Grantee name: Grantee address: Grant quarter:____________

Report Period: From: ______ To: ______

I. General Information on Use of HPG Funds During Period:

A. Use of Administrative Funds:

Budgeted Amount $______ Expended Thru Last Quarter ______ Direct Cost: Personnel $______ Supplies & Equip ______ Travel ______ Indirect Costs: (______% Rate) ______ This Quarter Total ______

B. Use of Program Funds:

Budgeted Amount ______ Expended Thru Last Quarter ______ Loans No. ______ $______ Grants No. ______ ______ Other subsidies (describe briefly) No. ______ ______ This Quarter Total ______

II. Description of recipients provided assistance during report period: (Attach breakdown for each HPG recipient on separate page including name, address, income, size, race, housing preservation activities, and type of assistance received):

Number of low-income homeowners assisted ______ Number of very low-income homeowners assisted ______ Total number of homeowners assisted ______ Racial composition: White ______ Black ______ Hispanic ______ Am. Indian ______ Other ______

III. Description of types of housing preservation provided:

IV. Objectives for next period:

Loans No. ______ $______ Grants No. ______ $______ Other subsidy No. ______ $______ Totals No. ______ $______

V. Project summary:

VI. Narrative:

A. Significant accomplishments.

B. Problem areas.

C. Proposed changes/assistance needed, etc.

D. Status of implementing environmental and historic preservation requirements. Include number of historic properties assisted.