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DocuSign Envelope ID: CB0C1343-06EB-4BE7-9AF6-62EE77BD69FE t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Wake County <br /> Total 235 363 363 <br /> Income Level—See following chart <br /> (Omit for HS) <br /> < 30%Area Median Income <br /> 31-50%Area Median Income <br /> 51-80%Area Median Income <br /> > 80%Area Median Income <br /> Total NA NA NA <br /> Special Needs(Omit for HS) <br /> Elderly(Over 62) <br /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids <br /> Total NA _ NA _ NA <br /> CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and Public Facilities) <br /> Street Census Tract Block Group Total Persons #LMI Persons <br /> Main Application 1/21/2016 18:35:26 a1/p1 Page 11 of 2 <br />