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Part C : (con't.) Household Characteristics. Enter one code only in each block. <br /> No. Tenant's Last No. Tenant Subsidy Total Rent % of Hisp Race of Size of Head of Type of Is HOME As- <br /> Name or First 5 of Payment Amount (a + b) Area Head of House House Contract sisted Tenant <br /> Letters of Last BRs (a) (b) Median Household hold hold O=Owner in HOME As- <br /> Name Income T=Tenant sisted Project <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 20 <br /> 21 <br /> 22 <br /> 23 <br /> 24 <br /> 25 <br /> 26 <br /> 27 <br /> 28 <br /> 29 <br /> 30 <br /> 31 <br /> 32 <br /> 33 <br /> 34 <br /> 35 <br /> 36 <br /> 37 <br /> 38 <br /> 39 <br /> 40 <br /> 41 <br /> No. of Bedrooms Code Hispanic Race of Head of Household Code Size of Household Code Head of Household Code <br /> 1 - 1 Bedroom y - yes 11 - White 1 - 1 Person 1 - Single/Non Elderly <br /> 2 - 2 Bedrooms n - no 12 - Black or African American 2 - 2 Persons 2 - Elderly <br /> 3 - 3 Bedrooms 13 - Asian 3 - 3 Persons 3 - Related/Single Parent <br /> 4 - 4 Bedrooms 14 - American Indian or Alaska Native 4 - 4 Persons 4 - Related/rwo Parent <br /> 5 - 5 or more Bedrooms 15 - Native Hawaiian or Other Pacific Islander 5 - 5 Persons 5 - Other <br /> 16 - American Indian or Alaska Native & White 6 - 6 Persons <br /> % of Area Median Code 17 - Asian & White 7 - 7 Persons <br /> 1 - 0 - 30% 18 - Black or African American & White 8 - 8 or more Persons <br /> 2 - 30 - 50% 19 - American Indian or Alaska Native & <br /> 3 - 50 - 60% Black or African American <br /> Page 2 of 4 form HIUD40095 (02/2003) <br />