Form Sf-424 - Application For Federal Assistance Sf-424 - Mandatory
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5OMB Number: 4040-0002
Expiration Date: 5/31/2014
APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY
1.d. Version:
1.a. Type of Submission:
1.b. Frequency:
Initial
Resubmission
Revision
Update
Application
Annual
2. Date Received:
STATE USE ONLY:
Plan
Quarterly
Funding Request
Other
3. Applicant Identifier:
5. Date Received by State:
Other
Other (specify):
Other (specify):
6. State Application Identifier:
4a. Federal Entity Identifier:
4b. Federal Award Identifier:
1.c. Consolidated Application/Plan/Funding Request?
Yes
No
Explanation
7. APPLICANT INFORMATION:
a. Legal Name:
b. Employer/Taxpayer Identification Number (EIN/TIN):
c. Organizational DUNS:
d. Address:
Street1:
Street2:
City:
County / Parish:
State:
Province:
Country:
Zip / Postal Code:
USA: UNITED STATES
e. Organizational Unit:
Department Name:
Division Name:
f. Name and contact information of person to be contacted on matters involving this submission:
Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Title:
Organizational Affiliation:
Fax Number:
Telephone Number:
Email:
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Parent category: Legal