Attachment A - SF 424 - Application for Federal Assistance.pdf
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- Attached to
- Dworshak Natural Resource Training and Education
- Opportunity number
- W912EF-26-2-A002
About this file
This is the SF-424 Application for Federal Assistance form, a standardized federal form used to apply for grants and other federal funding. The OMB Number is 4040-0004 with an expiration date of December 31, 2022.
The form captures essential applicant and project information required for federal grant submissions. Section 8 collects applicant details including legal name, Employer Identification Number (EIN), organizational DUNS number, complete address, and contact information for the primary application point of contact. Section 9 requires identification of the applicant type (e.g., state, local government, nonprofit, business). Section 10 requests the name of the federal agency receiving the application, while Section 11 requires the Catalog of Federal Domestic Assistance (CFDA) number and title. Section 12 mandates the Funding Opportunity Number and descriptive title, and Section 13 requests a Competition Identification Number if applicable. Section 16 requires identification of congressional districts for both the applicant and the program/project location. Section 17 specifies the proposed project start and end dates, and Section 18 requires itemized estimated funding amounts for federal, applicant, state, local, and other sources, plus program income and totals. Section 19 addresses Executive Order 12372 state review requirements, Section 20 asks about federal debt delinquency, and Section 21 requires certification and signature by an authorized representative, including telephone, email, and signature with date. The form allows attachments for supporting documentation as specified in agency instructions.
Attachment A - SF 424 - Application for Federal Assistance.
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OMB Number: 4040-0004 View Burden Statement Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
* 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s):
Preapplication
Application
Changed/Corrected Application
New
Continuation * Other (Specify):
Revision
* 3. Date Received: 4. Applicant Identifier:
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:
d. Address:
* Street1:
Street2:
* City:
County/Parish:
* State:
Province:
* Country: USA: UNITED STATES
* Zip / Postal Code:
e. Organizational Unit:
Department Name: Division Name:
f. Name and contact information of person to be contacted on matters involving this application:
Prefix:
Middle Name:
* Last Name:
Suffix:
* First Name:
Title:
Organizational Affiliation:
* Telephone Number: Fax Number:
* Email:
Application for Federal Assistance SF-424
* 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.):
Add Attachment
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* 15. Descriptive Title of Applicant's Project:
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments View Attachments
Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant
* b. Program/Project
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment Delete Attachment View Attachment
17. Proposed Project:
* a. Start Date: * b. End Date:
18. Estimated Funding ($):
* a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
* f. Program Income
* g. TOTAL
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
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.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)
Yes No
If "Yes", provide explanation and attach
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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)
** I AGREE
** 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:
Prefix:
Middle Name:
* Last Name:
Suffix:
* Title:
* Telephone Number:
* Email:
* First Name:
Fax Number:
* Signature of Authorized Representative: * Date Signed:
| Add Attachment Delete Attachment View Attachment |
| a. This application was made available to the State under the Executive Order 12372 Process for review on . |
| Yes No |
| ** I AGREE |
| Preapplication: Off |
| Application: Off |
| ChangedCorrected Application: Off |
| New: Off |
| Continuation: Off |
| Revision: Off |
| If Revision select appropriate letters: |
| Other Specify: |
| 3 Date Received: |
| 4 Applicant Identifier: |
| 5a Federal Entity Identifier: |
| 5b Federal Award Identifier: |
| 6 Date Received by State: |
| undefined: |
| a Legal Name: |
| b EmployerTaxpayer Identification Number EINTIN: |
| undefined_2: |
| undefined_3: |
| undefined_4: |
| undefined_5: |
| CountyParish: |
| undefined_6: |
| undefined_7: |
| Zip Postal Code: |
| Department Name: |
| Division Name: |
| Prefix Middle Name Last Name Suffix: |
| First Name: |
| Prefix Middle Name Last Name Suffix_2: |
| Title: |
| Organizational Affiliation: |
| Telephone Number: |
| Fax Number: |
| 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_2: |
| 13 Competition Identification Number: |
| Title_3: |
| 14 Areas Affected by Project Cities Counties States etc: |
| 15 Descriptive Title of Applicants Project: |
| Attach supporting documents as specified in agency instructions Add Attachments Delete Attachments View Attachments: |
| Attach an additional list of ProgramProject Congressional Districts if needed: |
| a Federal b Applicant c State d Local e Other f Program Income g TOTAL: |
| b Applicant: |
| undefined_8: |
| undefined_9: |
| f Program Income: |
| a This application was made available to the State under the Executive Order 12372 Process for review on: Off |
| b Program is subject to EO 12372 but has not been selected by the State for review: Off |
| c Program is not covered by EO 12372: Off |
| undefined_10: |
| 20 Is the Applicant Delinquent On Any Federal Debt If Yes provide explanation in attachment: Off |
| If Yes provide explanation and attach: |
| I AGREE: |
| undefined_11: |
| First Name_2: |
| Middle Name: |
| undefined_12: |
| Title_4: |
| Telephone Number_2: |
| Fax Number_2: |
| CD_1: |
| CD_2: |
| Start Date: |
| End Date: |
| Federal: |
| Applicant: |
| State: |
| Local: |
| Other: |
| Date Signed: |
| Name: |
| Last Name: |
| Email: |
File details come from the government source that posted it. Updated .