Orange County NC Website
DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Income Level—See following chart(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 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 0 0 <br /> Main Application1/25/20161` a g a 13 of 3 <br />