HUD 4138 Community Compass Monthly Activity Report

Community Compass TA and Capacity Building Program NOFA

HUD-4138-B

OMB: 2506-0197

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2506-0197 can be found here:

2024-03-12 - No material or nonsubstantive change to a currently approved collection

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OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

INSTRUCTIONS FOR COMMUNITY COMPASS MONTHLY ACTIVITY REPORT
General Instructions: 1. Data cannot be entered directly into cells containing dark red text; those cells will autofill from data entered elsewhere.
2. This document is primarily intended to be used in electronic form; it totals 65 pages when printed.

Summary: Sheet 1
Award Amounts Billed

Amount of All 8 Project Categories Billed this Billing Period
Total Amount Billed to Date
Remaining Award Balance

Located in box 3 of form HUD-1044 and under the 'Grants' module in DRGR System.
Beginning and ending dates of period covered by this report. E.g., 07/01/12 - 07/31/12.
Located in box 14 of form HUD-1044 and under the 'Grants' module in DRGR System.
The total of all funds obligated to the 10 project categories.
Total amount billed previous to this billing period on Administration, Coordination, Departmental, McKinney (HEARTH), NDAP
(HMIS), NAHASDA (ONAP), Receivership, and NAHCD TA Projects.
Total amount billed during this billing period on Administration, Coordination, Departmental, McKinney (HEARTH),
NDAP (HMIS), NAHASDA (ONAP), Receivership, and NAHCD TA Projects.
The sum of the amounts billed before this billing period and during this billing period.
= Award Amount - Total Amount Billed to Date.

Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Total Amount Billed this Billing Period
Total Amount Billed to Date
Remaining Balance
Notes

Amount obligated in TA provider's latest action plan.
Total hours of labor (staff, subcontractors, and/or consultants) billed over this period.
Total amount budgeted to this project on action plan.
Amount billed to this project before this billing period
Amount billed to this project during this billing period.
The sum of the amounts billed before this billing period and during this billing period.
= Total Amount Budgeted - Total Amount Billed to Date.
Space to enter any additional notes to GTR. E.g., no cost extensions/amendments approved.

Cooperative Agreement Number
Billing Period
Award Amount
Total Amount Obligated to Projects
Amount of All 8 Project Categories Billed Prior to this
Billing Period

Billed by Project

Deliverables
DATE
WORK PLAN NUMBER
DELIVERABLE TITLE

Date that deliverable was completed.
Self-explanatory
E.g., Smithtown Underwriting Worksheet, etc.

Work Plan Data by Project : Sheets 2 - 9
Amount Obligated to Project

Located under 'Projects' section in DRGR.

Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed To Date
TOTAL REMAINING BALANCE

Same as work plan number in TA Portal or DRGR.
Same as work plan number in DRGR.
Date work plan was started until expectected date of completion for work plan. E.g., 04/01/12 - 12/01/12
Total hours of labor (staff, subcontractors, and/or consultants) billed to work plan over this period.
Total amount budgeted to this work plan.
Amount billed on this work plan before this billing period.
Amount billed on this work plan during this billing period.
The sum of the amounts billed on this work plan before this billing period and during this billing period.
= Total Amount Budgeted - Total Billed to Date.

Traveler
Subcontractor or Consultant Organization
Destination and Number of nights

Enter name of individual staff member or contractor who billed travel during this billing period.
Enter name of individual traveler's organization (if other than TA Provider).
Enter the travel destination and number of nights spent in that location for the traveler.

Certification : Sheet 10
Enter name and title of certifying official, date, and telephone number. No signature is necessary.
Attach electronic copies of any required and/or pertinent documentation

COMMUNITY COMPASS MONTHLY ACTIVITY REPORT
AWARD AMOUNTS BILLED
COOPERATIVE AGREEMENT NO.
Billing Period
AWARD AMOUNT

Total Amount Obligated to Projects
Amount of All 8 Project Categories Billed Prior to this Billing Period
Amount of All 8 Project Categories Billed during this Billing Period
Total Amount Billed to date
REMAINING AWARD BALANCE

E.g., T-12-NN-00-0000
E.g., 3/01/12-3/31/12
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

BILLED BY PROJECT
Notes

ADMINISTRATION PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted To Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

$0
0
$0
$0
$0
$0
$0
$0

COORDINATION PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted To Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

$0
0
$0
$0
$0
$0
$0
$0

DEPARTMENTAL TA (formerly TI TA) PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted To Workplans
Amount Previously Billed
Amount Billed During this Billing Period

$0
0
$0
$0
$0

Notes

Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

$0
$0
$0

McKinney (HEARTH) TA PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted to Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

$0
0
$0
$0
$0
$0
$0
$0

NDAP TA (formlery HMIS TA) PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted to Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

$0
0
$0
$0
$0
$0
$0
$0

NAHASDA (ONAP) TA PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted to Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

$0
$0
$0
$0
$0
$0
$0
$0

Notes

RECEIVERSHIP TA PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted to Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS

Notes
$0
0
$0
$0
$0
$0
$0

TOTAL REMAINING BALANCE ON WORKPLANS

NAHCD TA PROJECT
Amount Obligated to this Project
Total Hours Billed this Billing Period
Total Amount Budgeted to Workplans
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to date
REMAINING PROJECT FUNDS
TOTAL REMAINING BALANCE ON WORKPLANS

Notes
$0
0
$0
$0
$0
$0
$0
$0

Notes

DELIVERABLES
DATE

WORK PLAN NUMBER

DELIVERABLE TITLE

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Administration
AMOUNT OBLIGATED TO PROJECT:

1st Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of Nights

OMB Approval No. 2506-0197

Coordination
AMOUNT OBLIGATED TO PROJECT:

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

2nd Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Coordination
3rd Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Coordination
5th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

AMOUNT OBLIGATED TO PROJECT:

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

3rd Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

5th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

6th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

7th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

8th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

9th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

10th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

11th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

12th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

13th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

14th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

15th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

16th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

17th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

18th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

19th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

20th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

21st Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

22nd Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

23rd Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

24th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

25th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

26th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

27th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

28th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Departmental TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

29th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

30th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

AMOUNT OBLIGATED TO PROJECT:

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

6th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

8th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

10th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

12th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

14th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

16th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

18th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

20th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

22nd Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

24th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

26th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

28th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

30th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

31st Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

32nd Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

33rd Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

34th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

35th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

36th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

37th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

38th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

McKinney

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

39th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

40th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NDAP (HMIS) TA
AMOUNT OBLIGATED TO PROJECT:

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
3rd Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
5th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

6th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
7th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

8th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
9th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

10th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
11th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

12th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
13th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

14th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
15th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

16th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
17th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

18th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NDAP (HMIS) TA
19th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

20th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

AMOUNT OBLIGATED TO PROJECT:

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

MB Approval No. 25060197 (Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

6th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

8th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

MB Approval No. 25060197 (Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

10th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

12th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

14th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

16th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

18th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

NAHASDA (ONAP) TA

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

20th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

RECEIVERSHIP TA
AMOUNT OBLIGATED TO PROJECT:

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA
5th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

6th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

8th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA
9th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

10th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA
11th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

12th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA
15th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

16th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

RECEIVERSHIP TA
19th Work Plan
Work Plan Name
Work Plan Number
Period of Performance
Total Hours Billed this Billing Period
Total Amount Budgeted
Amount Previously Billed
Amount Billed During this Billing Period
Total Amount Billed to-date
TOTAL REMAINING BALANCE

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

20th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

AMOUNT OBLIGATED TO PROJECT:

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

4th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

6th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

8th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

10th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

12th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

16th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

NAHCD

OMB Approval No. 2506-0197
(Exp. 03/31/2023)

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Name
No.
E.g., 04/01/12 - 07/01/12

Traveler

Subcontractor or Consultant
Organization

Work Performed

$0.00
$0.00
Destination + Number of nights

20th Work Plan
Work Performed

$0.00
$0.00
Destination + Number of nights

form HUD-4138

CERTIFICATION

OMB Approval No. 2506-0197
(Exp. 03/31/2023)
form HUD-4138

CERTIFICATION: I certify that the data contained in this document, as well as any information provided “I/We, the undersigned, certify under penalty of perjury that the information provided above is true
in the accompanying voucher, are true, correct, actual, and that all outlays were made in accordance with
the cooperative agreement conditions and applicable Regulations. I also certify that all subcontractors
and/or consultants have certified to the same certification statements, and the certifications on file for
future inspection and audit.
NAME/ TITLE of CERTIFYING OFFICIAL:

and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is
subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and
administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802).”

EMAIL ADDRESS:

TELEPHONE NO.

DATE:

BACKUP DOCUMENTATION: PLEASE PROVIDE ELECTRONIC COPIES OF ANY RECEIPTS, FINANCIAL MANAGEMENT PRINTOUTS, OR OTHER REQUIRED AND/OR PERTINENT DOCUMENTS

File Type	application/pdf
Author	Bernard, Richard
File Modified	2023-04-04
File Created	2023-04-04