HUD-52737 Indian Housing Block Grant (IHBG) IHP/APR

Indian Housing Block Grant (IHBG) U.S. Department of Housing OMB Approval Number 2577-0218

and Urban Development (exp. 03/31/16)

IHP/APR Office of Public and Indian Housing Office of Native American Programs

For Recipient’s Use:      

INDIAN HOUSING PLAN/ANNUAL PERFORMANCE REPORT

(NAHASDA §§ 102(b)(1)(A) and 404(a)(2))

This form meets the requirements for an Indian Housing Plan (IHP) and Annual Performance Report (APR) required by the United States Department of Housing and Urban Development. In addition to these requirements, a tribe or tribally designated housing entity (TDHE) may elect to prepare a more comprehensive IHP. If a tribe or TDHE elects to prepare a more comprehensive IHP, the required elements of this IHP must still be submitted on the prescribed HUD form. The information requested does not lend itself to confidentiality.

Regulatory and statutory citations are provided throughout this form as applicable. Recipients are encouraged to review these citations when completing the IHP and APR sections of the form.

Under the Native American Housing Assistance and Self-Determination Act of 1996 (NAHASDA) (25 U.S.C. 4101 et seq.), HUD will provide grants, loan guarantees, and technical assistance to Indian tribes and Alaska Native villages for the development and operation of low-income housing in Indian areas. Grants will be made to eligible recipients under the Indian Housing Block Grant (IHBG) program. To be eligible for the grants, recipients must submit an IHP that meets the requirements of the Act. The recipient is required to submit the IHP to HUD at least 75 days prior to the start of its 12-month` program year (NAHASDA § 102(a)(1)). The APR is due no later than 90 days after the end of the recipient’s program year (24 CFR § 1000.514).

The IHP and the APR (previously two separate forms) are now combined into one form. The sections pertaining to the IHP are submitted before the beginning of the 12-month program year, leaving the APR (shaded) sections blank. If the IHP has been updated or amended, use the most recent version when preparing the APR. After the 12-month program year, enter the results from the 12-month program year in the shaded sections of the form to complete the APR. More details on how to complete the IHP and APR sections of the form can be found in the body of this form. In addition, a separate IHP and APR report form guidance is available at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/ih/codetalk/nahasda/guidance.

FORM COMPLETION OPTIONS: The IHP/APR form may be completed either in hard copy or electronically. Hard copy versions may be completed either by hand or typewriter. Alternatively, the form may be completed electronically as it is a Word document. It is recommended that the form be completed electronically because it is more efficient to complete, submit, and review the form. Furthermore, electronic versions of the form may be submitted to HUD as an email attachment. To document official signatures on the electronic version, you should sign a hard copy of the pages and either fax that signed page or email it as an attachment to your Area Office of Native American Programs. The sections of the IHP that require an official signature are Sections 1 and 8, and Sections 15 and 16, if applicable. For the APR, Section 1 requires an official signature.

Public reporting burden for the collection of information is estimated to average 62 hours, 25 hours for the IHP and 37 hours for the APR. This includes the time for collecting, reviewing, and reporting the data. The IHP data is used to verify that planned activities are eligible, expenditures are reasonable, and recipient certifies compliance with related requirements. The APR data is used to audit the program accurately and monitor recipient progress in completing approved activities, including reported expenditures, outputs, and outcomes. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number.

TABLE OF CONTENTS

SECTION PAGE NUMBER

1: COVER PAGE 3

2: HOUSING NEEDS 5

3: PROGRAM DESCRIPTIONS 7

4: MAINTAINING 1937 ACT UNITS, DEMOLITION, AND DISPOSITION 11

5: BUDGETS 12

6: OTHER SUBMISSION ITEMS 15

7: INDIAN HOUSING PLAN CERTIFICATION OF COMPLIANCE 17

8: IHP TRIBAL CERTIFICATION 18

9: TRIBAL WAGE RATE CERTIFICATION 19

10: SELF-MONITORING 20

11: INSPECTIONS 21

12: AUDITS 22

13: PUBLIC AVAILABILITY 23

14: JOBS SUPPORTED BY NAHASDA 24

15: IHP WAIVER REQUESTS 25

16: IHP AMENDMENTS 26

Note: The page numbers in the Table of Contents can update automatically as the IHP or APR is completed. To update the page numbers, right-click anywhere in the table, select “Update Field” and select “update page numbers only.”

SECTION 1: COVER PAGE

1. Grant Number:      

2. Recipient Program Year:      

3. Federal Fiscal Year:      

4. Initial Plan (Complete this Section then proceed to Section 2)

5. Amended Plan (Complete this Section, Section 8 if applicable, and Section 16)

6. Annual Performance Report (Complete items 27-30 and proceed to Section 3)

7. Tribe

8. TDHE

Name of Recipient:      
Contact Person:      
Telephone Number with Area Code:      
Mailing Address:      
City:      	State:      	Zip Code:      
Fax Number with Area Code (if available):      
Email Address (if available):      
If TDHE, List Tribes Below:      

19. Tax Identification Number:      

19. DUNS Number:      

19. CCR/SAM Expiration Date:      

19. IHBG Fiscal Year Formula Amount:      

19. Name of Authorized IHP Submitter:      

19. Title of Authorized IHP Submitter:      

19. Signature of Authorized IHP Submitter:      

19. IHP Submission Date:      

19. Name of Authorized APR Submitter:      

19. Title of Authorized APR Submitter:      

19. Signature of Authorized APR Submitter:      

19. APR Submission Date:      

Certification: The information contained in this document is accurate and reflects the activities actually planned or accomplished during the program year. Activities planned and accomplished are eligible under applicable statutes and regulations.

Warning: If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Title 18 of the United States Code. In addition, any person who knowingly and materially violates any required disclosure of information, including intentional disclosure, is subject to a civil money penalty not to exceed $10,000 for each violation.

ONE YEAR PLAN & ANNUAL PERFORMANCE REPORT

SECTION 2: HOUSING NEEDS

(NAHASDA § 102(b)(2)(B))

1. Type of Need: Check the appropriate box(es) below to describe the estimated types of housing needs and the need for other assistance for low-income Indian families (column B) and all Indian families (column C) inside and outside the jurisdiction.

(A) Type of Need	Check All That Apply
	(B) Low-Income Indian Families	(C) All Indian Families
Overcrowded Households
Renters Who Wish to Become Owners
Substandard Units Needing Rehabilitation
Homeless Households
Households Needing Affordable Rental Units
College Student Housing
Disabled Households Needing Accessibility
Units Needing Energy Efficiency Upgrades
Infrastructure to Support Housing
Other (specify below)

2. Other Needs. (Describe the “Other” needs below. Note: this text is optional for all needs except “Other.”):

     

3. Planned Program Benefits. (Describe below how your planned programs and activities will address the needs of low income families identified above. Also describe how your planned programs will address the various types of housing assistance needs. NAHASDA § 102(b)(2)(B)):

     

4. Geographic Distribution. (Describe below how the assistance will be distributed throughout the geographic area and how this geographic distribution is consistent with the needs of low income families. NAHASDA § 102(b)(2)(B)(i)):      

SECTION 3: PROGRAM DESCRIPTIONS

(NAHASDA § [102(b)(2)(A)], [233(a)], [235(c)], [404(b)], 24 CFR §1000.512(b)(2) and (3)])

Planning and Reporting on Program Year Activities

For the IHP, the purpose of this section is to describe each program that will be operating during the 12-month program year.  Each program must include the eligible activity, its planned outputs, intended outcome, who will be assisted, and types and levels of assistance.  Each of the eligible activities has a specific, measurable output.  The first column in the table below lists all eligible activities, the second column identifies the output measure for each eligible activity, and the third column identifies when to consider an output as completed for each eligible activity.  Copy and paste text boxes 1.1 through 1.10 as often as needed so that all of your planned programs are included. 

For the APR, the purpose of this section is to describe your accomplishments, actual outputs, actual outcomes, and any reasons for delays. 

Eligible Activities May Include (citations below reference sections in NAHASDA)

Eligible Activity	Output Measure	Output Completion
(1) Modernization of 1937 Act Housing [202(1)]	Units	All work completed and unit passed final inspection
(2) Operation of 1937 Act Housing [202(1)]	Units	Number of units in inventory at Program Year End (PYE)
(3) Acquisition of Rental Housing [202(2)]	Units	When recipient takes title to the unit
(4) Construction of Rental Housing [202(2)]	Units	All work completed and unit passed final inspection
(5) Rehabilitation of Rental Housing [202(2)]	Units	All work completed and unit passed final inspection
(6) Acquisition of Land for Rental Housing Development [202(2)]	Acres	When recipient takes title to the land
(7) Development of Emergency Shelters [202(2)]	Households	Number of households served at any one time, based on capacity of the shelter
(8) Conversion of Other Structures to Affordable Housing [202(2)]	Units	All work completed and unit passed final inspection
(9) Other Rental Housing Development [202(2)]	Units	All work completed and unit passed final inspection
(10) Acquisition of Land for Homebuyer Unit Development [202(2)]	Acres	When recipient takes title to the land
(11) New Construction of Homebuyer Units [202(2)]	Units	All work completed and unit passed final inspection
(12) Acquisition of Homebuyer Units [202(2)]	Units	When recipient takes title to the unit
(13) Down Payment/Closing Cost Assistance [202(2)]	Units	When binding commitment signed
(14) Lending Subsidies for Homebuyers (Loan) [202(2)]	Units	When binding commitment signed
(15) Other Homebuyer Assistance Activities [202(2)]	Units	When binding commitment signed
(16) Rehabilitation Assistance to Existing Homeowners [202(2)]	Units	All work completed and unit passed final inspection
(17) Tenant Based Rental Assistance [202(3)]	Households	Count each household once per year
(18) Other Housing Service [202(3)]	Households	Count each household once per year
(19) Housing Management Services [202(4)]	Households	Count each household once per year
(20) Operation and Maintenance of NAHASDA-Assisted Units [202(4)]	Units	Number of units in inventory at PYE
(21) Crime Prevention and Safety [202(5)]	Dollars	Dollars spent (report in Uses of Funding Table only)
(22) Model Activities [202(6)]	Dollars	Dollars spent (report in Uses of Funding Table only)
(23) Self-Determination Program [231-235]
Acquisition	Units	When recipient takes title to the unit
Construction	Units	All work completed and unit passed final inspection
Rehabilitation	Units	All work completed and unit passed final inspection
Infrastructure	Dollars	Dollars spent (report in Uses of Funding Table only)
(24) Infrastructure to Support Housing [202(2)]	Dollars	Dollars spent (report in Uses of Funding Table only)
(25) Reserve Accounts [202(9)]	N/A	N/A

Outcome May Include:

(1) Reduce over-crowding	(7) Create new affordable rental units
(2) Assist renters to become homeowners	(8) Assist affordable housing for college students
(3) Improve quality of substandard units	(9) Provide accessibility for disabled/elderly persons
(4) Improve quality of existing infrastructure	(10) Improve energy efficiency
(5) Address homelessness	(11) Reduction in crime reports
(6) Assist affordable housing for low income households	(12) Other – must provide description in boxes 1.4 (IHP) and 1.5

IHP: PLANNED PROGRAM YEAR ACTIVITIES (NAHASDA § 102(b)(2)(A))

For each planned activity, complete all the non-shaded sections below. It is recommended that for each program name you assign a unique identifier to help distinguish individual programs. This unique number can be any number of your choosing, but it should be simple and clear so that you and HUD can track tasks and results under the program and collect appropriate file documentation tied to this program.

• One way to number your programs is chronologically. For example, you could number your programs 2011-1, 2011-2, 2011-3 etc.

• Or, you may wish to number the programs based on type. For example rental 1, rental 2, homebuyer 1, homebuyer 2 etc. This type of numbering system might be appropriate if you have many programs that last over several years.

• Finally, you may wish to use an outline style of numbering. For example, all programs under your first eligible activity would start with the number 1 and then be consecutively numbered as 1.1, 1.2, 1.3 etc. The programs under the second eligible activity would be numbered as 2.1, 2.2., 2.3 etc.

APR: REPORTING ON PROGRAM YEAR PROGRESS (NAHASDA § 404(b))

Complete the shaded section of text below to describe your completed program tasks and actual results. Only report on activities completed during the 12-month program year. Financial data should be presented using the same basis of accounting as the Schedule of Expenditures of Federal Awards (SEFA) in the annual OMB Circular A-133 audit. For unit accomplishments, only count units when the unit was completed and occupied during the year. For households, only count the household if it received the assistance during the previous 12-month program year.

1.1 Program Name and Unique Identifier:      

1.2 Program Description (This should be the description of the planned program.):

     

1.3 Eligible Activity Number (Select one activity from the Eligible Activity list.  For any activity involving housing units as the output measure (excluding operations and maintenance), do not combine homeownership and rental housing in one activity, so that when housing units are reported in the APR they are correctly identified as homeownership or rental.):      

1.4 Intended Outcome Number (Select one outcome from the Outcome list. Each program can have only one outcome. If more than one outcome applies, create a separate program for each outcome.):      

Describe Other Intended Outcome (Only if you selected "Other" above.):      

1.5 Actual Outcome Number (In the APR identify the actual outcome from the Outcome list.):      

Describe Other Actual Outcome (Only if you selected "Other" above.):      

1.6 Who Will Be Assisted (Describe the types of households that will be assisted under the program. Please note: assistance made available to families whose incomes fall within 80 to 100 percent of the median must be included as a separate program within this section.):      

1.7 Types and Level of Assistance (Describe the types and the level of assistance that will be provided to each household, as applicable.):      

1.8 APR: (Describe the accomplishments for the APR in the 12-month program year. In accordance with 24 CFR § 1000.512(b)(3), provide an analysis and explanation of cost overruns or high unit costs.):      

1.9: Planned and Actual Outputs for 12-Month Program Year

Planned Number of Units to be Completed in Year Under this Program	Planned Number of Households To Be Served in Year Under this Program	Planned Number of Acres To Be Purchased in Year Under this Program	APR: Actual Number of Units Completed in Program Year	APR: Actual Number of Households Served in Program Year	APR: Actual Number of Acres Purchased in Program Year
     	     	     	     	     	     

1.10: APR: If the program is behind schedule, explain why. (24 CFR § 1000.512(b)(2))

     

NOTE: Remember to complete all the text boxes in Section 3 for each IHBG-funded program. If you are completing an electronic version of this form, you may copy and paste text boxes 1.1 through 1.10 as needed to describe each of your programs. If you are completing this form in hard copy, you may photocopy Section 3 as needed to describe each of your programs.

SECTION 4: MAINTAINING 1937 ACT UNITS, DEMOLITION, AND DISPOSITION

1. Maintaining 1937 Act Units (NAHASDA § 102(b)(2)(A)(v)) (Describe specifically how you will maintain and operate your 1937 Act housing units in order to ensure that these units will remain viable.):

     

2. Demolition and Disposition (NAHASDA § 102(b)(2)(A)(iv)(I-III), 24 CFR 1000.134) (Describe any planned demolition or sale of 1937 Act or NAHASDA-assisted housing units.  If the recipient is planning on demolition or disposition of 1937 Act or NAHASDA-assisted housing units, be certain to include the timetable for any planned demolition or disposition and any other information that is required by HUD with respect to the demolition or disposition.):      

SECTION 5: BUDGETS

(1) Sources of Funding (NAHASDA § 102(b)(2)(C)(i) and 404 (b)) (Complete the non-shaded portions of the chart below to describe your estimated or anticipated sources of funding for the 12-month program year. APR Actual Sources of Funding -- Please complete the shaded portions of the chart below to describe your actual funds received. Only report on funds actually received and under a grant agreement or other binding commitment during the 12-month program year.)

	IHP					APR
SOURCE	Estimated amount on hand at beginning of program year	Estimated amount to be received during 12-month program year	Estimated total sources of funds (A + B)	Estimated funds to be expended during 12- month program year	Estimated unexpended funds remaining at end of program year (C minus D)	Actual amount on hand at beginning of program year	Actual amount received during 12-month program year	Actual total sources of funding (F + G)	Actual funds expended during 12-month program year	Actual unexpended funds remaining at end of 12-month program year (H minus I)	Actual unexpended funds obligated but not expended at end of 12-month program year
IHBG Funds	     	     	     	     	     	     	     	     	     	     	     
IHBG Program Income	     	     	     	     	     	     	     	     	     	     	     
Title VI	     	     	     	     	     	     	     	     	     	     	     
Title VI Program Income	     	     	     	     	     	     	     	     	     	     	     
1937 Act Operating Reserves	     		     	     	     	     		     	     	     	     
Carry Over 1937 Act Funds	     		     	     	     	     		     	     	     	     
LEVERAGED FUNDS
ICDBG Funds	     	     	     	     	     	     	     	     	     	     	     
Other Federal Funds	     	     	     	     	     	     	     	     	     	     	     
LIHTC	     	     	     	     	     	     	     	     	     	     	     
Non-Federal Funds	     	     	     	     	     	     	     	     	     	     	     
TOTAL	     	     	     	     	     	     	     	     	     	     	     

Notes:

1. For the IHP, fill in columns A, B, C, D, and E (non-shaded columns). For the APR, fill in columns F, G, H, I, J, and K (shaded columns).

2. Total of Column D should match the total of Column N from the Uses Table on the following page.

3. Total of Column I should match the Total of Column Q from the Uses Table on the following page.

4. For the IHP, describe any estimated leverage in Line 3 below. For the APR, describe actual leverage in Line 4 below (APR).

2. Uses of Funding (NAHASDA § 102(b)(2)(C)(ii)) (Note that the budget should not exceed the total funds on hand (Column C) and insert as many rows as needed to include all the programs identified in Section 3. Actual expenditures in the APR section are for the 12-month program year.)

		IHP			APR
PROGRAM NAME (tie to program names in Section 3 above)	Unique Identifier	Prior and current year IHBG (only) funds to be expended in 12-month program year	(M) Total all other funds to be expended in 12-month program year	(N) Total funds to be expended in 12-month program year (L + M)	(O) Total IHBG (only) funds expended in 12-month program year	(P) Total all other funds expended in 12-month program year	(Q) Total funds expended in 12-month program year (O+P)
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
Planning and Administration		     	     	     	     	     	     
Loan Repayment – describe in 3 and 4 below.		     	     	     	     	     	     
TOTAL		     	     	     	     	     	     

Notes:

1. Total of Column L cannot exceed the IHBG funds from Column C, Row 1 from the Sources Table on the previous page.

2. Total of Column M cannot exceed the total from Column C, Rows 2-10 from the Sources Table on the previous page.

3. Total of Column O cannot exceed total IHBG funds received in Column H, Row 1 from the Sources Table on the previous page.

4. Total of Column P cannot exceed total of Column H, Rows 2-10 of the Sources Table on the previous page.

5. Total of Column Q should equal total of Column I of the Sources Table on the previous page.

2. Estimated Sources or Uses of Funding (NAHASDA § 102(b)(2)(C)). (Provide any additional information about the estimated sources or uses of funding, including leverage (if any). You must provide the relevant information for any planned loan repayment listed in the Uses Table on the previous page. This planned loan repayment can be associated with Title VI or with private or tribal funding that is used for an eligible activity described in an IHP that has been determined to be in compliance by HUD. The text must describe which specific loan is planned to be repaid and the NAHASDA-eligible activity and program associated with this loan):      

(4) APR (NAHASDA § 404(b)) (Enter any additional information about the actual sources or uses of funding, including leverage (if any). You must provide the relevant information for any actual loan repayment listed in the Uses Table on the previous page. The text must describe which loan was repaid and the NAHASDA-eligible activity and program associated with this loan.):      

SECTION 6: OTHER SUBMISSION ITEMS

1. Useful Life/Affordability Period(s) (NAHASDA § 205, 24 CFR § 1000.142) (Describe your plan or system for determining the useful life/affordability period of the housing it assists with IHBG and/or Title VI funds must be provided in the IHP. A record of the current, specific useful life/affordability period for housing units assisted with IHBG and/or Title VI funds (excluding Mutual Help) must be maintained in the recipient’s files and available for review for the useful life/affordability period.):

     

2. Model Housing and Over-Income Activities (NAHASDA § 202 (6), 24 CFR § 1000.108) (If you wish to undertake a model housing activity or wish to serve non-low-income households during the 12-month program year, those activities may be described here or in a separate submission.  Each approved model activity must be included as a separate program in Section 3 (Program Descriptions) and the APR portions of Section 3 must be completed in the APR submission for any approved model activity.):

     

3. Tribal and Other Indian Preference (NAHASDA § 201(b)(5), 24 CFR § 1000.120)

If preference will be given to tribal members or other Indian families, the preference policy must be described. This

information may be provided here or in the program description section of the 1-year plan.

Does the Tribe have a preference policy? Yes No

If yes, describe the policy.      

4. Anticipated Planning and Administration Expenses (NAHASDA § 102(b)(2)(C)(ii), 24 CFR § 1000.238)

Do you intend to exceed your allowable spending cap for Planning and Administration? Yes No

If yes, describe why the additional funds are needed for Planning and Administration. For a recipient administering funds from multiple grant beneficiaries with a mix of grant or expenditure amounts, for each beneficiary state the grant amount or expenditure amount, the cap percentage applied, and the actual dollar amount of the cap.      

5. Actual Planning and Administration Expenses (NAHASDA § 102(b)(2)(C)(ii), 24 CFR § 1000.238)

Did you exceed your spending cap for Planning and Administration? Yes No

If yes, did you receive HUD approval to exceed your spending cap on Planning and Administration? Yes No

If you did not receive approval for exceeding your spending cap on Planning and Administration costs, describe the reason(s) for exceeding the cap. (See Section 6, Line 5 of the Guidance for information on carry-over of unspent Planning and Administration expenses.)

6. Expanded Formula Area – Verification of Substantial Housing Services (24 CFR § 1000.302(3))

If your Tribe has an expanded formula area, (i.e., an area that was justified based on housing services provided rather than the list of areas defined in 24 CFR § 1000.302 Formula Area (1)), the Tribe must demonstrate that it is continuing to provide substantial housing services to that expanded formula area. Does the Tribe have an expanded formula area?

Yes No If no, proceed to Section 7.

If yes, list each separate geographic area that has been added to the Tribe’s formula area and the documented number of Tribal members residing there.      

For each separate formula area expansion, list the budgeted amount of IHBG and other funds to be provided to all American Indian and Alaska Native (AIAN) households and to only those AIAN households with incomes 80% of median income or lower during the recipient’s 12-month program year:

Total Expenditures on Affordable Housing Activities for:
	All AIAN Households	AIAN Households with Incomes 80% or less of Median Income
IHBG funds:	     	     
Funds from other Sources:	     	     

7. APR: If answered “Yes” in Line 6, for each separate formula area expansion, list the actual amount of IHBG and other funds expended for all AIAN households and for only AIAN households with incomes 80% of median income or lower during the recipient’s 12-month program year.

Total Expenditures on Affordable Housing Activities for:
	All AIAN Households	AIAN Households with Incomes 80% or less of Median Income
IHBG funds:	     	     
Funds from other Sources:	     	     

SECTION 7: INDIAN HOUSING PLAN CERTIFICATION OF COMPLIANCE

(NAHASDA § 102(b)(2)(D))

By signing the IHP, you certify that you have all required policies and procedures in place in order to operate any planned IHBG programs.

1. In accordance with applicable statutes, the recipient certifies that It will comply with Title II of the Civil Rights Act of 1968 in carrying out this Act, to the extent that such title is applicable, and other applicable federal statutes.

Yes No

2. To be eligible for minimum funding in accordance with 24 CFR 1000.328, the recipient receiving less than $200,000 under FCAS certifies that there are households within its jurisdiction at or below 80 percent of median income.

Yes No Not Applicable

3. The following certifications will only apply where applicable based on program activities.

(a) The recipient will maintain adequate insurance coverage for housing units that are owned and operated or assisted with grant amounts provided under NAHASDA, in compliance with such requirements as may be established by HUD.

Yes No Not Applicable

(b) Policies are in effect and are available for review by HUD and the public governing the eligibility, admission, and occupancy of families for housing assisted with grant amounts provided under NAHASDA.

Yes No Not Applicable

(c) Policies are in effect and are available for review by HUD and the public governing rents charged, including the methods by which such rents or homebuyer payments are determined, for housing assisted with grant amounts provided under NAHASDA.

Yes No Not Applicable and

(d) Policies are in effect and are available for review by HUD and the public governing the management and maintenance of housing assisted with grant amounts provided under NAHASDA.

Yes No Not Applicable

SECTION 8: IHP TRIBAL CERTIFICATION

(NAHASDA § 102(c))

This certification is used when a Tribally Designated Housing Entity (TDHE) prepares the IHP on behalf of a tribe. This

certification must be executed by the recognized tribal government covered under the IHP.

1. The recognized tribal government of the grant beneficiary certifies that:

2. It had an opportunity to review the IHP and has authorized the submission of the IHP by the TDHE; or

3. It has delegated to such TDHE the authority to submit an IHP on behalf of the Tribe without prior review by the Tribe.

Tribe:	     
Authorized Official’s Name and Title:	     
Authorized Official’s Signature:	     
Date (MM/DD/YYYY):	     

SECTION 9: TRIBAL WAGE RATE CERTIFICATION

(NAHASDA §§ 102(b)(2)(D)(vi) and 104(b))

By signing the IHP, you certify whether you will use tribally determined wages, Davis-Bacon wages, or HUD determined wages. Check only the applicable box below.

1. You will use tribally determined wage rates when required for IHBG-assisted construction or maintenance activities. The Tribe has appropriate laws and regulations in place in order for it to determine and distribute prevailing wages.

2. You will use Davis-Bacon or HUD determined wage rates when required for IHBG-assisted construction or maintenance activities.

3. You will use Davis-Bacon and/or HUD determined wage rates when required for IHBG-assisted construction except for the activities described below.

4. List the activities using tribally determined wage rates:      

SECTION 10: SELF-MONITORING

(NAHASDA § 403(b), 24 CFR § 1000.502)

1. Do you have a procedure and/or policy for self-monitoring?

Yes No

2. Pursuant to 24 CFR § 1000.502 (b) where the recipient is a TDHE, did the TDHE provide periodic progress reports including the self-monitoring report, Annual Performance Report, and audit reports to the Tribe?

Yes No Not Applicable

3. Did you conduct self-monitoring, including monitoring sub-recipients?

Yes No

4. Self-Monitoring Results. (Describe the results of the monitoring activities, including inspections for this program year.):     

SECTION 11: INSPECTIONS

(NAHASDA § 403(b))

1. Inspection of Units (Use the table below to record the results of recurring inspections of assisted housing.)

				Results of Inspections
(A) Activity			(B) Total number of units (Inventory)	(C) Units in standard condition	(D) Units needing rehabilitation	(E) Units needing to be replaced	(F) Total number of units inspected
1.	1937 Housing Act Units:
	a.	Rental	     	     	     	     	     
	b.	Homeownership	     	     	     	     	     
	c.	Other	     	     	     	     	     
1937 Act Subtotal			     	     	     	     	     
2.	NAHASDA-Assisted Units:
	a.	Rental	     	     	     	     	     
	b.	Homeownership	     	     	     	     	     
	c.	Rental Assistance	     	     	     	     	     
	d.	Other	     	     	     	     	     
NAHASDA Subtotal			     	     	     	     	     
Total			     	     	     	     	     

Note: Total of column F should equal the sum of columns C+D+E.

2. Did you comply with your inspection policy: Yes No:

2. If no, why not:      

SECTION 12: AUDITS

(24 CFR §§ 1000.544 and 548)

This section is used to indicate whether an Office of Management and Budget Circular A-133 audit is required, based on a review of your financial records.

Did you expend $500,000 or more in total Federal awards during the APR reporting period?

Yes No

If Yes, an audit is required to be submitted to the Federal Audit Clearinghouse and your Area Office of Native American Programs.

If No, an audit is not required.

SECTION 13: PUBLIC AVAILABILITY

(NAHASDA § 408, 24 CFR § 1000.518)

1. Did you make this APR available to the citizens in your jurisdiction before it was submitted to HUD

(24 CFR § 1000.518)?

Check one: Yes No

2. If you are a TDHE, did you submit this APR to the Tribe(s) (24 CFR § 1000.512)?

Check one: Yes No Not Applicable

2. If you answered “No” to question #1 and/or #2, provide an explanation as to why not and indicate when you will do so.

     

4. Summarize any comments received from the Tribe(s) and/or the citizens (NAHASDA § 404(d)).

     

SECTION 14: JOBS SUPPORTED BY NAHASDA (NAHASDA §404(b))

Use the table below to record the number of jobs supported with IHBG funds each year.

Indian Housing Block Grant Assistance (IHBG)
(1) Number of Permanent Jobs Supported	     
(2) Number of Temporary Jobs Supported	     

3. Narrative (optional):      

SECTION 15: IHP WAIVER REQUESTS

(NAHASDA § 101(b)(2))

THIS SECTION IS ONLY REQUIRED IF THE RECIPIENT IS REQUESTING A WAIVER OF AN IHP SECTION OR A WAIVER OF THE IHP SUBMISSION DUE DATE. A waiver is valid for a period not to exceed 90 days. Fill out the form below if you are requesting a waiver of one or more sections of the IHP. NOTE: This is NOT a waiver of the IHBG program requirements but rather a request to waive some of the IHP submission items.

1. List below the sections of the IHP where you are requesting a waiver and/or a waiver of the IHP due date.

(List the requested waiver sections by name and section number):      

2. Describe the reasons that you are requesting this waiver (Describe completely why you are unable to complete a particular section of the IHP or could not submit the IHP by the required due date.):      

.

3. Describe the actions you will take in order to ensure that you are able to submit a complete IHP in the future and/or submit the IHP by the required due date. (This section should completely describe the procedural, staffing or technical corrections that you will make in order to submit a complete IHP in the future and/or submit the IHP by the required due date.):      

Recipient:	     
Authorized Official’s Name and Title:	     
Authorized Official’s Signature:	     
Date (MM/DD/YYYY):	     

SECTION 16: IHP AMENDMENTS

(24 CFR § 1000.232)

Use this section for IHP amendments only.

Fill out the text below to summarize your IHP amendment. Copy and paste Section 16 for each amendment. This amendment is only required to be submitted to the HUD Area Office of Native American Programs when (1) the recipient is adding a new activity that was not described in the current One-Year Plan that has been determined to be in compliance by HUD or (2) to reduce the amount of funding that was previously budgeted for the operation and maintenance of 1937 Act housing under NAHASDA § 202(1). All other amendments will be reflected in the APR and do not need to be submitted to HUD.

NOTES: 

1. If Line 2 in Section 8 (IHP Tribal Certification) is checked in the current IHP, a new certification must be signed and dated by the authorized tribal official and submitted with the IHP Amendment. 

 

2. Section 1 (Cover Page) is recommended but not required with an IHP Amendment submission.

APR: REPORTING ON PROGRAM YEAR PROGRESS (NAHASDA § 404(b))

Complete the shaded section of text below to describe your completed program tasks and actual results. Only report on activities completed during the 12-month program year. Financial data should be presented using the same basis of accounting as the Schedule of Expenditures of Federal Awards (SEFA) in the annual OMB Circular A-133 audit. For unit accomplishments, only count units when the unit was completed and occupied during the year. For households, only count the household if it received the assistance during the previous 12-month program year.

1. Program Name and Unique Identifier:      

2. Program Description (This should be the description of the planned program.):

     

3. Eligible Activity Number (Select one activity from the Eligible Activities list in Section 3. Do not combine homeownership and rental housing in one activity, so that when units are reported in the APR they are correctly identified as homeownership or rental.):

     

4. Intended Outcome Number (Select one Outcome from the Outcome list in Section 3.):

     

Describe Other Intended Outcome (Only if you selected "Other" above.):

     

5. Actual Outcome Number (Select one Outcome from the Outcome list in Section 3.):

     

Describe Other Actual Outcome (Only if you selected "Other" above.):

     

6. Who Will Be Assisted (Describe the types of households that will be assisted under the program. Please note: assistance made available to families whose incomes fall within 80 to 100 percent of the median income should be included as a separate program within this Section.):

     

(7). Types and Level of Assistance (Describe the types and the level of assistance that will be provided to each household, as applicable.):

     

8. APR: (Describe the accomplishments for the APR in the 12-month program year. In accordance with 24 CFR § 1000.512(b)(3), provide an analysis and explanation of cost overruns or high unit costs.):

     

9. Planned and Actual Outputs for 12-Month Program Year

Planned Number of Units to be Completed in Year Under this Program	Planned Number of Households To Be Served in Year Under this Program	Planned Number of Acres To Be Purchased in Year Under this Program	APR: Actual Number of Units Completed in Program Year	APR: Actual Number of Households Served in Program Year	APR: Actual Number of Acres Purchased in Program Year
     	     	     	     	     	     

9. APR: If the program is behind schedule, explain why. (24 CFR § 1000.512(b)(2))      

(11) Amended Sources of Funding (NAHASDA § 102(b)(2)(C)(i) and 404 (b)) (Complete the non-shaded portions of the chart below to describe your estimated or anticipated sources of funding for the 12-month program year. APR Actual Sources of Funding -- Please complete the shaded portions of the chart below to describe your actual funds received. Only report on funds actually received and under a grant agreement or other binding commitment during the 12-month program year.)

	IHP					APR
SOURCE	Estimated amount on hand at beginning of program year	Estimated amount to be received during 12-month program year	Estimated total sources of funds (A + B)	Estimated funds to be expended during 12- month program year	Estimated unexpended funds remaining at end of program year (C minus D)	Actual amount on hand at beginning of program year	Actual amount received during 12-month program year	Actual total sources of funding (F + G)	Actual funds expended during 12-month program year	Actual unexpended funds remaining at end of 12-month program year (H minus I)	Actual unexpended funds obligated but not expended at end of 12-month program year
IHBG Funds	     	     	     	     	     	     	     	     	     	     	     
IHBG Program Income	     	     	     	     	     	     	     	     	     	     	     
Title VI	     	     	     	     	     	     	     	     	     	     	     
Title VI Program Income	     	     	     	     	     	     	     	     	     	     	     
1937 Act Operating Reserves	     		     	     	     	     		     	     	     	     
Carry Over 1937 Act Funds	     		     	     	     	     		     	     	     	     
LEVERAGED FUNDS
ICDBG Funds	     	     	     	     	     	     	     	     	     	     	     
Other Federal Funds	     	     	     	     	     	     	     	     	     	     	     
LIHTC	     	     	     	     	     	     	     	     	     	     	     
Non-Federal Funds	     	     	     	     	     	     	     	     	     	     	     
TOTAL	     	     	     	     	     	     	     	     	     	     	     

Notes:

1. For the IHP, fill in columns A, B, C, D, and E (non-shaded columns). For the APR, fill in columns F, G, H, I, J, and K (shaded columns).

2. Total of Column D should match the total of Column N from the Uses Table on the following page.

3. Total of Column I should match the Total of Column Q from the Uses Table on the following page.

(12) Amended Uses of Funding (NAHASDA § 102(b)(2)(C)(ii)) (Note that the budget should not exceed the total funds on hand and insert as many rows as needed to include all the programs identified in Section 3. Actual expenditures in the APR section are for the 12-month program year.)

		IHP			APR
PROGRAM NAME (tie to program names in Section 3 above)	Unique Identifier	(L) Prior and current year IHBG (only) funds to be expended in 12-month program year	(M) Total all other funds to be expended in 12-month program year	(N) Total funds to be expended in 12-month program year (L + M)	(O) Total IHBG (only) funds expended in 12-month program year	(P) Total all other funds expended in 12-month program year	(Q) Total funds expended in 12-month program year (O+P)
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     
Planning and Administration	     	     	     	     	     	     	     
Loan repayment	     	     	     	     	     	     	     
TOTAL		     	     	     	     	     	     

Notes:

1. Total of Column L cannot exceed the IHBG funds from Column C, Row 1 from the Sources Table on the previous page.

2. Total of Column M cannot exceed the total from Column C, Rows 2-10 from the Sources Table on the previous page.

3. Total of Column O cannot exceed total IHBG funds received in Column H, Row 1 from the Sources Table on the previous page.

4. Total of Column P cannot exceed total of Column H, Rows 2-10 of the Sources Table on the previous page.

5. Total of Column Q should equal total of Column I of the Sources Table on the previous page.

Recipient:	     
Authorized Official’s Name and Title:	     
Authorized Official’s Signature:	I certify that all other sections of the IHP approved on       are accurate and reflect the activities planned.      
Date (MM/DD/YYYY):	     

Page 1 form HUD-52737 (12/22/2015)