FY22 Chart A Supplement.clean.xlsx

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Overview

A2 INT SHFA MSO Characteristics
Public Reporting Burden

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Sheet 1: A2 INT SHFA MSO Characteristics

NOTE: Below is a completed example of Chart A. Complete the blank version that follows. NOTE: Entering an "x" indicates a "Yes" response.

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O1

O2

O3

P

S

T

U

V

Name of Applicant, and the Branches and Subgrantees that Applicant proposes to Fund with this NOFO

Location City/State

Agency's HUD Housing Counseling System (HCS) Number

Branch of an Intermediary, MSO, or SHFA

Subgrantee of an Intermediary, MSO, or SHFA

# of Housing Counselor Full-Time Equivalents

# of HUD HECM Roster Reverse Mortgage Counselors Full-Time Equivalents

# of Default Counselors to Provide Reverse Mortgage/ HECM Default Counseling during Grant Period

Formal Housing Counseling Training

HUD-certified Housing Counselors On Staff

Adopted National Industry Standards

Issued Client Exit Surveys

Issued Follow-up Client Surveys

Pulled Credit Reports Prior to Termination of Counseling

Opportunity Zones - Census Tract Number (preference points)

Promise Zones (preference points)

HBCU (preference points)

% of Award Applicant Intends to Allocate to Each Branch or Subgrantee

Counseling/Group Education to be Provided In Person

Counseling/Group Education to be Provided Via Telephone or Video (Interactive)

Counseling/Group Education to be Provided Over the Internet

Counseling/Group Education to be Available in Multiple Languages

Applicant

ABC Intermediary

Alexandria, VA

12345

Branches and/or Sub-grantees

ABC Intermediary

Alexandria, VA

12346

x

2

x

x

x

x

51510201900

x

x

30

x

x

x

x

Housing Resources

Alamosa, CO

56789

x

3

1

2

x

x

x

x

x

08003960200

x

x

35

x

x

x

x

Housing Affiliate

Erie, PA

98765

x

8

x

x

x

x

42049000100

x

x

20

x

x

x

x

TOTAL

1

2

13

1

2

3

1

2

3

3

1

3

3

3

85

3

3

3

3

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O1

O2

O3

P

S

T

U

V

Applicant

These fields are not applicable for the Applicant's main office / headquarters. Applicants that provide housing counseling services at their main office must include this office in the list of Subgrantees and Branches below.

Branches and/or Sub-grantees

Not Applicable for FY 22 CHC NOFO

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

Branches and/or Sub-grantees

TOTAL

0

0

0.00

0.00

0

0

0

0

0

0

0

0

0

0.00%

0

0

0

0

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Sheet 2: Public Reporting Burden

OMB Approval #2502-0621

Exp Date 06/30/2023

Public reporting burden for this collection of information is estimated to average 40 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  The information is being collected for a housing counseling agency to participate in HUD’s Housing Counseling program.  The information will be used by HUD to ensure that Counselors provide guidance and advice to help families and individuals improve their housing conditions and meet the responsibilities of tenancy and homeownership.  Counselors also help borrowers avoid predatory lending practices, such as inflated appraisals, unreasonably high interest rates, unaffordable repayment terms, and other conditions that can result in a loss of equity, increased debt, default, and foreclosure.  This agency may not collect this information, and you are not required to complete this form, unless it displays a valid OMB control number.