Scribd
Upload
212 views3 pages

Federal Assistance Application SF-424

This document is an application for federal assistance. It contains information about the applicant such as their legal name, address, DUNS number, Congressional district, and contact details. It requests funding amounts from multiple sources for the proposed project, which includes start and end dates. The applicant must certify that the application contains true information and that they agree to the listed terms and conditions.

Uploaded by

Danijela Kenic
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
212 views3 pages

Federal Assistance Application SF-424

This document is an application for federal assistance. It contains information about the applicant such as their legal name, address, DUNS number, Congressional district, and contact details. It requests funding amounts from multiple sources for the proposed project, which includes start and end dates. The applicant must certify that the application contains true information and that they agree to the listed terms and conditions.

Uploaded by

Danijela Kenic
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Application Header: Covers the header information including submission type, applicant type, and date received.
  • Applicant Information: Contains identifying details of the applicant such as name, organization, contact information.
  • Application Details: Includes details about the funding opportunity, competition ID, and project description.
  • Project Funding and Review: Section dedicated to congressional districts, proposed project dates, and funding estimates.
  • Certification and Compliance: Contains certification and assurances related to compliance with executive orders.

OMB Number: 4040-0004

Expiration Date: 01/31/2009


03/31/2012

Application for Federal Assistance SF-424 Version 02

* 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s):

Preapplication New

Application Continuation * Other (Specify)

Changed/Corrected Application Revision

* 3. Date Received: 4. Applicant Identifier:

Completed by [Link] upon submission.

5a. Federal Entity Identifier: * 5b. Federal Award Identifier:

State Use Only:

6. Date Received by State: 7. State Application Identifier:

8. APPLICANT INFORMATION:

* a. Legal Name:

* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:

d. Address:

* Street1:

Street2:

* City:

County:

* State:

Province:

* Country: USA: UNITED STATES

* Zip / Postal Code:

e. Organizational Unit:

Department Name: Division Name:

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: * First Name:

Middle Name:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* Telephone Number: Fax Number:

* Email:
O
Expiration Date: 01/31/2009

Application for Federal Assistance SF-424 Version 02

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:

NGMS Agency

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

MBL-SF424FAMILY-ALLFORMS

* Title:

MBL-SF424Family-AllForms

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.

Vie
O
Expiration Date: 01/31/2009

Application for Federal Assistance SF-424 Version 02

16. Congressional Districts Of:

* a. Applicant * b. Program/Project

Attach an additional list of Program/Project Congressional Districts if needed.

Add Attachment View Attachment

17. Proposed Project:

* a. Start Date: * b. End Date:

18. Estimated Funding ($):

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

* g. TOTAL

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

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.

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation in attachment.)

Yes No If "Yes”, provide explanation and attach.

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)

** I AGREE

** 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:

Prefix: * First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* Telephone Number: Fax Number:

* Email:

* Signature of Authorized Representative: Completed by [Link] upon submission. * Date Signed: Completed by [Link] upon submission.

Authorized for Local Reproduction StaPrescribed by OMB Circular A-102


Prescribed by OMB Circular A-102

You might also like