ANNEX 2a - PHASE 2 COVER PAGE for FY21 RFA.pdf

ANNEX 2a – PHASE 2 TECHNICAL APPLICATION COVER PAGE

I. Cover Page (3 pages)

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:

Optional: Applicants may also include a photo or sketch in the space below (does not count against the page limit):

14. Public Diplomacy Benefit Summary - Please provide a brief summary of the public diplomacy benefit of this project.

SAM.GOV SCREENSHOT

Copy and paste a screenshot of the Applicant's current SAM account on this page.