Form 1 AFI Short Form

Assets for Independence (AFI) Performance Progress Report (PPR)

OCS-0292 AFI Information Collection Instrument SHORT form

FI PPR Short Form

OMB: 0970-0483

Document [docx]
Download: docx | pdf

OMB Control No: 0970- XXXX

Expiration date: XX/XX/XXXX


Fields highlighted in yellow are initially optional, as grantees phase-in data collection for these new data elements.


Proposed AFI PPR Short Form

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)


Public reporting burden for this collection of information is estimated to average 3.8 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.


An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.


1. Federal Agency and Organization Element to Which Report is Submitted



Pre-populated from Notice of Award (NOA)


2. Federal Grant or Other Identifying Number Assigned by Federal Agency



Pre-populated from NOA

3a. DUNS Number


Pre-populated from NOA

3b. EIN


Pre-populated from NOA

4. Recipient Organization (Name and complete address including zip code)



Pre-populated from NOA

5. Optional: Recipient Identifying Number or Account Number


Optional, enter the account or other identifying number that the grantee has assigned to the award reported on this form.

6. Project/Grant Period

7. Reporting Period End Date (MM,DD, YYYY)



Generated by OLDC

8. Final Report? Yes No

Generated by OLDC

Start Date: (MM, DD, YYYY)



Pre-populated from NOA

End Date: (MM, DD, YYYY)


Pre-populated from NOA

9. Report Frequency

Generated by OLDC

10. Optional: Performance Narrative


Optional. Grantees that want to provide a performance narrative can upload the narrative as a file.

11. Certification: I certify to the best of my knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.

11a. Typed or Printed Name and Title of Authorized Certifying Official


Generated by OLDC, based on user account.


11c. Telephone (area code, number and extension)


11d. Email Address

11b. Signature of Authorized Certifying Official


Generated by OLDC, based on user account.


11e. Date Report Submitted (MM, DD, YYYY)


Generated by OLDC



The Short Form consists of select questions from the Long Form, as indicated by the item numbers.

AFI PPR Short Form


NOTE: In this section, report cumulative data for this grant, i.e. data from the date of award through the end of this reporting period, unless otherwise specified.

Item

Data Element

Prior Report Data

Current Report Data

AFI-C003

Total number of AFI IDAs opened.


Enter the total number of IDAs opened under this grant. Include accounts transferred to this AFI IDA project from another AFI IDA project held by your organization.

Pre-populated from prior report


AFI-C004

Current total number of AFI IDAs open.


Enter the number AFI IDAs open under this grant as of the last day of this reporting period. (Not cumulative.)

Pre-populated from prior report


AFI-C006

Total amount of AFI IDA holder savings deposits in AFI IDAs.


Enter the total amount of savings that AFI IDA holders have deposited into AFI IDAs under this grant.

Pre-populated from prior report

$

AFI-C007

Current total amount of AFI IDA holder savings balances in AFI IDAs.


Enter the balance amount of AFI IDA holder savings in AFI IDAs under this grant as of the last day of this reporting period. (Not cumulative.)

Pre-populated from prior report

$

AFI-C034

Total number of AFI IDA holders who made a matched withdrawal for any allowable use.


Enter the total number of AFI IDA holders who made a matched withdrawal for first-home purchase, business capitalization, postsecondary education or training, or for a transfer to the AFI IDA of a dependent or spouse.

Pre-populated from prior report


AFI-C036

Total amount of AFI IDA holder savings withdrawn from an AFI IDA for a matched withdrawal.


Enter the total amount of AFI IDA holder savings withdrawn for a matched withdrawal for first-home purchase, business capitalization, postsecondary education or training, or for a transfer to the AFI IDA of a dependent or spouse.

Pre-populated from prior report

$

AFI-C037

Total amount of federal AFI grant funds disbursed as matching funds for matched withdrawals.


Enter the total amount of federal AFI grant funds disbursed for matched withdrawals.

Pre-populated from prior report

$

AFI-C038

Total amount of non-federal cash disbursed as matching funds for matched withdrawals.


Enter the total amount of federal AFI grant funds disbursed for matched withdrawals.

Pre-populated from prior report

$

Check: cannot be less than AFI -C037

AFI-C057

Total number of AFI IDA holders who exited this project without a matched withdrawal.


Enter the total number AFI IDA holders who exited this project without a matched withdrawal. Include AFI IDA holders transferred to a different AFI grant held by your organization.

Pre-populated from prior report


AFI-C058

Total amount of AFI IDA holder savings withdrawn/re-assigned due to project exit for any reason without a matched withdrawal.


Enter the total amount of AFI IDA holder savings withdrawn/re-assigned due to project exit for any reason without a matched withdrawal.

Pre-populated from prior report

$



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