Appendix A & B_RFA 693JJ920R000060.pdf

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Grants.gov Lobbying Form

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Certification for Contracts, Grants, Loans, and Cooperative Agreements

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard

Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* APPLICANT'S ORGANIZATION

* SIGNATURE:

* DATE:

* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

Suffix:

Middle Name:

* Title:

* First Name:

* Last Name:

Prefix:

CERTIFICATION REGARDING LOBBYING

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of

Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

The undersigned certifies, to the best of his or her knowledge and belief, that:

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief, that:

Mandatory:

Applicant's Organization: Enter the legal name of the organization that will undertake the assistance activity. This should normally be the name under which the organization has registered with the Business Partner Network.:

Prefix: Select the prefix (e.g., Mr., Mrs., Rev.) for the name of the Authorized Representative.:

Suffix: Select the suffix (e.g., Jr, Sr, PhD) for the name of the Authorized Representative.:

First Name: Enter the first (given) name of the Authorized Representative who is signing this form.:

Middle Name: Enter the middle name of the Authorized Representative.:

Title: Enter the title of the Authorized Representative who is signing this form.:

Last Name: Enter the last (family) name of the Authorized Representative signing this form.:

Signature: It is the organization's responsibility to assure that only properly authorized individuals sign in this capacity and/or submit the application to Grants.gov. Enter the Signature of Authorized Representative.:

Date Signed: Enter the date the AOR signed the application.:

XDPFirstField:

LastField:

OMB Number: 4040-0004 Expiration Date: 12/31/2019

* 1. Type of Submission: * 2. Type of Application:

* 3. Date Received: 4. Applicant Identifier:

5a. Federal Entity Identifier: 5b. Federal Award Identifier:

6. Date Received by State: 7. State Application Identifier:

* a. Legal Name:

* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:

* Street1:

Street2:

* City:

County/Parish:

* State:

Province:

* Country:

* Zip / Postal Code:

Department Name: Division Name:

Prefix: * First Name:

Middle Name:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* Telephone Number: Fax Number:

* Email:

* If Revision, select appropriate letter(s):

* Other (Specify):

State Use Only:

8. APPLICANT INFORMATION:

d. Address:

e. Organizational Unit:

f. Name and contact information of person to be contacted on matters involving this application:

Application for Federal Assistance SF-424

Preapplication

Application

Changed/Corrected Application

New

Continuation

Revision

* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

* g. TOTAL

Prefix: * First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* Telephone Number:

* Email:

Fax Number:

* Signature of Authorized Representative: * Date Signed:

18. Estimated Funding ($):

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

* a. Applicant

Attach an additional list of Program/Project Congressional Districts if needed.

* b. Program/Project

* a. Start Date: * b. End Date:

16. Congressional Districts Of:

17. Proposed Project:

a. This application was made available to the State under the Executive Order 12372 Process for review on

b. Program is subject to E.O. 12372 but has not been selected by the State for review.

c. Program is not covered by E.O. 12372.

Yes No

** I AGREE

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

If "Yes", provide explanation and attach

SF424_2_1 Page 4 win2k

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OMB Number: 4040-0004

Expiration Date: 12/31/2019

* 1. Type of Submission:

* 2. Type of Application:

* 3. Date Received:

4. Applicant Identifier:

5a. Federal Entity Identifier:

5b. Federal Award Identifier:

6. Date Received by State:

7. State Application Identifier:

* a. Legal Name:

* b. Employer/Taxpayer Identification Number (EIN/TIN):

* c. Organizational DUNS:

* Street1:

Street2:

* City:

County/Parish:

* State:

Province:

* Country:

* Zip / Postal Code:

Department Name:

Division Name:

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* Telephone Number:

Fax Number:

* Email:

* If Revision, select appropriate letter(s):

* Other (Specify):

State Use Only:

8. APPLICANT INFORMATION:

d. Address:

e. Organizational Unit:

f. Name and contact information of person to be contacted on matters involving this application:

Application for Federal Assistance SF-424

Type of Submission is required. Select one type of submission in accordance with agency instructions.

Type of Submission: Select one type of submission in accordance with agency instructions. One selection is required.

Type of Application: Select one type of application in accordance with agency instructions. One selection is required.

Type of Application is required. Select one type of application in accordance with agency instructions.

* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Application for Federal Assistance SF-424

Form Attachments:

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

* g. TOTAL

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* Telephone Number:

* Email:

Fax Number:

* Signature of Authorized Representative:

* Date Signed:

18. Estimated Funding ($):

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

Application for Federal Assistance SF-424

* a. Applicant

Attach an additional list of Program/Project Congressional Districts if needed.

* b. Program/Project

* a. Start Date:

* b. End Date:

16. Congressional Districts Of:

17. Proposed Project:

Application Subject to Review is required.

Application Subject to Review: One selection is required.

Applicant Delinquent on Federal Debt: A selection is required.

Applicant Delinquent on Federal Debt is required.

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

If "Yes", provide explanation and attach

ViewBurdenStatement:

Type of Submission is required. Select one type of submission in accordance with agency instructions. :

Type of Application is required. Select one type of application in accordance with agency instructions.:

Mandatory:

DateEntered1:

DateEntered2:

Submission Type - Preapplication: Select one type of submission in accordance with agency instructions. One selection is required.

Select if the type of submission is a Preapplication.:

Submission Type - Application: Select one type of submission in accordance with agency instructions. One selection is required.

Select if the type of submission is an Application.:

Submission Type - Changed Application: Select one type of submission in accordance with agency instructions. One selection is required.

Select this submission if requested by the agency to change or correct a previously submitted application. Unless requested by the agency, applicants may not use this to submit changes after the closing date.:

Application Type - New: Select one type of application in accordance with agency instructions. One selection is required..

Select New if the application is being submitted to an agency for the first time.:

Application Type - Continuation: Select one type of application in accordance with agency instructions. One selection is required.

Select Continuation if the submission is an extension for an additional funding/budget period for a project with a projected completion date. This can include renewals.:

Application Type - Revision: Select one type of application in accordance with agency instructions. One selection is required.

Select Revision if the submission is a change in the Federal Government’s financial obligation or contingent liability from an existing obligation. :

Revision Type: Select a revision type from the list provided. A selection is required if Type of Application is Revision.:

Other (specify): Please specify the type of revision. This field is required if E. Other is checked.:

Date Received: Enter the Date Received. Enter in the format mm/dd/yyyy. This field is required.:

Applicant Identifier: Enter the applicant's control number, if applicable.:

Federal Entity Identifier: Enter the number assigned to your organization by the Federal agency.:

Federal Award Identifier: For new applications leave blank. For a continuation or revision to an existing award, enter the previously assigned Federal award identifier number. If a changed/corrected application, enter the Federal Identifier in accordance with agency instructions.:

Date Received by State: Enter the date received by the State, if applicable. Enter in the format mm/dd/yyyy.:

State Application Identifier: Enter the identifier assigned by the State, if applicable.:

Organization Name: Enter the legal name of the applicant that will undertake the assistance activity. This field is required.:

EIN/TIN: Enter either TIN or EIN as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444. This field is required.:

DUNS Number: Enter the DUNS or DUNS+4 number of the applicant organization. This field is required.:

Street1: Enter the first line of the Street Address. This field is required.:

Street2: Enter the second line of the Street Address.:

City: Enter the City. This field is required.:

County/Parish: Enter the County/Parish.:

State: Select the state, US possession or military code from the provided list. This field is required if Country is the United States.:

Province: Enter the Province.:

Country: Select the Country from the provided list. This field is required.: USA: UNITED STATES

ZIP/ Postal Code: Enter the nine-digit Postal Code (e.g., ZIP code). This field is required if the country is the United States.:

Department Name: Enter the name of primary organizational department, service, laboratory, or equivalent level within the organization which will undertake the assistance activity.:

Division Name: Enter the name of primary organizational division, office, or major subdivision which will undertake the assistance activity.:

AOR Prefix: Select the Prefix from the provided list or enter a new Prefix not provided on the list.:

AOR First Name: Enter the First Name. This field is required.:

AOR Middle Name: Enter the Middle Name.:

AOR Last Name: Enter the Last Name. This field is required.:

AOR Suffix: Select the Suffix from the provided list or enter a new Suffix not provided on the list.:

Title: Enter the position title.:

Organizational Affiliation: Enter the organization if different from the applicant organization.:

Telephone Number: Enter the daytime Telephone Number. This field is required.:

Fax Number: Enter the Fax Number.:

Email: Enter a valid Email Address. This field is required.:

TextField1:

Type of Applicant 1: Select the appropriate applicant type. A selection is required.:

Type of Applicant 2: Select the appropriate applicant type.:

Type of Applicant 3: Select the appropriate applicant type.:

Type of Applicant Other: Enter the applicant type here if you selected "Other (specify)" for Type of Applicant.:

Agency Name: Enter Agency Name.:

CFDA Number: Enter the Catalog of Federal Domestic Assistance Number.:

CFDA/Program Title: Enter the CFDA Title.:

Opportunity Number: Enter the Funding Opportunity Number. This field is required.:

Opportunity Title: Enter the Title. This field is required.:

Competition Number: Enter the Competition Identification Number.:

Competition Title: Enter the Title.:

spacer:

Project Title: Enter a brief, descriptive title of the project. This field is required.:

FileName:

MimeType:

href:

hashAlgorithm:

HashValue_data:

ObjList:

FNList:

AttCount:

Add:

Delete:

View:

Done:

Attachment Check Box: Indicates whether an Attachment is attached:

Additional Project Title - View Attachment Button: Select to view attachment(s).:

Additional Project Title - Delete Attachment Button: Select to delete attachment(s).:

Additional Project Title - Add Attachment Button: Select to add attachment(s).:

Debt Explanation - View Attachment Button: Click here to view the attachment.:

Debt Explanation - Delete Attachment Button: Click here to delete the attachment.:

Debt Explanation - Add Attachment Button: Click here to add the attachment.:

Debt Explanation is required.:

Applicant District: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If outside the US, enter 00-000.

This field is required.:

Program District: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If all districts in a state are affected, enter "all" for the district number. Example: MD-all for all congressional districts in Maryland.

If nationwide (all districts in all states), enter US-all.

If the program/project is outside the US, enter 00-000.

This field is required.:

Additional Congressional Districts:

Additional Congressional Districts - Add Attachment Button: Click here to add the attachment.:

Additional Congressional Districts - Delete Attachment Button: Click here to delete the attachment.:

Additional Congressional Districts - View Attachment Button: Click here to view the attachment.:

Project End Date: Enter the date in the format MM/DD/YYYY. This field is required.:

Project Start Date: Enter the date in the format MM/DD/YYYY. This field is required.:

Federal Estimated Funding: Enter the dollar amount. This field is required.:

Applicant Estimated Funding: Enter the dollar amount. This field is required.:

State Estimated Funding: Enter the dollar amount. This field is required.:

Local Estimated Funding: Enter the dollar amount. This field is required.:

Other Estimated Funding: Enter the dollar amount. This field is required.:

Program Income Estimated Funding: Enter the dollar amount. This field is required.:

Total Estimated Funding: Enter the total dollar amount. This field is required.:

State Review Available: Click to select option.:

State Review Not Selected: Click to select option.:

State Review Not Covered: Click to select option.:

State Review Date: Enter the date in the format MM/DD/YYYY.:

Delinquent on Debt: Click to select option.:

Not Delinquent on Debt: Click to select option.:

I Agree checkbox is required: Check I Agree checkbox to provide the required Certifications and Assurances.:

Certification Agree: Check to select. This field is required.: N: No

AOR Title: Enter the position title. This field is required.:

AOR Telephone Number: Enter the daytime Telephone Number. This field is required.:

AOR Fax Number: Enter the Fax Number.:

AOR Email: Enter a valid Email Address. This field is required.:

AOR Signature: Enter the Signature of Authorized Representative.:

Market (choose one): Select the SEP market area that best pertains to this SEP activity. One selection is required.:

DateEntered19:

Applicant Delinquent on Federal Debt is required.:

DateEntered20:

Date Signed: Enter the Date Signed. Enter in the format mm/dd/yyyy. This field is required.:

SECTION A - BUDGET SUMMARY

BUDGET INFORMATION - Non-Construction Programs OMB Number: 4040-0006 Expiration Date: 01/31/2019

Grant Program Function or

Activity

(a)

Catalog of Federal Domestic Assistance

Number

(b)

Estimated Unobligated Funds New or Revised Budget

Federal (c)

Non-Federal (d)

Federal (e)

Non-Federal (f)

Total (g)

5. Totals

4.

3.

2.

1. $ $ $ $

Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 1

SECTION B - BUDGET CATEGORIES

7. Program Income

d. Equipment

e. Supplies

f. Contractual

g. Construction

h. Other

j. Indirect Charges

k. TOTALS (sum of 6i and 6j)

i. Total Direct Charges (sum of 6a-6h)

(1)

Authorized for Local Reproduction Prescribed by OMB (Circular A -102) Page 1A

GRANT PROGRAM, FUNCTION OR ACTIVITY

(2) (3) (4) (5)

Total6. Object Class Categories

a. Personnel

b. Fringe Benefits

c. Travel

SECTION D - FORECASTED CASH NEEDS

14. Non-Federal

SECTION C - NON-FEDERAL RESOURCES

(a) Grant Program (b) Applicant (d) Other Sources(c) State (e)TOTALS

$8.

9.

10.

11.

12. TOTAL (sum of lines 8-11)

15. TOTAL (sum of lines 13 and 14)

13. Federal

Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

FUTURE FUNDING PERIODS (YEARS)

SECTION F - OTHER BUDGET INFORMATION

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT

Authorized for Local Reproduction

$16.

17.

18.

19.

20. TOTAL (sum of lines 16 - 19)

21. Direct Charges: 22. Indirect Charges:

23. Remarks:

(a) Grant Program (b)First (c) Second (d) Third (e) Fourth

Prescribed by OMB (Circular A -102) Page 2

SF424A- Page1 win2k

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SECTION A - BUDGET SUMMARY

BUDGET INFORMATION - Non-Construction Programs

OMB Number: 4040-0006

Expiration Date: 01/31/2019

Grant Program

Function or Activity

(a)

Catalog of Federal Domestic Assistance Number

(b)

Estimated Unobligated Funds

New or Revised Budget

Federal

(c)

Non-Federal

(d)

Federal

(e)

Non-Federal

(f)

Total

(g)

5. Totals

4.

3.

2.

1.

Standard Form 424A (Rev. 7- 97)

Prescribed by OMB (Circular A -102) Page 1

SECTION B - BUDGET CATEGORIES

7. Program Income

d. Equipment

e. Supplies

f. Contractual

g. Construction

h. Other

j. Indirect Charges

k. TOTALS (sum of 6i and 6j)

i. Total Direct Charges (sum of 6a-6h)

(1)

Authorized for Local Reproduction

Prescribed by OMB (Circular A -102) Page 1A

Standard Form 424A (Rev. 7- 97)

GRANT PROGRAM, FUNCTION OR ACTIVITY

(2)

(3)

(4)

(5)

Total

6. Object Class Categories

a. Personnel

b. Fringe Benefits

c. Travel

Total

Total

Total

Total

Total

SECTION D - FORECASTED CASH NEEDS

14. Non-Federal

SECTION C - NON-FEDERAL RESOURCES

(a) Grant Program

(b) Applicant

(d) Other Sources

(c) State

(e)TOTALS

8.

9.

10.

11.

12. TOTAL (sum of lines 8-11)

15. TOTAL (sum of lines 13 and 14)

13. Federal

Total for 1st Year

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

FUTURE FUNDING PERIODS (YEARS)

SECTION F - OTHER BUDGET INFORMATION

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT

Authorized for Local Reproduction

16.

17.

18.

19.

20. TOTAL (sum of lines 16 - 19)

21. Direct Charges:

22. Indirect Charges:

23. Remarks:

(a) Grant Program

(b)First

(c) Second

(d) Third

(e) Fourth

Standard Form 424A (Rev. 7- 97)

Prescribed by OMB (Circular A -102) Page 2

XDPFirstField:

Mandatory:

CHECK1:

Enter the name of the activity or function.:

Enter the catalog number.:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Total:

Enter the name of the activity or function.:

Enter the catalog number.:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Total:

Enter the name of the activity or function.:

Enter the catalog number.:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Total:

Enter the name of the activity or function.:

Enter the catalog number.:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Total:

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Name of the grant program, function or activity from which funds will be derived.

Defaults to the corresponding program name in section A, but may be overwritten if called for by the instructions for this funding opportunity:

Enter funds required for personnel from the selected program:

Enter funds required for fringe benefits from the selected program:

Enter funds required for travel from the selected program:

Enter funds required for equipment from the selected program:

Enter funds required for supplies from the selected program:

Enter funds required for contractual costs from the selected program:

Enter funds required for construction from the selected program:

Enter funds required for other costs from the selected program:

Total Direct Charges:

Enter funds required for indirect charges from the selected program:

Total (sum of 6i and 6j):

Enter program income for the selected program:

Name of the grant program, function or activity from which funds will be derived.

Defaults to the corresponding program name in section A, but may be overwritten if called for by the instructions for this funding opportunity:

Enter funds required for personnel from the selected program:

Enter funds required for fringe benefits from the selected program:

Enter funds required for travel from the selected program:

Enter funds required for equipment from the selected program:

Enter funds required for supplies from the selected program:

Enter funds required for contractual costs from the selected program:

Enter funds required for construction from the selected program:

Enter funds required for other costs from the selected program:

Total Direct Charges:

Enter funds required for indirect charges from the selected program:

Total (sum of 6i and 6j):

Enter program income for the selected program:

Name of the grant program, function or activity from which funds will be derived.

Defaults to the corresponding program name in section A, but may be overwritten if called for by the instructions for this funding opportunity:

Enter funds required for personnel from the selected program:

Enter funds required for fringe benefits from the selected program:

Enter funds required for travel from the selected program:

Enter funds required for equipment from the selected program:

Enter funds required for supplies from the selected program:

Enter funds required for contractual costs from the selected program:

Enter funds required for construction from the selected program:

Enter funds required for other costs from the selected program:

Total Direct Charges:

Enter funds required for indirect charges from the selected program:

Total (sum of 6i and 6j):

Enter program income for the selected program:

Name of the grant program, function or activity from which funds will be derived.

Defaults to the corresponding program name in section A, but may be overwritten if called for by the instructions for this funding opportunity:

Enter funds required for personnel from the selected program:

Enter funds required for fringe benefits from the selected program:

Enter funds required for travel from the selected program:

Enter funds required for equipment from the selected program:

Enter funds required for supplies from the selected program:

Enter funds required for contractual costs from the selected program:

Enter funds required for construction from the selected program:

Enter funds required for other costs from the selected program:

Total Direct Charges:

Enter funds required for indirect charges from the selected program:

Total (sum of 6i and 6j):

Enter program income for the selected program:

Total:

Total:

Total:

Total:

Total:

Total:

Total:

Total:

Total Direct Charges:

Total:

Total (sum of 6i and 6j):

Total:

Name of the grant program from which funds will be derived.

Defaults to the corresponding program name in section A, but may be overwritten if called for by the instructions for this funding opportunity:

Enter resources provided by the applicant for the selected program:

Enter resources provided by one or more states for the selected program:

Enter resources provided by the other sources (e.g. donors) for the selected program:

Totals:

Name of the grant program from which funds will be derived.

Defaults to the corresponding program name in section A, but may be overwritten if called for by the instructions for this funding opportunity:

Enter resources provided by the applicant for the selected program:

Enter resources provided by one or more states for the selected program:

Enter resources provided by the other sources (e.g.