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EXHIBIT A <br />REPORT FORM D <br />(Housing Information /Coordination, Admin) <br />ORGANIZATION: <br />PROGRAM: <br />Total Households Receiving Housing Information: <br />Estimated Persons Receiving Housing Information: <br />HOPWA EXPENDITURE DETAIL <br />Enter the amount of HOPWA funds expended during the report period for one or more of the activities listed below: <br />Housing Coordination: $ <br />Administrative Costs: $ <br />Total: $ <br />Available HOPWA Funds: <br />Total HOPWA Funds for Project: $ <br />Total HOPWA Expended To Date: $ <br />Project Balance Remaining: $ <br />Leveraging (for year end report only): <br />Non-HOPWA Funds: $ <br />Value of to-Kind Support: $ <br />Total of Leveraged Amounts: $ <br />Pag~~E~24 Revised 05/05/09 <br />