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<br />. <br />0, <br /> <br />REPORT FORM C <br />SCATTERED SITE HOUSING ACTIVITY <br />(Tenant Based Rental Assistance, Emergency HousinglUtility Assistance) <br /> <br />ACTIVITY NAME: <br />ACTIVITY LOCATION: <br /> <br />DATE PAYMENTS BEGAN: <br /> <br />Number of Units Assisted bv Pavment TVDe: <br />SRO 0 Bdrm 1 Bdrm 2 Bdrms 3 Bdrms 4 Bdrms 5+ Bdrms <br /> <br />Tenant-Based Rent <br />Rent, Mortaaoe Utilities <br />Rent, MortQaQe, Utilities <br /> <br />Expenditures By Type: <br />Tenant Based Rental Assistance: $ <br /> <br />STRMU Assistance: $ <br /> <br />Total Families Assisted with Housing Assistance: <br /> <br />Program Departure Counts: <br /> <br />Number of Months <br /> <br />Voluntary: <br />Nonpayment af rent <br />Supportive Service noncompliance: <br />Unknown: <br />Criminal: <br />Death: <br />Other: <br /> <br /><3 <br /> <br />3-6 <br /> <br />7-12 <br /> <br />>12 <br /> <br />Available HOPWA Funds: <br />Total HOPWA Funds for Project: $ <br />Total HOPWA Expended To Date: $ <br />Project Balance Remaining: $ <br /> <br />Leveraging (for year end report only): <br /> <br />Non-HOPWA Funds: $ <br />$ <br /> <br />$ <br /> <br />Value of In-Kind Support: $ <br />$ <br /> <br />$ <br /> <br />Total of Leveraged Amounts: $ <br /> <br />Revised 05/05/09 <br />