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At t.a ,.llrren t M GENERAL INSTRUCTIONS This is a multi-purpose standard form. First, it will be used by applicants as a required facesheet tor Pf~appJtcat¡ons and applications submitted in accOfdance with OMB Circular A-10Z. Second. it wll\ be used by Federal agencies to report to clearinghouses on major actions taken on applications reviewed by clearinghouses in accordance with OMB Circular A-95. Third. it will be used by Federal agencies to notify States of grants-tn-ald awarded in accordance with Treasury Circular 1082. Fourth. it may be used. on an optional basis. as a notification of intent from applicants to clearinghouses. as an early initial notice that Federal assistance is to be applied for (clearinghouse procedures will govern). APPLICANT PROCEDURES fOR SECTION I .A~-";:>J!C4nl ""If complete all Items In SectJOn I II an Item '5 nol appIoÇ<Ù)Je, wme "NA" II addltlOflal space IS~, i/13oef1 an aslar,s, ..... "r>d \Is.<> ¡he ramarXs section on the back 01 th<! form An explar;atJon loIlows fO<' each item: Item Item 1 Mar. appropnate box. f'Te.app"catJon and appl!C4t>on to Governmental Ufllt ..-h<?re s.gnlf¡canl and meaningful 1m gUIdance IS In 01,18 CIrcular A-102 aod Federat agency pact could t>e oo.se<Ved List oniy I.argBsl unit or '.:rilS ¡:xogram If1structlons No¡,f'Cj!;on 01 Intenl guld¡¡nce IS ,n aHOCled. such as Stale. CCX.iflfy or CI~f It enl"e lint! Circular A-95 and procedures from cleannghouse Awll. "Heeled, ItSI II rather than subunlls can! 'MIl rrol use "Repo<1 of Feò",ral Act,on" box. 11 Estimated numbo';r 01 pe<sons direc1ly benefitIng from 2a Apphcant s own control number. rt de-slred prOjeCt 2b. Dille Section 1 IS prepared 12 Us.<> a¡Jp<Cip<'.ata C(JÓo3 !et1er. ~ilnrtlons are. 3iI Numbo';r aSS'9nOO by State cleannghouse. 0( rt OOIeg.aled A. New A subm<t'..al for the first tJme for a new project by Slale. by araa""K!e cl.aannghouse All rÐquesls 10 B. Reoewal An aX1enSlon fo< an additIonal fundlngf Federal agencIes muST cootaln this K!entl1Jef it the pro- tx.Jðçet penod for a prOject havIng no profected com. gram 15 covered by Circular A-95 and reqUIred by applica. plellon dale. but for whIch Federal support must be b!e State/ areawide clearinghouse procedures " in ren€'Wed each year doubt, consult your cleartnghouse Dale applH:cant notlhed 01 c!eannghouS<J IdentIfier C RevtSlOn A mOOlflcallon to pro¡ect nature or sco~ 30 whtçh rnay result In fund'ng change (Increase or de. 4a-4h Legal name of l19PhCant/reclpoent. name 01 primary or9a. craas.<» mzallonal uflll whIch wIll u~rtake the asSIstance actIvo 0 ConltnuatiOn An extenSIon for an addrtoonal fundlngl rty, complete address 01 applicant, aod name and ~t penod for a projeCt 1m. agency miùally agre«d telephone numbo';r of person who tan provide furth<!r to turod tor a òeflnlle numbel 01 years ,nformatlon abOut thIs request E. AugmenUlt>O11 A requorement for addItional tunds for a 5. Employer tdentlj¡catlOf'l numQer of appliCant as SSS'9ned prOjeCt pre'o'!O\JsJy awarded fuods tn the same funding! by Internal Revenue SeN>ce b<Jd<;¡e1 penod Project nature and S('~ unchanged Sa. Use Catalog of Federal DomestJ.:: ASSIstance number 13. Amount reqvasted Of 10 be COfItnöu1ed dunng the lirs! ass.gned to program un<ler whICh asSIstance IS request. luodlng/budget penod by each contnbu1or. Value of ,no ed If more than one program (eg., ¡o.nt-Iunding) wnte klod ÇO{11T'.bu1>ons ",,¡¡ be included rl the action is a "multIple" and explain in remart<s. II unknown, cite Public &..ar;g€ ,n doHar amount of an exIS!I~ grant (a rev'SIOn or law or U.S. Code augmentat'on), ir><J,(;ate 011/y th<! Brno<.snt of the change 6b. Program title from Federal Catalog. Abb<8\I1ate n neces- For òecreases enclose the amount," parentheses If both baSK: aod supplemental amounts are Included, sary break out In remarXs FOf multJp!e program funding. usa 7 8riBt tlUe and appropnate descriptIOn 01 prOjeCt For totals aod ShOw program breakouts ,n remarks Item no!ilicatlon at Intent. conbnue In remafJ(s sectlofl if neces. defJf1IIlOns: 13.8, amount requested from Federal Govern. sary to convey proper cIescn~ton ment; 13b, amount appfJ<;<int "",II contnb\Jte. 13c, amour:t 8. Mostly self-explar;atory. "City" 'ncluctes town, township 0<' from Stale, rl tlWteant IS not a State; 13d. arno<.snt Irom othef monìcip.altty Io<;al government, rl applteanl IS nol a local government; 13e. amount from any other sources, explaJ(1 In remar1<s 9. Ct>acJ< tOO type(s) of IlS$l$tance T'8qIJeS1e<t. The def",;- boos 01 the terms 81'9: 14a. Self explanðtory. A. BaSK: Grant. An origìnaJ l'eq<.>e$t fO<' Federaf funds. 14b. The dosbict(s) where most of actual woO< wjll be accom. nus wwid nol íncJuclt¡ any conlnòu1ion provided un- pi<shed. If city..wjce 0<' Stat:rW1de. COYering several dls- óef a SUppiømental grant. tJicis. wme "city..,.,;oe" 0<' "Sta1e-W>Óe." B. ~1a1 Grant. A r~t to increase II ba&c 15. Complete oNy fO<' ~s (rtem 12c). Q( augmentatJons gran! in certain cases whefe the eHg;Oie ~nt (rtam 12e) cannot IWPPly the raquírt'd ImItching share of the 16. Aw'oxirMle á.ltte prO8C1 expecte<t to begòn (usually as- b.\\SIC Federal program (e.g.. \ìfiSnts awarded by the ¡l\pp<tLachian R.eogiorIaI Commi:ssìon to provide the $OCtjIled wrth est:mated d.!Ite of ¡¡yail:!lbility of tuod'o¡¡) ~lC<Int a matcNng $hMe) H ElSbmated number of monl1>.s to ccmptete PfOeCt an"r F~I funds f;r9 IIIV~ C Loon. Self explana!çry 18 Estimated date ~~ppi>C.lltionfawteatJon wjll be 5ubn'>J- D. ln$Ufðl'iCe. SeI1 expianatO<)l tOO to Federal ~ n th1s prOOC1 r~es c~n"9- hoose rß'V1€'W If rev>ew r~t raqv¡red, thIS date WOUld E Qtt¡.£.r Explajn on remarks page. -..al/y be 3-11"1108 as Cl.ðte In Item 2b IrrÞ>J«)-"'O~""""(¡.£)IR.... 4.7)) Exh.ibi t M-- 3. Application for Federal Assis~~ce (N::mconstruction Prograrf1s) (Paqe 3 of 13) 13