oppCDC-RFA-DP18-1812PPHF18-cfda93.762-cidCDC-RFA-DP18-1812PPHF18.pdf

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Submission D:20061219143208- 05'00' D:20061219143305- 05'00' Grant Application Package Grants.gov Grant Application Package Grants.gov CFDA Number:

Opportunity Title:

Offering Agency:

Agency Contact:

Opportunity Open Date:

Opportunity Close Date:

CFDA Description:

Opportunity Number:

Competition ID:

Application Filing Name:

Select Forms to Complete Mandatory Optional Instructions About the Application Package.

· This application package is used to apply for the specific Federal funding opportunity referenced in this application package. Please verify that you have downloaded and completed the application package for the correct funding opportunity announcement.

· This application can be completed in its entirety offline using Adobe Reader.

· You can save your application at any time by clicking the "Save" button at the top of your screen.

Using the Application Package.

· The application package is a compilation of forms, such as the SF-424, budget forms, attachment forms, and narratives.

· It is recommended that the SF-424 cover page be the first form completed for the application package. Some data entered on the SF-424 cover page will pre-populate data fields in other subsequent forms in the application package.

· Forms identified as Mandatory are required to be filled out to successfully submit your grant application at a minimum. Optional Forms are used to provide additional support for this application or may be required for specific types of grant activity. Reference the application package instructions for more information regarding Optional Forms.

· Select the check box next to the form's name to add the form to the application package. To navigate to the form in the application package, click on the underlined form name. To remove a form from the application package, uncheck the box next to the form name.

· When you open a form, required fields are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a field, you will receive an error message.

· Your application will be rejected if you do not follow the Agency and Grants.gov guidance on file naming conventions. Please review the application instructions for this Opportunity Package for specific guidelines and refer to FAQs in the Grants.gov Applicants tab.

Submitting the Application Package.

· You can save the application as you work on it by clicking on the "Save" button.

· Click on the "Check Package for Errors" button to ensure that you have completed all required data fields. Correct any errors. If no errors are found, save the application package. The "Save & Submit" button will also become active.

· You need to be registered with Grants.gov and granted the role of Authorized Organizational Representative by your organization's eBIZ POC in order to successfully submit your application.

· Click on the "Save & Submit" button to begin the application submission process. (You must be connected to the Internet at this time.) You will be taken to the applicant login page to enter your Grants.gov username and password. Follow all onscreen instructions for submission. Upon submission, you will be provided with a Grants.gov Tracking Number.

· You will receive a series of emails after submission: 1. Successful transmission to Grants.gov and your application is undergoing a series of system checks, 2. An email either indicating specific errors in your application OR an email indicating that your submission is being prepared for agency download, and 3. Your application has been retrieved from Grants.gov by the funding agency for further review only after the agency acknowledges the download. If you receive an email with an error, please correct your application and resubmit.

Additional Application Package Information.

· Additional instructions and FAQs about the Application Package can be found in the Grants.gov Applicants tab.

This electronic grants application is intended to be used to apply for the specific Federal funding opportunity referenced here.

If the Federal funding opportunity listed is not the opportunity for which you want to apply, close this application package by clicking on the "Cancel" button at the top of this screen. You will then need to locate the correct Federal funding opportunity, download its application and then apply.

Name- Version Form Tag Name Mandatory Name- Version Form Tag Name Optional Name- Version Form Tag Name SelectedOptional Name- Version Form Tag Name SelectedMandatory Grant Application Package Grants.gov Grant Application Package Grants.gov

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THIS PACKAGE IS NO LONGER VALID AND CANNOT BE SUBMITTED.

To download the Grants.gov required version visit:

http://www.grants.gov/web/grants/applicants/adobe-software-compatibility.html For more information:

http://www.grants.gov/web/grants/applicants/applicant-faqs.html Also the Grants.gov Contact Center is available for further assistance. The Contact Center is available 24 hours a day, 7 days a week excluding federal holidays.

Email: support@grants.gov Phone: 1-800-518-4726 (local toll free). For international callers, please dial 1-606-545-5035 to speak with a Contact Center representative.

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To download the Grants.gov required version visit:

http://www.grants.gov/web/grants/applicants/adobe-software-compatibility.html For more information:

http://www.grants.gov/web/grants/applicants/applicant-faqs.html Also the Grants.gov Contact Center is available for further assistance. The Contact Center is available 24 hours a day, 7 days a week excluding federal holidays.

Email: support@grants.gov Phone: 1-800-518-4726 (local toll free). For international callers, please dial 1-606-545-5035 to speak with a Contact Center representative.

OMB Number: 4040-0004 Expiration Date: 10/31/2019

* 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:

E.O. 12372 Review selection is required: Select status of Review.

Application Subject to Review: One selection is required.

Applicant Delinquent on Federal Debt: A selection is required.

Applicant Delinquent on Federal Debt is required: Select an option.

* 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 Project Abstract Summary OMB Number: 0980-0204 Expiration Date: 04/30/2015 Program Announcement (CFDA) Program Announcement (Funding Opportunity Number) Closing Date Applicant Name Length of Proposed Project Application Control No.

Federal Share 1st Year Federal Share 2nd Year Federal Share 3rd Year Non-Federal Share 1st Year Non-Federal Share 2nd Year Non-Federal Share 3rd Year Project Title Federal Share Requested (for each year) Non-Federal Share Requested (for each year) Federal Share 4th Year Federal Share 5th Year Non-Federal Share 4th Year Non-Federal Share 5th Year Project Abstract Summary Project Summary Estimated number of people to be served as a result of the award of this grant.

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:$

* Street 1

* City State Zip Street 2

* Last Name Prefix

* First Name Middle Name Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 Approved by OMB 4040-0013

1. * Type of Federal Action:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Type of Federal Action is required: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. * Status of Federal Action:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action is required: Identify the status of the covered Federal action.

3. * Report Type:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Reporting Entity: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. This field is required.

Reporting Entity is required: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known:

* Name

* Street 1 Street 2

* City State Zip Congressional District, if known:

Congressional District, if known:

* Name

* City State

* Street 1 Street 2 Zip

6. * Federal Department/Agency:

7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a) Prefix

* First Name Middle Name

* Street 1

* City State Zip Street 2 11.

* Last Name Suffix Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name:

Prefix

* First Name Middle Name

* Last Name Suffix Title:

Telephone No.:

Date:

Federal Use Only:

Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

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

HHS-5161-1

OMB Number: 0930-0367 Expiration Date: 06/30/2020

CHECKLIST

NOTE TO APPLICANT: This form must be completed and submitted with the original of your application. Be sure to complete each page of this form. Check the appropriate boxes and provide the information requested. This form should be attached as the last pages of the signed original of the application.

Type of Application:

PART A: The following checklist is provided to assure that proper signatures, assurances, and certifications have been submitted.

Included NOT Applicable

1. Proper Signature and Date on the SF 424 (FACE PAGE)

2. If your organization currently has on file with HHS the following assurances, please identify which have been filed by indicating the date of such filing on the line provided. (All four have been consolidated into a single form, HHS 690) Civil Rights Assurance (45 CFR 80) Assurance Concerning the Handicapped (45 CFR 84) Assurance Concerning Sex Discrimination (45 CFR 86) Assurance Concerning Age Discrimination (45 CFR 90 & 45 CFR 91)

3. Human Subjects Certification, when applicable (45 CFR 46) PART B: This part is provided to assure that pertinent information has been addressed and included in the application.

YES

NOT Applicable

1. Has a Public Health System Impact Statement for the proposed program/project been completed and distributed as required?

2. Has the appropriate box been checked on the SF-424 (FACE PAGE) regarding intergovernmental review under E.O. 12372 ? (45 CFR Part 100)

3. Has the entire proposed project period been identified on the SF-424 (FACE PAGE)?

4. Have biographical sketch(es) with job description(s) been provided, when required?

5. Has the "Budget Information" page, SF-424A (Non-Construction Programs) or SF-424C (Construction Programs), been completed and included?

6. Has the 12 month narrative budget justification been provided?

7. Has the budget for the entire proposed project period with sufficient detail been provided?

8. For a Supplemental application, does the narrative budget justification address only the additional funds requested?

9. For Competing Continuation and Supplemental applications, has a progress report been included?

PART C: In the spaces provided below, please provide the requested information.

Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Title:

Street1:

Street2:

City:

State:

ZIP / Postal Code:

Telephone Number:

E-mail Address:

Fax Number:

Organization:

Business Official to be notified if an award is to be made Program Director/Project Director/Principal Investigator designated to direct the proposed project or program.

Title:

Street1:

Street2:

City:

State:

ZIP / Postal Code:

ZIP / Postal Code4:

Telephone Number:

ZIP / Postal Code4:

E-mail Address:

Fax Number:

Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Organization:

HHS Checklist (08-2007) PART D: A private, nonprofit organization must include evidence of its nonprofit status with the application. Any of the following is acceptable evidence. Check the appropriate box or complete the "Previously Filed" section, whichever is applicable.

(a) A reference to the organization's listing in the Internal Revenue Service's (IRS) most recent list of tax-exempt organizations described in section 501(c)(3) of the IRS Code.

(b) A copy of a currently valid Internal Revenue Service Tax exemption certificate.

(c) A statement from a State taxing body, State Attorney General, or other appropriate State official certifying that the applicant organization has a nonprofit status and that none of the net earnings accrue to any private shareholders or individuals.

(d) A certified copy of the organization's certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization.

(e) Any of the above proof for a State or national parent organization, and a statement signed by the parent organization that the applicant organization is a local nonprofit affiliate.

INVENTIONS

If this is an application for continued support, include: (1) the report of inventions conceived or reduced to practice required by the terms and conditions of the grant; or (2) a list of inventions already reported, or (3) a negative certification.

EXECUTIVE ORDER 12372

Effective September 30, 1983, Executive Order 12372(Intergovernmental Review of Federal Programs) directed OMB to abolish OMB Circular A-95 and establish a new process for consulting with State and local elected officials on proposed Federal financial assistance. The Department of Health and Human Services implemented the Executive Order through regulations at 45 CFR Part 100 (Inter-governmental Review of Department of Health and Human Services Programs and Activities). The objectives of the Executive Order are to (1) increase State flexibility to design a consultation process and select the programs it wishes to review, (2) increase the ability of State and local elected officials to influence Federal decisions and (3) compel Federal officials to be responsive to State concerns, or explain the reasons.

The regulations at 45 CFR Part 100 were published in the Federal Register on June 24, 1983, along with a notice identifying the Department’s programs that are subject to the provisions of Executive Order 12372. Information regarding HHS programs subject to Executive Order 12372 is also available from the appropriate awarding office.

States participating in this program establish State Single Points of Contact (SPOCs) to coordinate and manage the review and comment on proposed Federal financial assistance. Applicants should contact the Governor’s office for information regarding the SPOC, programs selected for review, and the consultation (review) process designed by their State.

Applicants are to certify on the face page of the SF-424 (attached) whether the request is for a program covered under Executive Order 12372 and, where appropriate, whether the State has been given an opportunity to comment.

HHS-5161-1 (08/2007)

THE FOLLOWING ASSURANCES/CERTIFICATIONS ARE MADE AND VERIFIED BY THE SIGNATURE OF THE OFFICIAL SIGNING FOR THE APPLICANT ORGANIZATION ON THE FACE PAGE OF THE APPLICATION:

BY SIGNING THE FACE PAGE OF THIS APPLICATION, THE APPLICANT ORGANIZATION CERTIFIES THAT THE STATEMENTS IN THIS APPLICATION ARE TRUE, COMPLETE, AND ACCURATE TO THE BEST OF THE SIGNER’S KNOWLEDGE, AND THE ORGANIZATION ACCEPTS THE OBLIGATION TO COMPLY WITH U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES’ TERMS AND CONDITIONS IF AN AWARD IS MADE AS A RESULT OF THE APPLICATION. THE SIGNER IS ALSO AWARE THAT ANY FALSE, FICTITIOUS, OR FRAUDULENT STATEMENTS OR CLAIMS MAY SUBJECT THE SIGNER TO CRIMINAL, CIVIL, OR ADMINISTRATIVE PENALTIES.

Civil Rights – Title VI of the Civil Rights Act of 1964 (P.L. 88-352), as amended, and all the requirements imposed by or pursuant to the HHS regulation (45 CFR part 80).

Handicapped Individuals – Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as amended, and all requirements imposed by or pursuant to the HHS regulation (45 CFR part 84).

Sex Discrimination – Title IX of the Educational Amendments of 1972 (P.L. 92-318), as amended, and all requirements imposed by orpursuant to the HHS regulation (45 CFR part 86).

Age Discrimination – The Age Discrimination Act of 1975 (P.L. 94-135), as amended, and all requirements imposed by or pursuant to the HHS regulation (45 CFR part 91).

Debarment and Suspension – Title 2 CFR part 376.

Certification Regarding Drug-Free Workplace Requirements – Title 45 CFR part 82.

Certification Regarding Lobbying – Title 32, United States Code, Section 1352 and all requirements imposed by or pursuant to the HHS regulation (45 CFR part 93).

Environmental Tobacco Smoke – Public Law 103-227.

Program Fraud Civil Remedies Act (PFCRA) HHS Checklist (08-2007) Project Narrative File(s)

* Mandatory Project Narrative File Filename:

To add more Project Narrative File attachments, please use the attachment buttons below.

Form Attachments:

Budget Narrative File(s)

* Mandatory Budget Narrative Filename:

To add more Budget Narrative attachments, please use the attachment buttons below.

Form Attachments:

Other Attachment File(s)

* Mandatory Other Attachment Filename:

To add more "Other Attachment" attachments, please use the attachment buttons below.

Form Attachments:

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. :

Click here to view the optional "Other Attachment" file:

Delete Optional Other Attachment:

Click here to delete the optional "Other Attachment" file:

Add Optional Other Attachment:

Click here to add the optional "Other Attachment" file:

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.:

Click here to add the mandatory "Other Attachment" file:

Delete Mandatory Other Attachment:

Click here to delete the mandatory "Other Attachment" file:

View Mandatory Other Attachment:

Click here to view the mandatory "Other Attachment" file:

Contract: Click if the Type of Federal Action is a contract.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Grant: Click if the Type of Federal Action is a grant.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Cooperative Agreement: Click if the Type of Federal Action is a cooperative agreement.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Loan: Click if the Type of Federal Action is a loan.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Loan Guarantee: Click if the Type of Federal Action is a loan guarantee.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Loan Insurance: Click if the Type of Federal Action is a loan insurance.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Bid, Offer, Application: Click if the Status of Federal Action is a bid, an offer or an application.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Initial Award: Click if the Status of Federal Action is an initial award.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Post Award: Click if the Status of Federal Action is a post-award.:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

Initial Filing: Click if the Report Type is a initial filing.:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

Material Change: Click if the Report Type is a material change.:

Prime: Click to designate the organization filing the report as the Prime Federal recipient.:

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.