Home in the Heartland
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Quarterly Report – Due January 31, April 31, July 30, October 31
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Community/Organization Name:
Program Administration
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Grant Amount Awarded:
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Amount Spent This Quarter:
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Total Spent to Date:
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Progress Toward Recruitment Goals (Narrative and supporting data):
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Activities Conducted This Quarter (include descriptions and supporting data):
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Challenges encountered and plan of action to overcome challenges for next quarter:
Quarterly Summary Metrics
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Total number of household applications received by the recipient:
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Total number of households moved for participation in the program (Please complete the moved households detail section):
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The economic impact of the program so far. If no households moved so far, what is the potential economic impact of applicants. (e.g., state & local tax revenue contributed and new consumer spending attributable to a participating household):
Moved Households Detail
Household #1
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
More households to report?
Yes
Household #2
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #3
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #4
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #5
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #6
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #7
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #8
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #9
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #10
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #11
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #12
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #13
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #14
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Household #15
Name of Head of Household:
Number in Household:
Date Relocated:
Origin State:
Cost incurred by recipient for this household:
Annual income for this household:
Occupation of Head of Household:
Authorized Representative
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Name and Title/Position:
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Date:
SUBMIT
System Request Messages
X
