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CDBG PUBLIC SERVICES GRANT <br />QUARTERLY BENEFICIARY REPORT <br />This report is due on Oct.31 (for I"Qtr.), Jan 31 (for 2"d Qtr.), Apr. 30 (for 3'd Qtr.), July 15 (for 4th Qtr.) <br />Grantee: Forward one copy to. your CDBG projcu maria er — Retain one copy for Your records - <br />Grantee <br />Name: <br />CDBG Contract No: <br />Subrecipient <br />Name: <br />Address: <br />Reporting V Quarter (July -Sept) ❑ 2" Quarter (Oct -Dec) _E13 Quarter (Jan -March) ❑ 4h Quarter (Apr -June) <br />Period <br />2016-2017 <br />Cumulative <br />THE TOTAL NUMBER OF: 1 Quarter 27 Quarter V Quarter I C Quarter Cumulative <br />PERSONS ASSISTED IN 2016-2017 <br />2nd Quarter <br />OF THE TOTAL NUMBER OF PERSONS ASSISTED, THE NUMBER OF PERSONS WITH: <br />NEW OR CONTINUING ACCESS TO SERVICE/ BENEFIT <br />IMPROVED ACCESS TO SERVICE/ BENEFIT <br />RECEIVING A SERVICE/BENEFIT THAT IS NO LONGER SUBSTANDARD <br />HISPANIC* = HUD has designated Hispanic as an ethnic group. A person can be identified as both a member of a racial group and an ethnic <br />group, but cannot be designated only as an ethnic group. <br />BENEFICIARY INCOME DATA <br />IsTQuarter <br />2nd Quarter <br />3rd Quarter <br />0 Quarter <br />Cumulative <br />RACE DATA OF BENEFICIARIES <br />IST Quarter <br />2nd Quarter <br />3rd Quarter <br />4th Quarter <br />Cumulative <br /># <br /># of <br /># <br /># of <br /># <br /># of <br /># <br /># of <br /># <br /># of <br />C <br />0 <br />51-80 % (MODERATE INCOME) <br />Hispanic <br />Oj <br />Hispanic <br />C <br />Hispanic <br />I 81% AND ABOVE <br />Hispanic <br />01 <br />Hispanic <br />WHITE <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />BLACK/AFRICAN AMERICAN <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />ASIAN <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />AMERICAN INDIAN/ALASKAN NATIVE <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />NATIVE HAWAIIAN/OTHER PACIFIC <br />0 <br />0 <br />0 <br />0 <br />ISLANDER <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />AMERICAN INDIAN/ALASKAN NATIVE <br />0 <br />0 <br />0 <br />AND WHITE <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />ASIAN AND WHITE <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />BLACK/AFRICAN AMERICAN AND WHITE <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />AMERICAN INDIAN/ALASKAN NATIVE <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />AND BLACK/AFRICAN AMERICAN <br />OTHER MULTI -RACIAL <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />TOTALS0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />HISPANIC* = HUD has designated Hispanic as an ethnic group. A person can be identified as both a member of a racial group and an ethnic <br />group, but cannot be designated only as an ethnic group. <br />BENEFICIARY INCOME DATA <br />MEDIAN INCOME (% OF HUD ADJUSTED <br />MEDIAN FAMILY INCOME) <br />IST Quarter <br />2nd Quarter <br />3rd Quarter <br />4th Quarter <br />Cumulative <br />0-30% (VERY LOW-INCOME)', <br />0 <br />01 <br />0 <br />C <br />0 <br />31- 50 % (LOW-INCOME) <br />0 <br />Oj <br />0 <br />C <br />0 <br />51-80 % (MODERATE INCOME) <br />0 <br />Oj <br />0 <br />C <br />0 <br />I 81% AND ABOVE <br />0 <br />01 <br />0 <br />0 <br />0 <br />TOTALS <br />C <br />0 <br />0 <br />0 <br />0 <br />Please provide a narrative explanation of the public services provided: (i.e., 150 meals provided to senior citizens, drug <br />Counseling provided to 25 people, etc.). <br />Signature Date of Signature <br />I certify that all CDBG funds expended for personnel costs are directly attributed to CDBG eligible activities. <br />Printed name, affiliation and phone number of person completing or signing this form: <br />