City of Naperville CDBG Annual Performance and Financial Report

Program Year 2014

This report covers:

Annual
Period / 4/1 - 3/31
Due Date / April 10th
1. Organization’s Name
2. Address
3. Contact Person / Phone # / E-mail
4. Project Name / Project #
5.Grant Award: $ / Cost Accrued to Date: $
Submitted for Reimbursement: $
Reimbursed from the City: $
6. Describe activities and accomplishments during this program year.
7. Were goals met? If not, please explain. Use your Project Timeline for comparison.
8. Describe any problems encountered. Did you use any technical assistance or can you see a need for technical assistance if awarded funding again?
9. Financial Report
Financial Data / Amount
Total CDBG Expended
Total Other Funds Expended
Total Project Cost
Program Income
10. Accomplishments in Numbers
a) For housing projects only
Total number of units assisted: ______
Of the Total Number, Number of Units:
Affordable Units / Section 504 Accessible Units
Qualified as Energy Star / Occupied by Elderly
Brought into Compliance with Lead Safety Rules / Created Through Conversion of Non-Residential to Residential Buildings
Subsidized with Project-Based Rental Assistance by Another Federal, State or Local Program / Created Through Conversion of Non-Residential to Residential Buildings
Permanent Housing Units Designated for Homeless, Number for the Chronically Homeless / Brought from Substandard to Standard Condition (HQS or Local Code)
Permanent Housing Units Designated for Homeless Persons and Families, Including Units Receiving Assistance for Operations / Permanent Housing Units Designated for Homeless, Number for the Chronically Homeless
b) For social service projects only
Total number of persons assisted: _____
Of the Total Number, Number of Persons:
With New or Continuing Access to a Service or Benefit / With Improved Access to a Service or Benefit
Receive a Service or Benefit that is No Longer Substandard / Receiving Emergency Financial Assistance to Prevent Homelessness
Receive a Service or Benefit that is No Longer Substandard / Receiving Emergency Financial Assistance to Prevent Homelessness
Receiving Emergency Legal Assistance to Prevent Homelessness
12. Additional Required Reports
Attach the following forms:
Performance Indicator Status Report
Organization’s audited financial statements no later than 30 days after audit completion
Name (type or print) Title
Signature Date

Office Use Only

Reviewer
Report Received / _ _/_ _/_ _ _ _
Project completed on time
PISR submitted with Annual Report
Correct Financial Information

Other Comments: