Form 1 MED Semi-Annual Report Submission Form

Generic Performance Progress Report

MED Semi-Annual Report Form Clean.xlsx

Microenterprise Development Program Indicators

OMB: 0970-0490

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Grantee Name:





Grant Number:





Reporting Period:








Microenterprise Development Program Indicators
# Category Annual Goal Semi-Annual Results Annual Results (SA1 + SA2) Cumulative Program Goal Cumulative Program Results
SA1 SA2
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.
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