OMB Approval No. 2506-0133
exp. 12/31/2017
Detailed Project Budget & Housing Outputs (each organization)
Note: Service delivery costs such as salary and overhead costs to deliver a particular budget line item
should be represented in the funding amount requested for that particular budget line item.
Insert application package page number
Name of Southern New Hampshire HIV/AIDS Task Force
organization:
Type: Grantee: J; Project Sponsor: X] | If applicable: | Faith based: L] | Grassroots: L]
B. Eligible Activity HOPWA Request
Yr. 1 Yr. 2 Yr. 3 Totals:
1, Acquisition Budget
+ & |Description:
5 3 # of Units
5. 4 P. Rehabilitation/Repair/Conversion Budget
32 iption:
gg [Descnption: It of Units
a 2 3. New Construction (Community Residences & SRO dwellings Budget
2 s Jonly) Description: .
OF # of Units
Sy
& & |Type of Facility: Short-term shelter [1]; transitional housing [_]; Community residence []; SRO dwelling LE); or other permanent
supportive housing [_]
z 4. Operating Costs for Housing Facility udget
eB S$ |Descnption: ,
25 H# of Units
oO 7
x & iacarta Budget
eseription: Ht of Units
6. Tenant-Based Rental Assistance Payments Budget
Description:
< 3 # of Households'
ms 7. Short-Term Rent, Mortgage & Utility Payments to Prevent Budget
m a Homelessness
Description:
# of Households
tg Budget $114,995 1$114,996 |$114,996 [$344,987
Fy 3B. Supportive Services Costs 31 31 31 40
eS c Description:
AW
# of Households|
9. Housing Information Services Budget
3 Description: H# of Households)
& 10. Permanent Housing Placement Services Budget $4,100 [$4,100 [$4,100 1$12,300
Description:
5 = ¥# of Households 4 4 4 12
5 1. Resource Identification to Establish, Coordinate, & Develop
© Housing Assistance
ec Description: Budget
a
= 12. Other Housing Costs (approved by HUD) Budget
Pescription: # of Units
2 13. Grantee's Administrative Costs
a g Description: Budget
%@ § |14. Project Sponsor's Administrative Costs
FE z Description:
< Budget $8,336 $8,337 $8,337 $25,010
15. Total HOPWA Request for this Organization
382,297
Form HUD-40110-B (Expiration Date 12/31/2010)
