Form 1 MED Program Indicators

Generic Performance Progress Reports

CLEAN MED PI Form.xlsx

Microenterprise Development (MED) Program Indicators

OMB: 0970-0490

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Recipient 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 Total Individuals Enrolled





1a Females Enrolled





1b Males Enrolled





1c Other Genders Enrolled






Technical Assistance
2 Total Pre-loan T/TA Hours





2a Pre-Loan Training Hours





2b Pre-Loan TA Hours





3 Total Post-loan TA Hours





3a Post-Loan Training Hours





3b Post-Loan TA Hours






Loans
4 Total 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/Non-ORR RLF





5 Total 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/Non-ORR RLF





6 Total 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/Non-ORR RLF





7 Total 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/Non-ORR RLF





8 Total 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/Non-ORR RLF





9 Total Amount Disbursed ($) for CBL





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





9b Amount Disbursed ($)for CBL from Leveraged/Non-ORR RLF





10 Total Loans Disbursed by Gender (%)





10a Loans Disbursed to Females (%)





10b Loan Disbursed to Males (%)





10c Loans Disbursed to Other Genders (%)






Historical Loan Loss Rate (%)





12 Average Change in Credit Score (+/-)





Funds Leveraged
13 Amount Leveraged for Operations ($)













Jobs
14 Number of Jobs Created





15 Number of Jobs Retained






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





17 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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