SF424_Individual_1_1-V1.1_DAT

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SF424_Individual_1_1-V1.1_DAT Powered By Docstoc
					FORM INFORMATION
Form Name / Title     Application for Federal Domestic Assistance- Individual
Form Number           SF424_Individual
Version Number        Version 1
Description           Application for individuals applying for Federal Domestic Assistance
OMB Control Number
                      4040-0005
OMB Expiration Date   7/30/2011
Form Family           Individual Form Family
FORM TITLE:                                      Application for Federal Domestic Assistance- Individual
       [1]                       [2]                       [3]                  [4]              [5]                       [6]                          [7]                   [8]                       [9]                                  [10]                       [11]                    [12]                   [13]                 [14]             [15]                [16]                         [17]

                                                                                              Minimum                                                                                             Global Library                                                                                                                      Min # of Chars   Max # of Chars         Field
    Field #                 Field Label             Short Field Label        Required?       Occurrences           Maximum Occurrences           Agency Field Name         Field Type              Field Name                         Field Type Source            Business Rules             Data Type           List of Values       or Min Value     or Max Value     Implementation                     Help Tip
0-0               View Burden Statement          View Burden            n/a              n/a                   n/a                         n/a                       Agency-specific    n/a                                n/a                              Clicking displays burden    n/a               n/a                         n/a              n/a              Button            View Burden Statement
                                                 Statement                                                                                                                                                                                                  statement.
                                                                                                                                                                                                                                                            Text for the Burden
                                                                                                                                                                                                                                                            Statement is available on
                                                                                                                                                                                                                                                            the website in the forms
                                                                                                                                                                                                                                                            repository.
0-1               OMB Number 4040-0005           n/a                    n/a              n/a                   n/a                         n/a                       n/a                n/a                                n/a                              n/a                         n/a               n/a                         n/a              n/a              Label             n/a
                  Expiration Date: 7/30/2011


0-2               APPLICATION FOR                n/a                    n/a              n/a                   n/a                         n/a                       n/a                n/a                                n/a                              n/a                         n/a               n/a                         n/a              n/a              Label             n/a
                  FEDERAL ASSISTANCE SF
                  424 - INDIVIDUAL



1                 1. NAME OF FEDERAL             Name of Federal        Yes              1                     1                           FederalAgency             Pre-populated      globLib:AgencyNameDataType         SubmissionDef.AgencyName         n/a                         AN                n/a                         1                60               Field             Pre-populated from the Application cover
                  AGENCY                         Agency                                                                                                                                                                                                                                                                                                                                   sheet.




2-1               2. CATALOG OF FEDERAL          CFDA Number            No               0                     1                           CFDANumber                Pre-populated      globLib:CFDANumberDataType         SubmissionDef.CFDANumber         n/a                         AN                n/a                         0                15               Field             Pre-populated from the Application cover
                  DOMESTIC ASSISTANCE                                                                                                                                                                                                                                                                                                                                                     sheet.
                  NUMBER:




2-2               CFDA TITLE:                    CFDA Title             No               0                     1                           CFDATitle                 Pre-populated      globLib:CFDATitleDataType          SubmissionDef.CFDATitle          n/a                         AN                n/a                         0                120              Field             Pre-populated from the Application cover
                                                                                                                                                                                                                                                                                                                                                                                          sheet.




3-1               3. DATE RECEIVED               Date Received:         Yes              1                     1                           Date_Received             Post-populated     globLib:DateReceivedDataType       n/a                              NA                          Date              n/a                         NA               NA               LABEL             Completed by Grants.gov upon
                                                                                                                                                                                                                                                                                                                                                                                          submission.



4-1               4. FUNDING OPPORTUNITY Funding Opportunity            Yes              1                     1                           OpportunityID             Pre-populated      globLib:OpportunityIDDataType      SubmissionDef.OpportunityID      n/a                         AN                n/a                         1                40               Field             Pre-populated from the Application cover
                  NUMBER:                Number                                                                                                                                                                                                                                                                                                                                           sheet.




4-2               TITLE:                         Funding Opportunity    Yes              1                     1                           OpportunityTitle          Pre-populated      globLib:OpportunityTitleDataType   SubmissionDef.OpportunityTitle   n/a                         AN                n/a                         1                255              Field             Pre-populated from the Application cover
                                                 Title                                                                                                                                                                                                                                                                                                                                    sheet.




5-1               5. APPLICANT                   n/a                    n/a              n/a                   n/a                         n/a                       n/a                n/a                                n/a                              n/a                         n/a               n/a                         n/a              n/a              Label             n/a
                  INFORMATION


5a-1              a. Name and Contact            n/a                    n/a              n/a                   n/a                         n/a                       n/a                n/a                                n/a                              n/a                         n/a               n/a                         n/a              n/a              Label             n/a
                  Information


5a-2              Prefix:                        Prefix                 No                                 0                             1 PrefixName                Global             globLib:PrefixName                 n/a                              n/a                         LIST              Mr.&&Mrs.&&Miss&&Ms.&&Dr.&& 0                10               combobox          Select the Prefix from the provided list or
                                                                                                                                                                                                                                                                                                          Rev.                                                                            enter a new Prefix not provided on the list.




5a-3              First Name:                    First Name             Yes                                1                             1 FirstName                 Global             globLib:FirstName                  n/a                              n/a                         AN                n/a                         1                35               Field             Enter the First Name. This field is
                                                                                                                                                                                                                                                                                                                                                                                          required.


5a-4              Middle Name:                   Middle Name            No                                 0                             1 MiddleName                Global             globLib:MiddleName                 n/a                              n/a                         AN                n/a                         0                25               Field             Enter the Middle Name.




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FORM TITLE:                                      Application for Federal Domestic Assistance- Individual
       [1]                        [2]                       [3]                 [4]              [5]                       [6]                           [7]                   [8]                        [9]                      [10]                        [11]                        [12]                     [13]                   [14]             [15]               [16]                            [17]

                                                                                              Minimum                                                                                             Global Library                                                                                                                     Min # of Chars   Max # of Chars         Field
  Field #                     Field Label           Short Field Label        Required?       Occurrences           Maximum Occurrences            Agency Field Name       Field Type               Field Name                Field Type Source            Business Rules                 Data Type             List of Values         or Min Value     or Max Value     Implementation                     Help Tip
5a-5              Last Name:                     Last Name              Yes                                1                             1 LastName                   Global           globLib:LastName                n/a                       n/a                              AN                 n/a                             1                60               Field             Enter the Last Name. This field is
                                                                                                                                                                                                                                                                                                                                                                                         required.


5a-6              Suffix:                        Suffix                 No                                 0                             1 Suffix                     Global           globLib:SuffixName              n/a                       n/a                              LIST               Jr.&&Sr.&&M.D.&&Ph.D            0                10               combobox          Select the Suffix from the provided list or
                                                                                                                                                                                                                                                                                                                                                                                         enter a new Suffix not provided on the list.




5a-7              Fax Number:                    Fax                    No               0                     1                                                     Global
                                                                                                                                           AuthorizedRepresentativeFax                 globLib:TelephoneNumberDataType n/a                       n/a                              AN                 n/a                             1                25               Field             Enter the Fax Number.


5a-8              Email:                         Email                  No               0                     1                                                     Global
                                                                                                                                           AuthorizedRepresentativeEmail               globLib:EmailDataType           n/a                       E-mail validation                AN                 n/a                             0                60               Field             Enter a valid Email Address.


5a-9              Telephone Number (Daytime): Daytime Phone             Yes              1                     1                                                     Global
                                                                                                                                           AuthorizedRepresentativePhoneNumber         globLib:TelephoneNumberDataType n/a                       Global                           AN                 n/a                             1                25               Field             Enter the daytime Telephone Number.
                                              Number                                                                                                                                                                                                                                                                                                                                     This field is required.




5a-10             Telephone Number (Evening): Evening Phone             No               0                     1                           EveningPhone               Global           globLib:TelephoneNumberDataType n/a                       Global                           AN                 n/a                             0                25               Field             Enter the evening Telephone Number.
                                              Number


5b-1              b. Address                     n/a                    n/a              n/a                   n/a                         n/a                        n/a              n/a                             n/a                       n/a                              n/a                n/a                             n/a              n/a              Label             n/a
5b-2              Street1:                       Street1                Yes              1                     1                           Street1                    Global           globLib:Street1                 n/a                       n/a                              AN                 n/a                             1                55               Field             Enter the first line of the Street Address.
                                                                                                                                                                                                                                                                                                                                                                                         This field is required.




5b-3              Street2:                       Street2                No               0                     1                           Street2                    Global           globLib:Street2                 n/a                       n/a                              AN                 n/a                             0                55               Field             Enter the second line of the Street
                                                                                                                                                                                                                                                                                                                                                                                         Address.



5b-4              City:                          City                   Yes              1                     1                           City                       Global           globLib:City                    n/a                       n/a                              AN                 n/a                             1                35               Field             Enter the City. This field is required.



5b-5              County/Parish:                 County/Parish          No               0                     1                           County                     Global           globLib:County                  n/a                       n/a                              AN                 n/a                             0                30               Field             Enter the County/Parish.

5b-6              State:                         State                  No               0                     1                           State                      Global           globLib:State                   n/a                       Conditionally required if Country LIST              50 US States, US possessions,   0                55               popup             Select the state, US possession or
                                                                                                                                                                                                                                                 is US then active. If Country is                    territories, military codes                                                         military code from the provided list. This
                                                                                                                                                                                                                                                 not US, then inactive                                                                                                                   field is required if Country is the United
                                                                                                                                                                                                                                                                                                                                                                                         States.




5b-7              Province:                      Province               No               0                     1                           Province                   Global           globLib:Province                n/a                       If Country is US then inactive. If AN               n/a                             0                30               Field             Enter the Province.
                                                                                                                                                                                                                                                 Country is not US, then active




5b-9              Country:                       Country                Yes              1                     1                           Country                    Global           globLib:Country                 n/a                       n/a                              LIST               ISO 3166 Country Code List      1                49               popup             Select the Country from the provided list.
                                                                                                                                                                                                                                                                                                                                                                                         This field is required.




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FORM TITLE:                                       Application for Federal Domestic Assistance- Individual
       [1]                       [2]                        [3]                  [4]              [5]                   [6]                          [7]                   [8]                        [9]                                   [10]                        [11]                       [12]                     [13]                [14]              [15]              [16]                           [17]

                                                                                               Minimum                                                                                         Global Library                                                                                                                             Min # of Chars   Max # of Chars         Field
     Field #                 Field Label             Short Field Label        Required?       Occurrences       Maximum Occurrences         Agency Field Name          Field Type               Field Name                            Field Type Source           Business Rules                 Data Type             List of Values      or Min Value     or Max Value     Implementation                      Help Tip
5b-8              Zip/Postal Code:                Zip/Postal Code        No               0                 1                         ZipPostalCode              Global             globLib:ZipPostalCode               n/a                               Conditionally required if Country AN               n/a                          0                30               Field             Enter the Postal Code (e.g., ZIP code).
                                                                                                                                                                                                                                                          is US then required. If Country                                                                                                     This field is required if Country is the
                                                                                                                                                                                                                                                          is US, min value 9 characters. If                                                                                                   United States.
                                                                                                                                                                                                                                                          Country is not US, then
                                                                                                                                                                                                                                                          optional.




5c-1              c. Citizenship Status:          n/a                    n/a              n/a               n/a                       n/a                        n/a                n/a                                 n/a                               n/a                             n/a                n/a                          n/a              n/a              Label             n/a


5c-2              U.S. Citizenship                n/a                    Yes              1                 1                         citizenship                Radio Group        globLib:YesNoDataType               citizenship                       n/a                             LIST               n/a                          n/a              n/a              Radio Group       n/a


5c-3              Yes                             U.S. Citizenship       No               0                 1                         n/a                        Radio Group        n/a                                 citizenship                       n/a                             n/a                Yes                          n/a              n/a              Radio             Select Yes if applicant is a citizen of the
                                                                                                                                                                                                                                                                                                                                                                                              United States.
5c-4              No                              U.S. Citizenship       No               0                 1                         n/a                        Radio Group        n/a                                 citizenship                       n/a                             n/a                No                           n/a              n/a              Radio             Select No if applicant is a permanent
                                                                                                                                                                                                                                                                                                                                                                                              resident and enter the Alien Registration
                                                                                                                                                                                                                                                                                                                                                                                              Number. Select No if applicant is a
                                                                                                                                                                                                                                                                                                                                                                                              foreign national and enter the country of
                                                                                                                                                                                                                                                                                                                                                                                              citizenship and start date of most recent
                                                                                                                                                                                                                                                                                                                                                                                              residency in the United States.

5c-5              If No                          n/a                     n/a              n/a               n/a                       n/a                        n/a                n/a                                 n/a                               n/a                              n/a               n/a                          n/a              n/a              Label             n/a
5c-6              If permanent resident of U.S., Alien Registration      No               0                 1                         AlienRegistrationNumber    Agency-specific    n/a                                 n/a                               Enabled if the Citzenship Status AN                n/a                          0                14               Field             Enter the Alien Registration Number.
                  enter the Alien Registration # Number                                                                                                                                                                                                   = "N", else Disabled.



5c-7              If foreign national, enter      Citizenship Country    No               0                 1                         CountryofOrigin            Global             globLib:Country                     n/a                               Global Enabled and Required if LIST                ISO 3166 Country Code List   0                49               popup             Select the Country from the provided list.
                  country of citizenship:                                                                                                                                                                                                                 the Citzenship Status = "N",                                                                                                        This field is required if the applicant is not
                                                                                                                                                                                                                                                          else Disabled.                                                                                                                      a U.S. Citizen.



5c-8              If foreign national, enter start Residency Start       No               0                 1                         VisitDate                  Agency Specific    n/a                                 n/a                               Enabled and Required if the     DATE               n/a                          n/a              n/a              Field             Enter the start date of the most recent
                  date of most recent residency                                                                                                                                                                                                           Citzenship Status = "N", else                                                                                                       residency in the U.S. Enter in the format
                  in U.S.:                                                                                                                                                                                                                                Disabled.                                                                                                                           MM/DD/YYYY. This field is required if the
                                                                                                                                                                                                                                                                                                                                                                                              applicant is not a U.S. Citizen.




5d                d. Congressional District of    Congressional District Yes              1                 1                                                     Global
                                                                                                                                      CongressionalDistrictApplicant                globLib:CongressionalDistrictDataTy n/a                               n/a                             AN                 n/a                          1                6                Field             Enter the Congressional District in the
                  Applicant:                      of Applicant                                                                                                                      pe                                                                                                                                                                                                        format: 2 character State Abbreviation - 3
                                                                                                                                                                                                                                                                                                                                                                                              character District Number. Examples: CA-
                                                                                                                                                                                                                                                                                                                                                                                              005 for California's 5th district, CA-012 for
                                                                                                                                                                                                                                                                                                                                                                                              California's 12th district, NC-103 for North
                                                                                                                                                                                                                                                                                                                                                                                              Carolina's 103rd district. This field is
                                                                                                                                                                                                                                                                                                                                                                                              required.

                                                                                                                                                                                                                                                                                                                                                                                              If outside the US, enter 00-000.


6                 6. PROJECT INFORMATION n/a                             n/a              n/a               n/a                       n/a                        n/a                n/a                                 n/a                               n/a                             n/a                n/a                          n/a              n/a              Label             n/a


6a                a. Project Title                Project Title          No               0                 1                         ProjectTitle               Global             globLib:ProjectTitleDataType        n/a                               n/a                             AN                 n/a                          0                200              Field             Enter a brief, descriptive title of the
                                                                                                                                                                                                                                                                                                                                                                                              project



6b                b. Project Description          Project Description    Yes              1                 1                         ProjectDecription          Agency-specific    n/a                                 n/a                               n/a                             AN                 n/a                          1                1000             Field             Enter a brief description of the project.
                                                                                                                                                                                                                                                                                                                                                                                              This field is required.




6c-1              c. Proposed Project             n/a                    n/a              n/a               n/a                       n/a                        n/a                n/a                                 n/a                               n/a                             n/a                n/a                          n/a              n/a              Label             n/a


6c-2              Start Date:                     Proposed Project       Yes              1                 1                         FundingPeriodStartDate     Agency-specific    n/a                                 n/a                               n/a                             DATE               n/a                          n/a              10               Field             Enter the start date for the proposed
                                                  Start Date                                                                                                                                                                                                                                                                                                                                  project. Enter in the format
                                                                                                                                                                                                                                                                                                                                                                                              MM/DD/YYYY. This field is required.


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FORM TITLE:                                        Application for Federal Domestic Assistance- Individual
       [1]                        [2]                          [3]              [4]             [5]                   [6]                        [7]                    [8]                      [9]                         [10]                     [11]                [12]                 [13]              [14]             [15]               [16]                          [17]

                                                                                             Minimum                                                                                        Global Library                                                                                                 Min # of Chars   Max # of Chars         Field
  Field #                     Field Label             Short Field Label     Required?       Occurrences       Maximum Occurrences         Agency Field Name          Field Type              Field Name                Field Type Source         Business Rules         Data Type         List of Values    or Min Value     or Max Value     Implementation                     Help Tip
6c-3              End Date:                        End Date               Yes           1                 1                         FundingPeriodEndDate       Agency-specific    n/a                            n/a                       n/a                    DATE              n/a                    n/a              n/a              Field             Enter the end date for the proposed
                                                                                                                                                                                                                                                                                                                                                               project. Enter in the format
                                                                                                                                                                                                                                                                                                                                                               MM/DD/YYYY. This field is required.
7-1               7. * By signing this application, n/a                   n/a           n/a               n/a                       n/a                        n/a                n/a                            n/a                       n/a                    n/a               n/a                    n/a              n/a              Label             n/a
                  I certify (1) to the statements
                  contained in the list of
                  certifications** and (2) that the
                  statements herein are true,
                  complete and accurate to the
                  best of my knowledge. I also
                  provide the required
                  assurances** and agree to
                  comply with any resulting
                  terms if I accept an award. I
                  am aware that any false,
                  fictitious, or fradulent
                  statements or claims may
                  subject me to criminal, civil, or
                  administrative penalties (U.S.
                  Code, Title 218, Section 1001)



7-2               ** I AGREE                       I Agree                Yes           1                 1                         ApplicationCertification   Agency Specific    n/a                            n/a                       n/a                    n/a               n/a                    n/a              n/a              Check             Check to select. This field is required.

7-3               ** The list of certifications and n/a                   n/a           n/a               n/a                       n/a                        n/a                n/a                            n/a                       n/a                    n/a               n/a                    n/a              n/a              Label             n/a
                  assurances, or an internet site
                  where you may obtain this list,
                  is contained in the
                  announcement or agency
                  specific instructions.

7-4               Signature                        Signature              Yes           1                 1                         AORSignature               Post-Populated     globLib:SignatureDataType      n/a                       n/a                    AN                n/a                    1                144              Label             Completed by Grants.gov upon
                                                                                                                                                                                                                                                                                                                                                               submission.



7-5               Date Signed                      Date Signed            Yes           1                 1                         AORDate                    Post-Populated     globLib:DateReceivedDataType   n/a                       n/a                    DATE              n/a                    n/a              n/a              Label             Completed by Grants.gov upon
                                                                                                                                                                                                                                                                                                                                                               submission.




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