NEIGHBORHOOD STABILIZATION PROGRAM 1 (NSP1)
ACTIVITY COMPLETION REPORT
NEBRASKA DEPARTMENT OF ECONOMIC DEVELOPMENT
Rental ACTIVITIES ONLY
Instructions: Report is due to NDED 30 days from final disbursement per activity. / Check The Appropriate Box
(Check only one)
Original Submission
Revision - # / 1st, 2nd etc
Name of Grantee / Grant Number / Federal Tax Identification Number / DUNS Number / DED Program Representative
Lynn Franzen
Contact Name / Contact Phone / Contact Fax / Contact Email
A. Type of Activity(Check all that apply) / B. Type of Property/Structure (Select All That Apply) / C. Activity Address
Rental New Construction / Abandoned / Street Address
Blighted / City
Demolished / County
Foreclosed / Zip Code
Vacant
D. NSP1 Eligible Activity (Check all that apply)
A. Establish financing mechanism for the purchase and redevelopment of foreclosed upon homes and residential properties, including such mechanisms as soft-seconds, loan loss reserves, and shared-equity loans for low-and moderate-income homebuyers.
B. Purchase and rehabilitate homes and residential properties that have been abandoned or foreclosed upon, in order to sell, rent, or redevelop such homes and properties.
C. Demolish blighted structures.
D. Redevelop demolished or vacant properties.
E. % Median Income:
0-50%
Above 50% - 120%
F. Activity Narrative
G. RaceandEthnicity of Head of Household
/ H. Size of Household / I. Annual Income
Choose from the dropdown listWhiteBlack / African AmericanAsianAmerican Indian / Alaskan NativeNative Hawaiian / Other Pacific IslanderAmerican Indian / Alaskan Native & WhiteAsian & WhiteBlack / African American & WhiteAm Indian / Alaskan Native & Black African AmOther Multi-Racial / 1 Person / Annual Household Income:
HISPANIC/LATINO HEAD OF HOUSEHOLDYES NO / 2 Persons
FEMALE HEAD OF HOUSEHOLDYES NO / 3 Persons
4 Persons
5 Persons
6 Persons
7 Persons
8 Persons

Department of Economic Development Use Only

Approved By:
Date Processed In DRGR:
Other Notes:

CDBG NSP1 ACTIVITY SET-UP REPORT INSTRUCTIONS

Name of Grantee: Name of local unit of government or 501(c)(3) organization awarded funds (must match name in CDBG NSP1 Contract).

Grant Number: Grant number listed in CDBG NSP1 Contract (i.e. 093ND82).

Federal Tax Identification Number: Tax ID number of local unit of government or 501(c)(3) organization (must match number in CDBG NSP1 Contract).

DUNS Number: DUNS Number of local unit of government or 501(c)(3) organization.

DED Program Representative: Your contact for program questions (identified in award letter).

Contact Name: Individual completing the set-up report on behalf of grantee.

Contact Phone, Fax, and E-mail: Phone, fax number, and e-mail address of individual completing Activity Set-Up Report.

A.Type of Activity: Read the list of possible activity types and check each box that corresponds to each activity conducted. Each activity must be listed in the CDBG NSP1 Contract.

B.Type of Property/Structure: Choose the type of property/structure that is being worked with for this activity. Choose all that apply.

C.Activity Address: Enter the street address, city, county and zip code for the property/structure being impacted by this activity.

D.NSP1 Eligible Activity: Select all NSP Eligible Activities being conducted under this activity.

  1. % Median Income: Select the Median Income Level of the household benefiting.

F.Activity Narrative: Provide a detailed activity narrative for the project completed.

G.Race And Ethnicity of Head Of Household: From the dropdown list provided select the appropriate race for the Head of Household. Select whether or not the Head of Household is Hispanic/Latino. Select whether the Head of Household is female.

H.Size of Household: Identify the number of people residing in the NSP assisted house.

I.Annual Income: Provide the annual income of the homebuyer, using the Section 8, 24 CFR Part 5 annual gross income calculation, consistent with the Nebraska HOME program guidelines.

Save a copy for the Grantee’s files and email to:

Contact Information: Lynn Franzen, 402-471-3781

*Code 0181 General Administration does not need to be reported on the “Activity Completion Report”.