SF424_Individual & Instructions.pdf

* 3. DATE RECEIVED:

5. APPLICANT INFORMATION

* 1. NAME OF FEDERAL AGENCY:

2. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

* 4. FUNDING OPPORTUNITY NUMBER:

* TITLE:

CFDA TITLE:

Prefix: * First Name: Middle Name:

* Last Name: Suffix:

* Telephone Number (Daytime):

Fax Number:* Email:

* Street1: Street2:

* City: County/Parish:

* State: Province:

* Zip/Postal Code:* Country:

b. Address

Telephone Number (Evening):

APPLICATION FOR FEDERAL ASSISTANCE SF 424 - INDIVIDUAL

OMB Number 4040-0005 Expiration Date: 02/28/2026

a. Name and Contact Information

USA: UNITED STATES

* c. Citizenship Status:

U.S. Citizenship

If No

6. PROJECT INFORMATION

If permanent resident of U.S., enter the Alien Registration #:

* If foreign national, enter country of citizenship:

* If foreign national, enter start date of most recent residency in U.S.:

d. * Congressional District of Applicant:

* a. Project Title:

* b. Project Description:

APPLICATION FOR FEDERAL ASSISTANCE SF 424 - INDIVIDUAL

Yes No

* c. Proposed Project:

7. * 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)

** 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.

* Date Signed:

Start Date: End Date:

* Signature:

** I AGREE

OMB Number: 4040-0005 1 OMB Expiration Date: 02/28/2026

Grants.gov Form Instructions Form Identifiers Information

Agency Owner Grants.gov

Form Name Application for Federal Assistance SF-424 – Individual V2.0 OMB Number 4040-0005

OMB Expiration Date 02/28/2026

Form Field Instructions Field Number

Field Name Required or Optional

Information

1. NAME OF FEDERAL

AGENCY

Required Public Affairs Section, U.S. Embassy Paramaribo

2. CATALOG of

FEDERAL

DOMESTIC

ASSISTANCE

NUMBER:

Completed by Grants.gov upon submission

CFDA TITLE 19.040 – Public Diplomacy Programs

3. DATE RECEIVED Completed by Grants.gov upon submission

4. FUNDING

OPPORTUNITY

NUMBER:

PAR-APS21-FY24

TITLE: U.S. Embassy Paramaribo PAS Annual Program Statement

5. APPLICANT

INFORMATION

Name and Contact Information

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

First Name: Required Enter the First Name.

Middle Name: Enter the Middle Name.

Last Name: Required Enter the Last Name.

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

Fax Number: Enter the Fax Number.

Email: Enter a valid Email Address.

Telephone Number (Daytime):

Required Enter the Daytime Telephone Number.

OMB Number: 4040-0005 2

Field Number

Field Name Required or Optional

Information

Telephone Number (Evening):

Enter the Evening Telephone Number.

Address

Street 1: Required Enter the first line of the Street Address.

Street 2: Enter the second line of the Street Address.

City: Required Enter the City.

County/Parish: Enter the County or 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: Required Select the Country from the provided list.

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

Citizenship Status

U.S. Citizenship?

Yes/No

Required Select Yes if applicant is a citizen of the United States. Select No if applicant is a permanent resident and enter the Alien Registration #. Select No if applicant is a foreign national and enter the country of citizenship and start date of most recent residency in the United States.

If No

If permanent resident of U.S., enter the Alien Registration #

Enter the Alien Registration Number.

If foreign national, enter country of citizenship:

Select the Country from the provided list.

This field is required if the applicant is not a U.S. Citizen.

If foreign national, enter start date of most recent residency in U.S.:

Required Enter the start date of the most recent residency in the U.S. Enter in the format MM/DD/YYYY. This field is required if the applicant is not a U.S. Citizen.

OMB Number: 4040-0005 3

Field Number

Field Name Required or Optional

Information

Congressional District of Applicant:

Required 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, NC-103 for North Carolina’s 103rd district. If outside the US, enter 00-000.

6. Project Information

Project Title Enter a brief, descriptive title of the project.

Project Description Required Enter a brief description of the project.

Proposed Project Required Start Date: Enter the start date for the proposed project. Enter in the format MM/DD/YYYY. End Date: Enter the end date for the proposed project. Enter in the format MM/DD/YYYY.

OMB Number: 4040-0005 4

Field Number

Field Name Required or Optional

Information

7. * 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

Required Check to select.

** 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

OMB Number: 4040-0005 5

Field Number

Field Name Required or Optional

Information

Signature Required Completed by Grants.gov upon submission

Date Signed Required Completed by Grants.gov upon submission