MED Semi-Annual Report Submission Form

Status: Original and derived artifacts are available for this document.

Download: xlsx | pdf | html

OMB #: 0970-0490
Expiration Date: 01/31/2023

Grantee Name:
Grant Number:
Reporting Period:

Microenterprise Development Program Indicators
Semi-Annual Results
#

Category

Annual Goal

SA1

SA2

Annual Results
(SA1 + SA2)

Cumulative
Program Goal

Cumulative
Program Results

Enrollment
1

Individuals Enrolled

Technical Assistance
2

Pre-loan TA hours

3

Post-loan TA hours

Loans
4

Number of Start-up Loans Disbursed (MED)

4a Number of Start-up Loans Disbursed (MED) from ORR Revolving Loan Fund (RLF)
4b Number of Start-up Loans Disbursed (MED) from Leveraged RLF
5

Number of Stabilization/Expansion Loans Disbursed (MED)

5a Number of Stabilization/Expansion Loans Disbursed (MED) from ORR RLF
5b Number of Stabilization/Expansion Loans Disbursed (MED) from Leveraged RLF

6

Number of Credit Building Loans Disbursed (CBL)

6a Number of CBL Loans Disbursed (CBL) from ORR RLF
6b Number of CBL Loans Disbursed (CBL) from Leveraged RLF

7

Amount Disbursed ($) for Start-up (MED)

7a Amount Disbursed ($) for Start-up (MED) from ORR RLF
7b Amount Disbursed ($) for Start-up (MED) from Leveraged RLF

8

Amount Disbursed ($) for Stabilization/Expansion (MED)

8a Amount Disbursed ($) for Stabilization/Expansion (MED) from ORR RLF
8b Amount Disbursed ($) for Stabilization/Expansion (MED) from Leveraged RLF

9

Amount Disbursed ($) for CBL

9a Amount Disbursed ($) for CBL from ORR RLF
9b Amount Disbursed ($)for CBL from Leveraged RLF

10 Historical Loan Loss Rate (%)

11 Avg. Change in Credit Score (+/-)

Funds Leveraged
12 Amount Leveraged for Operations ($)

Jobs
13 Number of Jobs Created

14 Number of Jobs Retained

Program Level Impact (To be measured once at the end of the program)
15 Avg. Change in Net Income (+/-)
16 Business Success Rate (%)

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to evaluate MED grantee program performance. Public reporting burden for this collection of information is
estimated to average 2 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Funding Opportunity
Announcement: HHS-2017-ACF-ORR-RG-1228). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays
a currently valid OMB control number. If you have any comments on this collection of information, please contact the Microenterprise Development Program Officer.