Standard Form 424 - Application For Federal Assistance Page 2
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1
2INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043),
Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO
THEADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required face sheet for pre-applications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant certification that States which have established a review and
comment procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been
given an opportunity to review the applicant’s submission.
Item
Entry
Item
Entry
1.
Select Type of Submission.
11.
Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary
description of this project.
2.
Date application submitted to Federal agency (or State if
12.
List only the largest political entities affected (e.g., State,
applicable) and applicant’s control number (if applicable).
counties, cities).
3.
State use only (if applicable).
13.
Enter the proposed start date and end date of the project.
4.
Enter Date Received by Federal Agency Federal identifier
14.
List the applicant’s Congressional District and any District(s)
number: If this application is a continuation or revision to an
affected by the program or project.
existing award, enter the present Federal Identifier number. If for
a new project, leave blank.
5.
Enter legal name of applicant, name of primary organizational
15.
Amount requested or to be contributed during the first
unit (including division, if applicable), which will undertake the
funding/budget period by each contributor. Value of in kind
assistance activity, enter the organization’s DUNS number
contributions should be included on appropriate lines as
(received from Dun and Bradstreet), enter the complete address
applicable. If the action will result in a dollar change to an existing
of the applicant including country), and name, telephone number,
award, indicate only the amount of the change. For decreases,
email and fax of the person to contact on matters related to this
enclose the amounts in parentheses. If both basic and
application.
supplemental amounts are included, show breakdown on an
attached sheet. For multiple program funding, use totals and
show breakdown using same categories as item 15.
6.
Enter Employer Identification Number (EIN) as assigned by the
16.
Applicants should contact the State Single Point of Contact
Internal Revenue Service.
(SPOC) for Federal Executive Order 12372 to determine whether
the application is subject to the State intergovernmental review
process.
7.
Select the appropriate letter in
17.
This question applies to the applicant organization, not the
the space provided.
I. State Controlled
person who signs as the authorized representative. Categories of
A. State
Institution of Higher
debt include delinquent audit disallowances, loans and taxes.
B. County
Learning
C. Municipal
J. Private University
D. Township
K. Indian Tribe
E. Interstate
L. Individual
F. Intermunicipal
M. Profit Organization
G. Special District
N. Other (Specify)
H. Independent School
O. Not for Profit
District
Organization
8.
Select the type from the following list:
18.
To be signed by the authorized representative of the applicant. A
• "New" means a new assistance award.
copy of the governing body’s authorization for you to sign this
•
“Continuation” means an extension for an additional
application as official representative must be on file in the
funding/budget period for a project with a projected
applicant’s office. (Certain Federal agencies may require that this
completion date.
authorization be submitted as part of the application.)
• “Revision” means any change in the Federal
Government’s financial obligation or contingent liability
from an existing obligation. If a revision enter the
appropriate letter:
A. Increase Award
B. Decrease Award
C. Increase Duration
D. Decrease Duration
9.
Name of Federal agency from which assistance is being
requested with this application
10.
Use the Catalog of Federal Domestic Assistance number and title
of the program under which assistance is requested.
SF-424 (Rev. 9-2003) Back
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