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DocuSign Envelope ID:2164F437-BF9D-46A1-B13B-7740B02003DA t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Raleigh" 0 <br /> Wake County" 0 <br /> Total 0 32 66 <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 I 0 0 0 <br /> Special Needs (Omit for HS) <br /> Elderly(Over 62) <br /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids <br /> Total I 0 0 0 I <br /> CDBG & HOME <br /> ONLY- Area <br /> Benefit Activities <br /> (Infrastructure <br /> and Public <br /> Facilities) <br /> Street Census Tract Block Group Total Persons #LMI Persons <br /> Main Application 5/24/2016 8:59:25 a5/p5 P 12 o of 23 <br />