| Grantee Name: | 
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		| Grant Number: | 
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		| Microenterprise Development Program Indicators | 
	
		| # | Category | Annual Goal | Semi-Annual Results | Annual Results (SA1 + SA2) | Cumulative Program Goal | Cumulative Program Results | 
	
		| SA1 | SA2 | 
	
		| Enrollment | 
	
		| 1 | Individuals Enrolled | 
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		| Technical Assistance | 
	
		| 2 | Pre-loan TA hours | 
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		| 3 | Post-loan TA hours | 
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		| Loans | 
	
		| 4 | Number of Start-up Loans Disbursed (MED) | 
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		| 4a | Number of Start-up Loans Disbursed (MED) from ORR Revolving Loan Fund (RLF) | 
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		| 4b | Number of Start-up Loans Disbursed (MED) from Leveraged RLF | 
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		| 5 | Number of Stabilization/Expansion Loans Disbursed (MED) | 
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		| 5a | Number of Stabilization/Expansion Loans Disbursed (MED) from ORR RLF | 
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		| 5b | Number of Stabilization/Expansion Loans Disbursed (MED) from Leveraged RLF | 
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		| 6 | Number of Credit Building Loans Disbursed (CBL) | 
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		| 6a | Number of CBL Loans Disbursed (CBL) from ORR RLF | 
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		| 6b | Number of CBL Loans Disbursed (CBL) from Leveraged RLF | 
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		| 7 | Amount Disbursed ($) for Start-up (MED) | 
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		| 7a | Amount Disbursed ($) for Start-up (MED) from ORR RLF | 
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		| 7b | Amount Disbursed ($) for Start-up (MED) from Leveraged RLF | 
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		| 8 | Amount Disbursed ($) for Stabilization/Expansion (MED) | 
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		| 8a | Amount Disbursed ($) for Stabilization/Expansion (MED) from ORR RLF | 
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		| 8b | Amount Disbursed ($) for Stabilization/Expansion (MED) from Leveraged RLF | 
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		| 9 | Amount Disbursed ($) for CBL | 
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		| 9a | Amount Disbursed ($) for CBL from ORR RLF | 
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		| 9b | Amount Disbursed ($)for CBL from Leveraged RLF | 
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		| 10 | Historical Loan Loss Rate (%) | 
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		| 11 | Avg. Change in Credit Score (+/-) | 
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		| Funds Leveraged | 
	
		| 12 | Amount Leveraged for Operations ($) | 
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		| Jobs | 
	
		| 13 | Number of Jobs Created | 
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		| 14 | Number of Jobs Retained | 
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		| Program Level Impact (To be measured once at the end of the program) | 
	
		| 15 | Avg. Change in Net Income (+/-) | 
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		| 16 | Business Success Rate (%) | 
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		| PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to evaluate MED grantee program performance. Public reporting burden for this collection of information is estimated to average 2 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Funding Opportunity Announcement: HHS-2017-ACF-ORR-RG-1228). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact the Microenterprise Development Program Officer. |