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 | Form 50900:  Elements for the Annual MTW Plan and Annual MTW Report
 | Attachment B
 | to
 | AMENDED AND RESTATED MOVING TO WORK AGREEMENT
 | BETWEEN
 | U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
 | AND
 | MOVING TO WORK (MTW) HOUSING AGENCIES
 | The information on this form is being collected so that HUD is able to evaluate the impacts of MTW activities; respond to congressional and other inquiries regarding outcome measures;  and identify promising practices learned through the Moving to Work (MTW) demonstration.  The information collected through this form is not confidential.  MTW public housing authorities (PHAs) will report outcome information on the effects of MTW policy changes on residents, the agency's operations, and the local community.  The estimated burden per year, per agency, is 81 hours.  Responses to this collection of information are required to obtain a benefit or to retain a benefit.  HUD may not conduct or sponsor, and MTW agencies are not required to respond to, a collection of information unless that collection displays a valid OMB control number.  All MTW PHAs will provide the following required elements in the order and format given in the 50900 in their Annual MTW Plans and Annual MTW Reports, consistent with the requirements in Section VII of the Standard MTW Agreement.
 | General Instructions for MTW Plan and Reports
 | Section Numbering: Some sections of the Form 50900 have been combined since the prior version of the form, resulting in the sections being renumbered.  The sections are now as follows: (I) Introduction, (II) General Housing Authority Operating Information, (III) Proposed MTW Activities, (IV) Approved MTW Activities, (V) Sources and Uses of Funds, and (VI) Administrative.
 | [NAME]: MTW PHAs are required to use the HUD generated spreadsheets for Sections (II) and (V) of the Form 50900. There is no prescribed format for presenting the required information in Sections (I), (III), (IV) or Section (VI) of the Form 50900, but all required information must be clearly provided. MTW PHAs can use a customized format or the same format the agency has been using for past MTW Plan/Report submissions for these sections.  MTW PHAs must, however, incorporate the "Standard HUD Metrics" in the order and format provided in this Form for Section (III) Proposed MTW Activities and as applicable in Section (IV) Approved Activities. HUD prefers that agencies also report agency-developed metric information in a similar format.
 | Submission Requirements (dissemination): MTW PHAs shall follow submission requirements as set forth in the Standard MTW Agreement and shall provide the initial submission of the Annual MTW Plan and the Annual MTW Report to HUD Headquarters and the agency's local HUD Field Office via an electronic format. Preferably, this transmittal will occur via email, but CD/DVD or USB flash drive submissions are acceptable. Submissions using File Transfer Protocol (FTP) and other forms of data download that require HUD staff to log-on to a web portal will require prior approval by the MTW Program Director.
 | Submission Requirements (file type): The electronic submission shall include a searchable PDF version (not a scanned PDF) of the Plan/Report or a Microsoft Word document version of the Plan/Report. The body of the MTW Plan/Report shall be submitted as one file type and preferably in one file. The body shall include the HUD-generated spreadsheets for Sections (II) and (V) and the HUD Standardized Metrics incorporated into Sections (III) and (IV). Sections (II) and (V) should also be provided as a separate Microsoft Excel file.  Supplemental materials (e.g. Capital Fund forms, signed Board Resolution, other appendix information) may be submitted in a different file type.
 | Submission Requirements (hard copy): Once HUD has provided either an approval letter for the PHA's Annual MTW Plan or an acceptance letter for the PHA's Annual MTW Report, the PHA will submit a final hard copy and electronic copy of the Plan/Report to HUD Headquarters and the PHA's local HUD Field Office, as stated in the Standard MTW Agreement in Section VII.A.1.c.  A hard copy of the Plan/Report is not required until an approval/acceptance letter is issued by HUD.
 | Section-by-Section Instructions for MTW Plans and Reports
 | Section I: Introduction
 | Generally: PHAs will include short-term and long-term MTW goals and objectives in this section.  This new section combines Sections I (Introduction) and IV (Long-Term MTW Plan) from the previous version of Form 50900: OMB Control Number 2577-0216, Expiration Date 12/31/2011.
 | Section II: General Housing Authority Operating Information
 | Generally: A pre-formatted Microsoft Excel table has been provided for PHAs to report the required housing stock, leasing and waitlist information in this section. PHAs will copy and paste the HUD provided Microsoft Excel tables into the body of Section (II) in their Plan/Report.  With the initial submittal of each Plan/Report to HUD, the PHA will also include the completed, separate Microsoft Excel file.  A PHA may include updates to its historical housing stock or leasing tables as an appendix to the Plan/Report. The PHA may reference such an appendix in Section (II) of the Plan/Report to direct readers to this information.
 | Section II.A Housing Stock Information
 | General Description of All Planned Capital Fund Expenditures: PHAs are required to provide a general description of planned capital expenditures by development.
 | Section II.B: Leasing Information
 | Definition of Households Served: "Households Served" under MTW includes all households that receive housing assistance, directly or indirectly, using any amount of MTW funds. Housing assistance through local, non-traditional MTW programs is included, as long as the activity conforms to the requirements stipulated in the Standard MTW Agreement and PIH Notice 2011-45.
 | Categories of Households Served: “Households Served” data will be reported in four categories: Federal MTW Public Housing Units Leased; Federal MTW Voucher (HCV) Units Utilized; Number of Units Occupied/Leased through Local Non-Traditional MTW Funded Tenant-Based Assistance Programs, and Number of Units Occupied/Leased through Local Non-Traditional MTW Funded Project-Based Assistance Programs.  Additionally, HUD will track “Households Served through Local, MTW Funded Non-Traditional Services Only.”  These households, however, will not be included in the “Total Households Served/Units Leased” calculation used to determine if the PHA is continuing to assist substantially the same total number of eligible low-income families as would have had the agency not combined its funds (as set forth in PIH Notice 2013-2).  The definitions for these categories are provided below.
 | • Federal MTW Public Housing Units Leased refers to the count of households that reside in any unit of housing authorized and funded under an Annual Contributions Contract (ACC) between the PHA and HUD pursuant to the U.S. Housing Act of 1937.
 | • Federal MTW Voucher (HCV) Units Utilized refers to households that receive rental assistance through Housing Assistance Payment (HAP) Contracts (pursuant to an ACC between HUD and the PHA) paid for with MTW funds at a location selected by the household and not tied to a specific location OR households that receive rental assistance through HAP Contracts (pursuant to an ACC between HUD and the PHA) paid for with MTW funds at a specific location that is not public housing.
 | • Units Occupied/Leased through Local, Non-Traditional MTW Activities refers to households or families that receive assistance through an MTW tenant-based or project-based housing program, or other type of assistance (i.e. Homeownership) outside of Sections 8 and 9 of the 1937 Housing Act.  This includes all households at or below 80% are median income (AMI) that receive housing through MTW funds but not through traditional Public Housing or Housing Choice Vouchers.  This could include low-income housing tax-credit (LIHTC) households if MTW funds were used for development costs or as a subsidy, as well as households that benefit from MTW funds that are not direct rental subsidies but are used in the development of below-market rate units restricted to eligible households.
 | • Households Served through Local, MTW Funded Non-Traditional Services Only are households at or below 80% AMI provided services through the MTW-funded block grant and not assisted through any type of housing assistance for the fiscal year and over the course of the agency's participation in the demonstration.  Households that are only receiving services and are also on one of the PHA's housing waiting lists should be included in this category.
 | Section II.C: Waitlist Information
 | Waitlist Information Submittal: A pre-formatted Microsoft Excel template will collect three aspects of the PHA's aggregate waitlists, including: the waitlist type, the number of households on the waitlist and whether the waitlist is open or closed.  Waitlist information will include those managed by the PHA and those managed by a third party.  PHAs may include additional narrative to provide explanations for changes to the waitlist(s) in the body of the Plan/Report.
 | Section III: Proposed MTW Activities and Section IV: Approved MTW Activities
 | Use of Standard HUD Metrics: PHAs are required to track all applicable "Standard HUD Metrics" under each statutory objective cited for the proposed MTW activity. Standard metrics must be given in the table format provided in the "HUD Standard Metrics" Section of the Form 50900 in order to allow analysis and aggregation across agencies for similar activities.
 | Additional Metrics: PHAs may report on agency-developed and previously established metrics in addition to the required HUD Standard Metrics.
 | Section IV: Approved MTW Activities
 | Generally: This section includes four subsections: Implemented, Not Yet Implemented, On Hold, and Closed Out.  Once an activity is approved it must be placed in Section (IV) under one of these four subcategories. Definitions of these categories are given below.
 | • Implemented includes MTW activities in which the PHA is actively engaged.
 | • Not Yet Implemented includes activities in which the PHA is not actively engaged but is preparing to implement in the future.
 | • On Hold includes activities that were previously implemented, that the PHA stopped implementing, but that the PHA plans to reactivate in the future.
 | • Closed Out includes activities that were MTW activities, but are now obsolete because they no longer require MTW authorization due to changes in regulation, activities completed because the PHA accomplished its stated objectives and no longer requires the use of MTW flexibility, activities that the PHA has decided to end before attaining the activity's objectives, or activities the PHA has never implemented and does not plan to implement at any point in the future.  In the year the activity is ended the PHA is required to provide information about the outcomes of the activity.
 | Use of Standard HUD Metrics: Standard metrics must be shown in the table format provided in the "HUD Standard Metrics" Section of the Form 50900 in order to allow analysis and aggregation across agencies for similar activities.        •  Ongoing, Implemented Activities:  PHAs are required to use all of the applicable "Standard HUD Metrics" under each statutory objective cited for the approved MTW activities in the "Implemented" category.       •  Not Yet Implemented and On Hold Activities: Since the PHA would not currently be engaged in these categories of approved activities, it is not necessary to include Standard HUD Metrics until implementation.      •  Closed Out Activities: PHAs are required to use all of the applicable "Standard HUD Metrics" under each statutory objective cited in the final reporting of activities in the "Closed Out" category.
 | Significant Changes to Activities: HUD requires PHAs to re-propose activities that require "significant changes."  A "significant change" occurs when the nature of the activity has changed such that an additional MTW authorization is needed OR when a PHA fundamentally changes the nature and scope of an activity to the extent that there is the potential for a different impact on residents (e.g. changing the calculation of rent).  In these cases, the activity must undergo a new public process.  HUD reserves the right to determine on a case-by-case basis if the change made to an activity crosses this threshold and therefore requires the activity to be re-proposed.
 | Section V: MTW Sources and Uses of Funds
 | Generally: A pre-formatted Microsoft Excel table has been provided for PHAs to report the required information in this section. PHAs will copy and paste the HUD-provided Microsoft Excel tables into the body of Section (V) in their Plan/Report.  With the initial submittal of the Plan/Report to HUD, the PHA will also include the completed, separate Microsoft Excel file.  A PHA may include additional information regarding sources and uses of funding as an appendix to the Plan/Report. The PHA may reference such an appendix in Section (V) of the Plan/Report to direct readers to this information.
 | Section VI: Administrative
 | Board Resolution Submittal: There is no predetermined format for submission of the required resolution signed by the Board of Commissioners or other authorized PHA official adopting the Annual MTW Plan Certification of Compliance.
 | Certification of Meeting the MTW Statutory Requirements Submittal: There is no predetermined format for submission with the Annual MTW Report of the required certification that the PHA has met the three MTW statutory requirements.
 | Additional Appendix Items
 | Appendix Information Submittal: The PHA may submit additional appendix items as it deems appropriate. Particular MTW PHAs may be required to submit additional appendix items depending on the content of the particular Standard MTW Agreement and Annual MTW Plan (examples include RHF Plan, Local Asset Management Plan, etc.)