Form SFN52677 "Esg/Ndhg Mid-term/Final Progress Report" - North Dakota

What Is Form SFN52677?

This is a legal form that was released by the North Dakota Department of Commerce - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the North Dakota Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN52677 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Commerce.

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Download Form SFN52677 "Esg/Ndhg Mid-term/Final Progress Report" - North Dakota

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ESG/NDHG MID-TERM/FINAL PROGRESS REPORT
NORTH DAKOTA DEPARTMENT OF COMMERCE
DIVISION OF COMMUNITY SERVICES
SFN 52677 (02/17)
PART I
Mid-term Progress Report
Final Progress Report on Entire Grant Year
Grantee
Instrument Number
Nonprofit Organization
Unit of Local Government
Budget/Project Period
Period Covered by this Report
From (Month, Day, Year)
To (Month, Day, Year)
From (Month, Day, Year)
To (Month, Day, Year)
Report Prepared by
Phone Number
Project Description (Please provide a specific description of how funds are being used, including any
amendments to your budget)
Typed Name of Authorized Representative
Title
Signature of Authorized Representative (mail original signed copy)
Date
DCS USE ONLY
Reviewed By:
Date Reviewed Mid-term/Final
ESG/NDHG MID-TERM/FINAL PROGRESS REPORT
NORTH DAKOTA DEPARTMENT OF COMMERCE
DIVISION OF COMMUNITY SERVICES
SFN 52677 (02/17)
PART I
Mid-term Progress Report
Final Progress Report on Entire Grant Year
Grantee
Instrument Number
Nonprofit Organization
Unit of Local Government
Budget/Project Period
Period Covered by this Report
From (Month, Day, Year)
To (Month, Day, Year)
From (Month, Day, Year)
To (Month, Day, Year)
Report Prepared by
Phone Number
Project Description (Please provide a specific description of how funds are being used, including any
amendments to your budget)
Typed Name of Authorized Representative
Title
Signature of Authorized Representative (mail original signed copy)
Date
DCS USE ONLY
Reviewed By:
Date Reviewed Mid-term/Final
PART II
Complete a separate Part II Report for your agency and any agency you contract with to provide services for
each subgrantee. When answering questions, use the space provided or attach additional sheets.
1. List funded activities accomplished to date.
2. Have any problems arisen which will delay grant completion? If yes, explain the problem and the extent of
delay.
3. List activities to be accomplished and estimated timeframes.
4. Do you anticipate requesting any amendments? If yes, explain.
5. List the numbers served with ESG or NDHG Funds during the period covered by this report. Ethnic numbers
should equal racial numbers.
Ethnic Categories
Select One
Hispanic or Latino White
Not-Hispanic or Latino White
Select All that Apply
Racial Categories
American Indian/Alaskan Native
Asian
Black/African American
Native Hawaiian or Other Pacific Islander
White
Other Racial
2
6. List the numbers of Persons in Households served with ESG or NDHG Funds during the period covered by
this report. (Mid-term: July-Dec) (Final: July-June)
Don’t Know/
Missing
Number of
Number of Adults
Refused/Other
Information
Youths*
Street Outreach
Emergency Shelter
Prevention
Re-Housing
*Age 21 and under as defined by the McKinney Vento Act.
7. Gender
Missing
Don’t Know/
Male
Transgender
Female
Information
Refused/Other
8. Age
Missing
Don’t Know/
Under 18
25 and Over
18-24
Information
Refused/Other
9. Special Populations Served - Complete for All Activities
Total Persons
Total Persons
Served in
Total Persons
Subpopulation
Served -
Total
Emergency
Served - RRH
Prevention
Shelters
Veterans
Victims of Domestic
Violence
Elderly
HIV/AIDS
Chronically
Homeless
Persons with Disabilities:
Severely Mentally Ill
Chronic Substance
Abuse
Other Disability
Total (Unduplicated
if possible)
3
10. Shelter Utilization
Number of Beds – Rehabbed (number of additional beds created as a result of a rehab activity)
Total Number of Beds – Nights Available (the total number of shelter bed-nights available is the
total number of beds in all shelters the recipient funded with ESG that were available to program
participants during the reporting period)
Number of Beds – Conversion (number of beds created as a result of conversion of a building to
a shelter)
Total Number of Beds – Nights Provided (total number of bed-nights provided is the total
number of beds in all shelters the recipient funded with ESG that were filled each night during the
reporting period)
11. For this reporting period, check the program(s) and service(s) provide by your facility( check all that apply):
Emergency Shelter Component
Renovation
Operations
Essential Services
Street Outreach Component
Street Outreach
Homeless Prevention Component (At Risk of Homelessness Individuals and/or Households)
Housing Relocation and Stabilization Services
Short-Term and/or Medium-Term Rental Assistance (Project Based Assistance)
Short-Term and/or Medium-Term Rental Assistance (Tenant Based Assistance)
Rapid Re-Housing Component (Homeless Individuals and/or Households)
Housing Relocation And Stabilization Services
Short-Term and/or Medium-Term Rental Assistance (Project Based Assistance)
Short-Term and/or Medium-Term Rental Assistance (Tenant Based Assistance)
HMIS Component
HMIS
Administrative Component (NDHG Only)
Salaries for administrative activities
4
PART III
Grantee
1. Total grant funds available
$
2. Total Recipient Share of the Budget (Match)
$
3. Total Funds Available
$
0.00
4. Funds activity to date -
Funds expended/obligated on:
a. Street Outreach Component
$
b. Emergency Shelter Component
$
c. Homeless Prevention Component
$
d. Rapid Re-Housing Component
$
e. HMIS Component
$
f. Administrative Component (NDHG Only)
$
0.00
g. Total funds expended/obligated
$
5. Match funds activity to date -
Funds expended/obligated on:
a. Street Outreach Component
$
b. Emergency Shelter Component
$
c. Homeless Prevention Component
$
d. Rapid Re-Housing Component
$
e. HMIS Component
$
f. Administrative Component
$
g. Total funds expended/obligated
$
0.00
6. Match funds unobligated (line 1 minus line 4g):
$
0.00
0.00
7. Recipient funds unobligated (line 2 minus line 5g):
$
8. Total funds unobligated (line 6 plus line 7):
$
0.00
5