OF
HOUSEHOLDS IN THE
PLAN YEAR

Program Name/Services Provided

#

#

Discussion of Any Actual Issues/Solutions Related to Leasing
Discussion of any actual issues and solutions utilized in the MTW housing programs listed.
HOUSING PROGRAM

DESCRIPTION OF ACTUAL LEASING ISSUES AND SOLUTIONS

MTW Public Housing
MTW Housing Choice Voucher
Local, Non-Traditional

Description
Description
Description

WAITING LIST INFORMATION
i.

Actual Waiting List Information
Snapshot information on the actual status of MTW waiting lists at the end of the Plan Year. The “Description”
should detail the structure of the waiting list and the population(s) served.

WAITING LIST NAME

DESCRIPTION

NUMBER OF
HOUSEHOLDS
ON WAITING
LIST

Name
Name
Name

Description
Description
Description

#
#
#

WAITING LIST OPEN,
PARTIALLY OPEN OR
CLOSED

WAS THE
WAITING LIST
OPENED
DURING THE
PLAN YEAR

Open/Partially Open/Closed
Open/Partially Open/Closed
Open/Partially Open/Closed

Yes/No
Yes/No
Yes/No

Please describe any duplication of applicants across waiting lists:
Description

ii.

Actual Changes to Waiting List in the Plan Year
Please describe any actual changes to the organizational structure or policies of the waiting list(s), including any
opening or closing of a waiting list, during the Plan Year.
WAITING LIST NAME

DESCRIPTION OF ACTUAL CHANGES TO WAITING LIST

Name
Name

Description
Description

HUD FORM 50900: (II) General Operating Information

12

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

D. INFORMATION ON STATUTORY OBJECTIVES AND REQUIREMENTS
i.

75% of Families Assisted Are Very Low Income
HUD will verify compliance with the statutory requirement that at least 75% of the households assisted by the
MTW PHA are very low income for MTW public housing units and MTW HCVs through HUD systems. The MTW
PHA should provide data for the actual households served reported in the “Local, Non-Traditional: TenantBased”; “Local, Non-Traditional: Property-Based”; and “Local, Non-Traditional: Homeownership” categories. Do
not include households reported in the “Local, Non-Traditional Services Only” category.
INCOME LEVEL

NUMBER OF LOCAL, NON-TRADITIONAL
HOUSEHOLDS IN THE PLAN YEAR

Above 80% Area Median Income
80%-50% Area Median Income
49%-30% Area Median Income
Below 30% Area Median Income

#
#
#
#
#

Total Local, Non-Traditional Households Served
ii.

Maintain Comparable Mix
HUD will verify compliance with the statutory requirement that MTW PHAs continue to serve a comparable mix
of families by family size by first assessing a baseline mix of family sizes served by the MTW PHA prior to entry
into the MTW demonstration (or the closest date with available data) and compare that to the current mix of
family sizes served during the Plan Year.
BASELINE MIX OF FAMILY SIZES SERVED (upon entry to MTW)
FAMILY
SIZE

OCCUPIED
PUBLIC HOUSING
UNITS

UTILIZED
HCVs

NON-MTW
ADJUSTMENTS*

BASELINE MIX
NUMBER

BASELINE MIX
PERCENTAGE

1 Person
2 Person
3 Person
4 Person
5 Person
6+ Person

#
#
#
#
#
#

#
#
#
#
#
#

#
#
#
#
#
#

#
#
#
#
#
#

#%
#%
#%
#%
#%
#%

TOTAL

#

#

#

#

#%

*

“Non-MTW Adjustments” are defined as factors that are outside the control of the MTW PHA. An example of an
acceptable “Non-MTW Adjustment” would include demographic changes in the community’s overall population. If the
MTW PHA includes “Non-MTW Adjustments,” a thorough justification, including information substantiating the numbers
given, should be included below.

Please describe the justification for any “Non-MTW Adjustments” given above:
Description

HUD FORM 50900: (II) General Operating Information

13

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

MIX OF FAMILY SIZES SERVED (in Plan Year)
FAMILY
SIZE

BASELINE MIX
PERCENTAGE**

NUMBER OF
HOUSEHOLDS SERVED
IN PLAN YEAR^

PERCENTAGE OF
HOUSEHOLDS SERVED
IN PLAN YEAR^^

PERCENTAGE CHANGE FROM
BASELINE YEAR TO CURRENT
PLAN YEAR

1 Person
2 Person
3 Person
4 Person
5 Person
6+ Person

#%
#%
#%
#%
#%
#%

#
#
#
#
#
#

#%
#%
#%
#%
#%
#%

#%
#%
#%
#%
#%
#%

TOTAL

#%

#

#%

#%

** The “Baseline Mix Percentage” figures given in the “Mix of Family Sizes Served (in Plan Year)” table should match those in
the column of the same name in the “Baseline Mix of Family Sizes Served (upon entry to MTW)” table.
^

The “Total” in the “Number of Households Served in Plan Year” column should match the “Actual Total” box in the “Actual
Number of Households Served in the Plan Year” table in Section II.B.i of this Annual MTW Report.

^^ The percentages in this column should be calculated by dividing the number in the prior column for each family size by
the “Total” number of households served in the Plan Year. These percentages will reflect adjustment to the mix of families
served that are due to the decisions of the MTW PHA. Justification of percentages in the current Plan Year that vary by
more than 5% from the Baseline Year must be provided below.

Please describe the justification for any variances of more than 5% between the Plan Year and Baseline Year:
Description

iii. Number of Households Transitioned to Self-Sufficiency in the Plan Year
Number of households, across MTW activities, that were transitioned to the MTW PHA’s local definition of self
sufficiency during the Plan Year.
MTW ACTIVITY
NAME/NUMBER

NUMBER OF
HOUSEHOLDS
TRANSITIONED TO
SELF SUFFICIENCY*

MTW PHA LOCAL DEFINITION OF SELF SUFFICIENCY

Name/Number
Name/Number
Name/Number

#
#
#

Definition
Definition
Definition

#

(Households Duplicated Across MTW Activities)

#
*

Total Households Transitioned to Self Sufficiency

Figures should match the outcome reported where metric SS#8 is used in Section IV of this Annual MTW Report.

HUD FORM 50900: (II) General Operating Information

14

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(III)

PROPOSED MTW ACTIVITIES: HUD Approval Requested
ANNUAL MTW PLAN

All required elements given below must be included in the body of the Annual MTW Plan, grouped by
each proposed MTW activity. For metrics information, MTW PHAs must follow the guidelines from the
“Standard HUD Metrics” section of this Form 50900. MTW PHAs must report all applicable Standard HUD
Metrics for each activity as assigned by HUD.
A. ACTIVITY DESCRIPTION
i.
ii.

Describe the proposed activity.
Describe how the proposed activity will achieve one or more of the three statutory objectives and the
specific impacts on that statutory objective(s).
iii. Provide the anticipated schedule for implementing the proposed activity.

B. ACTIVITY METRICS INFORMATION
i.
ii.

Provide the metrics from the “Standard HUD Metrics” section that are applicable to the proposed activity.
Give the baseline performance level for each metric (a numeric value) prior to the implementation of the
proposed activity.
iii. Give the annual benchmark for each metric (a numeric value).
iv. If applicable, give the overall and/or long term benchmark(s) for each metric (a numeric value).
v. Give the data source from which the metric data will be compiled.

C. COST IMPLICATIONS
i.
ii.

State whether the proposed activity will result in any cost implications (positive and/or negative) for the
MTW PHA.
If the proposed activity does result in cost implications, provide an estimate of the amount and discuss how
the MTW PHA will manage the surplus or deficit anticipated.

D. NEED/JUSTIFICATION FOR MTW FLEXIBILITY
i.

ii.

Cite the authorization(s) detailed in Attachment C and/or D of the Standard MTW Agreement (or applicable
successor section in future iterations of the MTW Agreement) that gives the MTW PHA flexibility to conduct
the proposed activity.
Explain why the cited authorization(s) is needed to engage in the proposed activity.
Every reasonable effort should be made by the MTW PHA to reference the complete and correct authorization(s) that are
applicable to a particular activity when proposing the activity. A failure to cite the correct or entire statue or regulation
will require a technical revision to the activity to include the correct authorization(s).

E. RENT REFORM INFORMATION (if applicable)
HUD defines “rent reform” as any change to how rent/tenant share is calculated for a household that would not be
allowable absent the MTW activity. Any MTW activity that an MTW PHA enacts that alters the rent calculation (the
amount a household contributes towards their housing costs) would be considered a type of rent reform. The
following information must be provided for all rent reform activities.
i. IMPACT ANALYSIS
The MTW PHA may provide an impact analysis for each component of the rent reform activity or a
comprehensive impact analysis of the rent reform activity. To assess the impacts of the rent reform activity,
the following steps are suggested:
(1) A description of how the proposed MTW activity will impact household rent/tenant share.
(2) A description of how the MTW PHA will implement and track the rent reform activity and how that
process will enable the identification of any unintended consequences/impacts.

HUD FORM 50900: (III) Proposed MTW Activities

15

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(3) A numerical analysis detailing the intended/possible impacts of the rent reform activity (including
changes to the amount of rent/tenant share, rent burden increases/decreases, households affected,
etc.)
(4) A plan for how the MTW PHA will weigh the consequences/benefits of the rent reform activity to
determine whether it should be adjusted/terminated/reduced/continued/expanded.
ii. HARDSHIP CASE CRITERIA
The MTW PHA must establish a hardship policy that clearly defines the circumstances under which
households may be exempted or provided temporary relief from the rent reform activity. The MTW PHA
must describe how such households could access the hardship policy and the associated process.
iii. DESCRIPTION OF ANNUAL REEVALUATION
The MTW PHA must provide an overview as to how the rent reform activity will be reevaluated on an annual
basis in the Annual MTW Report, mitigating negative impacts and unintended consequences.
iv. TRANSITION PERIOD
The MTW PHA must develop a plan and timeline for transitioning households out of the current rent
structure and into the rent reform activity. The MTW PHA should show how the impact analysis informed this
transition period.

(III)

PROPOSED MTW ACTIVITIES: HUD Approval Requested
ANNUAL MTW REPORT

Section III in the Annual MTW Report will be included and left blank. MTW PHAs should include a
placeholder section with the statement that reads: “All proposed MTW activities that were granted
approval by HUD are reported in Section IV as ‘Approved Activities’.”

HUD FORM 50900: (III) Proposed MTW Activities

16

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(IV)

APPROVED MTW ACTIVITIES: HUD Approval Previously Granted

ANNUAL MTW PLAN

ANNUAL MTW REPORT

All required elements below must be put in the body of the Annual MTW Plan/Report and grouped by
each approved MTW activity. For metrics information, MTW PHAs must follow the guidelines from the
“Standard HUD Metrics” section of this Form 50900. MTW PHAs must report all applicable Standard HUD
Metrics for each activity as assigned by HUD in the Annual MTW Report.
A. IMPLEMENTED ACTIVITIES
The MTW PHA must give the name and number of approved MTW activities in the implemented category
(see the “Section-by-Section Instructions” for more information on categorizing approved MTW activities)
and the following information:
i. Plan Year Approved, Implemented, Amended
i. Plan Year Approved, Implemented, Amended
Specify the Plan Year the MTW activity was
Specify the Plan Year the MTW activity was
proposed. Specify the Plan Year the MTW
proposed. Specify the Plan Year the MTW
activity was implemented. Provide any Plan
activity was implemented. Provide any Plan
Years in which the MTW activity was amended.
Years in which the MTW activity was amended.
ii. Description/Update
ii. Description/Impact/Update
Provide a description of the MTW activity.
Provide a description of the MTW activity and
Provide an update on the status of the MTW
detailed information on its impact during the
activity.
Plan Year. Provide the applicable Standard HUD
Metrics tables with numerical information for
baselines, benchmarks and outcomes for the
Plan Year. Describe how outcomes compared to
baselines and benchmarks. Indicate whether the
MTW activity is on schedule.

iii. Planned Non-Significant Changes
Indicate any non-significant changes or
modifications to the MTW activity that the
MTW PHA plans to pursue during the Plan Year
(or state that there are none).

iv. Planned Changes to Metrics/Data Collection
Indicate any changes or modifications to the
metrics the MTW PHA plans to pursue during
the Plan Year (or state that there are none).

HUD FORM 50900: (IV) Approved Activities

NOTE: For rent reform activities, describe the
number and results of any hardship requests and
details regarding the required “Annual
Reevaluation” that the MTW PHA put in place when
proposing the MTW activity.
iii. Actual Significant Changes
Indicate if the MTW PHA made the planned nonsignificant changes or modifications to the MTW
activity given in the Annual MTW Plan in the Plan
Year. Indicate any unplanned non-significant
changes or modifications to the MTW activity
the MTW PHA made in the Plan Year (or state
that there were none).
iv. Actual Changes to Metrics/Data Collection
Indicate if the MTW PHA made the planned
changes or modifications to the metrics given in
the Annual MTW Plan in the Plan Year. Indicate
any unplanned changes or modifications to the
metrics the MTW PHA made in the Plan Year (or
state that there were none).
17

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

v. Planned Significant Changes
Provide any plans to pursue a significant change
to the MTW activity through an Annual MTW
Plan amendment in the Plan Year (or state that
there are none).

v. Actual Significant Changes
Indicate if any significant changes were made to
the MTW activity in the Plan Year through an
Annual MTW Plan amendment (or state that
there were none).

NOTE: HUD requires MTW PHAs to re-propose MTW
activities that require a “significant change”. Reproposing an MTW activity requires that it be
included in Section (III) of an Annual MTW Plan/Plan
amendment with all the associated required
elements given in this Form 50900, including the
requisite public process. See the “Section-by-Section
Instructions” for more information on “significant
changes.”
vi. Challenges in Achieving Benchmarks and
Possible Strategies
If benchmarks were not achieved or if the MTW
activity was determined ineffective (as described
in IV.A.ii above), provide a narrative explanation
of the challenges and, if possible, identify
potential new strategies to make the MTW
activity more effective.
B. NOT YET IMPLEMENTED ACTIVITIES
The MTW PHA must give the name and number of approved MTW activities in the not yet implemented
category (see the “Section-by-Section Instructions” for more information on categorizing approved MTW
activities) and the following information:
i. Describe the approved MTW activity that was
i. Provide a brief description of the approved MTW
proposed in an Annual MTW Plan, approved by
activity that was proposed in an Annual MTW
HUD, and not yet implemented. Discuss why the
Plan, approved by HUD, and not yet
MTW activity was not yet implemented. Specify
implemented. Specify the Plan Year in which the
the Plan Year in which the MTW activity was
MTW activity was first approved.
first approved.
ii. Provide an update on the implementation plan
ii. Discuss any actions taken towards the
for the MTW activity. Provide a timeline
implementation plan for the MTW activity in the
associated with this implementation plan. If
Plan Year. Relate these actions to the
there are no plans to implement the MTW
implementation plan and timeline the MTW PHA
activity, state that the MTW PHA will move it to
provided in the Annual MTW Plan.
the “Closed Out Activities” category in the next
Annual MTW Report.
iii. Provide an explanation of any non-significant
changes or modifications to the MTW activity
since it was approved by HUD.
C. ACTIVITIES ON HOLD
The MTW PHA must give the name and number of approved MTW activities in the activities on hold
category (see the “Section-by-Section Instructions” for more information on categorizing approved MTW
activities) and the following information:
HUD FORM 50900: (IV) Approved Activities

18

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

i.

Describe the approved MTW activity that was
approved, implemented and that the MTW PHA
then stopped implementing (but has plans to
reactivate in the future). Describe why the
MTW activity was placed on hold. Specify the
Plan Year(s) in which the MTW activity was first
approved, implemented and placed on hold.
ii. Provide an update on the plan for reactivating
the MTW activity. Provide a timeline associated
with this reactivation plan. If there are no plans
to reactivate the MTW activity, state that the
MTW PHA will move it to the “Closed Out
Activities” category in the next Annual MTW
Report.
iii. Provide an explanation of any non-significant
changes or modifications to the MTW activity
since it was approved by HUD.

i. Provide a brief description of the approved MTW
activity that was approved, implemented and
that the MTW PHA then stopped implementing
(but has plans to reactivate in the future).
Specify the Plan Year(s) in which the MTW
activity was first approved, implemented and
placed on hold.
ii. Discuss any actions taken towards the plan for
reactivating the MTW activity in the Plan Year.
Relate these actions to the reactivation plan and
timeline the MTW PHA provided in the Annual
MTW Plan.

D. CLOSED OUT ACTIVITIES
The MTW PHA must give the name and number of approved MTW activities in the closed out category (see
the “Section-by-Section Instructions” for more information on categorizing approved MTW activities) and
the following information:
i. List the closed out MTW activity. Specify the
i. List the closed out MTW activity. Specify the Plan
Plan Year(s) in which the MTW activity was
Year(s) in which the MTW activity was approved,
approved, implemented (if applicable) and
implemented (if applicable) and closed out.
closed out.
ii. Explain why the MTW activity was closed out.
ii. Explain why the MTW activity was closed out.
iii. In the Plan Year that the MTW activity is closed
out, provide the following:
• Discussion of the final outcome and lessons
learned.
• Description of any statutory exceptions
outside of the current MTW flexibilities that
might have provided additional benefit to
the MTW activity (if applicable).
• Summary table listing outcomes from each
year the MTW activity was implemented (if
applicable).

HUD FORM 50900: (IV) Approved Activities

19

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(V) SOURCES AND USES OF MTW FUNDS
ANNUAL MTW PLAN
A. ESTIMATED SOURCES AND USES OF MTW FUNDS
i.

Estimated Sources of MTW Funds
The MTW PHA shall provide the estimated sources and amount of MTW funding by Financial Data Schedule (FDS)
line item.
FDS LINE ITEM NUMBER
70500 (70300+70400)
70600
70610
70700 (70710+70720+70730+70740+70750)
71100+72000
71600
71200+71300+71310+71400+71500

FDS LINE ITEM NAME
Total Tenant Revenue
HUD PHA Operating Grants
Capital Grants
Total Fee Revenue
Interest Income
Gain or Loss on Sale of Capital Assets
Other Income

70000
ii.

Total Revenue

DOLLAR
AMOUNT
$#
$#
$#
$#
$#
$#
$#
$#

Estimated Uses of MTW Funds
The MTW PHA shall provide the estimated uses and amount of MTW spending by Financial Data Schedule (FDS)
line item.
FDS LINE ITEM NUMBER

91000 (91100+91200+91400+91500+91600+91700+91800+91900)
91300+91310+92000
91810
92500 (92100+92200+92300+92400)
93000 (93100+93600+93200+93300+93400+93800)
93500+93700
94000 (94100+94200+94300+94500)
95000 (95100+95200+95300+95500)
96100 (96110+96120+96130+96140)
96000 (96200+96210+96300+96400+96500+96600+96800)
96700 (96710+96720+96730)
97100+97200
97300+97350
97400
97500+97600+97700+97800
90000

FDS LINE ITEM NAME
Total Operating - Administrative
Management Fee Expense
Allocated Overhead
Total Tenant Services
Total Utilities
Labor
Total Ordinary Maintenance
Total Protective Services
Total Insurance Premiums
Total Other General Expenses
Total Interest Expense & Amortization Cost

Total Extraordinary Maintenance
HAP + HAP Portability-In
Depreciation Expense
All Other Expense
Total Expenses

DOLLAR
AMOUNT
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#
$#

Please describe any variance between Estimated Total Revenue and Estimated Total Expenses:
Description or N/A

HUD FORM 50900: (V) Sources and Uses of MTW Funds

20

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

iii. Description of Planned Use of MTW Single Fund Flexibility
The MTW PHA shall provide a thorough narrative of planned activities that use only the MTW single fund
flexibility. Where possible, the MTW PHA may provide metrics to track the outcomes of these programs and/or
activities. Activities that use other MTW authorizations in Attachment C and/or D of the Standard MTW
Agreement (or analogous section in a successor MTW Agreement) do not need to be described here, as they are
already found in Section (III) or Section (IV) of the Annual MTW Plan. The MTW PHA shall also provide a thorough
description of how it plans to use MTW single fund flexibility to direct funding towards specific housing and/or
service programs in a way that responds to local needs (that is, at a higher or lower level than would be possible
without MTW single fund flexibility).
PLANNED USE OF MTW SINGLE FUND FLEXIBILITY
Description

B. LOCAL ASSET MANGEMENT PLAN
i. Is the MTW PHA allocating costs within statute?

Yes/No

ii. Is the MTW PHA implementing a local asset management plan (LAMP)?
iii. Has the MTW PHA provide a LAMP in the appendix?

Yes/No

Yes/No

iv. If the MTW PHA has provided a LAMP in the appendix, please describe any proposed changes to the LAMP in
the Plan Year or state that the MTW PHA does not plan to make any changes in the Plan Year.
Description

C. RENTAL ASSISTANCE DEMONSTRATION (RAD) PARTICIPATION
i. Description of RAD Participation
The MTW PHA shall provide a brief description of its participation in RAD. This description must include the
proposed and/or planned number of units to be converted under RAD, under which component the
conversion(s) will occur, and approximate timing of major milestones. The MTW PHA should also give the
planned/actual submission dates of all RAD Significant Amendments. Dates of any approved RAD Significant
Amendments should also be provided.
RENTAL ASSISTANCE DEMONSTRATION (RAD) PARTICIPATION
Description
ii. Has the MTW PHA submitted a RAD Significant Amendment in the appendix?

Yes/No

iii. If the MTW PHA has provided a RAD Significant Amendment in the appendix, please state whether it is the
first RAD Significant Amendment submitted or describe any proposed changes from the prior RAD Significant
Amendment?
Description

HUD FORM 50900: (V) Sources and Uses of MTW Funds

21

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(V) SOURCES AND USES OF MTW FUNDS
ANNUAL MTW REPORT
A. ACTUAL SOURCES AND USES OF MTW FUNDS
i.

Actual Sources of MTW Funds in the Plan Year
The MTW PHA shall submit unaudited and audited information in the prescribed Financial Data Schedule (FDS)
format through the Financial Assessment System – PHA (FASPHA), or its successor system.

ii.

Actual Uses of MTW Funds in the Plan Year
The MTW PHA shall submit unaudited and audited information in the prescribed FDS format through the
FASPHA, or its successor system.

iii. Describe Actual Use of MTW Single Fund Flexibility
The MTW PHA shall provide a thorough narrative of actual activities that use only the MTW single fund flexibility.
Where possible, the MTW PHA may provide metrics to track the outcomes of these programs and/or activities.
Activities that use other MTW authorizations in Attachment C and/or D of the Standard MTW Agreement (or
analogous section in a successor MTW Agreement) do not need to be described here, as they are already found
in Section (IV) of the Annual MTW Report. The MTW PHA shall also provide a thorough description of how it used
MTW single fund flexibility to direct funding towards specific housing and/or service programs in a way that
responds to local needs (that is, at a higher or lower level than would be possible without MTW single fund
flexibility).
ACTUAL USE OF MTW SINGLE FUND FLEXIBILITY
Description

B. LOCAL ASSET MANGEMENT PLAN
i. Did the MTW PHA allocate costs within statute in the Plan Year?

Yes/No

ii. Did the MTW PHA implement a local asset management plan (LAMP) in the Plan Year?
iii. Did the MTW PHA provide a LAMP in the appendix?

Yes/No

Yes/No

iv. If the MTW PHA has provided a LAMP in the appendix, please provide a brief update on implementation of
the LAMP. Please provide any actual changes (which must be detailed in an approved Annual MTW Plan/Plan
amendment) or state that the MTW PHA did not make any changes in the Plan Year.
Description

HUD FORM 50900: (V) Sources and Uses of MTW Funds

22

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

(VI)
ANNUAL MTW PLAN

ADMINISTRATIVE
ANNUAL MTW REPORT

A. BOARD RESOLUTION AND CERTIFICATIONS OF
A. REVIEWS, AUDITS AND INSPECTIONS
COMPLIANCE
The MTW PHA shall provide a general
The MTW PHA shall provide a resolution signed by
description of any HUD reviews, audits and/or
the Board of Commissioners (or other authorized
physical inspection issues that require the MTW
MTW PHA governing body) adopting the Annual
PHA to take action in order to address the issue.
MTW Plan and the Annual MTW Plan Certifications
of Compliance (as it appears in this Form 50900). A
signed version of the Annual MTW Plan
Certifications of Compliance must also be included.
B. DOCUMENTATION OF PUBLIC PROCESS
B. EVALUATION RESULTS
The beginning and end dates of when the Annual
The MTW PHA shall provide a description of the
MTW Plan was made available for public review and
results of the latest MTW PHA-directed
the dates, location and number of attendees of
evaluation (or state that there are none).
public hearings must be provided. HUD reserves the
right to request additional information to verify the
MTW PHA has complied with public process
requirements in the Standard MTW Agreement (or
successor MTW Agreement).
C. PLANNED AND ONGOING EVALUATIONS
C. MTW STATUTORY REQUIREMENT
CERTIFICATION
The MTW PHA shall provide a description of any
planned or ongoing MTW PHA-directed evaluations
The MTW PHA shall provide a certification that
of the MTW demonstration and/or of any specific
the MTW PHA has met the three MTW statutory
MTW activities (or state that there are none).
requirements in the Plan Year of: (1) ensuring
that at least 75% of households assisted by the
D. ANNUAL STATEMENT/PERFORMANCE AND
MTW PHA are very low-income, (2) continuing
EVALUATION REPORT (HUD 50075.1)
to assist substantially the same total number of
The MTW PHA shall provide the Annual
households as would have been assisted had the
Statement/Performance and Evaluation Report
MTW PHA not participated in the MTW
(HUD 50075.1) or successor form as required by
demonstration, and (3) maintaining a
HUD for all MTW and non-MTW Capital Fund grants
comparable mix of households (by family size)
for each grant that has unexpended amounts,
served as would have been served had the MTW
including estimates for the Plan Year and all three
PHA not participated in the MTW
parts of the Report.
demonstration.
E. LOBBYING DISCLOSURES
D. MTW ENERGY PERFORMANCE CONTRACT (EPC)
FLEXIBILITY DATA
The MTW PHA shall provide signed copies of the
Some MTW PHAs possess flexibility with regard
Disclosure of Lobbying Activities (SF-LLL) and the
to EPCs in the Standard MTW Agreement. MTW
related Certification of Payments (HUD-50071).
PHAs that possess and utilize this flexibility
should here report the data as specified in the
MTW PHA’s Standard MTW Agreement (or
successor MTW Agreement). If the MTW PHA
does not possess and/or utilize such flexibility,
this section should be marked not applicable.
HUD FORM 50900: (VI) Administrative

23

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

CERTIFICATIONS OF COMPLIANCE
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
OFFICE OF PUBIC AND INDIAN HOUSING
Certifications of Compliance with Regulations:
Board Resolution to Accompany the Annual Moving to Work Plan
Acting on behalf of the Board of Commissioners of the Moving to Work Public Housing Agency (MTW PHA) listed below, as its Chairman
or other authorized MTW PHA official if there is no Board of Commissioners, I approve the submission of the Annual Moving to Work
Plan for the MTW PHA fiscal year beginning (DD/MM/YYYY), hereinafter referred to as "the Plan", of which this document is a part and
make the following certifications and agreements with the Department of Housing and Urban Development (HUD) in connection with
the submission of the Plan and implementation thereof:
(1) The MTW PHA published a notice that a hearing would be held, that the Plan and all information relevant to the public hearing was
available for public inspection for at least 30 days, that there were no less than 15 days between the public hearing and the
approval of the Plan by the Board of Commissioners, and that the MTW PHA conducted a public hearing to discuss the Plan and
invited public comment.
(2) The MTW PHA took into consideration public and resident comments (including those of its Resident Advisory Board or Boards)
before approval of the Plan by the Board of Commissioners or Board of Directors in order to incorporate any public comments into
the Annual MTW Plan.
(3) The MTW PHA certifies that the Board of Directors has reviewed and approved the budget for the Capital Fund Program grants
contained in the Capital Fund Program Annual Statement/Performance and Evaluation Report, form HUD-50075.1 (or successor
form as required by HUD).
(4) The MTW PHA will carry out the Plan in conformity with Title VI of the Civil Rights Act of 1964, the Fair Housing Act, section 504 of
the Rehabilitation Act of 1973, and title II of the Americans with Disabilities Act of 1990.
(5) The Plan is consistent with the applicable comprehensive housing affordability strategy (or any plan incorporating such strategy)
for the jurisdiction in which the PHA is located.
(6) The Plan contains a certification by the appropriate state or local officials that the Plan is consistent with the applicable
Consolidated Plan, which includes a certification that requires the preparation of an Analysis of Impediments to Fair Housing
Choice, for the MTW PHA's jurisdiction and a description of the manner in which the Plan is consistent with the applicable
Consolidated Plan.
(7) The MTW PHA will affirmatively further fair housing by fulfilling the requirements at 24 CFR 903.7(o) and 24 CFR 903.15(d), which
means that it will take meaningful actions to further the goals identified in the Assessment of Fair Housing (AFH) conducted in
accordance with the requirements of 24 CFR 5.150 through 5.180, that it will take no action that is materially inconsistent with its
obligation to affirmatively further fair housing, and that it will address fair housing issues and contributing factors in its programs,
in accordance with 24 CFR 903.7(o)(3). Until such time as the MTW PHA is required to submit an AFH, and that AFH has been
accepted by HUD, the MTW PHA will address impediments to fair housing choice identified in the Analysis of Impediments to fair
housing choice associated with any applicable Consolidated or Annual Action Plan under 24 CFR Part 91.
(8) The MTW PHA will comply with the prohibitions against discrimination on the basis of age pursuant to the Age Discrimination Act
of 1975.
(9) In accordance with 24 CFR 5.105(a)(2), HUD’s Equal Access Rule, the MTW PHA will not make a determination of eligibility for
housing based on sexual orientation, gender identify, or marital status and will make no inquiries concerning the gender
identification or sexual orientation of an applicant for or occupant of HUD-assisted housing.
(10) The MTW PHA will comply with the Architectural Barriers Act of 1968 and 24 CFR Part 41, Policies and Procedures for the
Enforcement of Standards and Requirements for Accessibility by the Physically Handicapped.
(11) The MTW PHA will comply with the requirements of section 3 of the Housing and Urban Development Act of 1968, Employment
Opportunities for Low-or Very-Low Income Persons, and with its implementing regulation at 24 CFR Part 135.
(12) The MTW PHA will comply with requirements with regard to a drug free workplace required by 24 CFR Part 24, Subpart F.
(13) The MTW PHA will comply with requirements with regard to compliance with restrictions on lobbying required by 24 CFR Part 87,
together with disclosure forms if required by this Part, and with restrictions on payments to influence Federal Transactions, in
accordance with the Byrd Amendment and implementing regulations at 49 CFR Part 24.

HUD FORM 50900: Certifications of Compliance

24

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX
(14) The MTW PHA will comply with acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970 and implementing regulations at 49 CFR Part 24 as applicable.
(15) The MTW PHA will take appropriate affirmative action to award contracts to minority and women's business enterprises under 24
CFR 5.105(a).
(16) The MTW PHA will provide HUD or the responsible entity any documentation needed to carry out its review under the National
Environmental Policy Act and other related authorities in accordance with 24 CFR Part 58. Regardless of who acts as the
responsible entity, the MTW PHA will maintain documentation that verifies compliance with environmental requirements pursuant
to 24 Part 58 and 24 CFR Part 50 and will make this documentation available to HUD upon its request.
(17) With respect to public housing and applicable local, non-traditional development the MTW PHA will comply with Davis-Bacon or
HUD determined wage rate requirements under section 12 of the United States Housing Act of 1937 and the Contract Work Hours
and Safety Standards Act.
(18) The MTW PHA will keep records in accordance with 24 CFR 85.20 and facilitate an effective audit to determine compliance with
program requirements.
(19) The MTW PHA will comply with the Lead-Based Paint Poisoning Prevention Act and 24 CFR Part 35.
(20) The MTW PHA will comply with the policies, guidelines, and requirements of OMB Circular No. A-87 (Cost Principles for State, Local
and Indian Tribal Governments) and 24 CFR Part 200.
(21) The MTW PHA will undertake only activities and programs covered by the Plan in a manner consistent with its Plan and will utilize
covered grant funds only for activities that are approvable under the Moving to Work Agreement and Statement of Authorizations
and included in its Plan.

(22) All attachments to the Plan have been and will continue to be available at all times and all locations that the Plan is available for

public inspection. All required supporting documents have been made available for public inspection along with the Plan and
additional requirements at the primary business office of the PHA and at all other times and locations identified by the MTW PHA
in its Plan and will continue to be made available at least at the primary business office of the MTW PHA.

_________________________________________
MTW PHA NAME

_________________________________________
MTW PHA NUMBER/HA CODE

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment
herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in
criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802).

_________________________________________
NAME OF AUTHORIZED OFFICIAL

_________________________________________
TITLE

_________________________________________
SIGNATURE

_________________________________________
DATE

*

Must be signed by either the Chairman or Secretary of the Board of the MTW PHA's legislative body. This certification cannot be
signed by an employee unless authorized by the MTW PHA Board to do so. If this document is not signed by the Chairman or
Secretary, documentation such as the by-laws or authorizing board resolution must accompany this certification.

HUD FORM 50900: Certifications of Compliance

25

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

STANDARD HUD METRICS
For all activities in Section (III) Proposed Activities and activities in Section (IV) Approved Activities in the
"Implemented" category, the MTW PHA must use all of the applicable Standard HUD Metrics listed below.
Standard HUD Metrics must be reported in the table format provided in order to allow analysis and
aggregation across MTW PHAs for similar activities.
For Standard HUD Metrics that are different from the metrics the MTW PHA had been reporting on for an
implemented MTW activity, the MTW PHA may set a baseline prior to when the MTW activity began (through
historical records or extrapolation from available data). If such information is not available, the MTW PHA may
set the baseline in the Annual MTW Report where the Standard HUD Metric is first presented. If one of the
Standard HUD Metrics had not been used in previous Annual MTW Reports, the MTW PHA must begin tracking
the MTW activity using the Standard HUD Metrics during the current Plan Year.
MTW PHAs should show the component variables that comprise figures (for example, in showing a "Total
Cost," an MTW PHA would show the cost per transaction and number of transactions).
MTW PHAs have the flexibility to report on agency developed and previously established metrics in addition to
the required Standard HUD Metrics.

COST EFFECTIVENESS
When citing the statutory objective to “reduce cost and achieve greater cost effectiveness in federal expenditures,”
include all of the following metrics that apply:

CE #1: Agency Cost Savings
Unit of
Measurement
Total cost of task in
dollars (decrease).

Baseline
Cost of task prior to
implementation of
the activity (in
dollars).

Benchmark

Outcome

Expected cost of task
after implementation of
the activity (in dollars).

Actual cost of task after
implementation of the
activity (in dollars).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

CE #2: Staff Time Savings
Unit of
Measurement
Total time to
complete the task in
staff hours
(decrease).

Baseline

Benchmark

Outcome

Total amount of staff
time dedicated to the
task prior to
implementation of
the activity (in
hours).

Expected amount of
total staff time
dedicated to the task
after implementation of
the activity (in hours).

Actual amount of total
staff time dedicated to
the task after
implementation of the
activity (in hours).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

CE #3: Decrease in Error Rate of Task Execution
Unit of
Measurement
Average error rate in
completing a task as
a percentage
(decrease).

Baseline
Average error rate of
task prior to
implementation of
the activity
(percentage).

HUD FORM 50900: Standard HUD Metrics

Benchmark
Expected average error
rate of task after
implementation of the
activity (percentage).

Outcome
Actual average error
rate of task after
implementation of the
activity (percentage).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

26

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

CE #4: Increase in Resources Leveraged
Unit of
Measurement
Amount of funds
leveraged in dollars
(increase).

Baseline

Benchmark

Amount leveraged prior
to implementation of
the activity (in dollars).
This number may be
zero.

Expected amount
leveraged after
implementation of the
activity (in dollars).

Benchmark
Achieved?

Outcome
Actual amount
leveraged after
implementation of the
activity (in dollars).

Whether the outcome
meets or exceeds the
benchmark.

CE #5: Increase in Agency Rental Revenue
Unit of
Measurement
Total Household
contribution
towards housing
assistance
(increase).

Baseline

Benchmark

Household contribution
prior to
implementation of the
activity (in dollars).

Expected household
contribution after
implementation of the
activity (in dollars).

Benchmark
Achieved?

Outcome
Actual household
contribution after
implementation of the
activity (in dollars).

Whether the outcome
meets or exceeds the
benchmark.

CE #6: Reducing Per Unit Subsidy Costs for Participating Households
Unit of
Measurement
Average amount of
Section 8 and/or 9
subsidy (or local,
non-traditional
subsidy) per
household affected
by this policy in
dollars (decrease).

Baseline

Benchmark

Outcome

Average subsidy per
household affected by
this policy prior to
implementation of the
activity (in dollars).

Expected average
subsidy per household
affected by this policy
after implementation of
the activity (in dollars).

Actual average subsidy
per household affected
by this policy after
implementation of the
activity (in dollars).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

SELF SUFFICIENCY
When citing the statutory objective to “give incentives to families…whose heads of household are either working, seeking
work, or are participating in job training educational or other programs to assist in obtaining employment and becoming
economically self-sufficient,” include all of the following metrics that apply:

SS #1: Increase in Household Income
Unit of
Measurement
Average earned
income of
households
affected by this
policy in dollars
(increase).

Baseline
Average earned income
of households affected
by this policy prior to
implementation of the
activity (in dollars).

HUD FORM 50900: Standard HUD Metrics

Benchmark
Expected average
earned income of
households affected by
this policy prior to
implementation of the
activity (in dollars).

Outcome
Actual average earned
income of households
affected by this policy
prior to
implementation (in
dollars).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

27

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

SS #2: Increase in Household Savings
Unit of
Measurement
Average amount of
savings/escrow of
households
affected by this
policy in dollars
(increase).

Baseline

Benchmark

Outcome

Average
savings/escrow amount
of households affected
by this policy prior to
implementation of the
activity (in dollars). This
number may be zero.

Expected average
savings/escrow amount
of households affected
by this policy after
implementation of the
activity (in dollars).

Actual average
savings/escrow amount
of households affected
by this policy after
implementation of the
activity (in dollars).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

SS#3: Increase in Positive Outcomes in Employment Status
Benchmark
Achieved?

Unit of Measurement

Baseline

Benchmark

Outcome

Report the following
information separately for
each category:

Head(s) of households in
<> prior
to implementation of the
activity (number). This
number may be zero.

Expected head(s) of
work-able households in
<>
after implementation of
the activity (number).

Actual head(s) of
work-able
households in
<>
after implementation
of the activity
(number).

Whether the
outcome meets
or exceeds the
benchmark.

Percentage of total
work-able households in
<> prior
to implementation of
activity (percent). This
number may be zero.

Expected percentage of
total work-able
households in
<>
after implementation of
the activity (percent).

Actual percentage of
total work-able
households in
<>
after implementation
of the activity
(percent).

Whether the
outcome meets
or exceeds the
benchmark.

(1) Employed Full- Time
(2) Employed Part- Time
(3) Enrolled in an
Educational Program
(4) Enrolled in Job Training
Program
(5) Unemployed
(6) Other

SS #4: Households Removed from Temporary Assistance for Needy Families (TANF)
Unit of
Benchmark
Baseline
Benchmark
Outcome
Measurement
Achieved?
Number of
households
receiving TANF
assistance
(decrease).

Households receiving
TANF prior to
implementation of the
activity (number).

Expected number of
households receiving
TANF after
implementation of the
activity (number).

Actual households
receiving TANF after
implementation of the
activity (number).

Whether the outcome
meets or exceeds the
benchmark.

SS #5: Households Assisted by Services that Increase Self Sufficiency
Unit of
Measurement
Number of
households
receiving services
aimed to increase
self sufficiency
(increase).

Baseline

Benchmark

Outcome

Households receiving
self sufficiency services
prior to
implementation of the
activity (number).

Expected number of
households receiving self
sufficiency services after
implementation of the
activity (number).

Actual number of
households receiving
self sufficiency services
after implementation
of the activity
(number).

HUD FORM 50900: Standard HUD Metrics

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

28

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

SS #6: Reducing Per Unit Subsidy Costs for Participating Households
Unit of
Measurement
Average amount of
Section 8 and/or 9
subsidy (or local,
non-traditional
subsidy) per
household affected
by this policy in
dollars (decrease).

Baseline

Benchmark

Outcome

Average subsidy per
household affected by
this policy prior to
implementation of the
activity (in dollars).

Expected average
subsidy per household
affected by this policy
after implementation of
the activity (in dollars).

Actual average subsidy
per household affected
by this policy after
implementation of the
activity (in dollars).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

SS #7: Increase in Agency Rental Revenue
Unit of
Measurement
Total Household
contribution
towards housing
assistance
(increase).

Baseline

Benchmark

Household contribution
prior to
implementation of the
activity (in dollars).

Expected household
contribution after
implementation of the
activity (in dollars).

Benchmark
Achieved?

Outcome
Actual household
contribution after
implementation of the
activity (in dollars).

Whether the outcome
meets or exceeds the
benchmark.

SS #8: Households Transitioned to Self Sufficiency
Unit of Measurement

Baseline

Benchmark

Number of households
transitioned to self sufficiency
(increase). The PHA may create
one or more definitions for "self
sufficiency" to use for this
metric. Each time the PHA uses
this metric, the "Outcome"
number should also be provided
in Section (II) Operating
Information in the space
provided.

Households
transitioned to self
sufficiency (<>) prior
to implementation of
the activity
(number). This
number may be zero.

Expected households
transitioned to self
sufficiency (<>) after
implementation of
the activity
(number).

Outcome
Actual households
transitioned to self
sufficiency (<>) after
implementation of
the activity
(number).

Benchmark
Achieved?
Whether the
outcome meets or
exceeds the
benchmark.

HOUSING CHOICE
When citing the statutory objective to “increase housing choices for low-income families,” include all of the following
metrics that apply:

HC #1: Additional Units of Housing Made Available
Unit of Measurement

Baseline

Benchmark

Number of new housing units
made available for households
at or below 80% AMI as a result
of the activity (increase). If units
reach a specific type of
household, give that type in this
box.

Housing units of this
type prior to
implementation of
the activity
(number). This
number may be zero.

Expected housing
units of this type
after implementation
of the activity
(number).

HUD FORM 50900: Standard HUD Metrics

Outcome
Actual housing units
of this type after
implementation of
the activity
(number).

Benchmark
Achieved?
Whether the
outcome meets or
exceeds the
benchmark.

29

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

HC #2: Units of Housing Preserved
Unit of Measurement

Baseline

Number of housing units
preserved for households at or
below 80% AMI that would
otherwise not be available
(increase). If units reach a
specific type of household, give
that type in this box.

Housing units
preserved prior to
implementation of
the activity
(number).

Benchmark
Expected housing
units preserved after
implementation of
the activity
(number).

Benchmark
Achieved?

Outcome
Actual housing units
preserved after
implementation of
the activity
(number).

Whether the
outcome meets or
exceeds the
benchmark.

HC #3: Decrease in Wait List Time
Unit of
Measurement
Average applicant
time on wait list in
months (decrease).

Baseline

Benchmark

Outcome

Average applicant time
on wait list prior to
implementation of the
activity (in months).

Expected average
applicant time on wait
list after implementation
of the activity (in
months).

Actual average
applicant time on wait
list after
implementation of the
activity (in months).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

HC #4: Displacement Prevention
Unit of Measurement

Baseline

Number of households at or
below 80% AMI that would lose
assistance or need to move
(decrease). If units reach a
specific type of household, give
that type in this box.

Households losing
assistance/moving
prior to
implementation of
the activity
(number).

Benchmark
Achieved?

Benchmark

Outcome

Expected households
losing
assistance/moving
after implementation
of the activity
(number).

Actual households
losing
assistance/moving
after implementation
of the activity
(number).

Whether the
outcome meets or
exceeds the
benchmark.

HC #5: Increase in Resident Mobility
Unit of
Measurement
Number of
households able to
move to a better
unit and/or
neighborhood of
opportunity as a
result of the
activity (increase).

Baseline

Benchmark

Outcome

Households able to
move to a better unit
and/or neighborhood
of opportunity prior to
implementation of the
activity (number). This
number may be zero.

Expected households
able to move to a better
unit and/or
neighborhood of
opportunity after
implementation of the
activity (number).

Actual increase in
households able to
move to a better unit
and/or neighborhood
of opportunity after
implementation of the
activity (number).

HUD FORM 50900: Standard HUD Metrics

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

30

OMB Control Number: XXXX-XXXX
Expiration Date: XX/XX/XXXX

HC #6: Increase in Homeownership Opportunities
Unit of
Measurement
Number of
households that
purchased a home
as a result of the
activity (increase).

Baseline

Benchmark

Outcome

Number of households
that purchased a home
prior to
implementation of the
activity (number). This
number may be zero.

Expected number of
households that
purchased a home after
implementation of the
activity (number).

Actual number of
households that
purchased a home after
implementation of the
activity (number).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

HC #7: Households Assisted by Services that Increase Housing Choice
Unit of
Measurement
Number of
households
receiving services
aimed to increase
housing choice
(increase).

Baseline
Households receiving
this type of service
prior to
implementation of the
activity (number). This
number may be zero.

HUD FORM 50900: Standard HUD Metrics

Benchmark
Expected number of
households receiving
these services after
implementation of the
activity (number).

Outcome
Actual number of
households receiving
these services after
implementation of the
activity (number).

Benchmark
Achieved?
Whether the outcome
meets or exceeds the
benchmark.

31