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REPORT FORM C <br />SCATTERED SITE HOUSING ACTIVITY <br />(Tenant Based Rental Assistance, Emergency Housing/Utility Assistance) <br />ACTIVITY NAME: <br />ACTIVITY LOCATION: <br />DATE PAYMENTS BEGAN: <br />Number of Units Assisted by Payment Tvpe: <br />SRO 0 Bdrm 1 Bdrm 2 Bdrms 3 E3rlrmc d Rrlrm~ ei o.r-~- <br />Tenant-Based Rent <br />Rent, Mort a e, Utilities <br />Rent, Mort a e, Utilities <br />Expenditures By Type: <br />Tenant Based Rental Assistance: $ STRMU Assistance: $ <br />Total Families Assisted with Housing Assistance: <br />Program Departure Counts: <br />Number of Months <br />Voluntary: <br />Nonpayment of rent: <br />Supportive Service noncompliance: <br />Unknown: <br />Criminal: <br />Death: <br />Other: <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 In-Kind Support: <br />Total of Leveraged Amounts: <br /><3 3-6 7-12 >12 <br /> <br /> <br />Revised 05/05/09 <br />