Fillable Form Sf-424 - Application For Federal Assistance (Page 7 of 7) in pdf

title of the opportunity under which assistance is requested, as found in the program

announcement.

13.

Competition Identification Number/Title: Enter the Competition Identification Number and

title of the competition under which assistance is requested, if applicable.

C. Increase Duration D. Decrease Duration E. Other (specify)

14.

Areas Affected By Project: List the areas or entities using the categories (e.g., cities, counties,

states, etc.) specified in agency instructions. Use the continuation sheet to enter additional

areas, if needed.

15.

Descriptive Title of Applicant’s Project: (Required) Enter a brief descriptive title of the project.

If appropriate, attach a map showing project location (e.g., construction or real property

projects). For pre‐applications, attach a summary description of the project.

16.

Congressional Districts Of: (Required) 16a. Enter the applicant’s Congressional District, and

16b. Enter all District(s) affected by the program or project. Enter in the format: 2 characters

State Abbreviation – 3 characters District Number, e.g., CA‐005 for California 5th district, CA012

for California 12th district, NC‐103 for North Carolina’s 103rd district. • If all congressional

districts in a state are affected, enter “all” for the district number, e.g., MD‐all for all

congressional districts in Maryland. • If nationwide, i.e. all districts within all states are

affected, enter US‐all. • If the program/project is outside the US, enter 00‐000.

17.

Proposed Project Start and End Dates: (Required) Enter the proposed start date and end date

of the project.

18.

Estimated Funding: (Required) Enter the amount requested or to be contributed during the

first funding/budget period by each contributor. Value of in‐kind contributions should be

included on appropriate lines, as applicable. If the action will result in a dollar change to an

existing award, indicate only the amount of the change. For decreases, enclose the amounts in

parentheses.

19.

Is Application Subject to Review by State Under Executive Order 12372 Process? Applicants

should contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to

determine whether the application is subject to the State intergovernmental review process.

Select the appropriate box. If “a.” is selected, enter the date the application was submitted to

the State.

Is the Applicant Delinquent on any Federal Debt? (Required) Select the appropriate box. This

20.

question applies to the applicant organization, not the person who signs as the authorized

representative. Categories of debt include: But may not be limited to; delinquent

audit disallowances, loans and taxes. If yes, include an explanation in an attachement.

21.

Authorized Representative: (Required) To be signed and dated by the authorized

representative of the applicant organization. Enter the name (First and last name required) title

(Required), telephone number (Required), fax number, and email address (Required) of the

person authorized to sign for the applicant. A copy of the governing body’s authorization for

you to sign this application as the official representative must be on file in the applicant’s

office. (Certain Federal agencies may require that this authorization be submitted as part of the

application.)

Form Sf-424 - Application For Federal Assistance Page 7

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