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DocuSign Envelope ID:636AFD33-DA5C-4B55-88DC-03C0863BAFE3 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Chapel Hill 36 37 37 <br /> Chapel Hill Public Housing Residents _—_—_- <br /> Orange County 36 <br /> Raleigh <br /> Wake County <br /> Other(Person, Chatham, Caswell, <br /> Alamance, Vance, Warren) 10 12 11 <br /> Total 105 107 109 <br /> Income Level—See following chart <br /> (Omit for HS) <br /> < 30%Area Median Income 71 72 74 <br /> 31-50% Area Median Income 23 25 24 <br /> 51-80% Area Median Income 10 8 9 <br /> > 80%Area Median Income 1 2 2 <br /> Total 105 107 109 <br /> Special Needs (Omit for HS) <br /> Elderly(Over 62) 2 3 4 <br /> Disabled (not elderly) 3 3 4 <br /> Homeless 62 64 65 <br /> People with HIV/Aids 3 4 3 <br /> Total 70 74 76 <br /> CDBG & HOME ONLY - Area Benefit Activities (Infrastructure and Public Facilities) <br /> Street Census Tract Block Group Total Persons #LM1 Persons <br /> 2015 Area Median Family income Limits <br /> U.S. Department of Housing & Urban Development (HUD) <br /> 2015 Area Median Family Income Limits <br /> Effective March 15, 2015 <br /> Income 1 2 3 4 5 6 7 8 <br /> Level person people people people people people people people <br /> 30%AM! $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 <br /> Main Application 1/25/2016 4:55:19 PM Page 13 of 24 <br />