DLTChecklistFY2022CPF.xlsx
XLSX spreadsheet 41 KB Posted
- Attached to
- Distance Learning and Telemedicine Grant Program
- Opportunity number
- RUS-22-01-DLT
About this file
DLT Checklist
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DLTWorksheetsFY2022CPF.xlsx | XLSX spreadsheet | |
| DLT CPF App Guide_Final.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DLT CPF FY2022 Checklist
| FY2022 DLT CPF- Application Checklist | |||
| Section | Description | Complete | Schedule |
| A | Completed Standard Form 424 | ||
| B | Site Worksheet | ||
| C | Executive Summary of the Project, including Publicly Releasable Project Description | ||
| D | Scoring Criteria Documentation | ||
| D-1 Rurality | |||
| E | Matching Requirements | ||
| F | Scope of Work | ||
| 1 - Specific Activities to be performed | |||
| 2 - Who will carry out activities | |||
| 3 - Timeframes for accomplishing objectives | |||
| 4 - Budget for all capital expenditures | |||
| G | Financial Information and Sustainability | ||
| H | Statement of Experience | ||
| I | Telecommunications Systems Plan | ||
| 1 - Capabilities & Description of Telecommunications Equipment | |||
| 2 - Complete Listing of all Telecommunications Equipment. | |||
| 3 - Description of the consultations with telecommunications carriers. | |||
| 4 - A diagram or map of the proposed system overlaid with a geographic map of the service area | |||
| 5- Sites (hub, hub/end-users, or end-users that will participate in the project and where equipment is located | |||
| J | Compliance with Other Federal Statutes and Regulations | ||
| 1. Certificate Regarding Flood Hazard Area Precautions (check appropriate box below) | |||
| The Project is not located in a 100-yr Flood Plain. No flood insurance is required. | J-1 | ||
| The Project is located in a 100-yr Flood Plain. See attached statement regarding who is or will be providing the flood insurance. | |||
| 2. Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Certification | J-2 | ||
| 3. Certificate Regarding Architectural Barriers | J-3 | ||
| 4. Non-Duplication of Services Certificate | J-4 | ||
| K | Evidence of Legal Existence and Authority to Contract with the Federal Government | ||
| 1 - Evidence of Legal Existence | |||
| 2 - SAM.gov registration with Financial Assistance General Certifications & Representations | |||
| L | Environmental Impact and Historic Preservation (indicate which document was provided) | ||
| Environmental Impact Survey | |||
| Environmental Questionnaire | |||
| M | Supplemental Information |
By signing this certification, you are agreeing to the language in schedules J-1, J-2, J-3, and J-4, as shown in the application guide. If a box checked in Section J above requires an attachment, the attachment is provided with this application. If you have any questions about your application, please contact RUS prior to submitting this application and certification.
Print Name and Title below the line (sign on the line). Date
Flood Insurance Attachment
Flood Insurance Attachment (Please explain below who is or will be providing flood insurance for any project sites which lie in the 100-yr. flood plain.):
Debt Delinquency Attachment
Debt Delinquency Attachment (Please explain below the details of any outstanding delinquent federal debt.):
File details come from the government source that posted it. Updated .