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<br />EXHIBIT B, ATTACHMENT 1, PAGE 2 <br />Community Development Block Grant Program <br /> <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: <br /> <br /> <br />,,!:, ,- ~ <br /> <br /> <br /> <br /> <br /> <br />I <br /> <br />;¡ <br /> <br /> <br /> <br />Cllent(S)?<~¡""~; ',", <br />(Indicate Persóns o~ HoUse~o ds), <br /> <br />Tract #1 ITract #2 I H~~~'~ldá"':1t:,')::¡:5~ <~r:,; <br /> <br />a1* <br /> <br />I. <br /> <br />I <br /> <br /> <br />a2* <br /> <br /> <br />Period Covered: <br /> <br /> <br />I <br /> <br />I Indicate one category of race below I <br /> <br />Multi-Race <br /> <br />;' <br /> <br />>- <br />.a <br />.. <br />GI <br />oS <br />',I .¡ <br />, .. <br />c- <br />m ~ ~ <br />"'CIOO <br />õ-E! <br />.c"'CIGl <br />CIICIII1. <br />III' ¡j.. <br />::1- o <br />o III III <br />~~:!:! <br />° III o <br />'ltc.c <br />_°: <br />J! r!::I <br />~cf~ <br />C <br /> <br />C <br />ItI <br />U <br />'¡:; <br />Q) <br />E <br />oct: <br />¡:; <br />~ <br />'¡:; <br /> <br />lli~ ,~ <br />,.!!! III <br /> <br />~ <br />jtfZ: <br /> <br />I Housing T},I'!J <br /> <br />One Race <br /> <br />I <br /> <br />~ <br />æ <br />E <br />.g <br />~ <br />0 <br />C> "'CI <br />Q) - <br />- ° <br />r¡:!:! .¡ <br />Q) o III <br />_.c ::I <br />ItI GI o <br />Ìii!l :a: <br />c. ° .. <br />:¡¡:a: ¡ <br />,!!1"i:ã g' <br />,!!!"'CI 11. jii <br />.c III GI .. ::I <br />t:.. GI - .- o <br />u:a: g' :5 :a: <br />'ë;'¡ èñ .! -g <br />~E .! g' :ã <br />:f{f ~ èñ :i <br />r s t u <br /> <br /> <br />,'>', 'c", ' <br />:;:¡.;oj~¡i~; <br /> <br /> <br /> <br /> <br />.!! <br />~ <br /> <br /> <br />ij <br />"0 <br />¡:; <br />-Itl -oð <br />¡:;- ¡:; <br />,!!!!!! ,!!! ~ <br />,¡jU "0; <br />~!E E ItI <br />ItIU ¡:;z <br />J:'~ B ¡:; <br />Q).. 'I: J:! <br />.2: Q) Q) III <br />iii £; E ItI <br /> <br />.!! <br />~ <br />oð <br />I: <br />ItI <br />o¡¡¡ <br />~ <br />m <br /> <br /> <br />IT"';'::,:';;!;1;;';;: ":'~' ,>~iT <br />Total Monthly Benefit <br />Total Cumulative Benefit <br />Total Contract Goals <br />% to Date <br /> <br /> <br /> <br /> <br />~ <br />:k:; <br /> <br />h <br /> <br />0 <br />õ <br /> <br />~";:"I;":¡""':I';-:nY: <br />0 0 0 0 <br />0 0 0 0 <br /> <br />0 <br />0 <br /> <br />#DIV/O! <br /> <br />I <br /> <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. <br /> <br />SUBJECT TO CHANGE <br />