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 Section (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 Field Office via email. The MTW Coordinator will send an email confirming receipt onceafter 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, non-traditional 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).

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 includedconsidered 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 or families that receive assistance through an MTW tenant-based housing program outside of Sections 8 and 9 of the 1937U.S. Housing Act of 1937. This includes all households at or below 80% arearea median income (AMI) that receive tenant-based housing assistance through MTW funds but not through traditional Public Housingpublic housing or Housing Choice VouchersHCVs.

• Local, Non-Traditional: Property-Based: Number of households or families that receive assistance through an MTW property-based or project-based housing program outside of Sections 8 and 9 of the 1937U.S. Housing Act of 1937. This includes all households at or below 80% are median income (AMI) that receive property-based or project-based housing assistance through MTW funds but not through traditional Public Housingpublic housing or Housing Choice VouchersHCVs.

• Local, Non-Traditional: Homeownership: Number of households or families that receive assistance through an MTW homeownership housing program outside of Sections 8 and 9 of the 1937U.S. Housing Act of 1937. This includes all households at or below 80% are median income (AMI) that receive homeownership housing assistance through MTW funds but not through traditional Public Housingpublic housing or Housing Choice VouchersHCVs.

Households Receiving Services Only: HUD will track “Households Receiving Services Only through MTW-Funded Local, Non-Traditional Activities.” These households, however, will not be includedconsidered 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 the MTW-funded block grant funds and not assisted through any type of housing assistance for the fiscal year and over the course of the agency'sMTW 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 cited for each MTW activity. Standard HUD Metrics must be given 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. 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 subcategories.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 citedimplicated.

• 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 cited (and as availableimplicated 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 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 officialgoverning 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, etc.)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.

INTRODUCTION
Annual MTW Plan	Annual MTW Report
A. TABLE OF CONTENTS Include all of the required elements of the Annual MTW Plan. (including appendices).	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 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 non-MTW components, the MTW PHA should clearly delineate which are MTW and which are non-MTW 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.	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.
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: Fair Housing Goal: Explain Strategies and Actions

2. GENERAL OPERATING INFORMATION

Annual MTW Plan

1. HOUSING STOCK INFORMATION

1. AnticipatedPlanned New Public Housing Units

New public housing units that the MTW PHA anticipates will be added during the Plan Year.

AMP NAME AND NUMBER	BEDROOM SIZE						TOTAL UNITS	POPULATION TYPE*	# of UFAS Units
0/1	2	3	4	5	6+	Fully Accessible	Adaptable
Name/Number	#	#	#	#	#	#	#	Type (below)	#	#
Name/Number	#	#	#	#	#	#	#	Type (below)	#	#
Name/Number	#	#	#	#	#	#	#	Type (below)	#	#

#

#

Total Public Housing Units to be Added in the Plan Year

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

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

Description

Description

Anticipated

2. 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	#	Explanation
Name/Number	#	Explanation
Name/Number	#	Explanation

#

#

Total Public Housing Units to be Removed in the Plan Year

3. AnticipatedPlanned 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 agreements in which a Housing Assistance Payment (HAP) Agreement will be in place by the end of the PlayPlan 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	#	Yes/No	Description
Name	#	Yes/No	Description

#

#

Anticipated

Planned Total Vouchers to be Newly Project-Based

4. AnticipatedPlanned Existing Project Based Vouchers at the End of the Plan Year

Tenant-based vouchers that the MTW PHA is currently project-basing in the Plan Year. Tenant-based vouchers that the MTW PHA is currently project-basing in the Plan Year. These include only those agreements in which a Housing Assistance Payment (HAP) Agreement will beis already in place byat the beginning of the Plan Year. Indicate whether the end of the Plan Yearunit is included in RAD.

PROPERTY NAME	NUMBER OF PROJECT-BASED VOUCHERS	STATUS AT END OF PLAN YEAR*	RAD?	DESCRIPTION OF PROJECT
Name	#	Status (below)	Yes/No	Description
Name	#	Status (below)	Yes/No	Description

#

#

Anticipated

Planned Total Existing Project-Based Vouchers

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

5. AnticipatedPlanned Other Changes to MTW Housing Stock Anticipated inDuring 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.

ANTICIPATEDPLANNED OTHER CHANGES TO MTW HOUSING STOCK ANTICIPATED IN THE PLAN YEAR

Description

6. General Description of All AnticipatedPlanned 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 ANTICIPATEDPLANNED CAPITAL EXPENDITURES DURING THE PLAN YEAR

Description

2. LEASING INFORMATION

1. AnticipatedPlanned Number of Households Served in the Plan Year

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 VoucherVouchers (HCV) Utilized	#	#
Local, Non-Traditional: Tenant-Based^	#	#
Local, Non-Traditional: Property-Based^	#	#
Local, Non-Traditional: Homeownership^	#	#

#

#

#

#

Anticipated

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-Traditionallocal, 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.

LOCAL, NON-TRADITIONAL CATEGORY	MTW ACTIVITY NAME/NUMBER	PLANNED NUMBER OF UNIT MONTHS OCCUPIED/LEASED*	PLANNED NUMBER OF HOUSEHOLDS TO BE SERVED*
Tenant-Based	Name/#	#	#
Property-Based	Name/#	#	#
Homeownership	Name/#	#	#

* 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.

2. 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	Description
MTW Housing Choice Voucher	Description
Local, Non-Traditional	Description

3. WAITING LIST INFORMATION

1. Waiting List Information Anticipated for the Beginning of the Plan Year

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	WAITING LIST OPEN, PARTIALLY OPEN OR CLOSED	PLANS TO OPEN THE WAITING LIST DURING THE PLAN YEAR
Name	Description	#	Open/Partially Open/Closed	Yes/No
Name	Description	#	Open/Partially Open/Closed	Yes/No
Name	Description	#	Open/Partially Open/Closed	Yes/No

Please describe any duplication of applicants across waiting lists:

Description

Description

Anticipated

2. 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 ANTICIPATEDPLANNED CHANGES TO WAITING LIST
Name	Description
Name	Description

2. GENERAL OPERATING INFORMATION

Annual MTW REPORT

1. HOUSING STOCK INFORMATION

1. 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 agreements 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	NUMBER OF VOUCHERS NEWLY PROJECT-BASED		RAD?	DESCRIPTION OF PROJECT
	Planned*	Actual
Name	#	#	Yes/No	Description
Name	#	#	Yes/No	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 AnticipatedPlanned and Actual Number of Vouchers Newly Project-Based:

Description

Description

2. Actual Existing Project Based Vouchers at

3. Tenant-based vouchers that the End ofMTW PHA is currently project-basing in the Plan Year

Tenant-based vouchers that the MTW PHA is currently project-basing in the Plan Year. . These include only those agreements in which a HAP Agreement was in place by the endbeginning 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
	Planned*	Actual	Planned*		Actual
Name	#	#	#Yes/No	#	Description
Name	#	#	#Yes/No	#	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 AnticipatedPlanned and Actual Number of Vouchers Project-Based:

Description

Description

4. 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 ANTICIPATED IN THE PLAN YEAR

Description

5. 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

2. LEASING INFORMATION

1. Actual Number of Households Served in the Plan Year

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 VoucherVouchers (HCV) Utilized	#	#	#	#
Local, Non-Traditional: Tenant-Based^	#	#	#	#
Local, Non-Traditional: Property-Based^	#	#	#	#
Local, Non-Traditional: Homeownership^	#	#	#	#

#

#

Anticipated Total Actual Total

#

#

#

#

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-Traditionallocal, 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 anticipatedplanned and actual households served:

Description

Description

LOCAL, NON-TRADITIONAL CATEGORY	MTW ACTIVITY NAME/NUMBER	NUMBER OF UNIT MONTHS OCCUPIED/LEASED*		NUMBER OF HOUSEHOLDS TO BE SERVED*
		Planned^^	Actual	Planned^^	Actual
Tenant-Based	Name/#	#	#	#	#
Property-Based	Name/#	#	#	#	#
Homeownership	Name/#	#	#	#	#

#

#

#

#

Planned/Actual Totals

* 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.

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	#	#

2. 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	Description
MTW Housing Choice Voucher	Description
Local, Non-Traditional	Description

3. WAITING LIST INFORMATION

1. Actual Waiting List Information for the End of the Plan Year

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	WAITING LIST OPEN, PARTIALLY OPEN OR CLOSED	WAS THE WAITING LIST OPENED DURING THE PLAN YEAR
Name	Description	#	Open/Partially Open/Closed	Yes/No
Name	Description	#	Open/Partially Open/Closed	Yes/No
Name	Description	#	Open/Partially Open/Closed	Yes/No

Please describe any duplication of applicants across waiting lists:

Description

Description

2. 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	Description
Name	Description

4. INFORMATION ON STATUTORY OBJECTIVES AND REQUIREMENTS

1. 75% of Families Assisted areAre 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: Tenant-Based”; “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

2. 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

Description

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.1i 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

Description

3. 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	#	Definition
Name/Number	#	Definition
Name/Number	#	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.

2. 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.

1. ACTIVITY DESCRIPTION

1. Describe the proposed activity.

2. Describe how the proposed activity will achieve one or more of the three statutory objectives and the specific impacts on that statutory objective(s).

3. Provide the anticipated schedule for implementing the proposed activity.

2. ACTIVITY METRICS INFORMATION

1. Provide the metrics from the “Standard HUD Metrics” section that are applicable to the proposed activity.

2. Give the baseline performance level for each metric (a numeric value) prior to the implementation of the proposed activity.

3. Give the annual benchmark for each metric (a numeric value).

4. GiveIf applicable, give the overall and/or long term benchmark(s) for each metric (a numeric value).

5. Give the data source from which the metric data will be compiled.

3. COST IMPLICATIONS

1. State whether the proposed activity will result in any cost implications (positive and/or negative) for the MTW PHA.

2. 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.

4. NEED/JUSTIFICATION FOR MTW FLEXIBILITY

1. 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.

2. 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).

5. 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.

1. 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.

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.

2. 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.

3. 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.

4. 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.

3. 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’.”

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.
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:
Plan Year Approved, Implemented, Amended Specify the Plan Year the MTW activity was proposed. Specify the Plan Year the MTW activity was implemented. Provide any Plan Years in which the MTW activity was amended.	Plan Year Approved, Implemented, Amended Specify the Plan Year the MTW activity was proposed. Specify the Plan Year the MTW activity was implemented. Provide any Plan Years in which the MTW activity was amended.
Description/Update Provide a description of the MTW activity. Provide an update on the status of the MTW activity.	Description/Impact/Update Provide a description of the MTW activity and detailed information on its impact during the 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. 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.
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).	iii. Actual Significant Changes Indicate if the MTW PHA made the planned non-significant 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).
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).	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).
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). NOTE: HUD requires MTW PHAs to re-propose MTW activities that require a “significant change”. Re-proposing 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.”	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).
	Challenges in Achieving Benchmarks and Possible Strategies If benchmarks were not achieved or if the TMWMTW 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:
Describe the approved MTW activity that was proposed in an Annual MTW Plan, approved by HUD, and not yet implemented. Discuss why the MTW activity was not yet implemented. Specify the Plan Year in which the MTW activity was first approved.	Provide a brief description of the approved MTW activity that was proposed in an Annual MTW Plan, approved by HUD, and not yet implemented. Specify the Plan Year in which the MTW activity was first approved.
Provide an update on the implementation plan for the MTW activity. Provide a timeline associated with this implementation plan. If there are no plans to implement the MTW activity, state that the MTW PHA will move it to the “Closed Out Activities” category in the next Annual MTW Report.	ii. Discuss any actions taken towards the implementation plan for the MTW activity in the Plan Year. Relate these actions to the implementation plan and timeline the MTW PHA provided in the Annual MTW Plan.
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:
Describe the approved MTW activity that was approved, implemented and that the MTW tenPHA then stopped implementing (but has plans to reactivate in the future). Describe why the MTW activity was placeplaced on hold. Specify the Plan Year(s) in which the MTW activity was first approved, implemented and placed on hold.	Provide a brief description of the approved MTW activity that was approved, implemented and that the MTW tenPHA 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. 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.	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.
iii. Provide an explanation of any non-significant changes or modifications to the MTW activity since it was approved by HUD.
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:
List the closed out MTW activity. Specify the Plan Year(s) in which the MTW activity was approved, implemented (if applicable) and closed out.	List the closed out MTW activity. Specify the Plan Year(s) in which the MTW activity was approved, implemented (if applicable) and closed out.
Explain why the MTW activity was closed out.	ii. Explain why the MTW activity was closed out.
	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).

5. SOURCES AND USES OF MTW FUNDS

Annual MTW Plan

1. ESTIMATED SOURCES AND USES OF MTW FUNDS

1. Estimated Sources of MTW Funds in the Plan Year

The MTW PHA shall provide the estimated sources and amount of MTW funding by Financial Data Schedule (FDS) line item.

FDS LINE ITEM NUMBER	FDS LINE ITEM NAME	DOLLAR AMOUNT
70500 (70300+70400)	Total Tenant Revenue	$#
70600	HUD PHA Operating Grants	$#
70610	Capital Grants	$#
70700 (70710+70720+70730+70740+70750)	Total Fee Revenue	$#
71100+72000	Interest Income	$#
71600	Gain or Loss on Sale of Capital Assets	$#
71200+71300+71310+71400+71500	Other Income	$#
70000	Total Revenue	$#

2. Estimated Uses of MTW Funds in the Plan Year

The MTW PHA shall provide the estimated uses and amount of MTW spending by Financial Data Schedule (FDS) line item.

FDS LINE ITEM NUMBER	FDS LINE ITEM NAME	DOLLAR AMOUNT
91000 (91100+91200+91400+91500+91600+91700+91800+91900)	Total Operating - Administrative	$#
91300+91310+92000	Management Fee Expense	$#
91810	Allocated Overhead	$#
92500 (92100+92200+92300+92400)	Total Tenant Services	$#
93000 (93100+93600+93200+93300+93400+93800)	Total Utilities	$#
93500+93700	Labor	$#
94000 (94100+94200+94300+94500)	Total Ordinary Maintenance	$#
95000 (95100+95200+95300+95500)	Total Protective Services	$#
96100 (96110+96120+96130+96140)	Total Insurance Premiums	$#
96000 (96200+96210+96300+96400+96500+96600+96800)	Total Other General Expenses	$#
96700 (96710+96720+96730)	Total Interest Expense & Amortization Cost	$#
97100+97200	Total Extraordinary Maintenance	$#
97300+97350	HAP + HAP Portability-In	$#
97400	Depreciation Expense	$#
97500+97600+97700+97800	All Other Expense	$#
90000	Total Expenses	$#

Please describe any variance between Estimated Total Revenue and Estimated Total Expenses:

Description

Description or N/A

Describe

3. 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 Flexibilityflexibility 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

2. LOCAL ASSET MANGEMENT PLAN

Yes/No

Yes/No

1. Is the MTW PHA allocating costs within statute?

Yes/No

Yes/No

2. Is the MTW PHA implementing a local asset management plan (LAMP)?

Yes/No

Yes/No

3. Has the MTW PHA provide a LAMP in the appendix?

4. 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

Description

3. RENTAL ASSISTANCE DEMONSTRATION (RAD) PARTICIPATION

1. 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

Yes/No

2. Has the MTW PHA submitted a RAD Significant Amendment in the appendix?

3. 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

(V) SOURCES AND USES OF MTW FUNDS

Annual MTW REPORT

1. ACTUAL SOURCES AND USES OF MTW FUNDS

1. 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.

2. 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.

3. 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 Flexibilityflexibility 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).

PLANNEDACTUAL USE OF MTW SINGLE FUND FLEXIBILITY

Description

2. LOCAL ASSET MANGEMENT PLAN

Yes/No

Yes/No

1. Did the MTW PHA allocate costs within statute in the Plan Year?

Yes/No

Yes/No

2. Did the MTW PHA implement a local asset management plan (LAMP) in the Plan Year?

Yes/No

Yes/No

3. Did the MTW PHA provide a LAMP in the appendix?

4. If the MTW PHA has provided a LAMP in the appendix, please provide ana 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

Description

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

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 (MTW) 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 Statestate 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 PHA Plan is consistent with the applicable Consolidated Plan.

7. The PHA will affirmatively further fair housing by examining its programs or proposed programs, identify any impediments to fair housing choice within those programs, address those impediments in a reasonable fashion in view of the resources available and work with local jurisdictions to implement any of the jurisdiction's initiatives to affirmatively further fair housing that require the PHA's involvement and maintain records reflecting these analyses and actions.

8. 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.

9. The MTW PHA will comply with the prohibitions against discrimination on the basis of age pursuant to the Age Discrimination Act of 1975.

10. 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.

11. 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.

12.  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.

13. The MTW PHA will comply with requirements with regard to a drug free workplace required by 24 CFR Part 24, Subpart F.

14. 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.

15. 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.

16. The MTW PHA will take appropriate affirmative action to award contracts to minority and women's business enterprises under 24 CFR 5.105( a).

17. 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.

18. 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.

19. The MTW PHA will keep records in accordance with 24 CFR 85.20 and facilitate an effective audit to determine compliance with program requirements.

20. The MTW PHA will comply with the Lead-Based Paint Poisoning Prevention Act and 24 CFR Part 35.

21. 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 85 (Administrative Requirements for Grants and Cooperative Agreements to State, Local and Federally Recognized Indian Tribal Governments).200.

22. 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.

23. 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.

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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Total cost of task in dollars (decrease).	Cost of task prior to implementation of the activity (in dollars).	Expected cost of task after implementation of the activity (in dollars).	Actual cost of task after implementation of the activity (in dollars).	Whether the outcome meets or exceeds the benchmark.

CE #2: Staff Time Savings
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Total time to complete the task in staff hours (decrease).	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).	Whether the outcome meets or exceeds the benchmark.

CE #3: Decrease in Error Rate of Task Execution
Unit of Measurement		Baseline	Benchmark	Outcome	Benchmark Achieved?
Average error rate in completing a task as a percentage (decrease).		Average error rate of task prior to implementation of the activity (percentage).	Expected average error rate of task after implementation of the activity (percentage).	Actual average error rate of task after implementation of the activity (percentage).	Whether the outcome meets or exceeds the benchmark.
CE #4: Increase in Resources Leveraged
Unit of Measurement	Baseline		Benchmark	Outcome	Benchmark Achieved?
Amount of funds leveraged in dollars (increase).	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).	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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Total Household contribution towards housing assistance (increase).	Household contribution prior to implementation of the activity (in dollars).	Expected household contribution after implementation of the activity (in dollars).	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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Average amount of Section 8 and/or 9 subsidy (or local, non-traditional subsidy) per household affected by this policy in dollars (decrease).	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).	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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Average earned income of households affected by this policy in dollars (increase).	Average earned income of households affected by this policy prior to implementation of the activity (in dollars).	Expected average earned income of households affected by this policy prior to implementation of the activity (in dollars).	Actual average earned income of households affected by this policy prior to implementation (in dollars).	Whether the outcome meets or exceeds the benchmark.

SS #2: Increase in Household Savings
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Average amount of savings/escrow of households affected by this policy in dollars (increase).	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).	Whether the outcome meets or exceeds the benchmark.

SS#3: Increase in Positive Outcomes in Employment Status
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Report the following information separately for each category: (1) Employed Full- Time (2) Employed Part- Time (3) Enrolled in an Educational Program (4) Enrolled in Job Training Program (5) Unemployed (6) Other	Head(s) of households in <<category name>> prior to implementation of the activity (number). This number may be zero.	Expected head(s) of work-able households in <<category name>> after implementation of the activity (number).	Actual head(s) of work-able households in <<category name>> after implementation of the activity (number).	Whether the outcome meets or exceeds the benchmark.
Percentage of total work-able households in <<category name>> prior to implementation of activity (percent). This number may be zero.	Expected percentage of total work-able households in <<category name>> after implementation of the activity (percent).	Actual percentage of total work-able households in <<category name>> after implementation of the activity (percent).	Whether the outcome meets or exceeds the benchmark.

SS #4: Households Removed from Temporary Assistance for Needy Families (TANF)
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark 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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Number of households receiving services aimed to increase self sufficiency (increase).	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).	Whether the outcome meets or exceeds the benchmark.

SS #6: Reducing Per Unit Subsidy Costs for Participating Households
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Average amount of Section 8 and/or 9 subsidy (or local, non-traditional subsidy) per household affected by this policy in dollars (decrease).	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).	Whether the outcome meets or exceeds the benchmark.

SS #7: Increase in Agency Rental Revenue
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Total Household contribution towards housing assistance (increase).	Household contribution prior to implementation of the activity (in dollars).	Expected household contribution after implementation of the activity (in dollars).	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	Outcome	Benchmark Achieved?
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 (<<PHA definition of self-sufficiency>>) prior to implementation of the activity (number). This number may be zero.	Expected households transitioned to self sufficiency (<<PHA definition of self-sufficiency>>) after implementation of the activity (number).	Actual households transitioned to self sufficiency (<<PHA definition of self-sufficiency>>) after implementation of the activity (number).	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	Outcome	Benchmark Achieved?
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).	Actual housing units of this type after implementation of the activity (number).	Whether the outcome meets or exceeds the benchmark.

HC #2: Units of Housing Preserved
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
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).	Expected housing units preserved after implementation of the activity (number).	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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Average applicant time on wait list in months (decrease).	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).	Whether the outcome meets or exceeds the benchmark.

HC #4: Displacement Prevention
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
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).	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	Baseline	Benchmark	Outcome	Benchmark Achieved?
Number of households able to move to a better unit and/or neighborhood of opportunity as a result of the activity (increase).	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).	Whether the outcome meets or exceeds the benchmark.

HC #6: Increase in Homeownership Opportunities
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Number of households that purchased a home as a result of the activity (increase).	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).	Whether the outcome meets or exceeds the benchmark.

HC #7: Households Assisted by Services that Increase Housing Choice
Unit of Measurement	Baseline	Benchmark	Outcome	Benchmark Achieved?
Number of households receiving services aimed to increase housing choice (increase).	Households receiving this type of service prior to implementation of the activity (number). This number may be zero.	Expected number of households receiving these services after implementation of the activity (number).	Actual number of households receiving these services after implementation of the activity (number).	Whether the outcome meets or exceeds the benchmark.

HUD FORM 50900: Instructions 4