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Form Hud-40110-C - Annual Progress Report (Apr) - Housing Opportunities For Persons With Aids (Hopwa) Program Page 4

Housing Opportunities for Persons with AIDS (HOPWA)

Annual Progress Report – Measuring Performance Outcomes

PART 1: Grantee Summary

OMB Number 2506-0133 (Expiration Date: 12/31/2010)

As applicable, complete the following charts. Chart 1 requests general grantee information. Chart 2 is in response to the Federal

Funding and Accountability and Transparency Act of 2006 (Public Law 109-282) which requests that grant recipients provide

information that will enable federal agencies to establish a central website that makes available to the public full disclosure of all

entities (including all project sponsors and other organizations) receiving $25,000+ in federal funding. Note: Report all general

information pertaining to project sponsors in Part 5A: Summary of Project Sponsor Information.

1. Grantee Information

HUD Grant Number

Operating Year for this report

From (mm/dd/yy)

To (mm/dd/yy)

Yr 1;

Yr 2;

Yr 3;

ExtYr

Grantee Name

Parent Company if applicable

Type of HOPWA Grant

Competitive

Formula

Business Address

City, State, Zip, County

Employer Identification Number (EIN) or

DUN & Bradstreet Number (DUNs) if applicable

Tax Identification Number (TIN)

*Congressional District of Address

*Congressional District of Primary Service

Area(s)

*Zip Code of Primary Service Area(s)

City(ies) and County(ies) of Primary Service

Area(s)

Organization’s Website Address

Does your organization maintain a waiting list?

Yes

If yes, explain in the narrative section how this list is administered.

Have you prepared any evaluation report?

Is the sponsor a nonprofit organization?

Yes

If so, please indicate its location on an Internet site (url) or attach copy.

Please check if yes and a faith-based organization.

Please check if yes and a grassroots organization.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.

Warning: HUD will refer for prosecution false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010,

1012, 31 U.S.C. 3729, 3802)

Name and Title of Authorized Official

Signature & Date (mm/dd/yy)

Name and Title of Contact at Grantee Agency

Email Address

(person who can answer questions about the report and program)

Phone Number (include area code)

Fax Number (include area code)

Service delivery area information only needed for program activities being directly carried out by the grantee

Previous editions are obsolete

Page

form HUD-40110-C (Expiration Date: 12/31/2010)

Form Hud-40110-C - Annual Progress Report (Apr) - Housing Opportunities For Persons With Aids (Hopwa) Program Page 4

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