Application For Federal Assistance Form
Download a blank fillable Application For Federal Assistance Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Federal Assistance Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB Approval No. 0348-0043
APPLICATION FOR
2. DATE SUBMITTED
Applicant Identifier
FEDERAL ASSISTANCE
April 4, 2007
1. TYPE OF SUBMISSION:
3. DATE RECEIVED BY STATE
State Application Identifier
Application
Preapplication
Construction
Construction
4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
Non-Construction
Non-Construction
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
Address (give city, county, State, and zip code):
Name and telephone number of person to be contacted on matters involving
this application (give area code)
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
7. TYPE OF APPLICANT: (enter appropriate letter in box)
A. State
H. Independent School Dist.
8. TYPE OF APPLICATION:
B. County
I. State Controlled Institution of Higher Learning
C. Municipal
J. Private University
Revision
Continuation
New
D. Township
K. Indian Tribe
If Revision, enter appropriate letter(s) in box(es)
E. Interstate
L. Individual
F. Intermunicipal
M. Profit Organization
A. Increase Award
B. Decrease Award
C. Increase Duration
G. Special District
N. Other (Specify) ____________________
D. Decrease Duration
Other (specify):
9. NAME OF FEDERAL AGENCY:
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
11. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT:
TITLE:
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.):
13. PROPOSED PROJECT
14. CONGRESSIONAL DISTRICTS OF:
Start Date
Ending Date
a. Applicant
b. Project
15. ESTIMATED FUNDING:
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
00
a. Federal
$
.
a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE
00
b. Applicant
$
.
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
PROCESS FOR REVIEW ON:
00
c. State
$
.
DATE _____________________
00
d. Local
$
.
b. No.
PROGRAM IS NOT COVERED BY E. O. 12372
00
e. Other
$
.
OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
00
f. Program Income
$
.
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
00
g. TOTAL
$
.
Yes
If "Yes," attach an explanation.
No
0
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Type Name of Authorized Representative
b. Title
c. Telephone Number
d. Signature of Authorized Representative
e. Date Signed
Previous Edition Usable
Standard Form 424 (Rev. 7-97)
Authorized for Local Reproduction
Prescribed by OMB Circular A-102
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business