Code of Federal Regulations Title 7. Agriculture 7 CFR Pt. 1944, Subpt. I, Exh. B Exhibit B to Subpart I of Part 1944—Evaluation Report of Self–Help Technical Assistance (TA) Grants

Evaluation for Quarter Ending: (1) ___, 19___

1. a. Name of Grantee: (2) ___

b. Address: (3) ___

c. Area the grant serves: (4) ___

2. Date of Agreement: (5) ___ Time Extended (6) ___

3. a. Equivalent unit increase during quarter:

(7) __________

First Month

(8) __________

Second Month

(9) __________

Third Month

b. Cumulative total number of Equivalent Units since beginning of grant:

(10) __________

Total to Date

4. a. Method of Construction:

Stick built ___%, Panelized ___%, Combined ___%

b. Number of bedrooms per house built this grant period:

2BR, __________

3BR, __________

c. Household size this Quarter:

1 person ___,

2 persons ___,

3 persons ___,

4 persons ___,

5 persons ___.

d. Number of houses under construction this grant period, but started during previous grant period:  ___

5. a. Number of houses proposed under this grant:

(11) __________

b. Number of houses completed under this grant:

(12) __________

c. Number of houses currently under construction:

(13) __________

d. Number of families in pre construction:

(14) __________

e. Number of Construction Supervisors:

(15) __________

f. Number of TA employees:

(16) __________

6. a. Average time needed to construct a single house:

(17) __________

b. Number of months between submission of self-help borrower's docket and approval/rejection:

(18) __________

c. Number and percentage of loan docket rejections during reporting period:  ___

(19) __________

7. a. Did any of the following adversely affect the Grantee's ability to accomplish program objectives?

8. Attach information concerning number of families contacted, number who have indicated a willingness to be a participating family, number of mutual self-help groups organized, progress on any construction started, and any problems relating to the operation of this grant.

I certify that the statements made above are true to the best of my knowledge and belief.

(20) __________

(Date)

(21) __________

(Title)

GRANTEE

(22) __________

(Signature)

County Office Review

I have reviewed the above information which I have found to be substantially correct. Must be completed by County Office.

Comment:  Must be completed (23)

Average appraisal value of units financed this Quarter:

Average amount loan per unit financed this Quarter:

(24) __________

(Date)

(25) __________

County Supervisor

District Office Review

Comment:  Must be completed (26)

(27) __________

Date

(28) __________

District Director

State Office Review

Comments:  Must be completed (29)

(30) __________

Date

(31) __________

State Office Representative