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PART 6: Annual Certification of Continued Usage for HOPWAFFacility-Based Stewardship Units (ONLY) The Annual Certification of Usage for HOPWA Facility-Based Stewardship Units is to be used in place of Part 7B of the CAPER if the facility was originally acquired, rehabilitated or constructed/developed in part with HOPWA funds but no HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page. Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation are required to operate their facilities for HOPWA eligible individuals for at least ten (10) years. If non-substantial rehabilitation funds were used they are required to operate for at least three (3) years. Stewardship begins once the facility is put into operation. Note: See definition ofSteivardship Units. 1. VCIICl Al llll Vl ula Ll Vll Operating Year for this report From (mm/dd/yy) To (mm/dd/yy) ? Final Yr HUD Grant Number(s) ? Yr 1; ? Yr 2; ? Yr 3; ? Yr 4; ? Yr 5; ? Yr 6; ? Yr 7; ? Yr 8; ? Yr 9; ? Yr 10; Grantee Name Date Facility Began Operations (mm/dd/yy) N b r 1r 't and Non-HOPWA Expenditures 2. um er o n1 s Facility Name: Number of Stewardship Units Amount of Non-HOPWA Funds Expended in Support of the Developed with IIOPWA Stewardship Units during the Operating Year funds Total Stewardship Units subject to 3- or 10- year use periods) 2 T..4 :1.. ..t' Ur nt Lit J. L aIIJ V e Project Sites: Name of HOPWA-funded project Site Information: Project Zip Code(s) Site Information: Congressional District(s) Is the address of the project site confidential? ? Yes, protect information: do not list ? Not con tdential: information can be made available to the public If the site is not confidential: Please provide the contact information, phone, email address/location, ifbusiness address is different from facility address n I certify that the facility that received assistance for acquisition, rehabilitation, or new construction from the Housing Opportunities for Persons with AIDS Program has operated as a facility to assist HOPWA-eligible persons from the date shown above. I also certify that the grant is still serving the planned number of HOPWA-eligible households at this facility through leveraged resources and all other requirements of the grant agreement are being satisfied. I hereby certify that all the information stated herein, as well as any ht ormation provided in the accompaniment herewith, is true and accurate. Name & Title of Authorized Official of the organization that continues Signature & Date (mm/dd/yy) to operate the facility: Name & Title of Contact at Grantee Agency Contact Phone (with area code) (person who can ansiver questions about the report and program) End of PART 6 Previous editions are obsolete Page 19 form HUD-401 10-D (Expiration Date: 10/3112014) 25D-34