Survey of Ensuring Equal Opportunity for Applicants

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Applicant’s (Organization) Name: ______________________________________________________________
Applicant’s DUNS Number: ___________________________________________________________________
Grant Name: ____________________________________________________CFDA Number: _____________                                         



1.    Does the applicant have 501(c)(3) status?
				
		Yes						No

2.	How many full-time equivalent employees does the applicant have?  (Check only one box).

3 or Fewer	15-50 
4-5	51-100	
		6-14		over 100

3.	What is the size of the applicant’s annual budget? (Check only one box.)

		Less Than $150,000		
		$150,000 - $299,999
		$300,000 - $499,999
		$500,000 - $999,999
		$1,000,000 - $4,999,999

		$5,000,000 or more




4.   Is the applicant a faith-based/religious 
      organization? 
				
		Yes						No

5.	Is the applicant a non-religious community-based organization? 
	
		Yes		No


6.	Is the applicant an intermediary that will manage the grant on behalf of other organizations?

Yes	No


7.   Has the applicant ever received a government grant or contract (Federal, State, or local )?

			Yes		No


8.  Is the applicant a local affiliate of a national
 organization?  

			Yes		No


SF 424-SUPP (4/2004)

          Survey Instructions on Ensuring Equal Opportunity for Applicants

Provide the applicant’s (organization) name and DUNS number and the grant name and CFDA number.



1.	501(c)(3) status is a legal designation provided on application to the Internal Revenue Service by eligible organizations.  Some grant programs may require nonprofit applicants to have 501(c)(3) status. Other grant programs do not.    

2.	For example, two part-time employees who each work half-time equal one full-time equivalent employee.  If the applicant is a local affiliate of a national organization, the responses to survey questions 2 and 3 should reflect the staff and budget size of the local affiliate.  

3.	Annual budget means the amount of money your organization spends each year on all of its activities.

4.	Self-identify.

5.	An organization is considered a community-based organization if its headquarters/service location shares the same zip code as the clients you serve. 

6.	An “intermediary” is an organization that enables a group of small organizations to receive and manage government funds by administering the grant on their behalf.

    7. Self-explanatory.

    8. Self-explanatory.






According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.  The valid OMB control number for this information collection is 1890-0014.  The time required to complete this information collection is estimated to average five (5) minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:  U.S. Department of Housing and Urban Development, Office of Departmental Grants Management and Oversight, Room 3156, Washington, D.C. 20410.


If you have comments or concerns regarding the status of your individual submission of this form, write directly to the address above.






















SF 424-SUPP (4/2004)