91125-ORCF Forecasted Staffing Schedule

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Overview

Forecasted Staffing Schedule
Current Staffing Schedule

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Sheet 1: Forecasted Staffing Schedule

Public reporting burden for this collection of information is estimated to average 1 hour. This includes the time for collecting, reviewing, and reporting the data. The information is being collected to obtain the supportive documentation which must be submitted to HUD for approval, and is necessary to ensure that viable projects are developed and maintained. The Department will use this information to determine if properties meet HUD requirements with respect to development, operation and/or asset management, as well as ensuring the continued marketability of the properties. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. Warning: Any person who knowingly presents a false, fictitious, or fraudulent statement or claim in a matter within the jurisdiction of the U.S. Department of Housing and Urban Development is subject to criminal penalties, civil liability, and administrative sanctions.
	Project Name	Enter Name
	FHA Project No.	000-00000
	Address	Enter Address
	Instructions: Only light blue cells can be edited. Enter the staffing positions and salary projections for the subject as of the date when stabilized occupancy is realized. This tab is to be completed for both New Construction and for Substantial Rehab and 241a loans. For Substantial Rehabilitation and 241a loans also fill out the second tab (Current Staffing Schedule) with the subject's current staffing and salary information. Identify with a * any staff to be shared with additional facilities.
	Indicate the year in which stabilized occupancy will be reached.			enter year
	Job Title		# of Employees	Combined Hours Per Week	Combined Annual Salaries
	Administrative
	e.g. Administrator
	e.g. Business Office
	e.g. Receptionist
	e.g. Marketing Manager
	e.g. Marketing Assistant
	Administrative - Payroll Taxes & Benefits
	Total - Administrative				$0
	Building & Grounds
	e.g. Maintenance Supervisor
	e.g. Housekeeping Manager
	e.g. Housekeepers
	Building & Grounds - Payroll Taxes and Benefits
	Total - Building & Grounds				$0
	Activities & Other
	e.g. Activities Director
	e.g. Activities Assistant
	e.g. Transportation
	Activities & Other - Payroll Taxes and Benefits
	Total - Activities & Other				$0
	Personal Care
	e.g. Registered Nurses
	e.g. LPN’s
	e.g. CNAs
	Personal Care - Payroll Taxes and Benefits
	Total - Personal Care				$0
	Dietary
	e.g. Chef/Manager
	e.g. Cooks
	e.g. Assistants
	Dietary - Payroll Taxes and Benefits
	Total - Dietary				$0
	Totals
	Combined Number of Hours				0
	Full Time Equivalents Total (total # of hours divided by 40)				0
	Total Number of Employees (full time and part time)				0
	Total Annual Salaries Paid				$0
	Total Annual Taxes & Benefits				$0
	Total Annual Salaries with Benefits				$0

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Sheet 2: Current Staffing Schedule

Public reporting burden for this collection of information is estimated to average 3 hours. This includes the time for collecting, reviewing, and reporting the data. The information is being collected to obtain the supportive documentation which must be submitted to HUD for approval, and is necessary to ensure that viable projects are developed and maintained. The Department will use this information to determine if properties meet HUD requirements with respect to development, operation and/or asset management, as well as ensuring the continued marketability of the properties. Warning: Any person who knowingly presents a false, fictitious, or fraudulent statement or claim in a matter within the jurisdiction of the U.S. Department of Housing and Urban Development in subject to criminal penalties, civil liability, and administrative sanctions.
	Project Name	Enter Name
	FHA Project No.	000-00000
	Address	Enter Address
	Instructions: In addition to the first tab (Forecasted Staffing Schedule), this tab needs to be filled out for substantial rehabilitation & 241a loans. Enter the current staffing & salary levels prior to the construction or rehabiliation taking place. Identify with a * any staff shared with additional facilities.
	Indicate the year of the current staffing schedule.			enter year
	Job Title		# of Employees	Combined Hours Per Week	Combined Annual Salaries
	Administrative
	e.g. Administrator
	e.g. Business Office
	e.g. Receptionist
	e.g. Marketing Manager
	e.g. Marketing Assistant
	Administrative - Payroll Taxes & Benefits
	Total - Administrative				$0
	Building & Grounds
	e.g. Maintenance Supervisor
	e.g. Housekeeping Manager
	e.g. Housekeepers
	Building & Grounds - Payroll Taxes and Benefits
	Total - Building & Grounds				$0
	Activities & Other
	e.g. Activities Director
	e.g. Activities Assistant
	e.g. Transportation
	Activities & Other - Payroll Taxes and Benefits
	Total - Activities & Other				$0
	Personal Care
	e.g. Registered Nurses
	e.g. LPN’s
	e.g. CNAs
	Personal Care - Payroll Taxes and Benefits
	Total - Personal Care				$0
	Dietary
	e.g. Chef/Manager
	e.g. Cooks
	e.g. Assistants
	Dietary - Payroll Taxes and Benefits
	Total - Dietary				$0
	Totals
	Combined Number of Hours				0
	Full Time Equivalents Total (total # of hours divided by 40)				0
	Total Number of Employees (full time and part time)				0
	Total Annual Salaries Paid				$0
	Total Annual Taxes & Benefits				$0
	Total Annual Salaries with Benefits				$0