Form 1 AFI Long Form

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

OCS-0292 AFI Information Collection Instrument LONG form

AFI PPR Long 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 Long Form

Cover Page

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 (Month, Day, Year)


Generated by OLDC



AFI PPR Section A - Project Information and Administration


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-A001

AFI Project Name

Pre-populated from prior report


Enter the name of the AFI IDA project for this grant.

AFI-A002

Organization Website

Pre-populated from prior report


Enter the URL for your organization’s website.

AFI-A003

Geographic Service Area

Pre-populated from prior report


The geographic service area for this project. Use generally available geographic and/or political boundaries such as cities, counties, etc.

AFI-A004

Service Area Type

Pre-populated from prior report

Allow for multiple selections:

An Urbanized Area (UAs) of 50,000 or more people;

An Urban Cluster (UCs) of at least 2,500 and less than 50,000 people;

A Rural area


Select the service area type(s) for this project using U.S. Census Bureau data.

  • An Urbanized Area (UA) has 50,000 people or more;

  • An Urban Cluster (UC) has at least 2,500 people and less than 50,000 people;

  • Rural encompasses all population, housing, and territory not included within an urban area.

Visit http://www.census.gov/geo/www/ua/2010urbanruralclass.html for more information.

Find a list of all urbanized areas and urban clusters by selecting “List of 2010 Census Urban Areas” and opening the first Excel document, then search for the city or town in your service area.

AFI-A005

Target Population(s)

Pre-populated from prior report

Allow for multiple selections:

  • African Americans

  • Alaskan Natives

  • Asians/Asian Americans

  • EITC eligible individuals

  • Families with children

  • Hispanics/Latinos

  • Individuals experiencing or at risk of homelessness

  • Individuals who are incarcerated or formerly incarcerated

  • Individuals with disabilities

  • Native Americans

  • Native Hawaiians/Pacific Islanders

  • Refugees/immigrants

  • Seasonal/migrant workers

  • Survivors of domestic violence

  • TANF eligible individuals

  • Youth (ages 13-18 years)


  • No specific target population (all AFI eligible individuals)

Select any target populations for this project. Target populations are those that the project is specifically targeting and recruiting for their AFI project. If the project is not actively recruiting any specific population listed, select “No specific target population (all AFI eligible individuals)”

Non-Federal Cash Match Sources


Instructions for Respondents:

In this section, report the sources of the required non-federal cash match expected for this AFI grant, indicating the type of source and the amount. Both committed funds that have not yet been received by the grantee and funds that have been received should be reported here. Do not include non-federal cash in excess of the amount required for this grant. For example, if your organization has received $20,000 from a foundation and a commitment from that same foundation for $80,000 all to be used as non-federal match for the same AFI grant, you would select Third-party Organization - Foundation as the source type and enter $100,000 as the amount of funds committed for Source A. If you have a second non-federal cash match source, select ADD ANOTHER NON-FEDERAL CASH SOURCE to then enter information for Source B, and so on. ADD ANOTHER NON-FEDERAL CASH SOURCE for each commitment. For example, if your organization has a commitment from Financial Institution 1 for $10,000 and Financial Institution 2 for $5,000, list them separately, using ADD ANOTHER NON-FEDERAL CASH SOURCE to do so.

Item

Data Elements



Non-Federal Cash Source Type

Amount of Funds Committed

AFI-A006a

Source A

Select only one:

  • Grantee organization

  • Individual(s)

  • Legislative governmental entity

    • State legislative entity

    • Tribal legislative entity

    • County legislative entity

    • City legislative entity

    • Other legislative entity (please specify)

  • Third-party organization

    • Foundation

    • Financial Institution

    • Non-profit service organization

    • Other third-party organization (please specify)

  • Other (please specify)

$

ADD ANOTHER NON-FEDERAL CASH SOURCE (repeat prior row as AFI A006 b, etc.)

Reserve Fund Deposits and Expenditures


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI- A007

Amount of federal AFI award.

Pre-populate from NOA. Does not change over time.

The federal AFI grant amount will be pre-populated based on the Notice of Award.


AFI-A008

Amount of federal AFI award drawn down from the Payment Management System (PMS) grantee through the last day of this reporting period.

Pre-populated from prior report

$

This figure is the total amount of federal funds for this grant drawn down from the HHS Payment Management System (PMS).


AFI-A009

Total amount of required non-federal funds for this project received by the grantee through the last day of this reporting period.

Pre-populated from prior report

$

Enter the total amount of required non-federal funds for this grant received as of the reporting period end date. This figure includes both non-federal funds on hand (e.g. deposited in the Reserve Fund and in parallel accounts/IDAs as matching contributions) and expended as of the reporting period end date. Funds that have been committed but not yet received would not be included here. For example, if you receive $20,000 annually from your non-federal funder, reports in your first year would list $20,000, reports in your second year would list $40,000, and so on. Organizations that are providing the non-federal match from their own funds should only report non-federal funds actually transferred to/deposited in the AFI project Reserve Fund.

NOTE: This number should be at least as much as item AFI-A008 and not greater than 100% of your federal award. AFI grantees should not draw down more federal funds than the amount of required non-federal funds they have received into their Reserve Fund.



AFI-A010

Total amount of federal AFI funds expended through the last day of this reporting period for allowable project costs other than AFI IDA holder match.

Pre-populated from prior report

$

Enter the cumulative amount of federal funds that the grantee has actually expended from this AFI grant for costs other than matching AFI IDA holder savings.


Per Section 407(c)(3) of the AFI Act, grantees may not spend more than 15 percent of the AFI grant funds for purposes other than matching AFI IDA holders earned income deposits. Specifically:

  • Not less than 2 percent of the federal AFI grant funds shall be used for the collection of data and other information required for evaluation.

  • Up to 5.5 percent of federal AFI grant funds may be used for non-administrative functions as follows: assisting AFI IDA holders in the demonstration project in obtaining the skills and information necessary to achieve economic self-sufficiency.

  • Administrative costs, including program management, reporting requirements, recruitment and enrollment of individuals, and monitoring, may be up to 7.5 percent of the federal AFI grant funds. If the non-administrative function costs are less than 5.5 percent, the excess may be used for administrative costs, provided that the combined administrative and non-administrative expenditures do not exceed 13 percent of the federal AFI grant funds.

Expenditures of non-federal project funds and any expenditures of interest earned should NOT be included in this figure.



AFI-A011

Total amount of non-federal funds expended through the last day of this reporting period for allowable project costs other than AFI IDA holder match.

Pre-populated from prior report

$

Enter the cumulative amount of the required non-federal funds actually expended for this grant for costs other than matching AFI IDA holder savings.


Do not include the value of any in-kind contributions to the project, as the AFI Act requires that the non-federal match be cash. Do not include expenditures of any non-federal funds in excess of the amount required for this grant. Any expenditures of interest earned should NOT be included in this figure.







Project Partner Information

NOTE: For the fields below, report only on project partners that independently open and administer AFI Individual Development Accounts (IDAs) under this AFI grant. The project partners are often called sub-grantees or sub-recipients.


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-A012

Number of project partners who open AFI IDAs.

Pre-populated from prior report


Enter the number of project partners that independently open and administer AFI IDAs. If your organization does not have project partners, enter 0.

AFI-A013

Names of project partner organization(s).

Pre-populated from prior report

Upload a file.

Upload a Word, Excel, or PDF file that lists the full name project partners that independently open and administer AFI IDAs, acronyms will not be accepted. The number of partners on that list must be the same as the number reported in AFI-A012. Documents that include project partners’ contact information are preferred, but not required. If you entered 0 in AFI-A012, do not upload a file.





AFI PPR Section B - IDA Design


NOTE: In this section, report the IDA design types your organization uses. For example, if your organization offers a Fast Track IDA that features expedited saving, and a Standard IDA that offers savings over three years, complete this section twice, reporting on the differences in the design type. If your organization provides different match rates based on type of qualified expense, complete this form for each match rate. For example, if you organization offers a 3:1 match for first-home purchase, and a 2:1 match for business capitalization, complete this form twice. If your organization only offers one IDA design type, complete the section only once.


Individual Development Account Design Type A


Item

Data Element

Instructions for Respondents

AFI-B001

What qualified expenses (i.e., asset types) are allowed for this IDA design type?

Select all that apply:

  • First-home purchase

  • Postsecondary education or training

  • Business capitalization

  • Transfer of an IDA to a dependent or spouse

Select all that apply.

AFI-B002

Match rate.

(value between 1-8)

Enter the match rate for this IDA design type.

AFI-B003

Maximum AFI IDA holder savings matched.

$

Enter the maximum amount of AFI IDA holder savings that the project will match for this IDA design type.

AFI-B004

Is there a maximum saving period?

Y N

Select Y for Yes or N for No.

AFI-B005

Maximum saving period in months.

______ months

If prior response is N, skip.

Enter the maximum saving period in months for AFI IDA holders saving in this IDA design type.

AFI-B006

Is there a minimum opening deposit?

Y N

Select Y for Yes or N for No.

AFI-B007

Minimum opening deposit.

$

If prior response is N, skip.

Enter the minimum opening deposit for AFI IDA holders saving in this IDA design type.

AFI-B008

Is there a deposit frequency requirement?

Y N

Select Y for Yes or N for No.

AFI-B009

Required deposit frequency.


If prior response is N, skip.

Monthly Quarterly Other_________

Enter the required frequency of deposits for AFI IDA holders saving in this IDA design type.

AFI-B010

Is there a minimum regular deposit?

Y N

Select Y for Yes or N for No.

AFI-B011

Minimum regular deposit.

$

If prior response is N, skip.

Enter the minimum regular deposit for AFI IDA holders saving in this IDA design type.

AFI-B012

Are lump sum deposits allowed?

Y N

Select Y for Yes or N for No.

AFI-B013

Are there any limitations on lump sum deposits?

Y N

If prior response is N, skip.

Select Y for Yes or N for No.

AFI-B014

Limitations on lump sum deposits.


If prior response is N, skip.

Describe the limitations on lump sum deposits (e.g. amount of lump sum deposits, frequency of lump sum deposits).

AFI-B015

Is there a maximum number of missed deposits?

Y N

Select Y for Yes or N for No.

AFI-B016

Maximum number of missed deposits.


If prior response is N, skip.

Enter the maximum number of missed deposits allowed for AFI IDA holders saving in this IDA design type.

ADD ANOTHER IDA DESIGN TYPE
(replicates all fields above to be completed again: Type B, Type C, etc.)






AFI PPR Section C – AFI IDA Holder Account Activity

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.


AFI IFA Holder Enrollment and Active IDA Information


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C001

Total number of individuals who have applied for an AFI IDA.

Pre-populated from prior report

Check, must be equal to or greater than the number pre-populated from the prior report.

Enter the number of individuals who applied for an AFI IDA.

AFI-C002

Total number of applicants found eligible.

Pre-populated from prior report

Check, must not be greater than C001

Enter the number of applicants who were found eligible for an AFI IDA.

AFI-C003

Total number of AFI IDAs opened.

Pre-populated from prior report

Check, must not be greater than C002

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.

AFI-C004

Current total number of AFI IDAs open.

Pre-populated from prior report

Check, must not be greater than C003

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

AFI-C005

Total number of AFI IDAs transferred to this grant from a different AFI grant held by your organization.

Pre-populated from prior report


Enter the number of AFI IDAs transferred to this grant that were previously part of a different AFI IDA project held by your organization.

AFI-C006

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

Pre-populated from prior report

$

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

AFI-C007

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

Pre-populated from prior report

$

Check, must not be greater than C006

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.)

AFI-C008

Total number of AFI IDA holders who have met all requirements for making a matched withdrawal, but have not made a matched withdrawal.

Pre-populated from prior report


Enter the number of AFI IDA holders who have completed all requirements for making a matched withdrawal (e.g. saved for at least six months, reached savings goal, had business plan approved), but have not made a matched withdrawal.

AFI-C009

Total number of AFI IDA holders that selected first-home purchase as intended goal at enrollment.

Pre-populated from prior report


Enter the total number of AFI IDA holders that selected first-home purchase as intended goal at enrollment

AFI-C010

Total number of AFI IDA holders that selected business capitalization as intended goal at enrollment.

Pre-populated from prior report


Enter the total number of AFI IDA holders that selected business capitalization as intended goal at enrollment.

AFI-C011

Total number of AFI IDA holders that selected postsecondary education or training as intended goal at enrollment.

Pre-populated from prior report


Enter the total number of AFI IDA holders that selected postsecondary education or training as intended goal at enrollment.

AFI-C012

Total number of AFI IDA holders that selected transfer of an IDA to a dependent or spouse as intended goal at enrollment.

Pre-populated from prior report


Enter the total number of AFI IDA holders that selected transfer of an IDA to a dependent or spouse as intended goal at enrollment.

AFI-C13

Optional: Number of people on the waiting list to open an AFI IDA because all available slots are full.

Pre-populated from prior report


This is an optional question; no reply is required. Enter the number of people who are on the waiting list to open an AFI IDA on the last day of this reporting period.

Matched Withdrawals for First-Home Purchase


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C014

Does this project allow the use of AFI IDA savings for first-home purchase?

Pre-populated from prior report

Y N

If no, remaining fields in the section would be skipped.

Select Y for Yes or N for No.

AFI-C015

Total number of AFI IDA holders who made a matched withdrawal for first-home purchase.

Pre-populated from prior report


Enter the number of AFI IDA holders who withdrew their AFI IDA savings for authorized first-home purchase expenses.

AFI-C016

Total amount of AFI IDA holder savings withdrawn for first-home purchase.

Pre-populated from prior report

$

Enter the amount of AFI IDA holder savings withdrawn for first-time home purchase withdrawals from date of award through the last day of this reporting period. Do not include match funds.

AFI-C017

Total amount of federal AFI grant funds disbursed as matching funds for first-home purchase withdrawals.

Pre-populated from prior report

$

Enter the amount of federal AFI grant funds disbursed as matching funds for first-home purchase withdrawals.

AFI-C018

Total amount of non-federal cash disbursed as matching funds for first-home purchase withdrawals.

Pre-populated from prior report

$

Check, cannot be less than C017

Enter the amount of non-federal cash disbursed as matching funds for first-home purchase withdrawals.

Matched Withdrawals For Business Capitalization


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C019

Does this project allow use of AFI IDA savings for business capitalization?

Pre-populated from prior report

Y N

If no, remaining fields in the section would be skipped.

Select Y for Yes or N for No.

AFI-C020

Total number of AFI IDA holders who made a matched withdrawal for business capitalization.

Pre-populated from prior report


Enter the number of AFI IDA holders who withdrew their AFI IDA savings for authorized business capitalization expenses.

AFI-C021

Total amount of AFI IDA holder savings withdrawn for business capitalization.

Pre-populated from prior report

$

Enter the amount of AFI IDA holder savings withdrawn from an AFI IDA for authorized business capitalization expenses. Do not include match funds.

AFI-C022

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

Pre-populated from prior report

$

Enter the amount of federal AFI grant funds disbursed as matching funds for authorized business capitalization expenses.

AFI-C023

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

Pre-populated from prior report

$

Check, cannot be less than C022

Enter the amount of non-federal cash disbursed as matching funds for authorized business capitalization expenses.

Matched Withdrawals For Postsecondary Education or Training


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C024

Does this project allow use of AFI IDA savings to pay for postsecondary education or training?

Pre-populated from prior report

Y N

If no, remaining fields in the section would be skipped.

Select Y for Yes or N for No.

AFI-C025

Total number of AFI IDA holders who made a matched withdrawal for postsecondary education or training.

Pre-populated from prior report


Enter the number of AFI IDA holders who withdrew AFI IDA savings for authorized postsecondary education or training expenses.

AFI-C026

Total amount AFI IDA holder savings withdrawn for postsecondary education or training.

Pre-populated from prior report

$

Enter the amount of AFI IDA holder savings withdrawn from an AFI IDA for authorized postsecondary education or training expenses. Do not include match funds.

AFI-C027

Total amount of federal AFI grant funds disbursed as matching funds for postsecondary education or training withdrawals.

Pre-populated from prior report

$

Enter the amount of federal AFI grant funds disbursed as matching funds for authorized postsecondary education or training expenses.

AFI-C028

Total amount of non-federal cash disbursed as matching funds for postsecondary education or training withdrawals.

Pre-populated from prior report

$

Check, cannot be less than C027

Enter the amount of non-federal cash disbursed as matching funds for authorized postsecondary education or training expenses.

Matched Withdrawals For Transfers to the AFI IDA of a Dependent or Spouse


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C029

Does this project allow use of AFI IDA savings for a transfer to the AFI IDA of a dependent or spouse?

Pre-populated from prior report

Y N

If no, remaining fields in the section would be skipped.

Select Y for Yes or N for No.

AFI-C030

Total number of AFI IDA holders who made a matched withdrawal for a transfer to the AFI IDA of a dependent or spouse.

Pre-populated from prior report


Enter the number of AFI IDA holders who withdrew AFI IDA savings for an authorized transfer to a spouse’s or dependent’s AFI IDA.

AFI-C031

Total amount of AFI IDA holder savings withdrawn for a transfer to the AFI IDA of a dependent or spouse.

Pre-populated from prior report

$

Enter the amount of AFI IDA holder savings withdrawn from an AFI IDA for transfer to the AFI IDA of a spouse of dependent. Do not include match funds.

AFI-C032

Total amount of federal AFI grant funds disbursed as matching funds for a transfer to the AFI IDA of a dependent or spouse.

Pre-populated from prior report

$

Enter the amount of federal AFI grant funds disbursed as matching funds for authorized IDA transfers.

AFI-C033

Total amount of non-federal cash contribution disbursed as matching funds for a transfer to the AFI IDA of a dependent or spouse.

Pre-populated from prior report

$

Check, cannot be less than C032

Enter the amount of non-federal cash contribution disbursed as matching funds for transfer to AFI IDA of a dependent or spouse.

Total Matched Withdrawals


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C034

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

Pre-populated from prior report

Auto-calculation of amounts from the four categories above: C015, C020, C025, C030

Field is calculated automatically based on what has been entered in the prior sections.

AFI-C035

Total number of AFI IDA holders who made matched withdrawals in multiple asset categories.

Pre-populated from prior report


Enter the number of AFI IDA holders making withdrawals in multiple asset categories. For example, if an AFI IDA holder makes one matched withdrawal for post-secondary training and makes additional matched withdrawals for business capitalization.

AFI-C036

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

Pre-populated from prior report

$

Auto-calculation of amounts from the four categories above: C016, C021, C026, C031

Field is calculated automatically based on what has been entered in the prior sections.

AFI-C037

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

Pre-populated from prior report

$

Auto-calculation of amounts from the four categories above:

C017, C022, C027, C032

Field is calculated automatically based on what has been entered in the prior sections.

AFI-C038

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

Pre-populated from prior report

$

Auto-calculation of amounts from the four categories above: C018, C023, C028, C033

Field is calculated automatically based on what has been entered in the prior sections.

AFI-C039

Total number of AFI IDAs closed following matched withdrawals by the AFI IDA holder.

Pre-populated from prior report


Enter the number of AFI IDAs closed when AFI IDA holders withdrew their savings and received match funds for an authorized matched withdrawal.

Unmatched Withdrawals for AFI Act Emergency Withdrawal Purposes


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C040

Total number of AFI IDA holders who made an emergency withdrawal for expenses for medical care or necessary to obtain medical care.

Pre-populated from prior report


Enter the total number of AFI IDA holders who made authorized emergency withdrawals for expenses for medical care or necessary to obtain medical care for the AFI IDA holder or the spouse or dependent of the AFI IDA holder.

AFI-C041

Total amount of AFI IDA holder savings withdrawn for expenses for medical care or necessary to obtain medical care.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder savings withdrawn for expenses for medical care or necessary to obtain medical care for the AFI IDA holder or the spouse or dependent of the AFI IDA holder.

AFI-C042

Total number of AFI IDA holders who made an emergency withdrawal for payments necessary to prevent eviction or foreclosure.

Pre-populated from prior report


Enter the total number of AFI IDA holders who made authorized emergency withdrawals for payments necessary to prevent the eviction of the AFI IDA holder from their residence, or foreclosure on the mortgage for the principal residence of the AFI IDA holder.

AFI-C043

Total amount of AFI IDA holder savings withdrawn for payments necessary to prevent eviction or foreclosure.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder savings withdrawn for payments necessary to prevent the eviction of the AFI IDA holder from their residence, or foreclosure on the mortgage for the principal residence of the AFI IDA holder.

AFI-C044

Total number of AFI IDA holders who made an emergency withdrawal for payments to meet necessary living expenses following loss of employment.

Pre-populated from prior report


Enter the total number of AFI IDA holders who made authorized emergency withdrawals for payments necessary to enable the AFI IDA holder to meet necessary living expenses following loss of employment.

AFI-C045

Total amount of AFI IDA holder savings withdrawn for payments to meet necessary living expenses following loss of employment.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder savings withdrawn from AFI IDAs for payments necessary to enable the AFI IDA holder to meet necessary living expenses following loss of employment.

AFI-C046

Total number of AFI IDA holders making withdrawals for emergency purposes defined by AFI legislation.

Pre-populated from prior report


Enter the total number of AFI IDA holders making withdrawals for emergency purposes defined by AFI legislation for all account types.


If you provided the number of AFI IDA holders making withdrawals by type of emergency purpose this amount should equal to the sum of C040, C042, and C044 if reported above.

AFI-C047

Total amount of AFI IDA holder savings withdrawn for emergency purposes defined by AFI legislation.

Pre-populated from prior report

$


Enter the total amount of AFI IDA holder savings making withdrawals for emergency purposes defined by AFI legislation for all account types.


If you provided the amount of AFI IDA holder savings withdrawal by type of emergency purpose, this amount should equal to the sum of C041, C043, and C045 if reported above.

AFI-C048

Total amount AFI IDA holder savings deposited to replenish AFI IDAs after authorized emergency withdrawals.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder savings deposited to replenish AFI IDAs after authorized emergency withdrawals.

Project Exit Without a Matched Withdrawal


Item

Data Element

Prior Report Data

Current Report Data

Instructions for Respondents

AFI-C049

Total number of AFI IDA holders who withdrew their savings and exited the project due to a financial need or emergency not covered by the AFI Act.

Pre-populated from prior report


Enter the total number of AFI IDA holders who withdrew their savings and exited the project due to a financial need or emergency not covered by the AFI Act.

AFI-C050

Total amount of AFI IDA holder savings withdrawn by AFI IDA holders that exited the project due to a financial need or emergency not covered by the AFI Act.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder savings withdrawn by AFI IDA holders that exited the project due to a financial need or emergency not covered by the AFI Act.

AFI-C051

Total number of AFI IDA holders transferred to a different AFI grant held by your organization.

Pre-populated from prior report


Enter the total number of AFI IDA holders transferred to a different AFI grant held by your organization.

AFI-C052

Total amount of AFI IDA holder savings re-assigned to a different AFI grant held by your organization.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder savings re-assigned to a different AFI grant held by your organization due to transferring the AFI IDA holder to a different grant.

AFI-C053

Total number of AFI IDA holders who were terminated from the project because the AFI IDA holder did not meet project requirements.

Pre-populated from prior report


Enter the total number of AFI IDA holders who were terminated from the project because the AFI IDA holder did not meet project requirements (e.g. failure to replenish emergency withdrawal within 12 months, did not meet required project deposit frequency, etc.).

AFI-C054

Total amount of AFI IDA holder savings withdrawn due to termination from the project because the AFI IDA holder did not meet project requirements.

Pre-populated from prior report

$

Enter the total amount of AFI IDA holder AFI IDA savings withdrawn due to termination from the project because the AFI IDA holder did not meet project requirements (e.g. failure to replenish emergency withdrawal within 12 months, did not meet required project deposit frequency, etc.).

AFI-C055

Total number of AFI IDA holders who withdrew their savings and exited the project for any other reason.

Pre-populated from prior report


Enter the total number of AFI IDA holders who withdrew their savings and exited the project for any other reason. Please include here any AFI IDA holders that were not able to make a matched withdrawal and exited the project due to moving out of your service area, death, etc.

AFI-C056

Total amount of AFI IDA holder savings withdrawn due to project exit for any other reason.

Pre-populated from prior report

$

Enter the total number of AFI IDA holders who withdrew their savings and exited the project for any other reason. Please include here any AFI IDA holders that were not able to make a matched withdrawal and exited the project due to moving out of your service area, death, etc.

AFI-C057

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

Pre-populated from prior report

Auto-calculation of amounts from the four categories above: C049, C051, C053, C055

Field is calculated automatically based on what has been entered in the prior fields.

AFI-C058

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

$

Auto-calculation of amounts from the four categories above: C050, C052, C054, C056

Field is calculated automatically based on what has been entered in the prior fields.



AFI PPR Section D –Training, Services And Assistance Offered for AFI IDA Holders


Note: In this section, partner refers to any organization or entity that the grantee has partnered with to provide services for AFI IDA holders. This could include project partners who independently open and administer AFI IDAs, nonprofits, local government, financial institutions, and other partners who provide financial education, case management, financial assistance, or other services to AFI IDA holders.


Item

Data Element

Instructions for Respondents


Economic Literacy or Financial Education



AFI-D001

Availability of economic literacy or financial education for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Economic literacy or financial education is one or more workshops or classes that involve the transfer of information, often in a group setting, on a specific set of topics such as how to budget, use mainstream financial products, save, manage credit, reduce debt, access available tax credits, and more. Select one of the boxes to indicate whether economic literacy or financial education services were offered to AFI IDA holders. If the AFI project did not offer this particular service, select Not available from this project.

AFI-D002

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D003

How was economic literacy or financial education provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D004

Total number of unique AFI IDA holders who received economic literacy or financial education.


Enter the cumulative number of unduplicated AFI IDA holders who received economic literacy or financial education, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Asset Specific Education or Training For First-Home Purchase

Response


AFI-D005

Availability of first-home purchase asset specific education or training for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Asset specific education or training for first-home purchase is training or counseling services that help AFI IDA holders understand the benefits, liabilities, and responsibilities of home ownership. This may include: home selection, financing, insurance, and other information and skill development opportunities intended to improve the likelihood of successful purchase and retention of a primary residence. Select the appropriate box that indicates whether asset specific education or training for first-home purchase is offered to AFI IDA holders. If the AFI project does not offer this service, select Not available from this project.

AFI-D006

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D007

How was asset specific education or training for first-home purchase provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D008


Total number of unique AFI IDA holders who received asset specific education or training for a first-home purchase.


Enter the cumulative number of unduplicated AFI IDA holders who received asset specific education or training for their first-home IDA. Do not count individuals more than once.

Item

Asset Specific Education or Training For Business Capitalization

Response


AFI-ED009

Availability of business capitalization asset specific education or training for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Asset specific education or training for business capitalization is training or counseling services that help AFI IDA holders understand the benefits, liabilities, and responsibilities of business capitalization. This may include: business planning assistance, business financial management, market research, and other services that help develop a business. Select the appropriate box that indicates whether asset specific education or training for business capitalization is offered to AFI IDA holders. If the AFI project does not offer this service, select Not available from this project.

AFI-D010

If required, describe requirement.

Hours -

Other -



Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D011

How was asset specific education or training for business capitalization provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D012

Total number of unique AFI IDA holders who received asset specific education or training for business capitalization.


Enter the cumulative number of unduplicated AFI IDA holders who received asset specific education or training for their business capitalization IDA.

Item

Asset Specific Education or Training For Postsecondary Education or Training

Response


AFI-D013

Availability of postsecondary education or training asset specific education for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Asset specific education or training for postsecondary education is training or counseling that help AFI IDA holders have the knowledge and skills necessary as they work toward their academic/vocational goals. This may include: developing an educational plan, assessing academic goals, and planning financial aid. Select the appropriate box that indicates whether asset specific education or training for postsecondary is offered to AFI IDA holders. If the AFI project does not offer this service, select Not available from this project.


AFI-D014

If required, describe requirement.

Hours-

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.


AFI-D015

How was asset specific education or training for postsecondary education or training provided?

Select all that apply:

  • By the grantee

  • By a partner

Select whether the service was offered by the grantee, a partner, or both.

AFI-D016

Total number of unique AFI IDA holders who received asset specific education or training for postsecondary education.



Enter the cumulative number of unduplicated AFI IDA holders who received asset specific education or training for their postsecondary education IDA. Do not count individuals more than once.



Item

Financial Counseling or Coaching

Response


AFI-D017

Availability of financial counseling or coaching for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Financial counseling is individual one-on-one sessions driven by the counselor to help clients address specific financial matters. Financial coaching is multiple one-on-one interactions that empower clients to set and achieve their unique financial goals through behavior change and skill development. Select one of the boxes to indicate whether financial counseling services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D018

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D019

How was financial counseling or coaching provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D020

Total number of unique AFI IDA holders who received financial counseling or coaching.


Enter the cumulative number of unduplicated AFI IDA holders who received financial counseling or coaching, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Budgeting Assistance

Response


AFI-D021

Availability of budgeting assistances for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Budgeting assistance involves working with AFI IDA holders to develop a systematic and itemized plan allocating available income for expected expenditures during a given time period. Select one of the boxes to indicate whether budgeting assistance was offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D022

If required, describe requirement.

Hours -

Other -

Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D023

How was budgeting assistance provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D024

Total number of unique AFI IDA holders who received budgeting assistance.


Enter the cumulative number of unduplicated AFI IDA holders who received budgeting assistance, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Credit Counseling

Response


AFI-D025

Availability of credit counseling for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Credit counseling helps people manage and reduce debt and take positive steps to improve their credit. For example, a credit counselor might work with an individual to review his credit report, identify outstanding debts, and develop a plan for paying down those debts. Select the appropriate response. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D026

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D027

How was credit counseling provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D028

Total number of unique AFI IDA holders who received credit counseling.


Enter the cumulative number of unduplicated AFI IDA holders who received credit counseling, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Loans

Response


AFI-D029

Availability of loans for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Loans refer to funds given to individuals or families that do need to be repaid, with or without interest. Select one of the boxes to indicate whether or not loans are available to AFI IDA holders under this project.

AFI-D030

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-ED031

How were loans provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D032

Total number of unique AFI IDA holders who participated in a loan program.


Enter the cumulative number of unduplicated AFI IDA holders who participated in a loan program, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Peer Support

Response


AFI-D033

Availability of peer support for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Peer support may be provided in a number of ways such as discussion groups and list servs. For the purposes of the AFI program, peer support is defined as a formalized approach on the part of the grantee to facilitate communication among AFI IDA holders in order to share knowledge about shared challenges and experiences within the program. Select one of the boxes to indicate whether peer support services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D034

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D035

How was peer support provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D036

Total number of unique AFI IDA holders who received peer support.


Enter the cumulative number of unduplicated AFI IDA holders who received peer support, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Mentoring

Response


AFI-D037

Availability of mentoring for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Mentoring is a one-to-one relationship in which an experienced person is identified to counsel and assist an AFI IDA holder to develop specific skills and knowledge that will enhance AFI IDA holders’ personal ability to become self-sufficient. Select one of the boxes to indicate whether mentoring services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D038

If required, describe requirement.

Hours -

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D039

How was mentoring provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D040

Total number of unique AFI IDA holders who received mentoring.


Enter the cumulative number of unduplicated AFI IDA holders who received mentoring, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Case Management

Response


AFI-D041

Availability of case management for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.

Case management is the coordination of multiple social services by a designated professional responsible for assessing IDA needs and implementing plans of coordinated, ongoing care or support services such as housing, employment, social relationships, and community participation. Select one of the boxes to indicate whether case management services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D042

If required, describe requirement.

Hours-

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D043

How was case management provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D044

Total number of unique AFI IDA holders who received case management.


Enter the cumulative number of unduplicated AFI IDA holders who received case management. Do not count individuals more than once.

Item

Employment Support

Response


AFI-D045

Availability of employment support for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project and optional

  • Available from this project and required


If not available, skip to next service. If optional, skip next question.


Employment support includes services that help an individual become and stay employed. Select one of the boxes to indicate whether employment support services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D046

If required, describe requirement.

Hours-

Other -


Enter the number of hours of this service your organization requires AFI IDA holders to complete. Only enter hours for requirements that are standard for all AFI IDA holders. For example if online financial education is required, but the time it takes each AFI IDA holder to complete the course varies, please report that requirement in the other section.


If your organization requires verification other than, or in addition to hours, such as a training plan, describe the requirement in the other box. The other field can be completed in addition to reporting to reporting hours.

AFI-D047

How was employment support provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D048

Total number of unique AFI IDA holders who received employment support.


Enter the cumulative number of unduplicated AFI IDA holders who received employment support, from the date of award until the end of the reporting period. Do not count individuals more than once.

Item

Cash Assistance

Response


AFI-D049

Availability of cash assistance for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project


If not available, skip to next service.

Cash assistance refers to funds given to individuals or families that do not need to be repaid. Select one of the boxes to indicate whether cash assistance was offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D050

How was cash assistance provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D051

Total number of unique AFI IDA holders who received cash assistance.


Enter the cumulative number of unduplicated AFI IDA holders who received cash assistance. Do not count individuals more than once.

Item

Child Care

Response


AFI-D052

Availability of child care for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project


  • If not available, skip to next service.

Child care refers to services to take care of children. Select one of the boxes to indicate whether child care services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D053

How was child care provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D054

Total number of unique AFI IDA holders who received child care.


Enter the cumulative number of unduplicated AFI IDA holders who received child care. Do not count individuals more than once.

Item

Transportation

Response


AFI-D055

Availability of transportation for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project


If not available, skip to next service.

Transportation refers to services to help transport individuals. Select one of the boxes to indicate whether child care services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D056

How was transportation provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D057

Total number of unique AFI IDA holders who received transportation.


Enter the cumulative number of unduplicated AFI IDA holders who received transportation. Do not count individuals more than once.

Item

Medical Treatment

Response


AFI-D058

Availability of medical treatment for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project


If not available, skip to next service.

Medical treatment refers to medical treatment provided to individuals. Select one of the boxes to indicate whether medical treatment was offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D059

How was medical treatment provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D060

Total number of unique AFI IDA holders who received medical treatment.


Enter the cumulative number of unduplicated AFI IDA holders who received medical treatment. Do not count individuals more than once.

Item

Crisis Management

Response


AFI-D061

Availability of crisis management services for AFI IDA holders.

Select one:

  • Not available from this project

  • Available from this project


If not available, skip to next service.

Crisis management refers to services provided to individuals or families to cope with sudden and/or significant negative events. Select one of the boxes to indicate whether crisis management services were offered to AFI IDA holders. If the AFI project did not offer this particular service, check Not available from this project.

AFI-D062

How was crisis management provided?

Select all that apply:

  • By the grantee

  • By a partner


Select whether the service was offered by the grantee, a partner, or both.

AFI-D063

Total number of unique AFI IDA holders who received crisis management services.


Enter the cumulative number of unduplicated AFI IDA holders who received crisis management. Do not count individuals more than once.







AFI PPR Section E - AFI IDA holder Demographics at the Time of Enrollment



A-All IDA Holders



Instructions for Respondents:

Enter the cumulative, unduplicated number of AFI IDA holders for each self-reported demographic category at time of enrollment from date of award through last day of this reporting period. Do not count individuals more than once.

B-IDA Holders Who Made Matched Withdrawals


Instructions for Respondents:

Enter the cumulative, unduplicated number of AFI IDA holders that made matched withdrawals for each self-reported demographic category at time of enrollment from date of award through last day of this reporting period. Do not count individuals more than once. \


NOTE: The demographic information was recorded at the time of enrollment, but it is only reported for column B after the IDA holder has made a matched withdrawal.

Item

Data Element

Prior Report Data

Current Report Data

Prior Report Data

Current Report Data

AFI-E001 a, b


IDA Holder Gender – Unduplicated number of AFI IDA holders self-reported in each demographic category.

Pre-populated from prior report

____ Female

____ Male

____ Other

____ Declined to ID

Pre-populated from prior report

____ Female

____ Male

____ Other

____ Declined to ID

AFI-E002 a, b


IDA Holder Race – Unduplicated number of AFI IDA Holders self-reported in each demographic category.

Pre-populated from prior report

____ Black

____ Asian or Pacific Islander

____ White

____ American Indian or Alaskan Native

____ Multiracial

____ Unknown

____ Declined to ID

Pre-populated from prior report

____ Black

____ Asian or Pacific Islander

____ White

____ American Indian or Alaskan Native

____ Multiracial

____ Unknown

____ Declined to ID

AFI-E003 a, b


IDA Holder Ethnicity – Unduplicated number of AFI IDA Holders self-reported in each demographic category.

Pre-populated from prior report

____Hispanic or Latino

____Not Hispanic or Latino

____Declined to ID

Pre-populated from prior report

____Hispanic or Latino

____Not Hispanic or Latino

____Declined to ID

AFI-E004 a, b


IDA Holder Age – Unduplicated number of AFI IDA Holders self-reported in each demographic category.

Pre-populated from prior report

____ 19 years and under

____ 20-29 years

____ 30-39 years

____ 40-49 years

____ 50 years and older

____Declined to ID

Pre-populated from prior report

____ 19 years and under

____ 20-29 years

____ 30-39 years

____ 40-49 years

____ 50 years and older

____Declined to ID

AFI-E005 a, b

Marital Status – Unduplicated number of AFI IDA holders self-reported in each demographic category.


Pre-populated from prior report

____Single, never married

____Married

____Separated

____Divorced

____Widowed

____Declined to ID

Pre-populated from prior report

____Single, never married

____Married

____Separated

____Divorced

____Widowed

____Declined to ID

AFI-E006 a, b

Temporary Assistance for Needy Families (TANF) Recipients – Unduplicated number of AFI IDA holders self-reported in each demographic category.


Pre-populated from prior report

____Current TANF Recipient

____Not Current TANF Recipient

____Declined to ID

Pre-populated from prior report

____Current TANF Recipient

____Not Current TANF Recipient

____Declined to ID

AFI-E007 a, b

Federal Earned Income Tax Credit (EITC) Recipient – Unduplicated number of AFI IDA holders self-reported in each demographic category.


Pre-populated from prior report

____Has Ever Claimed EITC

____ Has Never Claimed EITC

____Declined to ID

Pre-populated from prior report

____Has Ever Claimed EITC

____ Has Never Claimed EITC

____Declined to ID

AFI-E008 a, b


Educational Attainment – Unduplicated number of AFI IDA holders’ highest level self-reported in each demographic category. Select only one item.


Pre-populated from prior report

____Completed grades K-5

____Completed grades 6-8

____Completed grades 9-11

____High School Diploma/GED

____Vocational School Diploma/Degree

____Some College

____AA Degree/Graduated two-year college

____BA/BS Degree/Graduated four-year college

____Some Graduate School

____Graduate Degree

____Declined to ID

Pre-populated from prior report

____Completed grades K-5

____Completed grades 6-8

____Completed grades 9-11

____High School Diploma/GED

____Vocational School Diploma/Degree

____Some College

____AA Degree/Graduated two-year college

____BA/BS Degree/Graduated four-year college

____Some Graduate School

____Graduate Degree

____Declined to ID

AFI-E009 a, b


Employment – Unduplicated number of AFI IDA holders self-reported in each demographic category.


Pre-populated from prior report

____Full Time Employed

____Part Time/Seasonally Employed

____Unemployed

____Other: ______________

____Declined to ID


Pre-populated from prior report

____Full Time Employed

____Part Time/Seasonally Employed

____Unemployed

____Other: ______________

____Declined to ID


AFI-E010 a, b

Auto Ownership – Unduplicated number of AFI IDA holders self-reported in each demographic category.


Pre-populated from prior report

____Owns an Automobile

____Does Not Own an Automobile

____Declined to ID

Pre-populated from prior report

____Owns an Automobile

____Does Not Own an Automobile

____Declined to ID

AFI-E011 a, b

Home Ownership – Unduplicated number of AFI IDA holders self-reported in each demographic category.

Pre-populated from prior report

____Owns a Home

____Does Not Own a Home

____Declined to ID

Pre-populated from prior report

____Owns a Home

____Does Not Own a Home

____Declined to ID

AFI-E012 a, b

Business Ownership – Unduplicated number of AFI IDA holders self-reported in each demographic category.


Pre-populated from prior report

____Owns a Business

____Does Not Own a Business

____Declined to ID

Pre-populated from prior report

____Owns a Business

____Does Not Own a Business

____Declined to ID

AFI-E013 a, b


Banking – Number of AFI IDA holders self-reported in each demographic category.

AFI IDA holders may be counted more than once in this category.


Pre-populated from prior report

____Ever held a checking account

____Ever held a savings account

____Ever used direct deposit

____Ever used a pre-paid card

____Declined to ID

Pre-populated from prior report

____Ever held a checking account

____Ever held a savings account

____Ever used direct deposit

____Ever used a pre-paid card

____Declined to ID

AFI-E014 a, b

Total Household size – Household means all individuals who share use of a dwelling unit as primary quarters for living and eating separate from other individuals. Include the IDA holder in the count.

Pre-populated from prior report

____ One

____ Two

____ Three

____ Four

____ Five

____ Six

____ Seven

____ Eight+

____ Declined to ID

Pre-populated from prior report

____ One

____ Two

____ Three

____ Four

____ Five

____ Six

____ Seven

____ Eight+

____ Declined to ID

AFI-E015 a, b

Household Composition – Adults

Number of persons age 18 and older in the household at the time of enrollment. If applicable, include the IDA holder in the count.

Pre-populated from prior report

____ Zero

____ One

____ Two

____ Three

____ Four

____ Five

____ Six

____ Seven

____ Eight+

____ Declined to ID

Pre-populated from prior report

____ Zero

____ One

____ Two

____ Three

____ Four

____ Five

____ Six

____ Seven

____ Eight+

____ Declined to ID

AFI-E016 a, b

Household Composition – Children Number of children (younger than age 18) in the AFI IDA Holder household, at the time of enrollment. If applicable, include IDA holder in the count.


Pre-populated from prior report

____ Zero

____ One

____ Two

____ Three

____ Four

____ Five

____ Six

____ Seven

____ Eight+

____ Declined to ID

Pre-populated from prior report

____ Zero

____ One

____ Two

____ Three

____ Four

____ Five

____ Six

____ Seven

____ Eight+

____ Declined to ID

AFI-E017 a, b


Household Adjusted Gross Income Level – Indicate the number of AFI IDA holders who reported household adjusted gross income at each level using the federal poverty guidelines developed by HHS.

Pre-populated from prior report

Federal Poverty Guideline

___Below 100%

___100–150%

___151-200%

___Declined to ID

Pre-populated from prior report

Federal Poverty Guideline

___Below 100%

___100–150%

___151-200%

___Declined to ID





AFI PPR Section F - AFI IDA Holder Demographics at the Time of Final Matched Withdrawal

Instructions for Respondents:

Enter the cumulative number of AFI IDA holders for each self-reported demographic category at time of enrollment from date of award through last day of this reporting period. Do not count individuals more than once

Item

Data Element

Prior Report Data

Current Report Data

AFI-F001

Educational Attainment – Unduplicated number of AFI IDA holders self-reported in each demographic category at time of final matched withdrawal.


Pre-populated from prior report

____Completed grades K-5

____Completed grades 6-8

____Completed grades 9-11

____High School Diploma/GED

____Vocational School Diploma/Degree

____Some College

____AA Degree/Graduated two-year college

____BA/BS Degree/Graduated four-year college

____Some Graduate School

____Graduate Degree

____Declined to ID

AFI-F002

Home Ownership – Unduplicated number of AFI IDA holders self-reported in each demographic category at time of final matched withdrawal.

Pre-populated from prior report

____Owns a Home

____Does Not Own a Home

____Declined to ID

AFI-F003

Business Ownership – Unduplicated number of AFI IDA holders self-reported in each demographic category at time of final matched withdrawal.


Pre-populated from prior report

____Owns a Business

____Does Not Own a Business

____Declined to ID

AFI-F004

TANF Recipients – Unduplicated number of AFI IDA holders self-reported in each demographic category at time of final matched withdrawal.


Pre-populated from prior report

____Current TANF Recipient

____Not Current TANF Recipient

____Declined to ID









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AuthorGretchen Lehman
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