| Recipient Name: |
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| Grant Number: |
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| Reporting Period: |
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| Microenterprise Development Program Indicators |
| # |
Category |
Annual Goal |
Semi-Annual Results |
Annual Results (SA1 + SA2) |
Cumulative Program Goal |
Cumulative Program Results |
| SA1 |
SA2 |
| Enrollment |
| 1 |
Total Individuals Enrolled |
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| 1a |
Females Enrolled |
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| 1b |
Males Enrolled |
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| Technical Assistance |
| 2 |
Total Pre-loan T/TA Hours |
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| 2a |
Pre-Loan Training Hours |
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| 2b |
Pre-Loan TA Hours |
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| 3 |
Total Post-loan TA Hours |
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| 3a |
Post-Loan Training Hours |
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| 3b |
Post-Loan TA Hours |
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| Loans |
| 4 |
Total Number of Start-up Loans Disbursed (MED) |
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| 4a |
Number of Start-up Loans Disbursed (MED) from ORR Revolving Loan Fund (RLF) |
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| 4b |
Number of Start-up Loans Disbursed (MED) from Leveraged/Non-ORR RLF |
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| 5 |
Total Number of Stabilization/Expansion Loans Disbursed (MED) |
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| 5a |
Number of Stabilization/Expansion Loans Disbursed (MED) from ORR RLF |
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| 5b |
Number of Stabilization/Expansion Loans Disbursed (MED) from Leveraged/Non-ORR RLF |
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| 6 |
Total Number of Credit Building Loans Disbursed (CBL) |
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| 6a |
Number of CBL Loans Disbursed (CBL) from ORR RLF |
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| 6b |
Number of CBL Loans Disbursed (CBL) from Leveraged/Non-ORR RLF |
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| 7 |
Total Amount Disbursed ($) for Start-up (MED) |
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| 7a |
Amount Disbursed ($) for Start-up (MED) from ORR RLF |
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| 7b |
Amount Disbursed ($) for Start-up (MED) from Leveraged/Non-ORR RLF |
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| 8 |
Total Amount Disbursed ($) for Stabilization/Expansion (MED) |
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| 8a |
Amount Disbursed ($) for Stabilization/Expansion (MED) from ORR RLF |
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| 8b |
Amount Disbursed ($) for Stabilization/Expansion (MED) from Leveraged/Non-ORR RLF |
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| 9 |
Total Amount Disbursed ($) for CBL |
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| 9a |
Amount Disbursed ($) for CBL from ORR RLF |
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| 9b |
Amount Disbursed ($)for CBL from Leveraged/Non-ORR RLF |
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| 10 |
Total Loans Disbursed by Sex (%) |
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| 10a |
Loans Disbursed to Females (%) |
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| 10b |
Loan Disbursed to Males (%) |
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Historical Loan Loss Rate (%) |
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| 12 |
Average Change in Credit Score (+/-) |
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| Funds Leveraged |
| 13 |
Amount Leveraged for Operations ($) |
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| Jobs |
| 14 |
Number of Jobs Created |
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| 15 |
Number of Jobs Retained |
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| Program Level Impact (To be measured once at the end of the program) |
| 16 |
Avg. Change in Net Income (+/-) |
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| 17 |
Business Success Rate (%) |
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| PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to evaluate MED grantee program performance. Public reporting burden for this collection of information is estimated to average 2 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Funding Opportunity Announcement: HHS-2017-ACF-ORR-RG-1228). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # for this collection is 0970-0490 and the current expiration date is 3/31/2026. If you have any comments on this collection of information, please contact the Microenterprise Development Program Officer. |
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| In immediate response to priorities of the current administration, this form has been updated with the following changes prior to approval by the Office of Management and Budget (OMB), as required by the Paperwork Reduction Act (PRA) of 1995 (44. USC. 3501 et seq.). The PRA requires that agencies obtain OMB approval before requesting information from the public, and OMB review and approval for most changes to an approved information. ACF is working to process these changes through OMB to come into compliance with the PRA but has implemented changes to the OMB-approved form to ensure compliance with the following Executive Orders: Executive Order(s) 14168 and/or 14151, 14173, 14224. Other than these changes, this form is approved under OMB #: 0970-0490. |