HUD-424 SUPP Faith Based EEO Survey

OMB Number: 1894-0010
Expiration Date: 05/31/2012

Survey on Ensuring Equal Opportunity 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 Submitting 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:
Applicant's DUNS Name:
Federal Program:

CFDA Number:

1. Has the applicant ever received a
grant or contract from the Federal
government?

5. Is the applicant a local affiliate of a
national organization?
Yes

Yes

2. Is the applicant a faith-based
organization?
Yes

6. 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

No

3. Is the applicant a secular
organization?

Yes

No

No

No

4. Does the applicant have 501(c)(3) status?

7. What is the size of the applicant's
annual budget? (Check only one box.)
Less Than $150,000
$150,000 - $299,999

Yes

No

$300,000 - $499,999
$500,000 - $999,999
$1,000,000 - $4,999,999
$5,000,000 or more

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.

Self-explanatory.

Paperwork Burden Statement

2.

Self-identify.

3.

Self-identify.

4.

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.

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. Public reporting burden for this
collection of information is estimated to average 5
minutes per response, including time for reviewing
instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and
reviewing the collection of information. The obligation to
respond to this collection is voluntary (EO 13198 and
13199).

5.

Self-explanatory.

6.

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.

7.

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

If you have comments concerning the accuracy of the
time estimate(s) or suggestions for improving the form,
please write to: The Agency Contact listed in this grant
application package.