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SURVEY ON ENSURING U. S . DEPARTMENT OF HOUSING OMB No. 1890-0014 EQUAL OPPORTUNITY AND URBAN DEVELOPMENT (EXP. 1 /31 /2006) FOR APPLICANTS Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faith- based, have an equal opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal funds, we are asking nonprofit private organizations (not including private universities) to fill out this survey. Upon receipt, the survey will be separated from the application. Information provided on the survey will not be considered in any way in making funding decisions and will not be included in the Federal grants database. While your help in this data collection process is greatly appreciated, completion of this survey is voluntary. Instructions for Submittine the Survey: If you are applying using a hard copy application, please place the completed survey in an envelope labeled "Applicant Survey." Seal the envelope and include it along with your application package. If you are applying electronically, please submit this survey along with your application. Applicant' s (Organization) Name : _INDIAN RIVER CO . BOARD OF COUNTY COMMISSIONERS Applicant' s DUNS Number : 079-208-989 Grant Name : COC HOMELESS ASSISTANCE PROGRAM CFDA Number : 14-235 4 . Is the applicant a faith-based/religious 1 . Does the applicant have 501 (c)(3 ) status? organization? 0 Yes a No [j Yes No 2 . How many full-time equivalent employees does 5 . Is the applicant a non-religious community-based the applicant have? (Check only one box). organization? 3 or Fewer 15 -50 Yes No 4 -5 51 - 100 6- 14 over 100 6 . Is the applicant an intermediary that will manage the grant on behalf of other organizations? 3 . What is the size of the applicant ' s annual budget? Yes IB No (Check only one box.) Less Than $ 150,000 7 . Has the applicant ever received a government grant or contract (Federal, State, or local ) ? $ 15000 - $ 299, 999 Yes El No $ 300 ,000 - $499,999 $ 500, 000 - $ 999 , 999 8 . Is the applicant a local affiliate of a national organization? $ 1 ,000, 000 - $4, 999, 999 Yes No $ 5 , 000, 000 or more SF 424- SUPP (4/2004)