OMB Approval No. 2506-0145 (exp.4/30/2003)

**U.S. Department of Housing**

**and Urban Development**

Office of Community Planning

and Development

**Annual Progress Report** (APR)

**for**

**Supportive Housing Program**

**Shelter Plus Care**

**and**

**Section 8 Moderate Rehabilitation for Single Room Occupancy Dwellings
(SRO) Program**

HUD-40118 (6/00)

**Public reporting burden** for this collection of information is
estimated to average 65 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. This agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless that
collection displays a valid OMB control number.

General Instructions

**Purpose.** The Annual Progress Report (APR) tracks program progress
and accomplishments in the Department's competitive homeless assistance
programs.

**Filing Requirements.** Recipients of HUD's homeless assistance grants
must submit an APR to HUD within 90 days after the end of each operating
year. Failure to submit an APR will delay receiving grant funds and may
result in a determination of lack of capacity for future funding. An APR
must be submitted for each operating year in which HUD funding is
provided. The report must be submitted to the CPD Division Director in
the local HUD Field Office responsible for managing the grant.

Grantees that received SHP funding for new construction, acquisition, or
rehabilitation are required to operate their facilities for 20 years.
They must submit an APR 90 days after the end of the first operating
year and any year in which they use SHP funding for leasing, supportive
services, or operations. For years in which they do not receive SHP
funding, they must submit an Annual Certification of Continued Project
Operation throughout the 20 years (contact local HUD Field Office).

A separate report must be submitted for each HUD grant received. For
Shelter Plus Care, a separate APR must be submitted for each Shelter
Plus Care component.

For those grantees receiving an extension, a separate report covering
that period must be submitted (see Extension below).

**Record keeping.** Grantees must collect and maintain information on
each participant in order to complete an APR. Optional worksheets are
attached. The worksheets may be used to record information manually or
to design a computerized system to store and tabulate the information.
The worksheets should not be submitted to HUD with the APR.

**Organization of the Report.** The APR is organized in the following
manner:

> **Part I: Project Progress.** This portion of the report describes the
> progress in moving homeless persons to self-sufficiency, services
> received, project goals, and beds created.
>
> **Part II: Financial Information.** This portion of the report is
> completed by all grantees receiving funding under SHP, S+C and SRO.

**Final Assembly of Report.** After the entire report is assembled,
number every page sequentially. Mark any questions that do not apply to
your program with "N/A" for not applicable. (See Special Instructions
for SSO Projects below.)

**Definitions.** The following terms are used in the APR. As indicated,
in some cases, terms are applied differently depending on whether the
funding is from SHP, S+C, or SRO.

> **Entered the program** for S+C and SRO projects means when the
> participant starts to receive rental assistance. For S+C, services
> provided prior to this point are recognized as necessary for
> outreach/enrollment and are eligible to count as match.
>
> **Left the program** for S+C projects means when the participant stops
> receiving rental assistance and is not expected to return to S+C
> assisted housing. If the participant returns to S+C assisted housing
> within 90 days, the person should not be considered as exiting from
> the program. If the person returns to S+C assisted housing after 90
> days, that person is considered a new participant. The worksheet is
> designed to capture this information.
>
> An **Extension APR** applies to SHP and S+C grantees that requested
> and received an extension of their grant term from the HUD field
> office. The only difference between an APR for the extension period
> and the regular APR (besides the amount of time covered) is the
> signature page. Grantees should circle yes to indicate the APR is for
> an extension period and circle the operating year for which the report
> is an extension. For example, if the grantee is extending year 3, the
> grantee should submit an APR as usual for year 3 and submit another
> APR for the extension period, indicating the second is an extension
> and also circling year 3 on the signature page.
>
> **Family** means a household composed of two or more related persons,
> at least one of whom is an adult. The term family also includes one or
> more persons living with an eligible participant who is determined to
> be important to their care or well being. Care givers are not reported
> on in the APR.
>
> **Grantee** means a direct recipient of the HUD award.
>
> **Match** for S+C means the value of supportive services received by
> participants in the S+C project which, in the aggregate, must at least
> equal the value of the S+C rental assistance provided over the life of
> the project. For SHP, match means cash used to provide the grantee's
> portion of acquisition, rehabilitation, new construction, operations
> and supportive services expenses.
>
> **Operating year** means for SHP the date when participants begin to
> receive housing and/or services. The first operating year begins after
> development activities for acquisition, rehabilitation, and new
> construction are complete, after a copy of the Certificate of
> Occupancy is sent to the local HUD office, and when the first
> participant is accepted into the project. For projects without
> acquisition, rehabilitation or new construction the operating start
> date begins when the grantee accepts the first participant. For S+C
> (SRA, PRA and TRA components), the first operating year begins on the
> date HUD signs the grant agreement. For S+C/SRO and for Sec. 8 SRO,
> the first operating year begins with the effective date of the Housing
> Assistance Payments (HAP) Contract.
>
> To determine which operating year to circle on the APR cover page,
> begin counting from the initial grant operating start date and include
> renewals grants. For example, a project receiving an initial grant for
> three years and a renewal grant for two years would circle years 1, 2,
> and 3 respectively on the APR cover sheet for the initial grant and
> would circle 4 and 5 respectively for the renewal grant. For any
> future renewal grants, the grantee would begin by circling 6 on the
> APR cover sheet.
>
> **Participant** means single persons and adults in families who
> received assistance during the operating year. Participant does not
> include children or caregivers who live with the adults assisted.
>
> **Project Sponsor** means the organization responsible for carrying
> out the daily operation of the project, if the organization is an
> entity other than the grantee.
>
> **Special Instructions for Supportive Services Only Projects.** SSO
> grantees should complete all questions, unless a written agreement has
> been reached with the field office concerning which questions can be
> answered using estimates, or in rare instances, skipped.

Below is an example of how information could be derived in a large,
single-service SSO project:

> A grantee/sponsor staff member could be assigned to collect
> information from the organizations housing the participants. The staff
> person would contact these individual organizations to request
> information regarding the persons in that facility who use the
> service. For participants living on the street, the grantee/project
> sponsor may provide estimates.
>
> Information could be collected for each participant or for
> participants receiving services at a point-in-time. If estimates or
> point-in-time counts are used, the method used must be described in
> the APR and the documentation kept on file.

+-----------------------------------------------------------------------+
| Grantee: HUD Grant or Project Number:                                 |
+-----------------------------------------------------------------------+
| Project Sponsor: Project Name:                                        |
+-----------------------------------------------------------------------+
| Operating Year: (Circle the operating year being reported on)         |
| Reporting Period: (mo./day/yr.)                                       |
|                                                                       |
| 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20                    |
|                                                                       |
| Indicate if extension: yes no from: to:                               |
|                                                                       |
| Indicate if renewal: yes no                                           |
+-----------------------------------------------------------------------+
| Previous Grant Numbers for this project:                              |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
+-----------------------------------------------------------------------+

Check the component for the program on which you are reporting.

Summary of the project : (One or two sentences with a description of
population, number served and accomplishments

this operating year)

+-----------------------------------------------------------------------+
| Name & Title of the Person who can answer questions about this        |
| report: Phone: (include area code)                                    |
+-----------------------------------------------------------------------+
| Address: Fax Number: (include area code)                              |
+-----------------------------------------------------------------------+
| I hereby certify that all the information stated herein is true and   |
| accurate.                                                             |
|                                                                       |
| **Warning:** HUD will prosecute false claims and statements.          |
| Conviction may result in criminal and/or civil penalties. (18 U.S.C.  |
| 1001, 1010, 1012; 31 U.S.C. 3729, 3802)                               |
+-----------------------------------------------------------------------+
| Name & Title of Authorized Grantee Official: Signature & Date:        |
|                                                                       |
| X                                                                     |
+-----------------------------------------------------------------------+
| Name and Title of Authorized Project Sponsor Official: Signature &    |
| Date:                                                                 |
|                                                                       |
| X                                                                     |
+-----------------------------------------------------------------------+

**Part I: Project Progress**

1.  **Projected Level of Persons to be served at a given point in
    time.** (from the application, SHP- Sec. F; SPC- Sec. C;

SRO- Sec. D)

+---+---------------------------------+--------+-------+-------+------+
|   | Projected Level                 | Number | N     | N     | Nu   |
|   |                                 | of     | umber | umber | mber |
|   |                                 | S      | of    | of    | of   |
|   |                                 | ingles | A     | Chi   | Fami |
|   |                                 | Not    | dults | ldren | lies |
|   |                                 |        | in    |       |      |
|   |                                 | in     | Fam   | in    |      |
|   |                                 | Fa     | ilies | Fam   |      |
|   |                                 | milies |       | ilies |      |
+---+---------------------------------+--------+-------+-------+------+
| a | Persons to be served at a given |        |       |       |      |
| \ | point in time                   |        |       |       |      |
| . |                                 |        |       |       |      |
+---+---------------------------------+--------+-------+-------+------+

2.  **Persons Served during the operating year.**

+---+----------------------------------+-------+-------+--------+-------+
|   |                                  | N     | N     | Number | N     |
|   |                                  | umber | umber | of     | umber |
|   |                                  | of    | of    | Ch     | of    |
|   |                                  | Si    | A     | ildren | Fam   |
|   |                                  | ngles | dults | in     | ilies |
|   |                                  | Not   | in    | Fa     |       |
|   |                                  | in    | Fam   | milies |       |
|   |                                  | Fam   | ilies |        |       |
|   |                                  | ilies |       |        |       |
+---+----------------------------------+-------+-------+--------+-------+
| a | Number on the first day of the   |       |       |        |       |
| \ | operating year                   |       |       |        |       |
| . |                                  |       |       |        |       |
+---+----------------------------------+-------+-------+--------+-------+
| b | Number entering program during   |       |       |        |       |
| \ | the operating year               |       |       |        |       |
| . |                                  |       |       |        |       |
+---+----------------------------------+-------+-------+--------+-------+
| c | Number who left the program      |       |       |        |       |
| \ | during the operating year        |       |       |        |       |
| . |                                  |       |       |        |       |
+---+----------------------------------+-------+-------+--------+-------+
| d | Number in the program on the     |       |       |        |       |
| \ | last day of the operating year   |       |       |        |       |
| . |                                  |       |       |        |       |
|   | (a+b-c) = d                      |       |       |        |       |
+---+----------------------------------+-------+-------+--------+-------+

> **3. Project Capacity.**

  ----- ---------------------------------- ---------- ---------- ---------- ----------
                                           Number of  Number of  Number of  Number of
                                           Singles    Adults in  Children   Families
                                           Not in     Families   in         
                                           Families              Families   

  a\.   Number on the last day (from 2d,                                    
        columns 1 and 4)                                                    

  b\.   Number proposed in application                                      
        (from 1a, columns 1 and 4)                                          

  c\.   Capacity Rate (divide a by b) = %  \%                               \%
  ----- ---------------------------------- ---------- ---------- ---------- ----------

4.  **Non-homeless persons.** This question is to be completed for
    Section 8 SRO projects.

  --------------------------------------------------------------- -------
  How many income-eligible non-homeless persons were housed by    
  the SRO program during the operating year?                      

  --------------------------------------------------------------- -------

5.  **Age and Gender.** Of those who **entered** the project during the
    operating year, how many people are in the following age and gender
    categories?

  ---------------------------------- ----- ---------- ----------- -----------
  **Single Persons (from 2b, column        Age        Male        Female
  1)**                                                            

                                     a\.   62 and                 
                                           over                   

                                     b\.   51-61                  

                                     c\.   31-50                  

                                     d\.   18-30                  

                                     e\.   17 and                 
                                           under                  

                                                                  

  **Persons in Families (from 2b,    f\.   62 and                 
  columns 2 & 3)**                         over                   

                                     g\.   51 - 61                

                                     h\.   31 - 50                

                                     i\.   18 - 30                

                                     j\.   13-17                  

                                     k\.   6-12                   

                                     l\.   1-5                    

                                     m\.   Under 1                
  ---------------------------------- ----- ---------- ----------- -----------

Answer questions 6 - 10 only for **participants who
[entered]{.underline} the project during the operating year** (from 2b,
columns 1 and 2). The term **participant** means single persons and
adults in families. It does not include children or caregivers. NOTE:
The total for questions, 7, 8 and 10 below should be the same; respond
to each of those questions for all participants.

**6. Veterans Status**. How many participants were veterans? A veteran
is anyone who has ever been on active military

duty status.

7.  **Ethnicity**. How many participants are in the following ethnic
    categories?

  ----- --------------------------------------------------------- -------
  a\.   Hispanic or Latino                                        

  b\.   Non-Hispanic or Non-Latino                                
  ----- --------------------------------------------------------- -------

8.  **Race.** How many participants are in the following racial
    categories?

  ----- --------------------------------------------------------- -------
  a\.   American Indian or Alaskan Native                         

  b\.   Asian                                                     

  c\.   Black or African American                                 

  d\.   Native Hawaiian or Other Pacific Islander                 

  e\.   White                                                     
  ----- --------------------------------------------------------- -------

**9. Special Needs.** How many participants have the following?
Participants

may have more than one. If so, count them in [all]{.underline}
applicable categories.

  ----- --------------------------------------------------------- -------
  a\.   Mental illness                                            

  b\.   Alcohol abuse                                             

  c\.   Drug abuse                                                

  d\.   HIV/AIDS and related diseases                             

  e\.   Developmental disability                                  

  f\.   Physical disability                                       

  g\.   Domestic violence                                         

  h\.   Other (please specify)                                    
  ----- --------------------------------------------------------- -------

10. **Prior Living Situation.** How many participants slept in the
    following places

in the week prior to entering the project? (Choose one)

  ----- ---------------------------------------------------------- ------
  a\.   Non-housing (street, park, car, bus station, etc.)         

  b\.   Emergency shelter                                          

  c\.   Transitional housing for homeless persons                  

  d\.   Psychiatric facility\*                                     

  e\.   Substance abuse treatment facility\*                       

  f\.   Hospital\*                                                 

  g\.   Jail/prison\*                                              

  h\.   Domestic violence situation                                

  i\.   Living with relatives/friends                              

  j\.   Rental housing                                             

  k\.   Other (please specify)                                     
  ----- ---------------------------------------------------------- ------

\*If a participant came from an institution but was there less than 30
days and was living on the street or in

emergency shelter before entering the treatment facility, he/she should
be counted in either the street or shelter

category, as appropriate.

Complete questions 11 - 15 for all **participants** **who
[left]{.underline} during the operating year** (from 2c, columns 1 and
2) The term participant means single persons and adults in families. It
does not include children or caregivers.

11. **Amount and Source of Monthly Income at Entry and at Exit.** Of
    those participants who left during the operating year, how many
    participants were at each monthly income level and with each source
    of income?

  -------- ------------------------------------------------- -------------
           A. Monthly Income at **Entry**                    

  a\.      No income                                         

  b\.      \$1-150                                           

  c\.      \$151 - \$250                                     

  d\.      \$251- \$500                                      

  e\.      \$501 - \$1,000                                   

  f\.      \$1001- \$1500                                    

  g\.      \$1501- \$2000                                    

  h\.      \$2001 +                                          
  -------- ------------------------------------------------- -------------

  -------- ------------------------------------------------- -------------
           B. Monthly Income at **Exit**                     

  a\.      No income                                         

  b\.      \$1-150                                           

  c\.      \$151- \$250                                      

  d\.      \$251- \$500                                      

  e\.      \$501- \$1000                                     

  f\.      \$1001- \$1500                                    

  g\.      \$1501- \$2000                                    

  h\.      \$ 2001 +                                         
  -------- ------------------------------------------------- -------------

**12. Length of Stay in Program.** Of those participants who
**[left]{.underline}** during the operating year (from 2c, columns 1 and
2), how many were in

the project for the following lengths of time?

  ------ --------------------------------------------- ------------------
  a\.    Less than 1 month                             

  b\.    1 to 2 months                                 

  c\.    3 - 6 months                                  

  d\.    7 months - 12 months                          

  e\.    13 months - 24 months                         

  f\.    25 months - 3 years                           

  g\.    4 years - 5 years                             

  h\.    6 years - 7 years                             

  i\.    8 years - 10 years                            

  j\.    Over 10 years                                 
  ------ --------------------------------------------- ------------------

13. **Reasons for Leaving.** Of those participants who
    **[left]{.underline}** the project during the operating year (from
    2c, columns 1 and 2), how many left for the following reasons? If a
    participant left for multiple reasons, ***include [only]{.underline}
    the primary reason***.

  ------ ------------------------------------------------------- ---------
  a\.    Left for a housing opportunity before completing        
         program                                                 

  b\.    Completed program                                       

  c\.    Non-payment of rent/occupancy charge                    

  d\.    Non-compliance with project                             

  e\.    Criminal activity / destruction of property / violence  

  f\.    Reached maximum time allowed in project                 

  g\.    Needs could not be met by project                       

  h\.    Disagreement with rules/persons                         

  i\.    Death                                                   

  j\.    Other (please specify)                                  

  k\.    Unknown/disappeared                                     
  ------ ------------------------------------------------------- ---------

14. **Destination.** Of those participants who **[left]{.underline}**
    during the operating year (from 2c, columns 1 and 2), how many left
    for

the following destination?

  ---------------------- ----- ------------------------------------ ------
  PERMANENT (a-h)        a\.   Rental house or apartment (no        
                               subsidy)                             

                         b\.   Public Housing                       

                         c\.   Section 8                            

                         d\.   Shelter Plus Care                    

                         e\.   HOME subsidized house or apartment   

                         f\.   Other subsidized house or apartment  

                         g\.   Homeownership                        

                         h\.   Moved in with family or friends      

  TRANSITIONAL (i-j)     i\.   Transitional housing for homeless    
                               persons                              

                         j\.   Moved in with family or friends      

  INSTITUTION (k-m)      k\.   Psychiatric hospital                 

                         l\.   Inpatient alcohol or other drug      
                               treatment facility                   

                         m\.   Jail/prison                          

  EMERGENCY SHELTER (n)  n\.   Emergency shelter                    

  OTHER (o-q)            o\.   Other supportive housing             

                         p\.   Places not meant for human           
                               habitation (e.g. street)             

                         q\.   Other (please specify)               

  UNKNOWN                r\.   Unknown                              
  ---------------------- ----- ------------------------------------ ------

15. **Supportive Services.** Of those participants who
    **[left]{.underline}** during the operating year (from 2, columns 1
    and 2), how

many received the following supportive services during their time in the
project?

  ----- ------------------------------------------------------- ----------
  a\.   Outreach                                                

  b\.   Case management                                         

  c\.   Life skills (outside of case management)                

  d\.   Alcohol or drug abuse services                          

  e\.   Mental health services                                  

  f\.   HIV/AIDS-related services                               

  g\.   Other health care services                              

  h\.   Education                                               

  i\.   Housing placement                                       

  j\.   Employment assistance                                   

  k\.   Child care                                              

  l\.   Transportation                                          

  m\.   Legal                                                   

  n\.   Other (please specify)                                  
  ----- ------------------------------------------------------- ----------

16. **Overall Program Goals.** Under Objectives, list your measurable
    objectives for this operating year (from your application, Technical
    Submission or APR) for each of the goals listed below. Under
    Progress, describe your progress in meeting the objectives. Under
    Next Operating Year's Objectives, specify the measurable objectives
    for the next operating year.

```{=html}
<!-- -->
```
a.  **Residential Stability**

> Objectives:
>
> Progress:
>
> Next Operating Year's Objectives:

b.  **Increased Skills or Income**

> Objectives:
>
> Progress:
>
> Next Operating Year's Objectives:
>
> c\. **Greater Self-determination**
>
> Objectives:
>
> Progress:

Next Operating Year's Objectives:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

17. **Beds**. SHP recipients answer 17a. S+C recipients answer 17b. SRO
    recipients answer 17c. **(SHP-SSO projects do not complete this
    question.)**

a\. **SHP**. How many beds were included in the application approved for
*this* project under 'Current Level' and under 'New Effort'?

How many of these New Effort beds were actually in place at the end of
the operating year?

Current Level New Effort New Effort in Place

Number of Beds: \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

b\. **S+C.** How many beds and dwelling units were being assisted with
project funds at the end of the operating year? (Include beds

> for all participants, other family members, and care givers.)

Number of Beds: \_\_\_\_\_\_\_\_\_

Number of Dwelling Units: \_\_\_\_\_\_\_\_\_

c\. **SRO.** How many dwelling units were being assisted at end of the
operating year? (Include units occupied by "in place" non-

homeless persons who qualify for assistance.)

Number of Dwelling Units: \_\_\_\_\_\_\_\_

**Part II: Financial Information**

**18. Supportive Services.**

For [Supportive Housing (SHP)]{.underline}, this exhibit provides
information to HUD on how SHP funding for supportive services was spent
**during the operating year.** Enter the amount of SHP funding spent on
these supportive services.

For [Shelter Plus Care (S+C)]{.underline}, this exhibit tracks the
supportive services match requirement. Specify the value of supportive
services from all sources that can be counted as match that all homeless
persons received **during the operating year. (**S+C grantees should
keep documentation on file, including source, amount, and type of
supportive services.)

For [Section 8 SRO]{.underline}, this exhibit provides information to
HUD on the value of supportive services received by homeless persons
**during the operating year.**

+----+---------------------------------------+-------------------------+
|    | Supportive Services                   | Dollars                 |
+----+---------------------------------------+-------------------------+
| a  | Outreach                              |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| b  | Case management                       |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| c  | Life skills (outside of case          |                         |
| \. | management)                           |                         |
+----+---------------------------------------+-------------------------+
| d  | Alcohol and drug abuse services       |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| e  | Mental health services                |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| f  | AIDS-related services                 |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| g  | Other health care services            |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| h  | Education                             |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| i  | Housing placement                     |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| j  | Employment assistance                 |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| k  | Child care                            |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| l  | Transportation                        |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| m  | Legal                                 |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| n  | Other (please specify)                |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
| o  | **TOTAL** (Sum of a thru n)           |                         |
| \. |                                       |                         |
+----+---------------------------------------+-------------------------+
|    |                                       |                         |
+----+---------------------------------------+-------------------------+
|    | Cumulative amount of match provided   |                         |
|    | to date for the                       |                         |
|    |                                       |                         |
|    | **Shelter Plus Care Program** under   |                         |
|    | this grant                            |                         |
+----+---------------------------------------+-------------------------+

**19. Supportive Housing Program: Leasing, Supportive Services,
Operating Costs and Administration**

All grantees receiving funding under the Supportive Housing Program must
complete these charts each operating year. For e**xpansion projects**:
If SHP grant funds are for the expansion of a pre-existing homeless
facility, only the people and expenditures for the additional expansion
may be included, as in the original application or any grant amendments.
Documentation of resources used is not required to be submitted with
this report but should be kept on file for possible inspection by HUD
and Auditors. Do not include any expenditures made before the SHP grant
was executed.

**Summary of Expenditures**. Enter the amount of SHP grant funds and
cash match expended during the operating year for each activity.

  ----- ------------------- ---------------- ----------------- ---------------
                            SHP Funds        Cash Match        Total
                                                               Expenditures

  a\.   Leasing                                                

  b\.   Supportive Services                                    

  c\.   Operating Costs                                        

  d\.   Administration                                         

  e\.   **Total**                                              
  ----- ------------------- ---------------- ----------------- ---------------

**Note:** Payments of principal and interest on any loan or mortgage may
not be shown as an operating expense.

**Sources of Cash Match**. Enter the sources of cash identified in the
Cash Match column, above, in the following

categories. Use additional sheets, an necessary.

  ----- ----------------------------------------- ------------------------
                                                  Amount

  a\.   Grantee/project sponsor cash              

  b\.   Local government (please specify)         

                                                  

                                                  

                                                  

  c\.   State government (please specify)         

                                                  

                                                  

                                                  

  d\.   Federal government (please specify)       

        Community Development Block Grant (CDBG   

                                                  

                                                  

  e\.   Foundations (please specify)              

                                                  

                                                  

                                                  

  f\.   Private cash resources (please specify)   

                                                  

                                                  

                                                  

  g\.   Occupancy charge/ fees                    

  h\.   **Total**                                 
  ----- ----------------------------------------- ------------------------

**20. Supportive Housing Program: Acquisition, Rehabilitation, and New
Construction**

All grantees that received SHP funds for acquisition, rehabilitation, or
new construction must complete these charts in the year one APR

only. This exhibit will demonstrate to HUD that the grantee has
contributed enough cash to at least equally match the amount of SHP
funds spent for acquisition, rehabilitation, or new construction.
Documentation that matching funds were provided is not required to be
submitted with this report but should be kept on file for possible
inspection by HUD and Auditors.

**Summary of Expenditures.** Enter the amount of SHP grant funds and
cash match expended during the operating year for each activity.

  ----- ------------------- -------------- ---------------- -----------------
                            SHP Funds      Cash Match       Total
                                                            Expenditures

  a\.   Acquisition                                         

  b\.   Rehabilitation                                      

  c\.   New construction                                    

  d\.   **Total**                                           
  ----- ------------------- -------------- ---------------- -----------------

**Cash Match.** Enter the sources of cash identified in the Cash Match
column, above, in the following categories. Use

additional sheets, as necessary.

  ----- ------------------------------------------- ----------------------
                                                    Amount

  a\.   Grantee/project sponsor cash                

  b\.   Local government (please specify)           

                                                    

                                                    

                                                    

  c\.   State government (please specify)           

                                                    

                                                    

                                                    

  d\.   Federal government (please specify)         

        Community Development Block Grant (CDBG)    

                                                    

                                                    

  e\.   Foundations (please specify)                

                                                    

                                                    

                                                    

  f\.   Private cash resources (please specify)     

                                                    

                                                    

                                                    

  g\.   Occupancy charge/ fees                      

  h\.   **Total**                                   
  ----- ------------------------------------------- ----------------------

**Describe any problems and/or changes implemented during the operating
year.**

**Technical Assistance and Recommendations**

Based on your experience during the last year, are there any areas in
which you need technical advice or assistance? If so, please describe.

**Persons Served Worksheet -** HUD Annual Progress Report

**This worksheet is optional and is intended to help you collect
information needed to complete the Annual Progress Report. Instructions
and Codes follow. Do not submit this worksheet to HUD.**

<table>
<colgroup>
<col style="width: 5%" />
<col style="width: 23%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 12%" />
<col style="width: 7%" />
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td>No.</td>
<td>Name</td>
<td>Relationship</td>
<td>Entry Date</td>
<td><p>Exit</p>
<p>Date</p></td>
<td><p>Number of Months in Project (calculate)</p>
<p>12</p></td>
<td><p>New Participant</p>
<p>(Y / N)</p></td>
<td><p>Non-Homeless (SRO Only)</p>
<p>(Y / N)</p>
<p>4</p></td>
<td><p>Date of</p>
<p>Birth</p>
<p>5a</p></td>
<td><p>Age</p>
<p>5b</p></td>
<td><p>Gender</p>
<p>(M/F)</p>
<p>5c</p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**Persons Served Worksheet** (continued)

**Do not submit this worksheet to HUD**

<table style="width:100%;">
<colgroup>
<col style="width: 6%" />
<col style="width: 11%" />
<col style="width: 11%" />
<col style="width: 6%" />
<col style="width: 12%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 10%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td>No.</td>
<td><p>Veterans</p>
<p>Status (Y/N)</p>
<p>6</p></td>
<td><p>Ethnicity</p>
<p>(code)</p>
<p>7</p></td>
<td><p>Race</p>
<p>(code)</p>
<p>8</p></td>
<td><p>Special Needs</p>
<p>(code)</p>
<p>9</p></td>
<td><p>Prior Living</p>
<p>Situation</p>
<p>(code)</p>
<p>10</p></td>
<td><p>At Project</p>
<p>Entry</p>
<p>11a</p></td>
<td><p>At Project</p>
<p>Exit</p>
<p>11b</p></td>
<td><p><u>Income</u></p>
<p>At Entry</p>
<p>11c</p>
<p>(code)</p></td>
<td><p><u>Sources</u></p>
<p>At Exit</p>
<p>11d</p>
<p>(code)</p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**Persons Served Worksheet (continued)**

**Do not submit this worksheet to HUD**

+---+---------+------+---------+-------------------------------------+
| N | Reason  | Des  | Sup     | Notes                               |
| o | for     | tina | portive |                                     |
| . | Leaving | tion |         |                                     |
|   |         |      | S       |                                     |
|   | Program | (c   | ervices |                                     |
|   | (code)  | ode) | (code)  |                                     |
|   |         |      |         |                                     |
|   | 13      | 14   | 15      |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+
|   |         |      |         |                                     |
+---+---------+------+---------+-------------------------------------+

**Instructions and Codes for Persons Served Worksheet**

The use of this worksheet is optional. It was designed to help you
collect information on participants needed to complete the Annual
Progress Report. If the worksheet is updated as participants move in and
move out of your project, most of the information required for
completion will be contained in the worksheet. Do not submit this
worksheet with the APR.

For projects that serve families, HUD only requires reporting on the
number of children served, and the age and gender of these children.
Only name, relationship, date of birth, and age on the worksheet need to
be completed for children. Assign the adults a number, but not each
family member. Use this number to transfer to the other pages of the
worksheet.

Beginning with number 4, the numbers in the columns refer to the
questions on the APR form. If any questions are answered with "Other,"
please enter the specific "Other" answer for inclusion in the APR.

**Participant Number**. This column allows you

to either number participants consecutively or to

assign a case number. One number should be

assigned to each adult.

**Name**. Names of persons will not be reported to

HUD. The use of names is for your record keeping

convenience.

**Relationship**. Enter the appropriate relationship.

Examples include: Self, Head of household, Spouse,

Child.

**Entry Date.** Enter date participant [entered the]{.underline}

[project]{.underline}. Usually this will be the date of actual

physical move-in for a housing project.

**Exit Date.** Enter date participant [left the project]{.underline}.

Usually this will be the date the participant

physically moved out for a housing project. Do not

include a participant who temporarily left the project

and is expected to return in less than 90 days (e.g.

hospitalization).

4\. **Income-eligible Non-homeless in SRO**. The SRO

program allows assistance to units occupied by

Section 8 income-eligible persons residing at the

SRO prior to rehabilitation. For SRO projects

only, indicate whether the participant is an

income-eligible, non-homeless person (Y) or not

(N). SHP and S+C projects should skip this item.

5a. **Date of Birth.** Enter date of birth including

month, day, and year.

5b. **Age.** Enter age at entry.

5c. **Gender.** Enter appropriate letter for gender.

M-Male F- Female.

> 6\. **Veterans Status**. Indicate if the participant
>
> is a veteran. *Please note: A veteran is*
>
> *anyone who has ever been on active military*
>
> *duty status for the United States.*

7\. **Ethnicity.** Enter appropriate letter for ethnic group.

a\. Hispanic or Latino

b\. Non-Hispanic or Non-Latino

8\. **Race.** Enter appropriate letter for race.

a\. American Indian or Alaskan Native

b\. Asian

c\. Black or African-American

> d\. Native Hawaiian or Other Pacific Islander

e\. White

9\. **Special Needs.** Enter the letter(s) for the

category(ies) that describe the participant's

disability(ies). (You may double count)

> a\. Mental illness
>
> b\. Alcohol abuse
>
> c\. Drug abuse
>
> d\. HIV/AIDS and related diseases
>
> e\. Developmental disability
>
> f\. Physical disability

g\. Domestic violence

> h\. Other (please specify)

10\. **Prior Living Situation.** Enter the letter that best describes
where the participant slept in the week prior to entering the project.
[Do not]{.underline} double count.

a\. Non-housing (street, park, car, bus

station, etc.)

b.  Emergency shelter

c.  Transitional housing for homeless persons

d.  Psychiatric facility\*

    e\. Substance abuse treatment facility\*

    f\. Hospital\*

    g\. Jail/prison\*

> h\. Domestic violence situation

i\. Living with relatives/friends

j\. Rental housing

k\. Other (please specify)

> \*If a participant came from an institution but
>
> was there less than 30 days and were living on
>
> the street or in an emergency shelter before
>
> entering the facility, he/she should be counted
>
> in either the street or shelter category, as
>
> appropriate.
>
> **Instruction and Codes for Persons Served Worksheet** (continued)

11a. **Gross Monthly Income at Project Entry**.

Enter the amount of gross monthly income the

participant is receiving at entry into

the project.

11b. **Gross Monthly Income at Project Exit.** Enter

the gross monthly income the participant is

receiving when exiting the project.

11c. **Income Sources Received at Project**

**Entry**. Enter all types of assistance the

participant is receiving at entry to the project.

> a\. Supplemental Security Income (SSI)
>
> b\. Social Security Disability Insurance (SSDI)
>
> c\. Social Security
>
> d\. General Public Assistance
>
> e\. Temporary Aid to Needy Families (TANF)
>
> f\. Child support

g\. Veterans benefits

> h\. Employment income
>
> i\. Unemployment benefits
>
> j\. Medicare

k\. Medicaid

l\. Food Stamps

m\. Other (please specify)

n\. No Financial Resources

11d. **Income Sources Received at Project Exi**t.

Enter all types of income the participant is

receiving at project exit. (Use codes as in 11c.)

12\. **Length in Stay in Program**. Calculated item.

(See Entry Date and Exit Date above.)

13. **Reason for Leaving Project.** Enter the

primary reason why the participant left the

project. (Complete only for participants who

left the project and are not expected to return

within 90 days.

a\. Left for a housing opportunity before

completing the program

> b\. Completed program

c.  Non-payment of rent/occupancy charge

d.  Non-compliance with project

e.  Criminal activity/destruction of

    property/violence

f.  Reached maximum time allowed in project

g.  Needs could not be met by project

h.  Disagreement with rules/persons

i.  Death

j\. Other (please specify)

k\. Unknown/disappeared

14\. **Destination.** Enter the destination of those

leaving the project.

**Permanent**

a\. Rental house or apartment (no subsidy)

b\. Public Housing

c\. Section 8

d\. Shelter Plus Care

e\. HOME subsidized house or apartment

f\. Other subsidized house or apartment

g\. Homeownership

h\. Moved in with family or friends

**Transitional**

i\. Transitional housing for homeless

persons

j\. Moved in with family or friends

**Institution**

k\. Psychiatric hospital

l\. Inpatient alcohol or drug treatment

facility

m\. Jail/prison

**Emergency**

n\. Emergency shelter

**Other**

> o\. Other supportive housing

p\. Places not meant for human habitation

(e.g., street)

q\. Other (please specify)

**Unknown**

r\. Unknown

> **15. Supportive Services.** Enter [all]{.underline} types of
>
> supportive services the participant
>
> received during the time in the project.
>
> a\. Outreach

b\. Case management

c\. Life skills (outside of case

management)

d\. Alcohol or drug abuse services

e\. Mental health services

f\. HIV/AIDs-related services

g\. Other health care services

h\. Education

i\. Housing placement

j\. Employment assistance

k Child care

l\. Transportation

m\. Legal

n\. Other (please specify)