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067 <br />North Carolina Department of Health and Human Services <br />Division of Social Services <br />OFFICE of ' <br />ECONOMIC OPPORTUNITY <br />Community Services Block Grant Program <br />Fiscal Year 2016-17 Application for Funding <br />Project Period July 1, 2016 — June 30, 2017 <br />Application Due Date: February 12, 2016 <br />Agency Information <br />Agency: <br />Johnston-Lee-Hamett Community Action, Inc. <br />Federal I.D. <br />560859623 <br />DUNS Number: <br />153233663 <br />Administrative Office Address: <br />1102 Massey Street, Smithfield, NC 27577 <br />Mailing Address (include the 4 -digit zip <br />code extension): <br />Post Office Drawer 711, Smithfield, NC 27577-0711 <br />Telephone Number: <br />919-934-2145 <br />Fax Number: <br />919-934-6231 <br />Board Chairperson: <br />Mr. Robert W. Atkinson <br />Board Chairperson's Address: <br />where communications should be sent <br />4212 Massey -Holt Road, Princeton, NC 27569 <br />Board Chairperson's Term of Office (enter <br />beginning and end dates): <br />02/2006-02/2016 <br />Executive Director: <br />Mrs. E. Marie Watson <br />Executive Director Email Address: <br />jlhca@jlhcommunityaction.org <br />Agency Fiscal Officer: <br />Mrs. Lakisha Nichols <br />Fiscal Officer Email Address: <br />lanichols@jlhcommunityaction.org <br />CSBG Program Director: <br />Mrs. Tina Ray <br />CSBG Program Director Email Address: <br />tinarray@jlhcommunityaction.org <br />Counties Served with CSBG funds: <br />Johnston, Lee and Harnett <br />Agency Operational Fiscal Year: <br />July 01 -June 30 <br />North Carolina Department of Health and Human Services <br />Office of Economic Opportunity - Verna P. Best, Director <br />2420 Mail Service Center/ Raleigh, North Carolina 27699-2420 <br />Fiscal Year 2016-17 Community Services Block Grant Application <br />Page 1 of 33 <br />