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<br />For each national program objective under which the proposed activity <br />qualifies, check the appropriate box and provide the information in that <br />section. <br />[~] PRINCIPALLY BENEFITS LOW AND MODERATE INCOME PERSONS <br /> Was this determined on direct benefit, area benefit, income eligibility, <br /> or condition eligibility? (See Appendix III for determining the basis <br /> for counting beneficiaries.) <br /> Direct Benefit Income Eligibility x <br /> Area Benefit - Condition Eligibility <br /> - <br /> If the applicant is using survey data, answer questions <br /> (a) through (c). [See Appendix VI for specific guidelines <br /> for conducting a survey.] <br /> (a) How many households/families will be assisted? <br /> (b) How many of the households/families to be assisted <br /> by the project responded to the survey? <br /> (c) How many of the contacted households/families did not <br /> respond? . (Contacted households include those where <br /> interviewers knocked on the door and there was no answer.) <br /> <br /> If the applicant is using Census data to determine low/moderate <br /> income benefit, answer questions (d) and (e). (See Appendix VII) <br /> (d) Has the applicant provided the required Census <br /> map showing the boundaries of the project area? Yes x No <br /> - <br /> (e) List all enumeration districts or census tracts/block <br /> groups (full and partial) included in the project area. <br /> For city or county-wide projects, simply indicate "All." <br /> 3795 - 0101 <br /> 3795 - 0105 <br /> <br /> If the applicant i s determining low/moderate income benefits based on <br /> income or condition eligibility, answer questions ( f) and (g) on the <br /> fo 11 owi ng page. <br /> 21 <br />