| Recipient Name: |
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| Grant Number: |
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| Reporting Period: |
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| 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 |
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| 1a |
Females Enrolled |
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| 1b |
Males Enrolled |
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| 1c |
Other Genders Enrolled |
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| Technical Assistance |
| 2 |
Total Pre-loan T/TA Hours |
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| 2a |
Pre-Loan Training Hours |
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| 2b |
Pre-Loan TA Hours |
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| 3 |
Total Post-loan TA Hours |
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| 3a |
Post-Loan Training Hours |
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| 3b |
Post-Loan TA Hours |
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| Loans |
| 4 |
Total Number of Start-up Loans Disbursed (MED) |
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| 4a |
Number of Start-up Loans Disbursed (MED) from ORR Revolving Loan Fund (RLF) |
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| 4b |
Number of Start-up Loans Disbursed (MED) from Leveraged/Non-ORR RLF |
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| 5 |
Total Number of Stabilization/Expansion Loans Disbursed (MED) |
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| 5a |
Number of Stabilization/Expansion Loans Disbursed (MED) from ORR RLF |
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| 5b |
Number of Stabilization/Expansion Loans Disbursed (MED) from Leveraged/Non-ORR RLF |
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| 6 |
Total Number of Credit Building Loans Disbursed (CBL) |
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| 6a |
Number of CBL Loans Disbursed (CBL) from ORR RLF |
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| 6b |
Number of CBL Loans Disbursed (CBL) from Leveraged/Non-ORR RLF |
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| 7 |
Total Amount Disbursed ($) for Start-up (MED) |
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| 7a |
Amount Disbursed ($) for Start-up (MED) from ORR RLF |
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| 7b |
Amount Disbursed ($) for Start-up (MED) from Leveraged/Non-ORR RLF |
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| 8 |
Total Amount Disbursed ($) for Stabilization/Expansion (MED) |
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| 8a |
Amount Disbursed ($) for Stabilization/Expansion (MED) from ORR RLF |
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| 8b |
Amount Disbursed ($) for Stabilization/Expansion (MED) from Leveraged/Non-ORR RLF |
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| 9 |
Total Amount Disbursed ($) for CBL |
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| 9a |
Amount Disbursed ($) for CBL from ORR RLF |
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| 9b |
Amount Disbursed ($)for CBL from Leveraged/Non-ORR RLF |
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| 10 |
Total Loans Disbursed by Gender (%) |
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| 10a |
Loans Disbursed to Females (%) |
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| 10b |
Loan Disbursed to Males (%) |
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| 10c |
Loans Disbursed to Other Genders (%) |
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Historical Loan Loss Rate (%) |
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| 12 |
Average Change in Credit Score (+/-) |
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| Funds Leveraged |
| 13 |
Amount Leveraged for Operations ($) |
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| Jobs |
| 14 |
Number of Jobs Created |
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| 15 |
Number of Jobs Retained |
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| Program Level Impact (To be measured once at the end of the program) |
| 16 |
Avg. Change in Net Income (+/-) |
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| 17 |
Business Success Rate (%) |
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| 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. |