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<br />EXHIBIT B, ATTACHMENT 1, PAGE 1
<br />Community Development Block Grant Program
<br />Direct Benefit Monthly Activities Report
<br />
<br />There are two forms on this Exhibit B - Benefits Report (one is the monthly report and the other is the cumulative totals report.)
<br />Both have to be submitted each month with your billing.
<br />Fill in the shaded portions only - the unshaded portions will calculate automatically. Indicate only one race per person.
<br />FILL OUT MONTHLY BENEFIT BELOW SHEET 1
<br />
<br />AGENCY:
<br />PROGRAM:
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<br />Period Covered:
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<br />Note: Census Tract #1 is a previous census tract where client resided.
<br />Census Tract #2 is where transitional and permanent (after transitional) housing services are provided.
<br />(See instructions for definitions.)
<br />Eligible Census Tracts are 6097,6098,6099,6100,6101,6102,6103,6104,6107, 6108,6109,6110,6111,6112,6113.
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