Certified current 5/10/07 2. DATE SUBMITTED Applicant Identifier APPLICATION FOR FEDERAL ASSISTANCE 1. TY PE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Preapplication 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier Construction Construction Non-Construction Non-Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit : Department: Organizational DUNS: Division: Address: Nam e and telephone num ber of person to be contacted on Street: m atters involving this application (give area code) Prefix: First Name: City: Middle Name: County: Last Name: State: Zip Code: Suffix: Country : Email: 6. EMPLOYER IDENTIFICATION NUMBER EIN): Phone number (give area code): FAX number (give area code): - 8. TY PE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) New Continuation Rev ision Other (specify) If Rev ision, enter appropriate letter(s) in box(es): (See back of f orm f or description of letters) 9. NAME OF FEDERAL AGENCY Other (specify) 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER : - TITLE: 12. AREAS AFFECTED BY PROJECT (cities, counties, states, etc.): 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF Start Date Ending Date a. Applicant b. Project 15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS a. Federal $ .00 a. Y es. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 b. Applicant $ .00 PROCESS FOR REVIEW ON c. State $ .00 DATE: d. Local $ .00 b. No. PROGRAM IS NOT COVERED BY E. O. 12372 e. Other $ .00 OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW f . Program income $ .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT ? g. TOTAL $ .00 Y es If “Y es” attach an explanation No 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. a. Authorized Representativ e Prefix First Name Middle Name Last Name Suffix b. Title c. Telephone number (give area code) d. Signature of Authorized Representative e. Date Signed Prev ious Editions Not Usable Standard Form 424 (Rev .9-2003) Authorized f or Local Reproduction Prescribed by OMB Circular A-102 INSTRUCTIONS FOR THE SF 424 Public reporting burden for this collection of inform ation is estim ated to average 45 m inutes per response, including tim e for review ing instructions, searching existing data sources, gathering and m aintaining the data needed, and com pleting and review ing the collection of inform ation. Send com m ents regarding the burden estim ate or any o ther aspect of this collection of inform ation, including suggestions for reducing this burden, to the Office of Managem ent and Budget, Paperw ork Reduction Project (0348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. This is a standard form used by applicants as required facesheet for preapplications 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. Ite Entry: Item Entry: m 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 show ing 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) & 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 14. List the applicant's Congressional District and any District(s) Federal identifier number: If this application is a continuation or affected by the program or project. revision to an existing aw ard, 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), w hich w ill 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 w ill result in a dollar change to an of the applicant (including country), and name, telephone existing aw ard, indicate only the amount of the change. For number, e-mail, and fax of the person to contact on matters decreases, enclose the amounts in parentheses. If both basic related to this application. and supplemental amounts are included, show breakdow n on an attached sheet. For multiple program funding, use totals and show breakdow n 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 w hether the application is subject to the State intergovernmental review process. 7. Enter the appropriate letter 17. This question applies to the applicant organization, not the in the space provided. I. State Controlled person w ho signs as the authorized representative. Categories A. State Institution of Higher of debt include delinquent audit disallow ances, loans and taxes. B. County Learning C. Municipal J. Private University D. Tow nship 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 Organization District 8. Select type from the follow ing list: 18. To be signed by the authorized representative of the applicant. A copy of the governing body's authorization for you to sign this "New " means a new assistance aw ard. application as official representative must be on file in the "Continuation" means an extension for an additional applicant's office. (Certain Federal agencies may require that this funding/budget period for a project w ith a projected authorization be submitted as part of the application.) completion date. "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 Aw ard B. Decrease Aw ard C. Increase Duration D. Decrease Duration 9. Name of Federal agency from w hich assistance is being requested w ith this application. 10. Use the Catalog of Federal Domestic Assistance number and title of the program under w hich assistance is requested. SF-424 (Rev. 7-97) Back PART IV PROGRAM NARRATIVE (Suggested Format) U.S. DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 2120-0569 PROJECT: AIRPORT: 1. Objective: 2. Benefits Anticipated: 3. Approach: (See approved Scope of Work in final Application) 4. Geographic Location: 5. Justification for Force Account Work: (if applicable) 6: Sponsor's Representative: (incl. address & tel. no.) FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 PAGE 6 INSTRUCTIONS PART IV PROGRAM NARRATIVE Prepare the program narrative statement in accordance w ith the follow ing instructions for all new grant programs. Requests f or supplemental assistance should be responsive to Item 5b only. Requests for continuation or refunding or other changes of an approved project should be responsive to Item 5c only. 1. OBJECTIVES AND NEED FOR THIS ASSISTANCE. 4. GEOGRAPHIC LOCATION. Pinpoint any relevant physical, economic, social, financial, Give a precise location of the project and area to be served by the institutional, or other problems requiring a solution. proposed project. Maps or other graphic aids may be attached. Demonstrate the need for assistance and state the principal and 5. IF APPLICABLE, PROVIDE THE FOLLOWING INFORMATION: subordinate objectives of the project. Supporting documentation or other testimonies from concerned interests a. Describe the relationship betw een this project and other w ork other than the applicant may be used. Any relevant data planned, anticipated, or underw ay under the Federal Assistance based on planning studies should be included or footnoted. listed under Part II, Section A, Item 10. 2. RESULTS OR BENEFITS EXPECTED. b. Explain the reason for all requests for supplemental assistance and justify the need for additional funding. Identify results and benefits to be derived. For example, include a description of w ho w ill occupy the facility and show c. Discuss accomplishments to date and list in chronological order a how the facility w ill be used. For land acquisition or schedule of accomplishments, progress or milestones anticipated development projects, explain how the project w ill benefit the w ith the new funding re-quest. If there have been significant public. changes in the project objectives, location, approach or time delays, explain and justify. For other requests for changes or amendments, 3. APPROACH explain the reason for the change(s). If the scope or objectives have changed or an extension of time is necessary, explain the a. Outline a plan of action pertaining to the scope and detail of circumstances and justify. If the total budget has been exceeded or how the proposed w ork w ill be accomplished for each grant if individual budget items have changed more than the prescribed program. Cite factors w hich might accelerate or decelerate limits contained in Attachment K, Office of Management and Budget the w ork and your reason for taking this approach as Circular No. A-102, explain and justify the change and its effect on opposed to others. Describe any unusual features of the the project. project such as design or technological innovations, reductions in cost or time, or extraordinary social and community involvements. b. Provide each grant program monthly or quarterly quantitative projections of the accomplishments to be achieved, if possible. When accomplishments cannot be quantified, list the activities in chronological order to show the schedule of accomplishments and their target dates. c. Identify the kinds of data to be collected and main-tained, and discuss the criteria to be used to evaluate the results and success of the project. Explain the methodology that w ill be used to determine if the needs identified and discussed are being met and if the results and benefits identified in Item 2 are being achieved. d. List each organization, cooperator, consultant, or other key individuals w ho w ill w ork on the project along w ith a short description of the nature of their ef fort or contribution. REQUIRED STATEMENTS AIRPORT IMPROVEMENT PROGRAM PROJECTS AIRPORT: LOCATION: AIP PROJECT NO.: STATEMENTS APPLICABLE TO THIS PROJECT a. INTEREST OF NEIGHBORING COMMUNITIES: In formulating this project, consideration has been given to the interest of communities that are near (Exact name of airport) . b. THE DEVELOPMENT PROPOSED IN THIS PROJECT will not require the use of publicly owned land from a public park, recreation area, wildlife and fowl refuge, or a historical site under Federal, State, or Local jurisdiction. c. FBO COORDINATION: The airport development proposed in this project has been coordinated with the Fixed Base Operator(s) utilizing (Exact name of airport) , and they have been informed regarding the scope and nature of this project. d. THE PROPOSED PROJECT IS CONSISTENT with existing approved plans for the area surrounding the airport. The above statements have been duly considered and are applicable to this project. (Provide comment for any statement not checked). BY: DATE: TITLE: SPONSORING AGENCY: NOTE: Where opposition is stated to an airport developm ent project, w hether expressly or by proposed revision, the follow ing specific inform ation concerning the opposition to the project m ust be furnished. a. Identification of the Federal, state, or local governmental agency, or the person or persons opposing the project; b. The nature and basis of opposition; c. Sponsor's plan to accommodate or otherw ise satisfy the opposition; d. Whether an opportunity for a hearing w as afforded, and if a hearing w as held, an analysis of the facts developed at the hearing as they relate to the social, economic, and environmental aspects of the proposed project and its consistency w ith the goals and objectives of such urban planning as has been carried out by the community. e. If the opponents proposed any alternatives, w hat these alternatives w ere and the reason for nonacceptance; f. Sponsor's plans, if any, to minimize any adverse effects of the project; g. Benefits to be gained by the proposed development; and h. Any other pertinent information w hich w ould be of assistance in determining w hether to proceed w ith the project.
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