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E}:HIBIT A <br />HOUSING OPPORTUNITY FOR PEOPLE WITH AIDS <br />ACCOMPLISHMENT REPORT <br />HOPWA Recipient Name: <br />HOPWA Funded Activity: <br />Location of Activity: <br />1. Select the one category that best describes service provided with HOPWA Funds: <br />^ Facility Based Housing: (e.g., Construction, Rehab) ..............Submit Report Form A 8~ Supplemental <br />^ Facility Based Non-Housing .................................................. Submit Report Form B 8 Supplemental <br />^ Scattered Site Only: (e.g., Tenant Based Rental Assistance) ..Submit Report Form C ~ Supplemental <br />^ Housing Infon»ation/Resource ID1Admin ..............................Submit Report Form D <br />^ Supportive Services Only .....................:................................ Submit Report Form E <br />2. Check Box Indicating Report Period: <br />^ 15~ Quarter <br />^ Z"d Quarter <br />^ 3'd Quarter <br />^ 4ei Quarter <br />(711- 9130) <br />(10/1-12/31) <br />(111- 3131) <br />(M1-6/30) <br />3. Amount of HOPWA Expended During This Report Period: $ <br />4. Number of Unduplicated Persons Assisted During the Report Period: <br />' Must aqua! Total NurnberotPersonsReceivaw AssFstarxe'isled h Repart Farm <br />5. Number of Units Completed During the Report Period (dappJ;caWe): <br />Far cbnshuc~Lion p-ojects any <br />I certify that the information within this quarterly report is true and correct. <br />Name: <br />Signature: <br />Telephone No: <br />Title: <br />Date- <br />Fax No: email: <br />2~5~'-22 <br />