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MMI ATS/ hl QAn <br />Version 7103 <br />mrrul �I#Wpm. V.. <br />FEDERAL ASSISTANCE <br />2. <br />DATE SUBMITTED <br />Applicant Identifier <br />1. TYPE OF SUBMISSION: 3. <br />DATE RECEIVED BY <br />STATE State Application Identifier <br />Application Pre -application <br />4• <br />DATE RECEIVED BY <br />FEDERAL AGENCY Federal Identifier <br />U Construction Construction <br />P,,Non-Construction Non -const uction <br />5. APPLICANT INFORMATION <br />Legal Name: <br />Organizational Unit; <br />Department <br />IDNIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS <br />BOARD OF COUNTY COMMISSIONERS <br />Organizational DUNS: <br />Division: <br />078-208-989 <br />Address: <br />Name and telephone number of person to be contacted on matters <br />Street <br />involving this application give area node) <br />COUNTY ADMINISTRATION BUILDING, <br />Prefix: First Name: <br />1640 25TH STREET <br />I Jason <br />VF170 BEACH <br />Middle Nam <br />County: <br />at Name <br />Brc wn <br />INDIAN RIVER COUNTY <br />State: <br />p <br />232960 a <br />Suffix: <br />FL <br />Country: <br />USAJBROWN <br />Email: <br />IRCGOV.COM <br />6. EMPLOYER IDENTIFICATION NUMBER (EIN): <br />Phone Number (give area code) Fax Number (give area code) <br />0 gp® <br />772-567-8000x1257 772-770-5331 <br />8. TYPE OF APPLICATION: <br />7. TYPE OF APPLICANT: (See back of form for Application Types) <br />QJ New Fj Continuation <br />151 Revision <br />g <br />If Revision, enter appropriate letters) in box(es) <br />See back of form for description of letters) ❑ <br />her (specify) <br />Other (specify) <br />9. NAME OF FEDERAL AGENCY: <br />US DEPT. OF HOUSING AND URBAN DEVELOPMENT <br />RENEWAL <br />10, CATALOG OF FEDERAL DOMESTIC ASSISTANCE <br />NUMBER: <br />11. OESCRIPTNE TITLE OF APPLICANTS PROJEOT: <br />�i®ALJnn© <br />SHELTER PLUS CARE TRA -ONE YEAR RENEWAL <br />TITLE (Name of Program): <br />Continnuum of Care Homeless Assistance <br />12. AREAS AFFECTED BY PROJECT fCi(fes, Com f!106, States, etc.): <br />INDIAN RIVER COUNTY <br />13. PROPOSED PROJECT <br />114. CONGRESSIONAL DISTRICTS OF: <br />Start Data: Ending Date: <br />a. Applicant Project <br />06/01/2006 61313/2007 <br />15-16 5-16 <br />16. ESTIMATED FUNDING: <br />16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />DRDER 12372 P CMSS? <br />a. Federal <br />[[f THIS PREAPPLICATION/APPLICATION WAS MADE <br />110806 <br />110.808 <br />a. Yes. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br />PROCESS FOR REVIEW ON <br />DATE: <br />b. Applicant <br />c. State <br />PROGRAM IS NOT COVERED BY E.O. 12372 , <br />d. Local <br />b. No.1 <br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br />e. Other <br />.. <br />FOR REVIEW <br />f. Program Income <br />17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />g, TOTAL <br />110808 <br />110,808' <br />[I Yes If "Yes" attach an explanation. VI No <br />18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, <br />ALL DATA IN THIS APPLICATIONIPREAPPLICATION ARE TRUE AND CORRECT. THE <br />DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br />ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. <br />Authorized Representative <br />a, <br />Prefix <br />First <br />Na Rte <br />HUN <br />fiddle Name <br />Last Name <br />uffuk <br />NEUBERGER <br />Title <br />Telephone Number (give area code) <br />. <br />COMMISSIONER <br />772-567-8000 <br />. Sign u of horized 1 e"enta a <br />.Date Signed <br />May 16- 2006 <br />VC <br />Previous Edition Usable V ( \ <br />Authorized for Local Reoroddction v <br />`. umcara term 4L4 kK0V.a-CUV0J <br />Prescribed by OMB Circular A-102 <br />