SF-424new.pdf

PDF 264 KB Posted Feb 14, 2017

Attached to: FMCS Labor-Management Cooperation Grant Program Federal grant opportunity
Opportunity number: FMCS-2017
Issued by: Federal Mediation and Conciliation Service

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SF-424

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Other files for this federal grant opportunity

Other files attached to FMCS Labor-Management Cooperation Grant Program, newest first.
File	Type	Posted
oppFMCS-2017-instructions.zip	ZIP file	May 30, 2017
oppFMCS-2017.pdf	PDF	May 30, 2017
2017FinancialAdministrativeGrantsManual.pdf	PDF	Feb 14, 2017
FY2017 Application Solicitation.pdf	PDF	Feb 14, 2017
2017 Kit Application Letter.pdf	PDF	Feb 14, 2017
SF-424new.pdf	PDF	Feb 14, 2017
FY2017 Application Solicitation.pdf	PDF	Feb 14, 2017
2017 Kit Application Letter.pdf	PDF	Feb 14, 2017
2017FinancialAdministrativeGrantsManual.pdf	PDF	Feb 14, 2017

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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

Preapplication

Application

Changed/Corrected Application

New

Continuation

Revision

* 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

* 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:

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.

Yes No

** I AGREE

* 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

SF424_2_1 Page 4 win2k D:20061002180508- 04'00' D:20061002180508- 04'00' 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 ($):

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:

Application Subject to Review is required.

Application Subject to Review: One selection is required.

Applicant Delinquent on Federal Debt: A selection is required.

Applicant Delinquent on Federal Debt is required.

* 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

Mandatory:

Type of Submission is required. Select one type of submission in accordance with agency instructions. :

Type of Application is required: Select one type of submission in accordance with agency instructions.:

DateEntered1:

DateEntered2:

Submission Type - Preapplication: Select one type of submission in accordance with agency instructions. One selection is required.

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. :

Revision Type: Select a revision type from the list provided. A selection is required if Type of Application is Revision.:

Other (specify): Please specify the type of revision. This field is required if E. Other is checked.:

Date Received: Enter the Date Received. Enter in the format mm/dd/yyyy. This field is required.:

Applicant Identifier: Enter the applicant's control number, if applicable.:

Federal Entity Identifier: Enter the number assigned to your organization by the Federal agency.:

Federal Award Identifier: For new applications leave blank. For a continuation or revision to an existing award, enter the previously assigned Federal award identifier number. If a changed/corrected application, enter the Federal Identifier in accordance with agency instructions.:

Date Received by State: Enter the date received by the State, if applicable. Enter in the format mm/dd/yyyy.:

State Application Identifier: Enter the identifier assigned by the State, if applicable.:

Organization Name: Enter the legal name of the applicant that will undertake the assistance activity. This field is required.:

EIN/TIN: Enter either TIN or EIN as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444. This field is required.:

DUNS Number: Enter the DUNS or DUNS+4 number of the applicant organization. This field is required.:

Street1: Enter the first line of the Street Address. This field is required.:

Street2: Enter the second line of the Street Address.:

City: Enter the City. This field is required.:

County/Parish: Enter the County/Parish.:

State: Select the state, US possession or military code from the provided list. This field is required if Country is the United States.:

Province: Enter the Province.:

Country: Select the Country from the provided list. This field is required.: USA: UNITED STATES

Zip / Postal Code: Enter the Postal Code (e.g., ZIP code). This field is required if Country is the United States. :

Department Name: Enter the name of primary organizational department, service, laboratory, or equivalent level within the organization which will undertake the assistance activity.:

Division Name: Enter the name of primary organizational division, office, or major subdivision which will undertake the assistance activity.:

AOR Prefix: Select the Prefix from the provided list or enter a new Prefix not provided on the list.:

AOR First Name: Enter the First Name. This field is required.:

AOR Middle Name: Enter the Middle Name.:

AOR Last Name: Enter the Last Name. This field is required.:

AOR Suffix: Select the Suffix from the provided list or enter a new Suffix not provided on the list.:

Title: Enter the position title.:

Organizational Affiliation: Enter the organization if different from the applicant organization.:

Telephone Number: Enter the daytime Telephone Number. This field is required.:

Fax Number: Enter the Fax Number.:

Email: Enter a valid Email Address. This field is required.:

TextField1:

ViewBurdenStatement:

Type of Applicant 1: Select the appropriate applicant type. A selection is required.:

Type of Applicant 2: Select the appropriate applicant type.:

Type of Applicant 3: Select the appropriate applicant type.:

Type of Applicant Other: Enter the applicant type here if you selected "Other (specify)" for Type of Applicant.:

Agency Name: Enter Agency Name.:

CFDA Number: Enter the Catalog of Federal Domestic Assistance Number.:

CFDA/Program Title: Enter the CFDA Title.:

Opportunity Number: Enter the Funding Opportunity Number. This field is required.:

Opportunity Title: Enter the Title. This field is required.:

Competition Number: Enter the Competition Identification Number.:

Competition Title: Enter the Title.:

spacer:

Project Title: Enter a brief, descriptive title of the project. This field is required.:

FileName:

MimeType:

href:

hashAlgorithm:

HashValue_data:

ObjList:

FNList:

AttCount:

Add:

Delete:

View:

Done:

Attachment Check Box: Indicates whether an Attachment is attached:

Additional Project Title - View Attachment Button: Select to view attachment(s).:

Additional Project Title - Delete Attachment Button: Select to delete attachment(s).:

Additional Project Title - Add Attachment Button: Select to add attachment(s).:

Debt Explanation - View Attachment Button: Click here to view the attachment.:

Debt Explanation - Delete Attachment Button: Click here to delete the attachment.:

Debt Explanation - Add Attachment Button: Click here to add the attachment.:

Debt Explanation is required.:

Applicant 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 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.:

Additional Congressional Districts:

Additional Congressional Districts - Add Attachment Button: Click here to add the attachment.:

Additional Congressional Districts - Delete Attachment Button: Click here to delete the attachment.:

Additional Congressional Districts - View Attachment Button: Click here to view the attachment.:

Project End Date: Enter the date in the format MM/DD/YYYY. This field is required.:

Project Start Date: Enter the date in the format MM/DD/YYYY. This field is required.:

Federal Estimated Funding: Enter the dollar amount. This field is required.:

Applicant Estimated Funding: Enter the dollar amount. This field is required.:

State Estimated Funding: Enter the dollar amount. This field is required.:

Local Estimated Funding: Enter the dollar amount. This field is required.:

Other Estimated Funding: Enter the dollar amount. This field is required.:

Program Income Estimated Funding: Enter the dollar amount. This field is required.:

Total Estimated Funding: Enter the total dollar amount. This field is required.:

State Review Available: Click to select option.:

State Review Not Selected: Click to select option.:

State Review Not Covered: Click to select option.:

State Review Date: Enter the date in the format MM/DD/YYYY.:

Delinquent on Debt: Click to select option.:

Not Delinquent on Debt: Click to select option.:

Certification Agree: Check to select. This field is required.: N: No

AOR Title: Enter the position title. This field is required.:

AOR Telephone Number: Enter the daytime Telephone Number. This field is required.:

AOR Fax Number: Enter the Fax Number.:

AOR Email: Enter a valid Email Address. This field is required.:

AOR Signature: Enter the Signature of Authorized Representative.:

Market (choose one): Select the SEP market area that best pertains to this SEP activity. One selection is required.:

DateEntered19:

Applicant Delinquent on Federal Debt is required.:

DateEntered20:

Date Signed: Enter the Date Signed. Enter in the format mm/dd/yyyy. This field is required.:

File details come from the government source that posted it. Updated Nov 14, 2017.