CHECK THE APPROPRIATE BOX
NEIGHBORHOOD STABILIZATION PROGRAM 1 (NSP1)
ACTIVITY COMPLETION REPORT
NEBRASKA DEPARTMENT OF ECONOMIC DEVELOPMENT
HOMEBUYER ACTIVITIES ONLY
(CHECK ONLY ONE)
Original Submission
1st, 2nd etc
Revision - #
Activity Number
Instructions: Report is due to NDED 30 days from final disbursement per activity.
Name of Grantee
Grant Number
Contact Name
Contact Phone
Federal Tax Identification Number
DUNS Number
DED Program Representative
Lynn Franzen
A. TYPE OF ACTIVITY (CHECK ALL THAT APPLY)
Homebuyer Purchase Rehab Resale
Homebuyer New Construction
Demolition/Clearance
Contact Fax
B. TYPE OF PROPERTY/STRUCTURE (SELECT ALL THAT APPLY)
Contact Email
C. ACTIVITY ADDRESS
Street Address
City
County
Zip Code
Abandoned
Blighted
Demolished
Foreclosed
Vacant
D. NSP1 ELIGIBLE ACTIVITY (CHECK ALL THAT APPLY)
A. Establish financing mechanism for the purchase and redevelopment of foreclosed upon homes and residential properties, including such mechanisms as soft-seconds, loan loss reserves,
and shared-equity loans for low-and moderate-income homebuyers.
B. Purchase and rehabilitate homes and residential properties that have been abandoned or foreclosed upon, in order to sell, rent, or redevelop such homes and properties.
C. Demolish blighted structures.
D. Redevelop demolished or vacant properties.
E. PERIOD OF AFFORDABILITY:
Resale Provision (# of Years)
Recapture Provision (# of Years)
F. % MEDIAN INCOME
0-50%
G. TYPE OF HOMEBUYER EDUCATION RECEIVED BY HOMEBUYER:
HUD-Approved Housing Counseling
Above 50% - 120%
REACH Approved Housing Counseling
Area of Presumed Affordability
H. ACTIVITY NARRATIVE
Revised 10/7/2010
NSP – Completion Report (Homebuyer Only)
Page 1 of 3
I. RACE AND ETHNICITY OF HEAD OF HOUSEHOLD
Choose from the dropdown list
HISPANIC/LATINO HEAD OF HOUSEHOLD
FEMALE HEAD OF HOUSEHOLD
YES
YES
J. SIZE OF HOUSEHOLD
1 Person
2 Persons
NO
NO
K. ANNUAL INCOME
Annual Household Income:
3 Persons
4 Persons
L. SALE PRICE
5 Persons
6 Persons
Sale Price of House
7 Persons
8 Persons
M. MAXIMUM SALES PRICE OF PROPERTY (ONLY COMPLETE
FOR ABANDONED AND FORECLOSED PROPERTIES)
N. FINAL BUDGET
Code
Description
Acquisition Cost
0452
Relocation/Reasonable Benefits
Redevelopment or Rehabilitation Cost
0531
SF Purchase/Rehab/Resale
Subtotal (Maximum Sales Price of Property):
0542
SF New Construction Homebuyer
Disposition Costs/Carrying Costs (i.e. lawn care,
snow removal, insurance, etc.)
0522
Demolition/Clearance
w/Redevelopment
TOTAL
TOTAL PROJECT COSTS
Original Appraised Value of House
Note: Please do not use cents.
NSP Funds
Other Funds
Total Funds
Department of Economic Development Use Only
Approved By:
Date Processed In DRGR:
Other Notes:
Revised 10/7/2010
NSP – Completion Report (Homebuyer Only)
Page 2 of 3
CDBG NSP1 ACTIVITY SET-UP REPORT INSTRUCTIONS
Name of Grantee: Name of local unit of government or 501(c)(3) organization awarded funds (must match name in
CDBG NSP1 Contract).
Grant Number: Grant number listed in CDBG NSP1 Contract (i.e. 093ND82).
Federal Tax Identification Number: Tax ID number of local unit of government or 501(c)(3) organization (must match
number in CDBG NSP1 Contract).
DUNS Number: DUNS Number of local unit of government or 501(c)(3) organization.
DED Program Representative: Your contact for program questions (identified in award letter).
Contact Name: Individual completing the set-up report on behalf of grantee.
Contact Phone, Fax, and E-mail: Phone, fax number, and e-mail address of individual completing Activity Set-Up
Report.
A. Type of Activity: Read the list of possible activity types and check each box that corresponds to each activity
conducted. Each activity must be listed in the CDBG NSP1 Contract.
B. Type of Property/Structure: Choose the type of property/structure that is being worked with for this activity. Choose
all that apply.
C. Activity Address: Enter the street address, city, county and zip code for the property/structure being impacted by this
activity.
D. NSP1 Eligible Activity: Select all NSP Eligible Activities being conducted under this activity.
E. Period of Affordability: Identify whether Resale Provisions or Recapture Provisions are being enforced or if the
grantee is working in an Area of Presumed Affordability. If Resale Provisions are being enforced identify the number
of years the Resale Provisions are in effect for. If Recapture Provisions are being enforced identify the total number
of years the Recapture Provisions are being enforced.
F. % Median Income: Select the Median Income Level of the household benefiting.
G. Type of Homebuyer Education Received By Homebuyer: Identify whether the homebuyer received HUDApproved Housing Counseling or REACH Approved Housing Counseling.
H. Activity Narrative: Provide a detailed activity narrative for the project completed.
I.
Race And Ethnicity of Head Of Household: From the dropdown list provided select the appropriate race for the
Head of Household. Select whether or not the Head of Household is Hispanic/Latino. Select whether the Head of
Household is female.
J. Size of Household: Identify the number of people residing in the NSP assisted house.
K. Annual Income: Provide the annual income of the homebuyer, using the Section 8, 24 CFR Part 5 annual gross
income calculation, consistent with the Nebraska HOME program guidelines.
L. Sale Price: Identify the final sales price the home was sold to the homebuyer for.
M. Maximum Sales Price of Property (ONLY COMPELTE FOR ABANDONED AND FORECLOSED PROPERTIES):
 Acquisition Cost: Identify the acquisition cost for the local unit of government or 501c(3) organization to
purchase the property.
 Redevelopment or Rehabilitation Cost: Identify the total amount of funds contributed to the property to
redevelop or rehabilitate the property.
 Subtotal (Maximum Sales Price of Property): Acquisition Cost + Redevelopment or Rehabilitation Cost.
 Disposition Costs/Carrying Costs: Identify the total amount of disposition costs/carrying costs which would
include but not limited to lawn care, snow removal and insurance.
 Total: Subtotal + Disposition Costs/Carrying Costs.
 Original Appraised Value of House: Identify the appraised value of the property prior to the local unit of
government or 501c(3) organization purchasing the property.
N. Final Budget: Provide the final activity budget information.
Save a copy for the Grantee’s files and email to: lynn.franzen@nebraska.gov
Contact Information: Lynn Franzen, 402-471-3781
*Code 0181 General Administration does not need to be reported on the “Activity Completion Report”.
Revised 10/7/2010
NSP – Completion Report (Homebuyer Only)