ANNEX 4a - PHASE 2 BUSINESS APPLICATION COVER PAGE for FY22 RFA.pdf

American Schools and Hospitals Abroad Initiative Solicitation No.: 720DD122RFA00002

ANNEX 4a – PHASE 2 BUSINESS APPLICATION COVER PAGE

I. Cover Page (3 pages)

1. Date of submission

2. Name of the applicant USO and address

3. USO’s Unique Entity Identifier (UEI): Please list the UEIs that apply to your organization.

System for Award Management UEI

Dun and Bradstreet Universal Numbering System (DUNS) number

4. The USO’s System for Award Management (SAM) expiration date

5. USO’s Federal Employer/Taxpayer Identification Number (EIN/TIN)

6. Name of the benefiting OSI and address

Check one: School/University Hospital Center Library Center of Excellence

7. Amount of federal funding requested

8. Amount of leveraged funds (if applicable) or cost share (if applicable)

9. The total activity cost

10. Activity Name/Title

11. ASHA Funding Is For

Commodities only Construction/renovation only Construction/renovation with commodities

12. Please describe what the ASHA resources will fund:

13. Project Summary