oppHU0001-18-TSNRP-0003-cfda12.750.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.

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· 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.

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· 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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To download the Grants.gov required version visit:

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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.

State Application Identifier Applicant Identifier

1. TYPE OF SUBMISSION

4. a. Federal Identifier

5. APPLICANT INFORMATION

Organizational DUNS:

Legal Name:

Department:

Division:

Street1:

Street2:

City:

State:

ZIP / Postal Code:

Country:

Person to be contacted on matters involving this application First Name:

Middle Name:

Last Name:

Suffix:

Phone Number:

Fax Number:

Email:

6. EMPLOYER IDENTIFICATION (EIN) or (TIN):

7. TYPE OF APPLICANT:

Other (Specify):

Women Owned Socially and Economically Disadvantaged Small Business Organization Type If Revision, mark appropriate box(es).

9. NAME OF FEDERAL AGENCY:

A. Increase Award B. Decrease Award C. Increase Duration D. Decrease Duration E. Other (specify):

10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

Is this application being submitted to other agencies?

TITLE:

11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:

2. DATE SUBMITTED

3. DATE RECEIVED BY STATE

APPLICATION FOR FEDERAL ASSISTANCESF 424 (R&R)

County / Parish:

Province:

Prefix:

What other Agencies?

TYPE OF SUBMISSION is required: If this submission is to change or correct a previously submitted "New", "Resubmission", "Renewal", "Continuation", or "Revision" application, click the Changed/Corrected Application box and enter the Grants.gov tracking number in the Previous Grants.gov Tracking ID field. Unless requested by the agency, applicants may not use this to submit changes after the closing date.

Is this application being submitted to other agencies: Check box if applicable.

This field is required.

Is this application being submitted to other agencies is required.

8. TYPE OF APPLICATION:

OMB Number: 4040-0001 Expiration Date: 10/31/2019

b. Agency Routing Identifier

12. PROPOSED PROJECT:

Start Date Ending Date

13. CONGRESSIONAL DISTRICT OF APPLICANT

c. Previous Grants.gov Tracking ID Country:

Position/Title:

Province:

County / Parish:

State:

City:

Street2:

Street1:

ZIP / Postal Code:

APPLICATION FOR FEDERAL ASSISTANCE

SF 424 (R&R)

15. ESTIMATED PROJECT FUNDING

a. Total Federal Funds Requested

17. 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 18, Section 1001)

19. Authorized Representative First Name:

Middle Name:

Last Name:

Suffix:

Position/Title:

Organization:

Department:

Division:

Street1:

Street2:

City:

State:

ZIP / Postal Code:

Country:

Phone Number:

Fax Number:

Email:

Signature of Authorized Representative Date Signed

20. Pre-application *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.

County / Parish:

c. Total Federal & Non-Federal Funds

18. SFLLL (Disclosure of Lobbying Activities) or other Explanatory Documentation Province:

b. Total Non-Federal Funds Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Position/Title:

Organization Name:

Department:

Division:

Street1:

Street2:

City:

ZIP / Postal Code:

Country:

Phone Number:

Fax Number:

Email:

State:

County / Parish:

Province:

Prefix:

16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?

DATE:

THIS PREAPPLICATION/APPLICATION WAS MADE

AVAILABLE TO THE STATE EXECUTIVE ORDER 12372

PROCESS FOR REVIEW ON:

PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW

PROGRAM IS NOT COVERED BY E.O. 12372; OR

d. Estimated Program Income

21. Cover Letter Attachment

14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION

Project/Performance Site Location(s) OMB Number: 4040-0010 Expiration Date: 10/31/2019 Project/Performance Site Primary Location I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization.

Organization Name:

DUNS Number:

* Street1:

Street2:

* City:

County:

* State:

Province:

* Country:

* ZIP / Postal Code:

* Project/ Performance Site Congressional District:

Project/Performance Site Location I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization.

Organization Name:

DUNS Number:

* Street1:

Street2:

* City:

County:

* State:

Province:

* Country:

* ZIP / Postal Code:

* Project/ Performance Site Congressional District:

Additional Location(s) Project/Performance Site Location(s) Province:

PROFILE - Project Director/Principal Investigator Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Organization Name:

Division:

Position/Title:

Department:

* Street1:

Street2:

* Phone Number:

Fax Number:

* E-Mail:

Credential, e.g., agency login:

* Project Role:

Other Project Role Category:

* Zip / Postal Code:

* Country:

* State:

County:

* City:

Attach Current & Pending Support RESEARCH & RELATED Senior/Key Person Profile

* Attach Biographical Sketch Province:

PROFILE - Senior/Key Person Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Organization Name:

Division:

Position/Title:

Department:

* Street1:

Street2:

* Phone Number:

Fax Number:

* E-Mail:

Credential, e.g., agency login:

* Project Role:

Other Project Role Category:

* Zip / Postal Code:

* Country:

* State:

County:

* City:

Attach Current & Pending Support

* Attach Biographical Sketch

ADDITIONAL SENIOR/KEY PERSON PROFILE(S)

Additional Biographical Sketch(es) (Senior/Key Person) Additional Current and Pending Support(s) OMB Number: 4040-0001 Expiration Date: 10/31/2019

1. Are Human Subjects Involved?

IRB Approval Date:

Human Subject Assurance Number:

2. Are Vertebrate Animals Used?

IACUC Approval Date:

Animal Welfare Assurance Number:

4.b. If yes, please explain:

4.c. If this project has an actual or potential impact on the environment, has an exemption been authorized or an environmental assessment (EA) or environmental impact statement (EIS) been performed?

4.d. If yes, please explain:

6. Does this project involve activities outside of the United States or partnerships with international collaborators?

6.b. Optional Explanation:

7. Project Summary/Abstract

11. Equipment

8. Project Narrative

12. Other Attachments RESEARCH & RELATED Other Project Information Is the IACUC review Pending?

If no, is the IRB review Pending?

2.a.

If YES to Vertebrate Animals

3. Is proprietary/privileged information included in the application?

4.a. Does this Project Have an Actual or Potential Impact - positive or negative - on the environment?

6.a. If yes, identify countries:

9. Bibliography & References Cited

10. Facilities & Other Resources Are Human Subjects Involved is required.

Are Human Subject Involved: If activities involving human subjects are planned at any time during the proposed project at any performance site. Check yes even if the proposed project is exempt from Regulations for the Protection of Human Subjects. If no, skip the rest of block 1.

This field is required.

1.a.

If YES to Human Subjects Is the Project Exempt from Federal regulations is required.

Is the Project Exempt from Federal regulations?

Is the IRB review Pending is required.

Is the IRB review Pending?

If yes, check appropriate exemption number.

Are Vertebrate Animals Used is required.

Are Vertebrate Animals Used? If activities involving vertebrate animals are planned at any time during the proposed project at any performance site, check yes. If no, skip the rest of block 2.

Is the IACUC review Pending is required.

Is the IACUC review Pending? Indicate if an Institutional Animal Care and Use Committee (IACUC) review is pending.

Is proprietary/privileged information included in the application is required.

Is proprietary/privileged information included in the application: Patentable ideas, trade secrets, privileged or confidential commercial or financial information, disclosure of which may harm the applicant, should be included in applications only when such information is necessary to convey an understanding of the proposed project. If the application includes such information, check yes and clearly mark each line or paragraph on the pages containing the proprietary/privileged information with a legend similar to: "The following contains proprietary/privileged information that (name of applicant) requests not be released to persons outside the Government, except for purposes of review and evaluation." This field is required.

Does this project have an actual or potential impact - positive or negative - on the environment is required.

Does this project have an actual or potential impact on the environment: Indicate if this project has an actual or potential impact on the environment? This field is required.

Does this project involve activities outside of the United States or partnerships with international collaborators is required.

Does this project involve activities outside of the United States or partnerships with international collaborators? Indicate whether this project involve activities outside of the United States or partnerships with international collaborators. This field is required.

Form Attachments:

Is the Project Exempt from Federal regulations?

5. Is the research performance site designated, or eligible to be designated, as a historic place?

Is the research performance site designated, or eligible to be designated, as a historic place is required.

Is the research performance site designated, or eligible to be designated, as a historic place?: If any research performance site is designated or eligible to be designated as a historic place, if Yes, check the Yes box and then provide an explanation in the box provided in 5.a. Otherwise, check the No box.

5.a. If yes, please explain:

OMB Number: 4040-0001 Expiration Date: 10/31/2019 Budget Type:

Enter name of Organization:

Start Date:

End Date:

ORGANIZATIONAL DUNS:

OMB Number: 4040-0001 Expiration Date: 10/31/2019 A. Senior/Key Person Prefix First Middle Last Suffix Base Salary ($) Months Cal.

Acad.

Sum.

Requested Salary ($) Fringe Benefits ($) Funds Requested ($) Project Role:

Additional Senior Key Persons:

Total Funds requested for all Senior Key Persons in the attached file Total Senior/Key Person B. Other Personnel Number of Personnel Project Role Funds Requested ($) Fringe Benefits ($) Requested Salary ($) Sum.

Acad.

Cal.

Months Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical Total Number Other Personnel Total Other Personnel Total Salary, Wages and Fringe Benefits (A+B) C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment item Funds Requested ($) Total funds requested for all equipment listed in the attached file Total Equipment Additional Equipment:

D. Travel Domestic Travel Costs ( Incl. Canada, Mexico and U.S. Possessions) 1.

Foreign Travel Costs 2.

Total Travel Cost Funds Requested ($) E. Participant/Trainee Support Costs Tuition/Fees/Health Insurance 1.

Stipends 2.

Travel 3.

Subsistence 4.

Other 5.

Funds Requested ($) Number of Participants/Trainees Total Participant/Trainee Support Costs F. Other Direct Costs Funds Requested ($) 1.

Materials and Supplies 2.

Publication Costs 3.

Consultant Services 4.

ADP/Computer Services 5.

Subawards/Consortium/Contractual Costs 6.

Equipment or Facility Rental/User Fees 7.

Alterations and Renovations 8.

9.

10.

Total Other Direct Costs G. Direct Costs Funds Requested ($) Total Direct Costs (A thru F) H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($) Total Indirect Costs Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) I. Total Direct and Indirect Costs Funds Requested ($) Total Direct and Indirect Institutional Costs (G + H) J. Fee Funds Requested ($) K. Total Costs and Fee Funds Requested ($) Total Costs and Fee (I + J) L. Budget Justification (Only attach one file.)

Section A, Senior/Key Person Section C, Equipment RESEARCH & RELATED BUDGET - Cumulative Budget Section D, Travel Domestic Section E, Participant/Trainee Support Costs Foreign Tuition/Fees/Health Insurance Stipends Travel Subsistence Other Number of Participants/Trainees 1.

2.

3.

4.

5.

6.

1.

2.

Section F, Other Direct Costs Materials and Supplies 1.

Publication Costs 2.

Consultant Services 3.

ADP/Computer Services 4.

Subawards/Consortium/Contractual Costs 5.

Equipment or Facility Rental/User Fees 6.

Alterations and Renovations 7.

8.

9.

10.

Totals ($) Total Number Other Personnel Total Salary, Wages and Fringe Benefits (A+B) Other 1 Other 2 Other 3 Section B, Other Personnel Section J, Fee Section I, Total Direct and Indirect Costs (G + H) Section H, Indirect Costs Section G, Direct Costs (A thru F) Budget Type is required.

Section K, Total Costs and Fee (I + J)

ATTACHMENTS FORM

Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format and named as specified in the Guidelines.

Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format and named as specified in the Guidelines.

15) Please attach Attachment 15

1) Please attach Attachment 1

2) Please attach Attachment 2

3) Please attach Attachment 3

4) Please attach Attachment 4

5) Please attach Attachment 5

6) Please attach Attachment 6

7) Please attach Attachment 7

8) Please attach Attachment 8

9) Please attach Attachment 9

10) Please attach Attachment 10

11) Please attach Attachment 11

12) Please attach Attachment 12

13) Please attach Attachment 13

14) Please attach Attachment 14 Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.

Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.

OMB Number: 4040-0010 Expiration Date: 10/31/2019

* Applicant Organization Name:

Key Contacts Form Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* Street1:

Street2:

* City:

County:

* State:

Province:

* Country:

* Zip / Postal Code:

* Telephone Number:

Fax:

* Email:

Enter the individual's role on the project (e.g., project manager, fiscal contact).

Enter the individual's role on the project (for example, project manager, fiscal contact).

Project Abstract OMB Number: 4040-0010 Expiration Date: 10/31/2019

* Please click the add attachment button to complete this entry.

The Project Abstract must not exceed one page and must contain a summary of the proposed activity suitable for dissemination to the public. It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields and insofar as possible understandable to a technically literate lay reader. This Abstract must not include any proprietary/confidential information.

OMB Number: 4040-0001 Expiration Date: 10/31/2019

RESEARCH & RELATED PERSONAL DATA

Project Director/Principal Investigator and Co-Project Director(s)/Co-Principal Investigator(s) The Federal Government has a continuing commitment to monitor the operation of its review and award processes to identify and address any inequities based on gender, race, ethnicity, or disability of its proposed PDs/PIs and co-PDs/PIs. To gather information needed for this important task, the applicant should submit the requested information for each identified PD/PI and co-PDs/PIs with each proposal. Submission of the requested information is voluntary and is not a precondition of award. However, information not submitted will seriously undermine the statistical validity, and therefore the usefulness, of information received from others. Any individual not wishing to submit some or all the information should check the box provided for this purpose. Upon receipt of the application, this form will be separated from the application. This form will not be duplicated, and it will not be a part of the review process. Data will be confidential.

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Gender:

Race (check all that apply):

American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander Do Not Wish to Provide White Asian Ethnicity:

Disability Status (check all that apply):

Visual Other Mobility/Orthopedic Impairment None Hearing Do Not Wish to Provide Citizenship:

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Gender:

Race (check all that apply):

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Do Not Wish to Provide Ethnicity:

Disability Status (check all that apply):

Hearing Visual Mobility/Orthopedic Impairment Other None Do Not Wish to Provide Citizenship:

This field is required if Country is the United States.:

This field is required.:

If Small Business is selected as Type of Applicant, then note if the organization is Woman-owned and/or Socially and Economically Disadvantaged.

This field is required.:

New: An application that is being submitted to an agency for the first time.

Resubmission: An application that has been previously submitted, but was not funded, and is being resubmitted for new consideration.

Renewal: An application requesting additional funding for a period subsequent to that provided by a current award. A renewal application competes with all other applications and must be developed as fully as though the applicant is applying for the first time.

Continuation: A non-competing application for an additional funding/budget period within a previously approved project period.

Revision: An application that proposes a change in: 1) the Federal Government's financial obligations or contingent liability from an existing obligation; or, 2) any other change in the terms and conditions of the existing award.

This field is required.:

TYPE OF APPLICATION - New: Select the type from the following list. Check only one:

New: An application that is being submitted to an agency for the first time.

Resubmission: An application that has been previously submitted, but was not funded, and is being resubmitted for new consideration.

Renewal: An application requesting additional funding for a period subsequent to that provided by a current award. A renewal application competes with all other applications and must be developed as fully as though the applicant is applying for the first time.

Continuation: A non-competing application for an additional funding/budget period within a previously approved project period.

Revision: An application that proposes a change in: 1) the Federal Government's financial obligations or contingent liability from an existing obligation; or, 2) any other change in the terms and conditions of the existing award.

This field is required.:

TYPE OF APPLICATION - Resubmission: Select the type from the following list. Check only one:

New: An application that is being submitted to an agency for the first time.

Resubmission: An application that has been previously submitted, but was not funded, and is being resubmitted for new consideration.

Renewal: An application requesting additional funding for a period subsequent to that provided by a current award. A renewal application competes with all other applications and must be developed as fully as though the applicant is applying for the first time.

Continuation: A non-competing application for an additional funding/budget period within a previously approved project period.

Revision: An application that proposes a change in: 1) the Federal Government's financial obligations or contingent liability from an existing obligation; or, 2) any other change in the terms and conditions of the existing award.

This field is required.:

TYPE OF APPLICATION - Renewal: Select the type from the following list. Check only one:

New: An application that is being submitted to an agency for the first time.

Resubmission: An application that has been previously submitted, but was not funded, and is being resubmitted for new consideration.

Renewal: An application requesting additional funding for a period subsequent to that provided by a current award. A renewal application competes with all other applications and must be developed as fully as though the applicant is applying for the first time.

Continuation: A non-competing application for an additional funding/budget period within a previously approved project period.

Revision: An application that proposes a change in: 1) the Federal Government's financial obligations or contingent liability from an existing obligation; or, 2) any other change in the terms and conditions of the existing award.

This field is required.:

TYPE OF APPLICATION - Continuation: Select the type from the following list. Check only one:

New: An application that is being submitted to an agency for the first time.

Resubmission: An application that has been previously submitted, but was not funded, and is being resubmitted for new consideration.

Renewal: An application requesting additional funding for a period subsequent to that provided by a current award. A renewal application competes with all other applications and must be developed as fully as though the applicant is applying for the first time.

Continuation: A non-competing application for an additional funding/budget period within a previously approved project period.

Revision: An application that proposes a change in: 1) the Federal Government's financial obligations or contingent liability from an existing obligation; or, 2) any other change in the terms and conditions of the existing award.

This field is required.:

TYPE OF APPLICATION - Revision: Select the type from the following list. Check only one:

New: An application that is being submitted to an agency for the first time.

Resubmission: An application that has been previously submitted, but was not funded, and is being resubmitted for new consideration.

Renewal: An application requesting additional funding for a period subsequent to that provided by a current award. A renewal application competes with all other applications and must be developed as fully as though the applicant is applying for the first time.

Continuation: A non-competing application for an additional funding/budget period within a previously approved project period.

Revision: An application that proposes a change in: 1) the Federal Government's financial obligations or contingent liability from an existing obligation; or, 2) any other change in the terms and conditions of the existing award.

This field is required.:

A. Increase Award May select more than one.:

If a revision mark the appropriate box(es):

B. Decrease Award May select more than one.:

If a revision mark the appropriate box(es):

C. Increase Duration May select more than one.:

If a revision mark the appropriate box(es):

D. Decrease Duration May select more than one.:

If a revision mark the appropriate box(es):

E. Other If "Other" is selected, please specify in text box provided.:

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 outside the US, enter 00-000.

To locate your congressional district, visit the Grants.gov web site

This field is required.:

If no, check appropriate box. This field is required.:

IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS: If yes, check box. If the announcement indicates that the program is covered under Executive Order 12372, applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372.

If no, check appropriate box. This field is required.:

IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS: If yes, check box. If the announcement indicates that the program is covered under Executive Order 12372, applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372.

If no, check appropriate box. This field is required.:

IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS - YES, THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:

If yes, check box. If the announcement indicates that the program is covered under Executive Order 12372, applicants should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372. One selection is required.:

This field is required.:

This field is required if the Authorized Representative is located in the United States.: