HUD-52735-AS Indian Housing Block Grant (IHBG) Annual Performance Rep

Indian Housing Block Grant (IHBG)
Annual Performance Report

U.S. Department of Housing

OMB Approval Number

and Urban Development
Office of Public and Indian Housing
Office of Native American Programs

2577-0218 (exp. 05/31/09)

Annual Performance Report

These forms meet the minimum requirements for an Annual
Performance Report (APR) required by the United States Department
of Housing and Urban Development. In addition to these minimum
requirements, a tribe/tribally designated housing entity (TDHE) may
elect to prepare a more comprehensive APR. If a tribe/TDHE elects to
prepare a more comprehensive report, the required elements of this
APR must still be submitted on the prescribed HUD forms.

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form HUD-52735-AS (07/2003)

Annual Performance Report
Under the Native American Housing Assistance and Self-Determination Act of 1996 (NAHASDA) (25 U.S.C. 4104 et seq.) HUD will provide
grants, loan guarantees, and technical assistance to Indian tribes and Alaskan Native villages for the development and operation of lowincome housing in Indian areas. Grants will be made to eligible recipients under the Indian Housing Block Grant Program. To be eligible for
the grants, respondents must submit an Indian Housing Plan that meets the minimum requirements of the Act, consult with residents,
prepare Title VI application/certification, submit performance reports, and maintain records for HUD monitoring and audit review.
Public reporting burden for this collection of information is estimated to average 120 hours 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
information. Recipients of Indian Housing Block Grant (IHBG) program funds are required to submit an Annual Performance Report (APR)
to HUD within 60 days of the end of their program year. Statutory reference is contained in the Native American Housing Assistance and
Self-Determination Act (NAHASDA) of 1996, as amended, Sec. 404 Performance Reports. The regulatory reference is found at 24 CFR
Part 1000, sections 512 through 521. Response to the Annual Performance Report is mandatory and is required by Sections 403 and 404
of NAHASDA and by the regulations at 24 CFR 1000.
The information requested does not lend itself to confidentiality.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control
number.

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form HUD-52735-AS (07/2003)

Annual Performance Report
Recipients of NAHASDA funds are required to prepare and submit an Annual Performance Report (APR) within 60 days of
the end of the program year. The APR shall contain the information required below and narrative statements as needed.
The Annual Performance Report consists of the following parts:
Cover sheet - General information on the tribe or TDHE
Part I - Reporting on the One-Year Indian Housing Plan
Table I - Sources of Funds
Table II - Uses of Funds
Part II - Reporting on Program Year Accomplishments
Section A - Monitoring
Table III - Inspection of Assisted Housing
Section B - Audits
Section C - Public Accountability
Section D - Jobs Created by NAHASDA
Part I (including Tables I and II) – One separate part must be submitted for each open grant.
Part II (including Sections A, B, C, and Table III) – This part is not grant specific. A single part is to be prepared and
submitted at the end of each program year and will cover all open grants.
Part D (including Table IV) – This part is optional.

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form HUD-52735-AS (07/2003)

Annual Performance Report
Cover Sheet
1. APR is submitted by (mark one) tribe

THDE

2. Reporting period for which this APR is prepared: from: ________________ to: ____________________
(mm/dd/yy)

(mm/dd/yy)

3. Recipient Name and Address

4. Name of Contact Person

Title

Telephone no. (include Area Code)

If APR is submitted by the TDHE
5. Enter the name of each tribe included in this APR

6. Name of official authorized to submit APR

Title

Signature

Date

Certification: The information contained in this report is accurate and reflects the activities actually accomplished during the
reporting period. Activities planned and accomplished are eligible under applicable statutes and regulations and were
included in the applicable one year activities in the corresponding Indian Housing Plan.
Warning: If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under
Section 1001 of Title 18 of the United States Code. In addition, any person who knowingly and materially violates any
required disclosure of information, including intentional disclosure, is subject to civil money penalty not to exceed $10,000 for
each violation.
For HUD use only

Date APR is received by HUD

Time

logged in by

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form HUD-52735-AS (07/2003)

PART I - REPORTING ON THE ONE-YEAR INDIAN HOUSING
PLAN (IHP)
One separate Part I (that includes Tables I and II) must be submitted for each open grant.
Grant Number:
Enter the date HUD notified you that
your IHP was found in compliance:

Is this the final APR for this grant?

____________
(mm/dd/yy)

Check one:

yes

no

Each year, you develop goals and objectives and performance objectives in the IHP that describe the use of your IHBG
funds. At the end of the program year, you report on the progress made towards achievement of them.
1. Please report on each of the one-year goals and objectives and report on each of the performance objectives identified in
the IHP for this reporting period only in a format as follows:
Note: Goals and Objectives should be reported from inception to the present while the performance objectives should be
reported for the reporting period only.

GOAL
# ____

Goal as identified in the IHP:

Objective #_____

Objective as identified in the IHP:

Performance Objective
#_____

Performance objective relating to the above listed goal and
its objective(s) as identified in the IHP:

Accomplishment(s)

Progress made toward completion of the goal and
objective(s) as they relate to this performance objective:

No accomplishment

If no progress was made, explain why not and describe
what you will do to complete the activities:

Repeat this format for each one year goal and objective(s) and performance objective(s) in the IHP for this grant.

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form HUD-52735-AS (07/2003)

2. Are you on schedule to complete the 5-year goals identified in your IHP?
Check one:

yes

no

3. If the answer to #2 is no, explain causes for delays and how you plan to modify your program to meet your 5-year goals
and objectives.

4. How would you change your programs in general as a result of your experience with the implementation of NAHASDA?

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form HUD-52735-AS (07/2003)

Grant Number:

Table I - Sources of Funds

Planned
Amount (from
the IHP)
(b)

Sources of Funds for IHBG Activities
(a)
1. HUD Resources
a. NAHASDA Block Grant
b. NAHASDA Program Income
c. NAHASDA Title VI (Federal Guarantee)
d. Section 184 Loan Guarantee
e. Indian Community Development Block Grant
f. Drug Elimination
g. Prior year funds
h. Other (explain in narrative)
2. Existing Program Resources
a. 1937 Housing Act Programs
b. Other HUD Programs
3. Other Federal or State Resources
a. BIA Home Improvement Program
b. Other (explain in narrative)
4. Private Resources
a. Tribe
b. Financial Institution
c. Other (explain in narrative)
5. Other (explain in narrative)

Amount
Actually
Awarded
(c)

Total Resources
Narrative:
1. If column c is less than column b, explain why the planned funds were not realized.

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form HUD-52735-AS (07/2003)

Grant Number:

Table II - Uses of Funds
Cumulative
Activity

(a)
1. Indian Housing Assistance
(1937 Housing Act units)
a. Modernization
b. Operating
2. Development
a. Rental
i. Construction of new units
ii. Acquisition
iii. Rehabilitation
b. Homeownership
i. Construction of new units
ii. Acquisition
iii. Rehabilitation
3. Housing Services
4. Housing management
services
5. Crime Prevention & Safety
6. Model Activities
7. Planning & administration
8. Reserves
9. Other

Budgeted Amount
(from the IHP)

Grant (IHBG)
funds expended

Other funds
expended

Total funds
expended from all
sources
(c + d)

Percentage of
IHBG Grant Amount
Obligated

(b)

(c)

(d)

(e)

(f)

Total

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form HUD-52735-AS (07/2003)

Table II (continued)
Cumulative

Activity

Number of units
planned
(from the IHP)

Number of units
completed

Number of
units started
not completed

(a)

(g)

(h)

(i)

Number of families assisted

low-income
Indian families
(j)

non low-income
Indian families
(k)

1. Indian Housing
Assistance (1937 Act
units)
a. Modernization
b. Operating
2. Development
a.

3.
4.
5.
6.
7.
8.
9.

Rental

i. Construction of
new units
ii. Acquisition
iii. Rehabilitation
a. Homeownership
i. Construction of
new units
ii. Acquisition
iii. Rehabilitation
Housing Services
Housing Management
Services
Crime Prevention &
Safety
Model Activities
Planning &
administration
Reserves
Other

Total

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form HUD-52735-AS (07/2003)

non-Native
American
(l)

Narrative:
1. Column (a), line item #8, Reserves: Identify the purpose for the funds you placed in this category.

2. Explain any unexpected cost overruns associated with IHBG funds.

3. Investments:

Date HUD approved: ________________
(mm/dd/yy)

Amount approved for investment: $_______________
Amount of IHBG funds (principal only) invested as of this reporting period end date:
$ _______________

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form HUD-52735-AS (07/2003)

Part II - Reporting on Program Year Accomplishments
This Part is not grant specific. A single Part II consisting of Sections A through D (including Table III), is to be prepared and
submitted at the end of each program year and will cover all open grants.

SECTION A - MONITORING
I. Self-Monitoring: Sec 403(b) of the NAHASDA statute and §1000.502 of the program regulations require that the recipient
and the tribe are to be involved in monitoring activities. You are responsible for monitoring your grant activities to ensure
compliance with NAHASDA and its implementing regulations, and for monitoring the performance goals included under the
IHP. In addition, if you are the TDHE, the tribe is responsible for monitoring your programmatic performance for compliance
with the IHP, its stated goals and objectives, and the NAHASDA statute and its implementing regulations.
If you are a tribe reporting as the recipient, answer questions 1, 2 and 5. If you are a TDHE, answer all of the questions in
this part.
1. Briefly describe the self monitoring systems and internal control procedures you used and those you implemented during
the past year to assure that program activities comply with NAHASDA and its program regulations.

2. If you are a tribe or a TDHE reporting as the recipient:
a. List the activities you monitored:

b. Describe the results of each monitoring activity:

c.

Describe any required corrective action:

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form HUD-52735-AS (07/2003)

3. If you are a TDHE (in addition to answering #2):
d. Describe the procedures the tribe used to monitor your affordable housing activities:

e. List your activities the tribe monitored:

f.

Describe the results of the activities the tribe monitored:

g. Describe any corrective action required:

4. If you are a TDHE, describe any issues regarding your program activities that were referred to the tribe by HUD, an
auditor, etc. and your responses to them.

5. Describe any monitoring activities you conducted of your sub-recipients.

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form HUD-52735-AS (07/2003)

II. Inspection of Units: Per 403(b) of NAHASDA, a monitoring program must include an on-site inspection of all housing
units assisted with NAHASDA funds and 1937 Housing Act funds. Use Table III to record the results of the assisted housing
units inspected in this reporting period.

Table III - Inspection of Assisted Housing
Units Inspected
Total
number of
units

Number of
units needing
rehabilitation
(costing less
than $20,000)

Number of
units
needing
rehabilitation
(more than
$20,000)

(total d
through g)

Activity
(a)
1937 Housing Act funded units
a. Mutual Help
b. Low Rent
c. Turnkey III
d. Other
2. NAHASDA funded units
a. Owned or managed by recipient
b. Homeownership
c. Rental
d. Temporary housing
e. Other

Total
number
of units
Inspected

Number
of units
in
standard
condition

b.

c.

d.

e.

f.

Number
of units
needing
to be
replaced
g.

1.

Total
Narrative:
1. Describe your plan of action for complying with your inspection policy:

2. If applicable, explain why all units were not inspected:

3. Describe the process you use to perform inspections on units you do not own or manage which are assisted with IHBG
funds:

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form HUD-52735-AS (07/2003)

SECTION B - AUDITS
Per 24 CFR 1000.544, IHBG recipients must comply with the requirements of the Single Audit Act and OMB Circular A-133
which require annual audits of recipients that expend Federal funds equal to or in excess of an amount specified by the U.S.
Office of Management and Budget. (Currently set at $500,000). Audit reports are to be submitted to HUD within 30 days
after receipt or nine months after the end of the audit period (whichever is soonest). Per 24 CFR 1000.548, if a copy of the
audit has not already been submitted, it must be submitted with the APR.
1. For this program year, did you expend Federal funds equal to or more than $500,000?
Check one:

yes

No

2. If the audit is not submitted with this APR, the time period your last audit was covered is _______________ to
(mm/dd/yy)
_______________
(mm/dd/yy)

3. If you are a TDHE, will your housing activities be included in the tribe’s audit (in which case you will not be submitting an
audit for this period)?
Check one:

yes

No

4. If the answer to #3 is no, have you submitted your latest audit report to the tribe in accordance with 24 CFR 1000.550?
Check one:

yes

No

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form HUD-52735-AS (07/2003)

SECTION C - Public Accountability:
1. Did you make this APR available to the citizens in your jurisdiction before it was submitted to HUD per 24 CFR
1000.518?
Check one:

yes

No

2. If you are a TDHE, did you submit this APR to the tribe per 24 CFR 1000.512?
Check one:

yes

No

N/A

3. If you answered no to question #1 and/or #2, provide an explanation as to why not and indicate when you will do so.

4. Summarize any comments received from citizens:

5. Summarize any comments received from the tribe if applicable:

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form HUD-52735-AS (07/2003)

SECTION D - Jobs Created by NAHASDA
SUBMISSION OF THIS TABLE IS OPTIONAL . The information provided in this table may be used to respond to inquiries from
Congress, other Federal agencies, and the public regarding the impact of the IHBG Program.

Table IV - Jobs Created by NAHASDA

(a)
Indian Housing Block Grant
Assistance

Number of
permanent
positions created

Number of
temporary
positions created

(b)

(c)

Number of
positions needed to
implement
NAHASDA
(d)

Narrative:

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form HUD-52735-AS (07/2003)