ANNEX 4a - PHASE 2 BUSINESS APPLICATION COVER PAGE for FY21 RFA.pdf
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- 72ASHA21RFA00001
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US Agency for International Development
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Annex 4a
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ANNEX 4 – PHASE 2 BUSINESS COST APPLICATION COVER PAGE
I. Cover Page
1. Date of submission:
2. Solicitation number of this RFA:
3. Name of the applicant USO and address:
4. USO’s Dun and Bradstreet Universal Numbering System (DUNS) number: _____________________
5. The USO’s System for Award Management (SAM) expiration date:_________________
6. USO’s Federal Employer Identification Number (EIN): _______________________
7. Name of the benefiting OSI and address:
Check one: School/university Hospital Center Library Center of Excellence
8. Amount of federal funding requested: ______________
9. Amount of leveraged funds (if applicable): _____________ or cost share (if applicable): __________
10. The total activity cost: ___________________
11. Activity Name/Title: ______________________________________________
12. ASHA Funding Is For:
Commodities-only
13. Project Summary:
Construction/renovation with commodities / without commodities
Please describe what the ASHA resources will fund:
| ANNEX 1 – PHASE 1 TECHNICAL APPLICATION TEMPLATE |
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| ANNEX 2 - PHASE 2 COVER PAGE for FY21 RFA.pdf |
| ANNEX 1 – PHASE 1 TECHNICAL APPLICATION TEMPLATE |
| Untitled |
| Untitled |
| Blank Page |
| 7: |
| Address of benefitting OSI: |
| 9: |
| Leveraged funds: |
| 10: |
| The total activity cost: |
| 11: |
| Activity Name/Title: |
| Group12: Off |
| 3 Name of the applicant USO and address 2: |
| 4 USOs Dun and Bradstreet Universal Numbering System DUNS number: |
| 5 The USOs System for Award Management SAM expiration date: |
| 6 USOs Federal Employer Identification Number EIN: |
| 7 Name of the benefiting OSI and address: |
| 8 Amount of lfederal funding requested: |
| cost share if applicable: |
| MM / DD / YYYY: |
| RFA NUMBER: |
| Name of USO: |
| Check Box6: Off |
| Check Box8: Off |
| Check Box9: Off |
| Check Box10: Off |
| Check Box11: Off |
| without: Off |
| with: Off |
| Description of what's ASHA funded: |
| Project summary: |
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