Form

HUD_Form_96006.docx

Healthy Home and Lead Hazard Control Grant Programs Data Collection -- Progress Reporting

Form

OMB: 2539-0008

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OFFICE OF HEALTHY HOMES AND LEAD HAZARD CONTROL

Quarterly Progress Report


Grant Program:



1. Grant Agreement Number:



2. Grantee Organization:



3. Type of Organization



4. Special Source:



5. DUNS Number


6. Project Title


7. Organization Address:



8. Report Period:

Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31

9. Project Period of Performance:

(Start - Expiration Date)

9a. Original


9b. Current

10. Total Grant Amount:


10a. Original


10b. Current

11. Cumulative Federal Grant Funds Drawn (LOCCS) Through End Date of Report Period:

11a. Dollar Amount

11b. Percentage of Total

12. Number of Projected Units per HUD Grant Agreement (HUD 1044):


13. Cumulative Number of Units Completed Through End Date of Report Period:

13a. Units Completed

13b. Percentage of Total

14. Program Manager:


15. CFDA Program Number


16. Federal Award Identifier Number


17. Principal Place of Performance State/ FIPS Code

State

FIPS Code

18 Principal Place of Performance (County/FIPS Code)

County

FIPS Code

19. Principal Place of Performance (City/FIPS Code)

City

FIPS Code

20. Principal Place of Performance Zip+4



20. Recipient FIPS Code

City

County

21. Recipient State FIPS Code/ ZIP+4

State FIPS Code

Zip+4

22. Match

Current:

Cumulative:








If any items in this report require explanation or clarification, please address them in the PROGRAM NARRATIVE RESPONSE portion of the quarterly report.

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OMB Control No. 2539-0008. This information is designed to provide timely information to HUD regarding the progress of the grantees in carrying out the Lead-Based Paint Hazard Control, Lead Hazard Reduction Demonstration, Lead Outreach, Lead Technical Studies, Healthy Homes Technical Studies, Green and Healthy Homes Technical Studies, Operation Lead Elimination Action Program, Lead Hazard Control Capacity Building, and Healthy Homes Demonstration grant programs, and to provide the Congress with status reports on the lead grants as required by Title X of the Housing and Community Development Act of 1992 (P.L. 102-550).  Public reporting burden for this collection of information is estimated to be 10 hours per response.  This collection does not require the retention of confidential or sensitive material.  Response to this request for information is required in order to receive the benefits to be derived. This information is also designed to provide timely information under the Federal Financial Accountability and Transparency Act of 2006 (P.L. 109-282), and the American Recovery and Reinvestment Act of 2009 (ARRA; P.L. 111-5). This agency may not collect this information, and you are not required to complete this form packet, unless it displays a currently valid OMB control number.




I. Lead Hazard Control


PART 1

PROGRAM NARRATIVE RESPONSE


Discuss your progress and accomplishments in meeting the tasks and objectives outlined in your HUD-approved work plan. You should respond to each narrative item with a short paragraph. Work plan tasks that must be covered in this report include:


  1. Program Management and Capacity Building

  2. Community Education, Outreach and Training

  3. Lead Hazard Control Activities (including relocation)


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Note: If your narrative response to a particular question (such as A4.) remains unchanged from the previous quarterly report or no new information can be reported (i.e., changes to key personnel), you should reply by repeating your response from the previous report and indicating the date of the original response (i.e. Jan 1 - Mar 31, 2003).

Summarize your activities for this report quarter, and cumulatively if appropriate. In the discussion of these work plan tasks, highlight issues and/or activities that had a significant impact on the program. The narrative discussion is to complement the data submitted on these OMB-approved report forms.


  1. Program Management and Capacity Building

Within the context of the current work plan and grant agreement, summarize your progress in the overall grant program.


  1. Describe any obstacles to performance and measures taken to overcome these obstacles.

  2. Describe efforts to enhance the coordination and integration of lead hazard control work with other housing, health, and environmental programs (i.e., childhood lead poisoning prevention programs, health and housing code enforcement, housing rehabilitation, weatherization, etc.). Describe other services to be provided such as blood lead screening and community education and outreach; intra- and interagency partnerships, and public and private partnerships.

  3. Describe the availability of lead-based paint contractors in your area. Describe activities you have taken to increase the number of contractors available to provide lead hazard control work as part of your grant.

  4. Describe any changes in key personnel in the program, and among sub-grantees or other entities directly involved in your grant program and its impact. Provide information on any new program participants, including resumes of key individuals. (Include letters of commitments, MOUs, or other arrangements with community-based organizations and other partners.) Describe any significant changes to the work plan or budget that have occurred. Describe methods used to collect program data and what criteria were used to evaluate the performance of your grant program. Describe the effectiveness of the financing mechanisms used in enrolling property owners, including owners of rental properties, in the program. Describe any efforts undertaken to develop and utilize a lead-safe housing registry. (Include information on the number of units included, the public availability of the system, and examples of how the registry has been used.) Describe any proposed or actual changes in State or local laws, regulations, or policies that may affect your grant program.

  5. Job Creation and Retention

Enter the numbers of jobs created and retained by you, the Grantee, and your first tier contractors and subgrantees. Provide narrative explanation as necessary.


Activity- number of jobs funded under the grant

Jobs –

this Quarter

Jobs –

Cumulative

Green Jobs –

this Quarter

Green Jobs –

Cumulative

Created in your agency

a. 0

e. 2

i. 0

m. 2

Created by subcontractors

b. 0

f.  2

j. 0

n. 2

Retained in your agency

c. 0


k. 0


Retained by subcontractors

d. 0


l. 0


.

Employment Baseline. Enter the number of jobs that existed at the signing of the grant agreement. Also provide a narrative description of the job categories and numbers of employees.


Baseline employment

Jobs –At beginning of award

Green Jobs – At beginning of award

Grantee


q.

s.

Sub Grantees


r.

t.



  1. Community Education, Outreach and Training


  1. Describe education and outreach activities and events completed this quarter. Discuss the expected results of your efforts. Describe your outreach efforts at reaching specific groups you have targeted (door-to-door, presentations, training, broadcast media, mailings) and the intended recipients of this outreach (tenants, landlords, parent groups, child-care providers). These activities should be included in Item B5 below.

  2. Describe outreach techniques and/or particular methods, materials, and formats that have proved to be most effective (attach copies of any media coverage and materials, including press clippings, to this report).

  3. Describe training efforts completed this quarter. Discuss the types of training provided and any certifications received. These efforts should correspond to Item B4 below.


  1. Skills Training and Economic Opportunities

Skills Training Conducted

(For Report Quarter)

Number of Individuals Trained

Number of Individuals Employed as a Result of Training

Cumulative Total

Low-Income Individuals


B4a.

B4b.

B4i.

Property Owners / Tenants / Remodelers / Renovators / Maintenance Workers

B4c.


B4j.

Lead-Based Paint Contractors


B4d.


B4k.

Grant Program & Partnering Entities Staff

B4e.


B4l.

Lead-Safe Work Practices (1012-1013)


B4f.


B4m.

Other (specify)


B4g.


B4n.

Total Trained This Quarter


B4h.


B4o.

Community Education and Outreach Activities

Target Audiences

Activities Conducted

(For Report Quarter)

Number of Events

Number of Individuals Reached

Cumulative Number of Events

Cumulative Individuals Reached

Health & Child Care Providers


B5a.

B5m.

B5b.

B5v.


Schools, Parent groups, Places of Worship


B5c.

B5n.

B5d.

B5w.


Landlords / Landlord Groups, Tenants / Tenant Groups, Housing Corporations

B5e.

B5o.

B5f.

B5x.


Community or Target Area Wide


B5g.

B5p.

B5h.

B5y.


Real Estate Professionals


B5i.

B5q.

B5j.

B5z.


Other (specify)


B5k.

B5r.

B5l.

B5aa.


Total



B5s.

B5t.

B5u.



  1. Lead Hazard Control Activities


  1. Describe the extent to which lead hazard control activities were conducted in conjunction with other work (i.e., rehabilitation, code correction, weatherization, etc.).

  2. Describe the lead hazard control methods or combination of methods used. To the extent possible, describe the number of housing units completed and cleared for the methods used (e.g., low-level interventions, interim controls, hazard abatement). Discuss the lead hazard control and rehabilitation costs for units completed this quarter.

  3. Describe any post-hazard control maintenance plans for units where lead hazard control grant work has been completed.

  4. Lead Hazard Evaluations and Units in Progress

Activity

Number Completed This Quarter

Number Completed Cumulatively

Number of Units Receiving Lead Hazard Evaluations

C4a.

C4d.

Number of Units with Lead Hazards Identified

C4b.

C4e.


Number of Units Enrolled


C4c.

C4f.

Number of Units in Progress or Under Contract


C4g.

C4h.



  1. Lead Hazard Control – Unit Production

Number of Units Completed and Cleared



Number Completed and Cleared*


Number of Units With Other Rehab, Code work

Number of Units Where Occupants Were Relocated


Occupied Rental Units

C5a.

C5b.

C5c.


Vacant Units

C5d.

C5e.



Owner-Occupied Units

C5f.

C5g.

C5h.


Quarter Total

C5i.

C5j.

C5k.

Cumulative Total

(Since the Inception of the Grant)

C5l.

C5m.

C5n.


A Listing of Units Completed and Cleared during the Quarter by street address is to be attached to the Quarterly Report (see PART 2 – LISTING OF UNITS COMPLETED AND CLEARED)


  1. Age of Units Completed and Cleared

Age of Housing (based on number of units completed and cleared)

Pre-1940





1940 - 1959


1960 - 1977

Unknown

Quarter Total

C6a.


C6b.

C6c.

C6d.

Cumulative Units


C6e.

C6f.

C6g.

C6h.


  1. Occupant Information of Units Completed

Number of Occupants Residing in Units when Lead Hazard Control Work was Initiated



Children under 6 Years of Age

Children under 6 Years of Age Receiving Medicaid

Occupants over 6 years of age (including adults)

Quarter Total

C7a.

C7b.

C7c.

Cumulative Units


C7d.

C7e.

C7f.


Blood Lead Values of Children

Blood Lead Values of Children Under 6 of Age Residing in Units when Lead Hazard Control Work was Initiated


BLL under 10 µg/dL



BLL between 10-19 µg/dL

BLL >20 µg/dL

Not Tested or results not available

Quarter Total

C8a.



C8b.

C8c.

C8d.

Cumulative Units


C8e.

C8f.

C8g.

C8h.


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In addition to the quarterly report, the HUD Office of Healthy Homes and Lead Hazard Control is always interested in the accomplishments of our Lead Hazard Control grantees and in sharing these with lead poisoning prevention advocates. If you have a particular “success story” which may reflect innovative approaches in implementing your program, or if you have overcome any obstacles that would be of interest or benefit to others, please submit the information as an email attachment to [email protected].


PART 2

LISTING OF UNITS COMPLETED AND CLEARED


Grant Agreement Number:



Grantee Organization:



Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31

Please submit the following information for units that have undergone lead hazard control activities and subsequently cleared:


Lead Hazard Control – Unit Production Using HUD OHHLHC Grant Funds


Housing unit information


Costs

Where

What




Housing Unit Counter

Street Address

Apt #

City

State

ZIP +4 Code

Housing Unit Area (sq ft)

Total Number of Rooms

Lead Hazard Control Intervention

Relocation

Rehab or other Work

Applicant match and Leverage $

Total Project Cost

Interior

Exterior

Soil

No. Rooms Treated

Dust cleaning only

Stabilize paint

Replace component

Abatement

Other

Income <50% AMI

50-% AMI< Income

__80% AMI

Income > 80%








 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




PART 3

FINANCIAL REPORTING

HUD Lead Hazard Control Grant Funds

If applicable, please also attach “HUD Form 269, Financial Status Report” or its successor to this quarterly report.


Grant Agreement Number:



Grantee Organization:




Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31




BUDGET CATEGORIES*


NEGOTIATED BUDGET



APPROVED LOCCS DRAWDOWNS THIS PERIOD*


CUMULATIVE LOCCS DRAWDOWNS TO DATE*


AVAILABLE BALANCE

1. Personnel (Direct Labor)









2. Fringe Benefits









3. Travel









4. Equipment









5. Supplies and Materials





6. Consultants





7. Contracts / Sub-Grantees /


7a.





7b.





7c.





7d.





7e.





7f.





7g.





7h.





7i.





Subtotal Item 7





8. Other Direct Costs






9. Indirect Costs







10. TOTALS*







Negotiated

This Period

Cumulative


Match/Leverage





* Administrative costs included in totals expended are not to exceed 10-percent.


II. Healthy Homes Initiative and Lead Technical Studies Grants


The Healthy Homes Initiative and Lead Technical Studies Grantee Quarterly Progress Reporting Form reflects reporting requirements that will assist both HUD and grantees in monitoring and evaluating their progress in implementing grant activities. This report, together with a well-designed work plan, provides a system to assist all parties in measuring grantee performance and fulfilling program management, monitoring, and oversight responsibilities.


Before completing the quarterly report for the first time, we recommend that Grantees confirm with their GTRs which report sections are applicable to tracking their grant’s progress.


In most cases, Healthy Homes Demonstration and Outreach Grantees will need to complete:

  • Part 1A thru 1C (and applicable sections of 1D)

  • Part 2 (if the Grantee performs work in dwelling units)

  • Part 3


In most cases, Healthy Homes Technical Studies and Lead Technical Studies Grantees will need to complete:

  • Part 1A and 1D

  • Part 3


PART 1

PROGRAM NARRATIVE RESPONSE


Discuss your progress and accomplishments in meeting the tasks and objectives outlined in your HUD-approved work plan. You should respond to each narrative item with a short paragraph. The narrative sections that follow address the following types of work plan tasks:


  1. Program Management and Capacity Building

  2. Assessment and Intervention Activities

  3. Community Education, Outreach, Training, and Capacity Building

  4. Data Collection and Analysis


When responding to the narratives, summarize your activities for this quarter and cumulatively, if appropriate. In the discussion of these work plan tasks, highlight issues and/or activities that had a significant impact on the program. The narrative discussion should complement the information submitted in the tables.


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Note: If your narrative response to a particular question remains unchanged from the previous quarterly report or no new information can be reported (i.e., changes to key personnel), you should reply by repeating your response from the previous report and indicating the date of the original response (i.e. Jan 1 - Mar 31, 2003).



A. Program Management and Capacity Building


Within the context of the current work plan and grant agreement, summarize your overall progress in completing your project/study. As part of your summary, please address the topics listed below, as applicable.


  1. Start-up Activities. Please indicate the status of the following start-up activities by clicking on the appropriate box below. Comments on your progress can be addressed in the narratives that follow.



Activity

Status

(select one category for each activity)

Not-yet-started

In-progress

Date Completed)

Quality Assurance Plan Submitted and Accepted (if applicable)




Staff Hired




Approval for Environmental Review Received (if applicable)




Internal Policies and Procedures Established




Process for Invoicing HUD through LOCCS Established with Grantee’s Finance Staff




Subcontracts and Sub-grants In-place




IRB Approval Received (if applicable)




Necessary Supplies and Materials Procured




NOTE: Corresponds to Section I on the Grantee Benchmark Performance Standards Worksheet.


  1. Personnel Changes. Describe any changes in key personnel in the project/study and among sub-grantees or other entities directly involved in your grant project/study and its impact. Please identify any staff hired and address how current staffing levels compare to your work plan. Provide information on any new project/study participants, including resumes of key individuals or letters of commitment, Memoranda of Understanding (MOUs) or other arrangements with community-based organizations and other partners.

  2. Work Plan or Budget Changes. Describe any significant changes to the work plan or budget that have occurred during this time period.

  3. Financial Partnerships. Describe existing or prospective partnerships with financial institutions.

  4. Job Creation and Retention

Enter the numbers of jobs created and retained by you, the Grantee, and your first tier contractors and subgrantees. Provide narrative explanation as necessary.


Activity- number of jobs funded under the grant

Jobs –

this Quarter

Jobs –

Cumulative

Green Jobs –

this Quarter

Green Jobs –

Cumulative

Created in your agency

a. 0

e. 2

i. 0

m. 2

Created by subcontractors

b. 0

f.  2

j. 0

n. 2

Retained in your agency

c. 0

g. 2

k. 0

o. 2

Retained by subcontractors

d. 0

h. 2

l. 0

p. 2

.

Employment Baseline. Enter the number of jobs that existed at the signing of the grant agreement. Also provide a narrative description of the job categories and numbers of employees.

Baseline employment

Jobs –At beginning of award

Green Jobs – At beginning of award

Grantee

q.

s.

Sub Grantees

r.

t.


  1. Written Policies and Procedures. Discuss progress toward developing internal written policies and procedures or any changes to policies and procedures already in-place.

  2. Coordination with Existing Programs (if applicable). Describe efforts to enhance the coordination and integration of work performed under your current grant with other existing housing, health, and environmental programs. For Healthy Homes grantees, include other projects and activities that also address Healthy Homes issues.

  3. Environmental Review and IRB Approval (if applicable). Describe status of Environmental Review and Institutional Review Board (IRB) approval. If original or revised IRB approval has been obtained, please list the date(s); if the most recent approval has been obtained this quarter, please attach the approval to this quarterly report.

  4. Challenges. Describe any obstacles or challenges to performance, activities, or research and measures taken to overcome those challenges.


B. Assessment and Intervention Activities


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Note: If the family has not been “enrolled” for the activity and no data have been collected (e.g., the activity consists of distributing materials door-to-door, with no record of recipient information and no individual follow-up), then the activity is characterized as a community education and outreach activity and should instead be addressed in Part 1, Section C.


Note: If your project does not perform unit assessments and interventions, check with your GTR to verify whether you need to complete this section.

This section focuses on the assessment and intervention activities implemented through your project, particularly environmental interventions in participants’ homes. An intervention occurs when activities (e.g., repair, renovation, provision of supplies, installation of safety equipment, or education of residents) have been performed in a residence to reduce environmental health and safety hazards or to inform residents about Healthy Homes or Lead Hazard Control issues.



Because of the wide range of activities, interventions, and measures involved in Healthy Homes and Lead Technical Studies projects, not all questions may be applicable to your grant. If an item asks about a type of activity that is not relevant to your project, please respond “Not Applicable" or “N/A.”


  1. Enrollment. Describe the types of recruitment/enrollment activities completed this quarter and complete the corresponding cells in B6. Also describe the effectiveness of financing mechanisms or incentives used in enrolling participants in the project and encouraging their continued participation during this time period.

  2. Assessment and Intervention Activities. Describe the types of assessments and/or interventions that took place this quarter in the following categories:

    1. Assessment and mitigation of hazards associated with asthma and/or other respiratory illnesses (including mold and moisture controls).

    2. Assessment and mitigation of hazards associated with injury and safety hazards.

    3. Assessment and mitigation of lead-based paint hazards.

    4. Assessment and mitigation of other hazards (please specify).

      1. Intervention Methods. Describe the methods or combination of methods used to perform the activities listed in question B2 above. Include a description of costs for units completed during this quarter. (These costs will also be reported in Part 2.)

      2. Follow-up Activities. Describe any post-intervention follow-up or assessment activities for units in which work was completed this quarter. A unit can be considered completed if a follow-up assessment remains to be performed (for example, a six-month follow-up environmental assessment), as long as the actual physical work or other intervention activity has been completed.

      3. Findings. For units in which assessments, interventions, and analysis have been completed, briefly discuss the findings.

  1. Summary of Unit Assessments and Interventions


    Current Quarter


    Assessments or Inspections


    Units Assessed / Intervened for Respiratory Hazards

    (Mold/Moisture or Allergens, etc.)

    Units Assessed / Intervened for Safety Hazards

    Units Assessed / Intervened for Lead Hazards

    Units Assessed / Intervened for Other Hazards

    Please list:

    Shape6

    Shape7


    (CO, pesticides, radon, etc.)

    Total for this Quarter

    Cumulative Totals

    Number of potential clients contacted

    a.

    f.

    k.

    p.

    u.


    Number of clients enrolled


    b.

    g.

    l.

    q.

    v.

    NOTE: This response corresponds to II.A.2 on the Grantee Benchmark Performance Standards Worksheet.

    Number of units with completed assessment

    c.

    h.

    m.

    r.

    x.

    NOTE: This response corresponds to II.B.2 on the Grantee Benchmark Performance Standards Worksheet.

    Number of units with completed interventions

    d.

    i.

    n.

    s.

    x.

    NOTE: This response corresponds to II.C.2 on the Grantee Benchmark Performance Standards Worksheet.

    Number of units with interventions in progress

    e.

    j.

    o.

    t.

    y.

    NOTE: This response corresponds to II.C.4 on the Grantee Benchmark Performance Standards Worksheet.

    Note: Shaded boxes above do NOT need to be filled in.

    Current Quarter Information: The responses to all items located under the “Current Quarter” heading should indicate the number of enrollments, assessments, and interventions conducted during this reporting period. These figures may include assessments that occurred either prior to participant enrollment or in homes that were not enrolled in the program. If a single unit was inspected for more than one assessment category it should be counted once in both columns (for example, if an apartment is assessed for both lead hazards and mold and moisture, it would be counted in both Asthma/Other Respiratory Illnesses and Lead Hazard Control). The same rule applies to hazards identified, units enrolled, and interventions underway. The “Total for this Quarter” and “Cumulative Totals” columns should reflect the net number of housing units in the classification for each row. It is not the sum of the safety, lead, and other hazard categories, as summing these columns would result in double-counting some units.

    Cumulative Totals: The cumulative total units column should reflect the total number of enrollments, units assessed, and interventions since the grant program was initiated. It is a cumulative measure of the units counted under the “Total for this Quarter” column and the “Cumulative Totals” figure from the previous reports.

  2. Unit Type for Completed Units

Type of Units

(Based on number of interventions completed this quarter)

Total Units

This Quarter

Cumulative Totals

Owner-Occupied Units

a.

e.

Occupied Rental Units

b.

f.

Vacant Units

c.

g.

TOTAL INTERVENTIONS (all types)

d.

h.

The responses in this table should reflect only the units in which interventions have been completed and cleared (if necessary) during this quarter. A unit can be considered completed if follow-up evaluation remains to be performed (for example, a six-month follow-up environmental assessment), as long as the actual physical work or other intervention activity has been completed.

As with B6, the “Total Units this Quarter” and “Cumulative Totals” columns should be a net count of units across all hazard categories, ensuring that each unit is counted only once. The “Total Interventions” row should be a sum of the interventions for all types of units.


  1. Age of Units Completed

Age of Housing

(Based on number of interventions completed this quarter)

Total Units

This Quarter

Cumulative Totals

Pre-1940

a.

f.

1940-1959

b.

g.

1960-1977

c.

h.

Post-1977

d.

i.

Unknown Age

e.

j.

If the age of the unit is not known precisely, use the most reasonable age category based on available information. If the age of the unit cannot be reasonably estimated, it should be counted under “Unknown Age.”


  1. Occupant Information for Units Completed

Ages of Occupants in Completed Units

Total This Quarter

Cumulative Totals

Children Under Age 6

a.

d.

Occupants Age 6 to 17

b.

e.

Occupants Age 18 and Over

c.

f.

Responses should reflect the total number of occupants residing in the unit at the time the intervention was completed. Even if a unit receives more than one intervention, count each unit’s occupants only once.



C. Community Education, Outreach, Training, and Capacity Building


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Note: If your project does not perform education, training, outreach, or capacity-building activities, check with your GTR to verify whether you need to complete this section.

This section focuses on the educational, outreach, and training activities implemented through your project. These activities involve a broad dissemination of Healthy Homes and/or Lead Hazard Control information to health care providers and community members through workshops, health fairs, radio broadcasts, distribution of brochures, and other venues. Note: If the grantee has “enrolled” the participant and collected any personal information (family names, health status, etc.) and housing data (e.g., address), then the activity is considered a unit intervention and should instead be addressed in Part 1, Section B.


  1. Describe Activities Completed. Describe education and outreach activities completed this quarter, including the expected results of your efforts. Describe your outreach methods (door-to-door, presentation, broadcast media, mailings) and the intended recipients of this outreach (tenants, landlord groups, etc.). These activities should also be accounted for in C6 and C8.

  2. Effective Outreach Formats. Describe outreach techniques and/or particular methods, materials, and formats that have proven to be most effective. If any media coverage or educational brochures are available, please attach to this report.

  3. Training and Education. Describe the types of training and education efforts completed this quarter and any certification received. Please specify the types of staff training conducted, as well as training activities for community workers. These efforts should correspond to C7.

  4. Training and Education Evaluation. If training or education activities have been evaluated during this quarter, briefly describe the evaluation methods used and discuss the findings. Please attach copies of blank evaluation form(s) (e.g., pre- and post-test forms) in an appendix to this report.

  5. Capacity Building. Describe activities completed that either build the capacity of grantee and partner staff or build the capacity of other organizations and institutions in the community (activities may include staff training and/or training activities for community workers described in question C3). Please differentiate between internal (“grantee”) and external (“project recipient”) capacity-building efforts.


  1. Community Education and Outreach Activities

Target Audience

Activities Conducted (please list type for each audience)

Individuals Reached This Quarter

Cumulative Totals of Individuals Reached

Health/child care providers

a.

h.

o.

Schools, parent groups, etc.

b.

i.

p.

Landlords

c.

j.

q.

Tenants and other community residents

d.

k.

r.

Other (specify) ___________________

e.

l.

s.

Other (specify) ___________________

f.

m.

t.

TOTAL FOR ALL AUDIENCES

g.

n.

u.

Responses should correspond to the narrative answers in C1 and C2. List all activities undertaken to reach each target audience during the quarter (e.g. meetings, presentations, mailings, health fairs, etc.). The number of individuals reached is the total number of individuals reached through all of the types of activities conducted. If an audience reached by your activities is not listed here, please list the audience under “Other.”


NOTE: This table corresponds to Part III.A on the Grantee Benchmark Performance Standards Worksheet.




  1. Skills Training

Target Audience

Type of Training Conducted

(please list type for each audience)

Number Trained This Quarter

Cumulative Number Trained

Tenants or Owner-occupants

a.

g.

m.

Property Owners (non-residents)

b.

h.

n.

Remodelers and Other Contractors

c.

i.

o.

Grant Project (or Partner) Staff

d.

j.

p.

Other (specify) ___________________

e.

k.

q.

Other (specify) ___________________

f.

l.

r.

Responses should correspond to the narrative answers in C3. The number of individuals trained should reflect the total number of individuals in each category trained for all types of training. If an audience reached by your training is not listed here, please list the audience under “Other.”

NOTE: This table corresponds to Part III. B on the Grantee Benchmark Performance Standards Worksheet.


  1. Publications and Other Materials Distributed

Description of Outreach Materials

Method of Circulation (health fair, door-to-door, etc.)

Number Distributed This Quarter

Cumulative Number Distributed

1.

a.

e.

j.

2.

b.

f.

k.

3.

c.

g.

l.

4.

d.

i.

m.

Responses should correspond to the narrative answers in C1 and C2, as well as C3 and C4, as appropriate.

NOTE: This table corresponds to Part III. C on the Grantee Benchmark Performance Standards Worksheet.


D. Data Collection and Analysis


This section focuses on data collection activities performed as part of your grant. Note: Any activities involving collection of family and unit data through home visits may also be defined by HUD as interventions and should also be addressed in Part 1, Section B.

  1. Data Collection and Analysis Activities. Summarize activities performed during this reporting period and complete D7 through D9. As appropriate, indicate progress in the following areas:


    1. Development of data collection instruments. Describe progress in developing hazard assessment tools, surveys, etc. (you are encouraged to use or adapt instruments that have already been validated, when possible). Also include the development of new sampling and analytical methods.

    2. Data collection. Summarize progress in data collection with respect to work plan milestones.

    3. Data validation and analysis. Describe progress in completing final data validation and analysis.


  1. Quality Assurance and Quality Control Activities. Describe QA/QC activities for the quarter (e.g., observation of field data collection, summary of QC sample analyses) and indicate whether any corrective actions were taken. Also, include progress made toward completion of the mid-project Quality Assurance Report.

  2. Study Methods and Data Collection Instruments. Describe the methods or combination of methods used to perform the activities listed in D1. Include a discussion of the instruments used to collect your data. Please attach sample forms, etc. as an appendix to this report.

  3. Changes in Study/Evaluation Design. Describe any changes in the study design or evaluation of the project during this time period. Explain why changes were made and their potential impact on the project.

  4. Preliminary Results. Discuss results of preliminary data analysis in the context of what was anticipated (i.e., your hypotheses) at the start of the project. Specify how these preliminary results might affect the remainder of your study.

  5. Capturing Health Outcomes and Environmental Outputs. As applicable, describe the expected and realized health outcomes that you expect to achieve or have achieved (e.g., number of children with reduced asthmatic episodes, respiratory symptoms, lead poisoning/blood lead levels, allergy symptoms, or improvements in home safety, reduction of school absenteeism, reduced emergency room visits, etc.). Similarly, describe the expected and realized environmental outcomes or outputs that you expect to achieve, or have achieved (e.g., reductions in allergen levels (from mold, pests and/or pets), injury hazards, lead in dust, pesticides, carbon monoxide, radon, etc.). The method of capturing this data should be included in this discussion (e.g., survey, questionnaire, spirometry, diaries, pre- and post-environmental sampling and analysis, pre-and post interviews, pest counting, etc.).







D6. Outcomes and Methods Captured

Health Outcomes and Method of Capture (list all)

Work Plan Goal (e.g., #’s of children in units receiving interventions for asthma)

Number of Children with a Reduction in Asthmatic Episodes

Number of Children With Improvement in Health Outcome other than Asthmatic Episodes)

1. Example: Reduced Asthma / Asthmatic Episodes; spirometry

a.

f.

k.

2.

b.

g.

l.

3.

c.

h.

m.

4.

d.

i.

n.

5.

e.

j.

o.

Environmental Outputs/Outcomes and Method of Capture (list all, particularly reductions in allergens, including mold and allergens from pests and/or pets)

Work Plan Goal (#’s of units)

Number of Units with a Reduction in Allergen Levels (mold, allergens from pests and/or pets) Realized

Number of Units with a Reduction in Environmental Hazards other than Allergen Levels)

1. Example: Reduction in cockroach allergen, environmental sampling and analysis

a.

f.

k.

2.

b.

g.

l.

3.

c.

h.

m.

4.

d.

i.

n.

5.

e.

j.

o.


  1. Data Collection Instruments

Data Collection Instruments Developed (list)

Work Plan Milestone for Completion (mm/dd/yyyy)

Date of Actual Completion (mm/dd/yyyy)

1.

a.

e.

2.

b.

f.

3.

c.

g.

4.

d.

h.

NOTE: This table corresponds to Part IV. A on the Grantee Benchmark Performance Standards Worksheet.


  1. Data Collection Activities and Milestones

Data Collection Activities in Work Plan (list)

Work Plan Milestone for Completion (mm/dd/yyyy)

Date of Actual Completion (mm/dd/yyyy)

1.

a.

e.

2.

b.

f.

3.

c.

g.

4.

d.

h.

NOTE: This table corresponds to Part IV. B on the Grantee Benchmark Performance Standards Worksheet.



  1. Data Analysis Activities and Milestones

Data Analysis Activities in Work Plan (list)

Work Plan Milestone for Completion (mm/dd/yyyy)

Date of Actual Completion (mm/dd/yyyy)

1. Data Validation


a.

e.

2. Data Analysis


b.

f.

3. Other (specify) ______________________


c.

g.

4. Other (specify) ______________________


d.

h.

NOTE: This table corresponds to Part IV.D on the Grantee Benchmark Performance Standards Worksheet.


D10. Status of Mid-Project Quality Assurance Report (Please check appropriate box) NOTE: This should be a concise report that describes the status of Quality Assurance/Quality Control (QA/QC) activities and findings during the first half of the project period-of-performance. The major elements of the grantee’s Quality Assurance Plan should be used as a guide with respect to the report’s contents. The report should describe any QA/QC-related problems that were encountered, efforts to address the problems, and the outcome of such efforts. The report should also include the results of QC sample analyses (e.g., field blank and field spike samples) if used in the grantee’s project.

  • Not-yet-started

  • In-progress

  • Completed (list date submitted ____________)

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NOTE: Corresponds to Part IV.C on the Grantee Benchmark Performance Standards Worksheet.



Part 2

LISTING OF UNITS COMPLETED

This part of the report provides additional information about units in which interventions were completed during the current reporting period. Indicate the unit address, city, state, and zip code for each unit listed. Also identify the types of interventions performed (e.g., control of asthma and other respiratory illnesses, injury prevention, or lead hazard control) and the total cost of the interventions. Please include a description of these costs in the narrative response to Part 1, Section B.


Note: If your program does not involve unit assessments and interventions, check with your GTR to verify that you do not need to complete this part.


Grant Agreement Number:



Grantee Organization:



Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31



Housing unit information


Costs

Where

What




Housing Unit Counter

Street Address

Apt #

City

State

ZIP Code

Housing Unit Area (sq ft)

Total Number of Rooms

Healthy Homes Intervention

Relocation

Rehab or other Work

Applicant leveraged funds

Total

Crawl Space

Basement

Ground Floor

Upper Level(s)

Top Level/Attic

No. Rooms Treated

Radon

Carbon Monoxide

Mold

Other Allergens

Pesticides

Other Toxic Substances

Home Safety

Income A50% AMI

50-% AMI< Income

__0% AMI

Income > 80%
















































































































































































PART 3

Financial Reporting

HUD Healthy Homes Initiative AND TECHNICAL STUDIES Grant Funds

If applicable, please also attach “HUD Form 269, Financial Status Report” or its successor to this quarterly report.


Grant Agreement Number:



Grantee Organization:




Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31




BUDGET CATEGORIES*


NEGOTIATED BUDGET



APPROVED LOCCS DRAWDOWNS THIS PERIOD*


CUMULATIVE LOCCS DRAWDOWNS TO DATE*


AVAILABLE BALANCE

1. Personnel (Direct Labor)









2. Fringe Benefits









3. Travel









4. Equipment









5. Supplies and Materials





6. Consultants





7. Contracts / Sub-Grantees /


7a.





7b.





7c.





7d.





7e.





7f.





7g.





7h.





7i.





Subtotal Item 7





8. Other Direct Costs






9. Indirect Costs







10. TOTALS*







Negotiated

This Period

Cumulative


Leverage






* Administrative costs included in totals expended are not to exceed 10 percent.

III Lead Outreach Grantee Quarterly Progress Report


The Lead Outreach Grantee Quarterly Progress Reporting Form reflects reporting requirements that will assist both HUD and grantees in monitoring and evaluating their progress in implementing grant activities. This report, together with a well-designed work plan, provides a system to assist all parties in measuring grantee performance and fulfilling program management, monitoring, and oversight responsibilities. This format requires current quarter information as well as cumulative numbers for some items.


The importance of tracking costs and activities: Because Lead Outreach Grantees and Lead Hazard Control Grantees perform somewhat similar activities in the areas of outreach and training, the costs and source of funds associated with outreach activities must be tracked. This format is to be used only for reporting outreach activities conducted with funds from the Lead Outreach Grant. Outreach activities conducted using funds from a Lead Hazard Control Grant should be reported in the quarterly report format for the Lead Hazard Control Grant Program.


PART 1

PROGRAM NARRATIVE RESPONSE


Discuss your progress and accomplishments in meeting the tasks and objectives outlined in the HUD-approved work plan for your Lead Outreach Grant. You should respond to each narrative item with a short paragraph. Work plan tasks that must be covered in this report include:


  1. Program Management and Capacity Building

  2. Housing Assessment/Inspection,

  3. Community Outreach Activities

  4. Training and Education Activities


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Note: If your narrative response to a particular question (such as A4.) remains unchanged from the previous quarterly report or no new information can be reported (i.e., changes to key personnel), you should reply by repeating your response from the previous report and indicating the date of the original response (i.e. Jan 1 - Mar 31, 2003).

Summarize your activities for this report quarter, and cumulatively, as requested. In the discussion of these work plan tasks, highlight issues and/or activities that had a significant impact on the program. The narrative discussion should complement the information submitted in the tables.


  1. Program Management and Capacity Building


Within the context of the current work plan and grant agreement, summarize your progress in the overall grant program. As part of your summary, please address the topics listed below.


  1. Challenges: Describe any obstacles or challenges to performance or activities, and measures taken to overcome those challenges.

  2. Coordination with Existing Programs: Describe efforts to enhance the coordination and integration of lead outreach work with other existing housing, health, and environmental programs. Include other grant applications in process that will address lead-based paint or outreach issues.

  3. Personnel Changes: Describe any changes in key personnel in the program and among sub-grantees or other entities directly involved in your grant program and its impact. Provide information on any new program participants, including resumes of key individuals or letters of commitments, Memoranda of Understanding, or other arrangements with community-based organizations and other partners.

  4. Work Plan or Budget Changes: Describe any significant changes to the work plan or budget that have occurred during this quarter.

  5. Design or Evaluation Changes: Describe any changes in the design or evaluation of the program during this quarter. Explain why changes were made and their potential impact on the program.

  6. Effectiveness of Incentives: For this quarter, generally describe the effectiveness of the financing mechanisms or incentives used in reaching members of your target audience and encouraging enrollment of their unit into a lead hazard treatment program.

  7. Program Data Collection: Describe the methods you used this quarter to collect data regarding outreach activities and the criteria employed to evaluate the performance of the overall grant program.

  8. Financial Partnerships: Describe the effectiveness of partnerships with financial institutions, corporations or non-profit organizations for this reporting period.


    1. Housing Assessment/Inspection, Community Outreach, and Training Activities


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Note: Because of the wide range of activities involved in the Lead Outreach grant program, not all questions or possible responses will be applicable to your particular grant. If an item asks about a type of activity that is not relevant to your program, please respond “Not Applicable.”

This section focuses on assessments, including home visits (e.g., resident questionnaires, environmental or visual assessments) performed.


    1. Describe the lead-based paint housing assessments or unit inspections that took place this quarter under the Lead Outreach grant. These efforts should correspond to B2 below.


    1. Summary of Housing Assessments/Inspections Performed




Current Quarter

Cumulative for

All Quarters


Number of units contacted:

a.

e.


Number of units assessed or inspected:

b.

f.


Check type of assessment performed:

(Check all that apply)

  • Visual Assessment

  • Code Inspection

  • LBP Inspection

  • LBP Risk Assessment

  • Other

  • Visual Assessment

  • Code Inspection

  • LBP Inspection

  • LBP Risk Assessment

  • Other


Number of units with hazards:

c.

g.


Number of units with hazards referred for treatment:

d.

h.


Note: HUD recognizes that grantees normally contact people and not units. However, this table is designed to compare the number of units that were contacted in order to generate the stated number of units assessed.

C. Community Outreach Events, Effective Publications and Collateral Materials



  1. Describe your target audience (tenants, landlord groups, etc.) for each type of outreach activity (see box below) conducted this quarter. Discuss the expected outcomes of your efforts. For this quarter, describe how you measured your activities’ effectiveness in reaching your target audience. Include new evidence: 1) for why you believe a specific strategy is effective, and 2) which raises questions about a strategy’s effectiveness. If applicable, describe how you altered activities to improve their effectiveness. All outreach activities described in the narrative should be accounted for in C2 below.



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For this report, outreach activities/events are categorized into four major types:


  1. Community outreach” includes participation in community events, small group presentations, meetings, mailings, health fairs, etc. Include blood-lead screenings arranged or conducted by your program as community outreach activities. Community outreach activities may include use of “collateral materials” such as publications, documents or props, giveaways, cleaning kits or tee-shirts, etc.

  2. Earned media” are public service announcements and media stories on television, radio or in print that are provided at no cost to your program. Please estimate the number of people reached.

  3. Advertising” means paid advertisements on billboards, buses or other locations. Please estimate the number of people reached.

  4. Infrastructure and Support” includes development and maintenance of telephone hotlines and websites. These represent major communication elements for many lead outreach grantees.

    1. Quarterly Community Outreach Activities by Target Audience (Numerical responses should correspond to the narrative answers provided in response to the questions above.)

Target Audience

Number of Activities Conducted this Quarter

Type of Activity/Activities

(Check all that apply)

Community Outreach (CO),

Earned Media (M),

Paid Advertising (A)

Infrastructure (I)

Other (O)

Documented Number of Individuals Reached

(Estimate for M and A)

Main Purpose of Activities

Increase Awareness of Lead Poisoning and need for screening (A)

Enroll Units (E)

Other (O)

Type of organization having Primary Responsibility

Grantee (G)

Subgrantee (S) Contractor (C)

Volunteer (V)

Other partner (P)

Were any activities of this type evaluated?

(Y/N)

Did you meet your quarterly benchmark(s) for this target audience?

Yes (Y)

No (N)

Partially (P)

Cumulative number of events held

Health/child care providers









Schools, parent groups, etc.









Landlords/tenants and groups









Community- or target area-wide









Other (specify)









Other (specify)









Other (specify)









Other (specify)









Total









  1. Effectiveness Publications and Collateral Materials. Describe the publications, collateral materials, and/or formats that proved effective for your program this quarter. Identify why and how you developed new printed materials or purchased new items for use. State how costs were tracked and linked to outreach activities. Please attach one copy of your documents and materials used to perform outreach activities to this report if they have not been previously provided as an attachment to a quarterly report. Please mail one copy of your collateral materials to your GTR. Do not attach copies of Federal government publications. These materials should correspond to Item C4 below


  1. Tools and Collateral Materials used for Outreach Activities. Provide information on all publications used during the quarter, (e.g., pamphlets, program information sheets, etc.). Include other items used such as visual presentations, videos, giveaways, mascots, cleaning kits, calendars, coloring books, and other props, etc.

    Publication/Item (provide exact titles of publications)

    Number Used this Quarter

    Source of Publication or Item

    (Federal, State or Local Gov’t, Purchased Commercially, Original Item)

    Costs for this Publication/Item This Quarter

    New Publications or Items Developed or Purchased This Quarter

    Copy Attached or Mailed

    ()

    Cumulative Number Used

    Cumulative Costs for Publication/Item

    Your Program Information Sheet








    Building Code Information Sheet








    Protect Your Family from Lead in Your Home





    N/A



    Lead Paint Safety Field Guide





    N/A



    Lead in Your Home: A Parent’s Reference Guide





    N/A



    Reducing Lead Hazards When Remodeling Your Home





    N/A



    Lead Disclosure Rule Information





    N/A



    Hotline Calls/Website “Hits”





    Please submit screen captures and/or hotline information



    Other (specify)








    Other (specify)








    Other (specify)








    Other (specify)








    Total








  2. Costs of Outreach Events and Collateral Materials. Describe your method for tracking costs and linking costs to outreach activities for this quarter. Is this method effective? Is the benefit equal to or greater than the costs for the event or publication? Explain any unexpected or unusual costs this quarter. These efforts should correspond to Item C6 below.


  1. Costs and Benefits of Materials (Supplies) by Event Type this Quarter (Do not include labor costs for grantee staff)

Note: If units are enrolled in a lead hazard control grant program, the lead grantee may not also take credit for applicants or enrollment of units reported here.

Activity Type

Number Held this Quarter

Number of People Reached at Activity Type this Quarter

Approximate Supply Costs for all Activities of this Type this Quarter

Approximate Cost

Per Person Reached

Number of Applications for Lead Hazard Control Programs Resulting from Activity Type (Select primary activity type)

Number of Units Enrolled from Activity Type for Quarter (Select primary activity type)

Approximate Materials/Supply Costs for one Enrolled Unit from this Activity Type for Quarter

Cumulative Number of Units Enrolled from this Activity Type

Cumulative Supply Costs for one Enrolled Unit from this Activity Type

Community Events










Small Group Meetings










Door-to-Door campaigns










Advertising










Other (specify)










Other (specify)










Other (specify)










Other (specify)











  1. Reaching People of Limited English Proficiency. In your narrative covering this quarter, provide information you consider to be interesting or different related to your activities to reach individuals whose native language is not English. Include any new evidence that these activities were or were not effective. Describe how you altered any activities to improve their effectiveness. These efforts should correspond to Item C8 and C9.



  1. Reaching Persons of Limited English Proficiency (LEP)- Languages Used During Outreach Events (not training).

Activity Type

Primary Native Language of Majority of Audience

English (E)

Spanish (S)

Asian (A)

Other (O)

Mixed (M)

Primary Language(s) Used by Speakers/ Program Representatives

Select all that apply

English (E)

Spanish (S)

Asian (A)

Other (O)

Mixed (M)

Interpreter (s) Used?

Translation/

Interpreter Costs for Quarter

Community Events





Small Group Meetings





Door-to-Door campaigns





Advertising





Intake/Enrollment for Lead Hazard Control Program





Other (specify)





Other (specify)





  1. Publications for People of Limited English Proficiency

Publications and Materials

Primary Native Language of Majority of Audience

English (E)

Spanish (S)

Asian (A)

Other (O)

Mixed (M)

Language(s) of Publication or Item

Select all that were used

English (E)

Spanish (S)

Asian (A)

Other (O)

Mixed (M)

Who translated it?

Outreach Grantee (G)

LHC Grantee (LG)

Outreach Subgrantee (S) Contractor (C)

Volunteer (V)

Other partner (P)

Translation Costs for Quarter

We need Federal document(s) in the following language(s)

Grant Program Information Sheet





N/A

Protect Your Family from Lead in Your Home





Please specify language(s) needed

Lead Paint Safety Field Guide





Please specify language(s) needed

Lead in Your Home: A Parent’s Reference Guide





Please specify language(s) needed

Reducing Lead Hazards When Remodeling Your Home





Please specify language(s) needed

Lead Disclosure Rule Information





Please specify language(s) needed

Collateral Documents






Other (specify)







  1. Training/Education Activities and Evaluation


    1. Training/Education: Describe training and education activities your outreach grant supported or provided for your target area this quarter. Discuss the types of training or education provided and the expected outcome of the training in your targeted area. These efforts should correspond to D2 below. If grantee staff attended/completed training this quarter, please discuss it in the narrative, but do not include it in the table.


    1. Community Training and Education Activities. List all types of training conducted for each category. The number of individuals trained should reflect the total number of individuals in each category trained for all types of training. If an audience reached by your training is not listed here, please include under “Others” and briefly describe the audience. Do not include training received by grantee staff.


Type of Training Conducted

Number of People Trained this Quarter

Cumulative Number of People Trained

Language(s) Used

English (E)

Spanish (S)

Asian (A)

Other (O)

Name of Curriculum Used

Language of Curriculum

English (E)

Spanish (S)

Asian (A)

Other (O)

Tenants or Homeowners







Property Owners (non-residents)







Remodelers and Other Contractors







Grant Program (or Partners’) Staff







Day care providers







Teachers







Students







Others (specify)








  1. Evaluation of Training or Education (Narrative only): If training or education activities have been evaluated during this quarter, briefly describe the evaluation methods used and discuss the findings.

PART 3

FINANCIAL REPORTING

HUD Lead Hazard Control Grant Funds

If applicable, please also attach “HUD Form 269, Financial Status Report” or its successor to this quarterly report.

Grant Agreement Number:



Grantee Organization:




Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31




BUDGET CATEGORIES*


NEGOTIATED BUDGET



APPROVED LOCCS DRAWDOWNS THIS PERIOD*


CUMULATIVE LOCCS DRAWDOWNS TO DATE*


AVAILABLE BALANCE

1. Personnel (Direct Labor)









2. Fringe Benefits









3. Travel









4. Equipment









5. Supplies and Materials





6. Consultants





7. Contracts / Sub-Grantees /


7a.





7b.





7c.





7d.





7e.





7f.





7g.





7h.





7i.





Subtotal Item 7





8. Other Direct Costs






9. Indirect Costs







10. TOTALS*







Negotiated

This Period

Cumulative


Leverage






* Administrative costs included in totals expended are not to exceed 10-percent.

IV. Operation Lead Elimination Action Program


PART 1

PROGRAM NARRATIVE RESPONSE


Discuss your progress and accomplishments in meeting the tasks and objectives outlined in your HUD-approved work plan. You should respond to each narrative item with a short paragraph. Work plan tasks that must be covered in this report include:


    1. Program Management and Capacity Building

    2. Community Outreach Events and Training

    3. Lead Hazard Control Activities

    4. Leveraging Resources


Summarize your activities for this report quarter, and cumulatively if appropriate. In the discussion of these work plan tasks, highlight issues and/or activities that had a significant impact on the program. The narrative discussion is to complement the data submitted on these OMB-approved report forms.


Program Management and Capacity Building


A. Program Management and Capacity Building


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Note: If your narrative response to a particular question (such as A4.) remains unchanged from the previous quarterly report or no new information can be reported (i.e., changes to key personnel), you should reply by repeating your response from the previous report and indicating the date of the original response (i.e. Jan 1 - Mar 31, 2003).


Within the context of the current work plan and grant agreement, summarize your overall progress in completing your project/study. As part of your summary, please address the topics listed below, as applicable.


  1. Start-up Activities. Please indicate the status of the following start-up activities by clicking on the appropriate box below. Comments on your progress can be addressed in the narratives that follow.



Activity

Status

(select one category for each activity)

Not-yet-started

In-progress

Completed (list mm/dd/yyyy for date completed)

Staff Hired




Internal Policies and Procedures Established




Process for Invoicing HUD through LOCCS Established with Grantee’s Finance Staff




Subcontracts and Sub-grants In-place




NOTE: Corresponds to Section I on the Grantee Benchmark Performance Standards Worksheet.


  1. Challenges. Describe any obstacles or challenges to performance, activities, or research and measures taken to overcome those challenges.

  2. Personnel Changes. Describe any changes in key personnel in the project/study and among sub-grantees or other entities directly involved in your grant project/study and its impact. Please identify any staff hired and address how current staffing levels compare to your work plan. Provide information on any new project/study participants, including resumes of key individuals or letters of commitment, Memoranda of Understanding (MOUs) or other arrangements with community-based organizations and other partners.

  3. Work Plan or Budget Changes. Describe any significant changes to the work plan or budget that have occurred during this time period.

  4. Job Creation and Retention

Enter the numbers of jobs created and retained by you, the Grantee, and your first tier contractors and subgrantees. Provide narrative explanation as necessary.



Activity- number of jobs funded under the grant

Jobs –

this Quarter

Jobs –

Cumulative

Green Jobs –

this Quarter

Green Jobs –

Cumulative

Created in your agency

a. 0

e. 2

i. 0

m. 2

Created by subcontractors

b. 0

f.  2

j. 0

n. 2

Retained in your agency

c. 0

g. 2

k. 0

o. 2

Retained by subcontractors

d. 0

h. 2

l. 0

p. 2

.

Employment Baseline. Enter the number of jobs that existed at the signing of the grant agreement. Also provide a narrative description of the job categories and numbers of employees.


Baseline employment

Jobs –At beginning of award

Green Jobs – At beginning of award

Grantee


q.

s.

Sub Grantees


r.

t.


  1. Financial Partnerships. Describe existing or prospective partnerships with financial institutions.

  2. Coordination with Existing Programs (if applicable). Describe efforts to enhance the coordination and integration of work performed under your current grant with other existing housing, health, and environmental programs.


  1. Community Education, Outreach and Training


    1. Shape14

      For this report, outreach activities/events are categorized into four major types:


      1. Community outreach” includes participation in community events, small group presentations, meetings, mailings, health fairs, etc. Include blood-lead screenings arranged or conducted by your program as community outreach activities. Community outreach activities may include use of “collateral materials” such as publications, documents or props, giveaways, cleaning kits or tee-shirts, etc.

      2. Earned media” are public service announcements and media stories on television, radio or in print that are provided at no cost to your program. Please estimate the number of people reached.

      3. Advertising” means paid advertisements on billboards, buses or other locations. Please estimate the number of people reached.

      4. Infrastructure and Support” includes development and maintenance of telephone hotlines and websites. These represent major communication elements for many lead outreach grantees.

      Describe education and outreach activities and events completed this quarter. Discuss the expected results of your efforts. Describe your outreach efforts at reaching specific groups you have targeted (door-to-door, presentations, training, broadcast media, mailings) and the intended recipients of this outreach (tenants, landlords, parent groups, child-care providers). These activities should be included in Item B4 below.



      1. Describe outreach techniques and/or particular methods, materials, and formats that have proved to be most effective (attach copies of any media coverage and materials, including press clippings, to this report).

      2. Describe your target audience (tenants, landlord groups, etc.) for each type of outreach activity (see box below) conducted this quarter. Discuss the expected outcomes of your efforts. For this quarter, describe how you measured your activities’ effectiveness in reaching your target audience. Include new evidence: 1) for why you believe a specific strategy is effective, and 2) which raises questions about a strategy’s effectiveness. If applicable, describe how you altered activities to improve their effectiveness. All outreach activities described in the narrative should be accounted for in B4 below.

      3. Quarterly Community Outreach Activities by Target Audience (Numerical responses should correspond to the narrative answers provided in response to the questions above.)

        Target Audience

        Number of Activities Conducted this Quarter

        Type of Activity/Activities

        (Check all that apply)

        Community Outreach (CO),

        Earned Media (M),

        Paid Advertising (A)

        Infrastructure (I)

        Other (O)

        Documented Number of Individuals Reached

        (Estimate for M and A)

        Main Purpose of Activities

        Increase Awareness of Lead Poisoning and need for screening (A)

        Enroll Units (E)

        Other (O)

        Type of organization having Primary Responsibility

        Grantee (G)

        Subgrantee (S) Contractor (C)

        Volunteer (V)

        Other partner (P)

        Were any activities of this type evaluated?

        (Y/N)

        Did you meet your quarterly benchmark(s) for this target audience?

        Yes (Y)

        No (N)

        Partially (P)

        Cumulative number of events held

        Health/child care providers









        Schools, parent groups, etc.









        Landlords/tenants and groups









        Community- or target area-wide









        Other (specify)









        Other (specify)









        Other (specify)









        Other (specify)









        Total









      4. Effectiveness Publications and Collateral Materials. Describe the publications, collateral materials, and/or formats that proved effective for your program this quarter. Identify why and how you developed new printed materials or purchased new items for use. State how costs were tracked and linked to outreach activities. Please attach one copy of your documents and materials used to perform outreach activities to this report if they have not been previously provided as an attachment to a quarterly report. Please mail one copy of your collateral materials to your GTR. Do not attach copies of Federal government publications. These materials should correspond to Item B6 below


      1. Tools and Collateral Materials used for Outreach Activities. Provide information on all publications used during the quarter, (e.g., pamphlets, program information sheets, etc.). Include other items used such as visual presentations, videos, giveaways, mascots, cleaning kits, calendars, coloring books, and other props, etc.

Publication/Item (provide exact titles of publications)

Number Used this Quarter

Source of Publication or Item

(Federal, State or Local Gov’t, Purchased Commercially, Original Item)

Costs for this Publication/Item This Quarter

New Publications or Items Developed or Purchased This Quarter

Copy Attached or Mailed

()

Cumulative Number Used

Cumulative Costs for Publication/Item

























































Hotline Calls/Website “Hits”





Please submit screen captures and/or hotline information



Other (specify)








Other (specify)








Other (specify)








Other (specify)








Total









      1. Costs of Outreach Events and Collateral Materials. Describe your method for tracking costs and linking costs to outreach activities for this quarter. Is this method effective? Is the benefit equal to or greater than the costs for the event or publication? Explain any unexpected or unusual costs this quarter. These efforts should correspond to Item B8 below.


      1. Costs and Benefits of Materials (Supplies) by Event Type this Quarter (Do not include labor costs for grantee staff)

Activity Type

Number Held this Quarter

Number of People Reached at Activity Type this Quarter

Approximate Supply Costs for all Activities of this Type this Quarter

Approximate Cost

Per Person Reached

Number of Applications for Lead Hazard Control Programs Resulting from Activity Type (Select primary activity type)

Number of Units Enrolled from Activity Type for Quarter (Select primary activity type)

Approximate Materials/Supply Costs for one Enrolled Unit from this Activity Type for Quarter

Cumulative Number of Units Enrolled from this Activity Type

Cumulative Supply Costs for one Enrolled Unit from this Activity Type

Community Events










Small Group Meetings










Door-to-Door campaigns










Advertising










Other (specify)










Other (specify)










Other (specify)










Other (specify)











Shape15

Note: If units are enrolled in a lead hazard control grant program, the lead grantee may not also take credit for applicants or enrollment of units reported here.


      1. Describe training efforts completed this quarter. Discuss the types of training provided and any certifications received. These efforts should correspond to Item B13 below.

      2. Evaluation of Training or Education (Narrative only): If training or education activities have been evaluated during this quarter, briefly describe the evaluation methods used and discuss the findings.


      1. Skills Training and Economic Opportunities

Skills Training Conducted

(For Report Quarter)

Number of Individuals Trained

Number of Individuals Employed as a Result of Training

Cumulative Total

Low-Income Individuals


B4a.

B4b.

B4i.

Property Owners / Tenants / Remodelers / Renovators / Maintenance Workers


B4c.


B4j.

Lead-Based Paint Contractors


B4d.


B4k.

Grant Program & Partnering Entities Staff


B4e.


B4l.

Lead-Safe Work Practices (1012-1013)


B4f.


B4m.

Other (specify)


B4g.


B4n.

Total Trained This Quarter


B4h.


B4o.


  1. Lead Hazard Control Activities


  1. Describe the extent to which lead hazard control activities were conducted in conjunction with other work (i.e., rehabilitation, code correction, weatherization, etc.).

  2. Describe the lead hazard control methods or combination of methods used. To the extent possible, describe the number of housing units completed and cleared for the methods used (e.g., low-level interventions, interim controls, hazard abatement). Discuss the lead hazard control and rehabilitation costs for units completed this quarter.

  3. Describe any post-hazard control maintenance plans for units where lead hazard control grant work has been completed.


  1. Lead Hazard Evaluations and Units in Progress

Activity

Number Completed This Quarter

Number Completed Cumulatively

Number of Units Receiving Lead Hazard Evaluations


C4a.

C4d.

Number of Units with Lead Hazards Identified

C4b.

C4e.


Number of Units Enrolled


C4c.

C4f.

Number of Units in Progress or Under Contract


C4g.

C4h.



  1. Lead Hazard Control – Unit Production

Number of Units Completed and Cleared



Number Completed and Cleared*


Number of Units With Other Rehab, Code work

Number of Units Where Occupants Were Relocated


Occupied Rental Units

C5a.

C5b.

C5c.


Vacant Units

C5d.

C5e.



Owner-Occupied Units

C5f.

C5g.

C5h.


Quarter Total

C5i.

C5j.

C5k.

Cumulative Total

(Since the Inception of the Grant)

C5l.

C5m.

C5n.


A Listing of Units Completed and Cleared during the Quarter by street address is to be attached to the Quarterly Report (see PART 2 – LISTING OF UNITS COMPLETED AND CLEARED)


  1. Age of Units Completed and Cleared

Age of Housing (based on number of units completed and cleared)

Pre-1940







1940 - 1959


1960 - 1977

Unknown

Quarter Total

C6a.


C6b.

C6c.

C6d.

Cumulative Units


C6e.

C6f.

C6g.

C6h.


  1. Occupant Information of Units Completed

Number of Occupants Residing in Units when Lead Hazard Control Work was Initiated



Children under 6 Years of Age

Children under 6 Years of Age Receiving Medicaid

Occupants over 6 years of age (including adults)

Quarter Total

C7a.

C7b.

C7c.

Cumulative Units


C7d.

C7e.

C7f.



  1. Leveraging Resources


    1. Describe your efforts to engage new private sector partners.

    2. Describe your work with continuing partners.

    3. Describe how you are mobilizing resources and coordinating efforts.

    4. How are you employing innovative and/or creative strategies to engage these partners?


    1. Resources Leveraged

Partner

Organization Type

(financial, foundation, manufacturer,

retail, etc.)

Resources
Contributed ($)

Number of Activities Conducted this Quarter

Description of Activity and Results








































































Cumulative Totals




PART 2

LISTING OF UNITS COMPLETED AND CLEARED


Grant Agreement Number:



Grantee Organization:



Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31

Please submit the following information for units that have undergone lead hazard control activities and subsequently cleared:


Lead Hazard Control – Unit Production Using HUD OHHLHC Grant Funds


Housing unit information


Costs

Where

What




Housing Unit Counter

Street Address

Apt #

City

State

ZIP +4 Code

Housing Unit Area (sq ft)

Total Number of Rooms

Lead Hazard Control Intervention

Relocation

Rehab or other Work

Applicant match and Leverage $

Total Project Cost

Interior

Exterior

Soil

No. Rooms Treated

Dust cleaning only

Stabilize paint

Replace component

Abatement

Other

Income <50% AMI

50-% AMI< Income

__80% AMI

Income > 80%








 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 




PART 3

FINANCIAL REPORTING

HUD Lead Hazard Control Grant Funds

If applicable, please also attach “HUD Form 269, Financial Status Report” or its successor to this quarterly report.



Grant Agreement Number:




Grantee Organization:





Report Period:


Jan 1 – Mar 31 Jul 1 – Sep 30 Year 20____

Apr 1 – Jun 30 Oct 1 – Dec 31



BUDGET CATEGORIES*


NEGOTIATED BUDGET



APPROVED LOCCS DRAWDOWNS THIS PERIOD*


CUMULATIVE LOCCS DRAWDOWNS TO DATE*


AVAILABLE BALANCE


1. Personnel (Direct Labor)










2. Fringe Benefits










3. Travel










4. Equipment










5. Supplies and Materials






6. Consultants






7. Contracts / Sub-Grantees /



7a.






7b.






7c.






7d.






7e.






7f.






7g.






7h.






7i.






Subtotal Item 7






8. Other Direct Costs







9. Indirect Costs








10. TOTALS*








Negotiated

This Period

Cumulative



Leverage







* Administrative costs included in totals expended are not to exceed 10 percent.

Lead Hazard Control Capacity Building will use I. I. Lead Hazard Control, except part 2.


Green Healthy Homes Technical Studies will use II. Healthy Homes Initiative and Lead Technical Studies Grants .


1

Office of Healthy Homes and Lead Hazard Control OMB Control No. 2539-0008

Grantee Quarterly Reporting Form Form HUD-96006

Exp. Date MM/DD/200Y


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleQuarterly Progress Report System form
SubjectJune 2006
AuthorOHHLHC
File Modified0000-00-00
File Created2021-01-15

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