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<br />EXHIBIT A <br /> <br />HOUSING OPPORTUNITY FOR PEOPLE WITH AIDS <br />ACCOMPUSHMENTREPORT <br /> <br />HOPWA Recipient Name: <br /> <br />HOPWA Funded Activity: <br /> <br />Location of Activity: <br /> <br />1. Select the one category that best describes service provided with HOPWA Funds: <br /> <br />D Facility Based Housing: (e.g., Construction, Rehab) .............. Submit Report Form A & Supplemental <br />D Facility Based Non-Housing .................................................. Submit Report Form B & Supplemental <br />D Scattered Site Only: (e.g., Tenant Based Rental Assistance).. Submit Report Form C & Supplemental <br />D Housing Information/Resource ID/Admln .............................. Submit Report Form D <br />D Supportive Services Only...................................................... Submit Report Form E <br /> <br />2. Check Box Indicating Report Period: <br /> <br />o 1st Quarter (7/1 - 9/30) <br />o 2nd Quarter (10/1 -12/31) <br />o 3rd Quarter (1/1 - 3/31) <br />o 4th Quarter (4/1 - 6/30) <br /> <br />3. Amount of HOPWA Expended During This Report Period: $ <br /> <br />4. Number of Unduplicated Persons Assisted During the Report Period: * <br />'* Must equal "Total Number of Persons .Receivina Assistance" listed in Report Form <br /> <br />5. Number of Units Completed During the Report Period (ifapplicable): <br />For construction projects only <br /> <br /> <br />I certify that the information within this quarterly report is true and correct. <br /> <br />Name: <br /> <br />Title: <br /> <br />Signature: <br /> <br />Date: <br /> <br />Telephone No: <br /> <br />Fax No: <br /> <br />email: <br /> <br />1 of 7 <br />