Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2008 Page 5
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5Department of Revenue Services
State of Connecticut
(Rev. 02/08)
2008 Connecticut Neighborhood Assistance Act (NAA)
Program Proposal
Instructions
Complete all items on Form NAA-01, 2008 Connecticut Neighborhood Assistance Act (NAA) Program
Proposal. Incomplete applications will not be accepted. Direct inquiries to Department of Revenue Services
(DRS), Neighborhood Assistance Act Program, Attn: Research Unit, 25 Sigourney Street, Hartford CT 06106,
or call 860-297-5687.
Part III - Financial Information
Part I - General Information
Each program proposal must include a program
Enter the name of the tax exempt organization or
budget that includes all sources of funding and all
municipal agency, address, and Federal Employer
anticipated expenditures. The information provided
Identification Number.
in the budget may be used during a post-project
Program Title: Assign a unique program title to each
audit.
program for which your organization is making an
application.
Sources of Revenue: The budget must include
the requested NAA funding and any other anticipated
Federal Form 990: Attach a copy of the first page
revenue sources.
of your organization’s most recent federal Form 990
or Form 990EZ. If your organization is not required
NAA Funding Requested: Indicate the total amount
to file either Form 990 or Form 990EZ, attach a copy
your organization is requesting for its program. This
of the determination letter from the U.S. Treasury
amount may not exceed the total proposed
Department, Internal Revenue Service.
expenditures. Please note that the minimum NAA
funding is $250, with a maximum funding of $150,000
Part II - Program Information
per organization or agency per year.
Description of Program: Describe the program,
Other Funding Sources: Provide a detailed
including information about how the program will
description(s) and the amount(s) of all funding
operate, its benefit to the community, how recipients
sources.
will be selected, and any measures used to
determine the program’s impact on the community.
Proposed Program Expenditures: The budget
must include a detailed description and the
Need for Program: Demonstrate a need for this
amount of all direct operating and administrative
program. For example, provide relevant statistics.
expenditures. Expenditures must equal or
exceed total funding.
Neighborhood Area to Be Served: Describe the
neighborhood or municipality this program will serve.
Direct Operating Expenses: Expenses include
materials, equipment, wages, salaries, tuition fees,
Total Number of Recipients: Provide an estimate
sub-contracting services, and any other expenses
of the number of recipients this program will serve.
needed to administer the program.
Administration of Program: Identify the name and
Part IV - Municipal Information
address of every person or organization involved
in the implementation and administration of this
This part is to be completed by the municipal agency
program. Use additional sheets if necessary.
overseeing implementation of the program.
Timetable: Indicate the starting and ending dates
Municipal Liaison: The municipality must designate
of the program. Any program receiving $25,000 or
an individual to serve as a liaison with DRS for all
more in NAA funding is required to provide a post-project
NAA matters.
review to the municipality overseeing the program.
Post Project Review: Any program receiving
$25,000 or more in NAA funding is required to provide
a post-project review to the municipality overseeing
the program.
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