Family Self-Sufficiency Program (FSS)

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Overview

MF FSS Reporting Tool
Reporting Tool Instructions
Summary

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Sheet 1: MF FSS Reporting Tool

FSS Participant Contract of Particiption (CoP)

Benefits in Current Employment (Select "Yes" or "No" from dropdown list)

Assistance Received by the Family (Select "Yes" or "No" from dropdown list)

Education/Training

High School/ GED

Post Secondary Education

Vocational/ Job Training

Job Search/ Job Placement

Job Retention

Transportation

Health Services

Alcohol/Drug Abuse Prevention Services

Mentoring

Homeownership Counseling

Individual Development Account (IDA)

Child Care

FSS Client Outcomes

Terminated CoP

Escrow Accrued January

Escrow Accrued February

Escrow Accrued March

Escrow Accrued April

Escrow Accrued May

Escrow Accrued June

Escrow Accrued July

Escrow Accrued August

Escrow Accrued September

Escrow Accrued October

Escrow Accrued November

Escrow Accrued December

HAP Contract #

Project Name

Unit Number

Head of Household (HOH) Last Name

HOH First Name

HOH Education Level at CoP Start Date (Select from dropdown list)

Employment Status of HOH at CoP Start Date (Select from dropdown list)

Number of Family Members with Individual Training and Services Plans

Current Employment Status of HOH (Select from dropdown list)

Date Current Employment Began

Initial Start Date of CoP

Initial End Date of CoP

CoP Date Extended to… (if applicable)

Health

Retirement Account

Other

TANF Income Assistance

General Assistance

SNAP/WIC/Other Food Assistance

Medicaid/Children's Health Insurance Program

Earned Income Tax Credit

Need Met During Participation in Program (Select Yes/No from dropdown list)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Select Yes/No from dropdown list)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Select Yes/No from dropdown list)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Select Yes/No from )

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Need Met During Participation in Program (Yes/No)

Service Provider (Select from dropdown list)

Did Family Complete CoP? (Yes/No)

Graduated from FSS (Yes/No)

CoP Completion Date

Escrow Total Distributed to Participant

Voucher Month/Year Escrow Distributed to Participant

Did Family Move to Homeownership? (Yes/No)

HOH Education Level at CoP End Date (Select from dropdown list)

CoP Terminated (Yes/No)

Date CoP Terminated

Primary Reason for Exit (Select from dropdown list)

Escrow Total at Termination

Termination with Disbursement? (Yes/No)

Escrow Account Total

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Voucher Month: (select from dropdown list)

Comments

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Sheet 2: Reporting Tool Instructions

MF FSS Reporting Tool	Instructions
	The following instructions will assist in correctly inputting data to the MF FSS Reporting Tool.
HAP Contract #	Input the property's Housing Assistance Payment (HAP) contract number.
Project Name	Input the project name.
Unit Number	Input the FSS participant's unit number.
Head of Household (HOH) Education Level at CoP Start Date	Select particpant's education level at Contract of Participation (CoP) start date from the dropdown list.
Employment Status of HOH at CoP Start Date	Select participant's employment status at CoP start date from the dopdown list.
Number of Family Members with Individual Training Services Plan	Enter the number of familly members with ITSP.
Current Employment Status of HOH	Select participant's current employment status from the dropdown list.
Date Current Employment Began	Enter the date the participant's current employment began.
Initial Start Date of CoP	Enter the initial effective start date of the CoP.
Initial End Date of CoP	Enter the initial end date of othe signed CoP.
CoP Date Extended to...	Enter the date to which the CoP was extended (if applicable).
Benefits in Current Employment	Select "Yes" or "No" from dropdown list for each category: Health, Retirement Account, Other
Assistance Received by the Family	Select "Yes" or "No" from dropdown list for each category: TANF Income Assistance, General Assistance, SNAP/WIC (Food Stamps), Medical/Children's Health Insurance Program, Earned Income Tax Credit
Family Services Needs:	For each of the listed services needs select "Yes" or "No" for "Need Met During Participation in Program" ...for "Service Provider" select from dropdown list.
Education / Training	" "
High School/GED	" "
Post Secondary	" "
Vocational / Job Training	" "
Job Search / Job Placement	" "
Job Retention	" "
Transportation	" "
Health Services	" "
[Threaded comment] Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924 Comment: OGCFH concurrence: The term “drug abuse” is viewed as stigmatizing and derogatory throughout the medical and disability communities. Instead, we recommend using the term “substance use.” Alcohol / Drug Abuse Prevention Services	" "
Mentoring	" "
Homeownership Counseling	" "
Indiviual Development Account (IDA)	" "
Child Care	" "
Did Family Complete CoP?	Select "Yes" or "No" from dropdown list.
Graduated from FSS	Did the participant graduate MF FSS? i.e., complete the requirements of the CoP. Yes or No.
CoP Completion Date	Enter the date the participant family graduated FSS; i.e., completed the CoP.
Escrow Total Distributed to Participant	In the event of FSS graduation, enter the total amount of FSS escrow distributed to the participant.
Voucher Month/Year Escrow Distributed to Participant	Enter the Month / Year of distribution of escrow to graduated participants.
Did Family Move to Homeownership?	Select "Yes" or "No" from dropdown list.
Head of Household Education Level at CoP End Date	Select particpant's education level at CoP end date from the dropdown list.
CoP Terminated	Select "Yes" or "No" from dropdown list.
Date CoP Terminated	Enter the date the CoP was terminated (if applicable).
Primary Reason for Exit	Select primary reason for exit from dropdown list.
Escrow Total at Termination	In the event of termination, enter the total amount of FSS escrow at the time the CoP was terminated.
Termination with Disbursement?	If the CoP was terminated with escrow disbursement to the participant, select Yes. If the accrued escrow was not disbursed and will remain with the property for the benefit of other FSS participants, select No.
Escrow Account Total	Enter the current total amount of FSS participant's escrow account.
Escrow Accrued January (February, March...etc.)	Input amount of escrow credit accrued in the subject month, as calculated by HUD Form-52652 Multifamily Monthly FSS Escrow Credit Worksheet. Note: Under "Voucher Month:", from the dropdown list, select the month in which the "Escrow Accrued..." was vouchered.
Comments	Enter any comments regarding voucher descrepancies and/or adjustments.
Summary worksheet	The Summary worksheet populates itself with summary data from the Reporting Tool, about the respective FSS program . Account Executives will input the data from the Summary worksheet into the MF FSS Sharepoint site.
OMB Approval No. 2577-0178 HUD-XXXXX Expiration Date: xx/xx/2030	Each Housing Agency (PHA/owner) must implement the FSS Program in compliance with 24 CFR 984 and 24 CFR 877. This collection of information is estimated to average 1hour per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of the requested information. Comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to: U.S. Department of Housing and Urban Development, Office of the Chief Data Officer, R, 451 7th St SW, Room 8210, Washington, DC 20410-5000. Do not send completed forms to this address. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid OMB control number. This agency is authorized to collect this information under Section 102 of the Department of Housing and Urban Development Reform Act of 1989. The information you provide will enable HUD to carry out its responsibilities under this Act and ensure greater accountability and integrity in the provision of certain types of assistance administered by HUD. This information is required to obtain the benefit sought in the grant program. Failure to provide any required information may delay the processing of your application and may result in sanctions and penalties including the administrative and civil money penalties specified under 24 CFR §4.38. This information will not be held confidential and may be made available to the public in accordance with the Freedom of Information Act (5 U.S.C. §552). The information contained on the form is not retrieved by a personal identifier, therefore it does not meet the threshold for a Privacy Act Statement.

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Sheet 3: Summary

							Education				Employment					Employment Benefits Rec'd						Assistance Received by Family										Escrow Total	CoP Outcome								Family Services Needs (met during participation)
CoP count	Completed CoP		Terminated CoP		Active CoP	# of ITSP	Head of Household (HOH) Education Level - Start of CoP		HOH Education Level - CoP End Date		HOH Employed	HOH Employment Status - Start of CoP		HOH Employment Status - Current		Health		Retirement		Other		TANF		General Assistance		Food Assistance		Medicaid/CHIP		Earned Income Tax Credit		Escrow Account Total	CoP Completed	Family moved to Homeownership		CoP Terminated	Primary Reason for Exit (CoP termination)		# of Escrow accounts Remitted to HUD (Result of termination)	Escrow Amount Remitted to HUD	Education / Training		Education / Training - Service Provider		High School / GED		High School / GED - Service Provider		Post Secondary Education		Post Secondary Education Service Provider		Vocational / Job Training		Vocational / Job Training - Service Provider		Job Search / Job Placement		Job Search / Job Placement - Service Provider		Job Retention		Job Retention - Service Provider		Transportation		Transportation - Service Provider		Health Services		Health Services - Service Provider		[Threaded comment] Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924 Comment: OGCFH concurrence: The term “drug abuse” is viewed as stigmatizing and derogatory throughout the medical and disability communities. Instead, we recommend using the term “substance use.” Alcohol / Drug Abuse Prevention Services		[Threaded comment] Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924 Comment: OGCFH concurrence: Please see prior comment. Alcohol / Drug Abuse Prevention Services - Service Provider		Mentoring		Mentoring - Service Provider		Homeownership Counseling		Homeownership Counseling - Service Provider		Individual Development Account (IDA)		Individual Development Account (IDA) - Service Provider		Child Care		Child Care - Service Provider
0	Yes	0	Yes	0	0	0	Elementary	0	Elementary	0	0	Part-time	0	Part-time	0	Yes	0	Yes	0	Yes	0	Yes	0	Yes	0	Yes	0	Yes	0	Yes	0	$0	0	Yes	0	0	Left voluntarily	0	0	$0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0	Yes	0	PHA	0													January
	No	0	No	0			Middle School	0	Middle School	0		Not employed	0	Not employed	0	No	0	No	0	No	0	No	0	No	0	No	0	No	0	No	0			No	0		Portability move-out	0			No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0	No	0	TANF agency	0													February
							Some High School	0	Some High School	0		Full-time (32 hours per week or more)	0	Full-time (32 hours per week or more)	0																						Contract expired but family did not fulfill obligations	0					DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0			DOL grantee	0													March
							High School Graduate / GED	0	High School Graduate / GED	0																											Asked to leave program	0					Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0			Voluntary organization	0													April
							Vocational / Trade School Diploma	0	Vocational / Trade School Diploma	0																											Left because essential service was unavailable	0					For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0			For profit entity	0													May
							Some College	0	Some College	0																											Termination with FSS escrow disbursement	0					Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0			Nonprofit agency	0													June
							Associate Degree	0	Associate Degree	0																																	Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0			Employer	0													July
							Bachelor's Degree	0	Bachelor's Degree	0																																	Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0			Community College	0													August
							Master's Degree	0	Master's Degree	0																																	4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0			4-year College/University	0													September
							Professional / Doctoral Degree	0	Professional / Doctoral Degree	0																																	Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0			Governmental entity	0													October
																																											School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0			School District	0													November
																																											Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0			Healthcare Provider	0													December