23-Attachment L - Monthly Activities Report (Direct Benefits).pdf

City of Dallas Monthly Activities Report (Direct Benefits)

Contractor’s Name Report Period

Current Month Unduplicated Monthly Unduplicated Unduplicated Cumulative Total YTD Section I. Total number of households/persons assisted

# of served by zip code List Below:

# of served by QCT List Below:

Section II. Total number of households/persons assisted (from Section I) who are:

Part A. Financial Status *

1. Low Income – ARPA (Up to 185% FPL OR up to 40% AMI)

2. Moderate – ARPA (Up to 300% FPL OR up to 65% AMI)

3. Low Income – HUD (Up to 80% AMI)

Total

* See Federal Income Eligibility Guidelines

Part B. Family Status

1. Total Female Headed Households

Part C. Race and Ethnicity Data

Single Race

Current Month Undupl. Total

Current Month Undupl. Total

(Hispanic or Latino)

Undupl.

Cumulative Y-T-D

Undupl. Cumulative Y-T-D

(Hispanic or Latino)

1. White ________ ________ __________ ___________

2. Black/African American ________ ________ __________ ___________

3. Asian

4. American Indian/Alaskan Native ________ ________ __________ ___________

5. Native Hawaiian or Other Pacific Islander

Multi-Race

1. American Indian/Alaskan Native & White

2. Asian & White ________ ________ __________ ___________

3. Black/African American & White ________ ________ __________ ___________

4. American Indian or Alaskan Native & Black & African American

5. Other Multi-Racial ________ ________ __________ ___________ Total ________ ________ __________ ___________

Section III. Council District (List the Council District Information for facility)

FACILITY LOCATION(S)

SERVICE AREA

(List the Council District information for the individuals shown in Section I, Column I.)

I certify that 100% of the clients receiving services are eligible in accordance with the appropriate income limits as specified by the U. S. Department of Housing and Urban Development (HUD), Federal Income Eligibility Guidelines.

Executive Director Date

DEFINITIONS

The five racial categories are defined as follows:

a) American Indian or Alaska Native. A person having origins in any of the original peoples of North and

South America (including Central America), and who maintains tribal affiliation or community attachment.

b) Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian

Subcontinent including, for example, Cambodia, China, Japan, Malaysia, Pakistan, the Philippines Islands, Thailand, and Vietnam.

c) Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

d) Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of

Hawaii, Guam, Samoa, or other Pacific Islands.

e) White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

The two ethnic categories are defined as follows:

a) Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central America, or other

Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to

"Hispanic or Latino."

b) Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

CDBG Presumed Benefit

If a Contractor is serving presumed eligible clientele, their financial status should be based on the categories listed below unless other information is available to support another income category.

a) Abused Children: Extremely Low Income

b) Battered Spouses: Low Income

c) Severely Disabled Adults: Low Income

d) Homeless Persons: Extremely Low Income

e) Illiterate Adults: Low Income

f) Persons with AIDS: Low Income

g) Migrant Farm Workers: Low Income

h) Elderly: (a) if assistance is to acquire, construct, convert and/or rehabilitate a senior center or to pay for providing center-based senior services, report clientele as moderate income; or (b) If assistance is for other services (not center-based), report the elderly as low-income

ARPA Eligible Disproportionately Impacted Populations

The below is Treasury’s ARPA description of eligible disproportionately impacted populations:

a) Low-income households and communities

b) Households residing in Qualified Census Tracts

c) Households that qualify for certain federal 5 benefits

d) Households receiving services provided by Tribal governments

e) Households receiving services provided by Tribal governments

f) Households residing in the U.S. territories or receiving services from these governments