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Attachrrent M GENERAL INSTRUCTIONS This is a multi-purpose standard form. First, it will be used by applicants as a required facesheet for pre-applications and applications submitted in accordance with OMB Circular A-102. Second, it will be used by Federal agencies to report to cleannghouses on major actions taken on appiications reviewed by clearinghouses in accordance with OMB Circular A-95. Third. it will be used by Federal agencies to notify States of grants-In-aid 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 iOitial notice that Federal assistance is to be applied for (clearinghouse procedun~s will govern). APPLICANT PROCEDURES FOR SECTION I A.-'pllcant 'Mil complete all Items in SectIOn I If an í1em IS not applicable. W'lite "NA". If additIOnal space is needed. ,nsen an asterisk ..... ..nd use the remaò<s secbon on the back 01 the form An explanabon follows tOl' each í1em. I1fffl'I Item 1. Maò< appropriate box. Pre-apphcatton and appllCabon 10. GOvarn~ntal Unit where SIgnifICant and IT1€snlngful 1m. gulÓ3nce IS In 01.18 Circular A-102 and Federal agency pact coord be oòserveo. Ust only largest unt! or UnIts Pfogram Instruct,ons Notification of ,ntent gUIdance's In sHeeted. such as State. county, or city. If entire Unll C...cular Â-95 and prOCeOures from cleannghouse Apph- affected. Itst It ralner than suoonilS canl 'Mil not use "Aepo<1 of Federal Action" box. 11. Eslima!eO number 01 persons directly beneflllng from 23 Applocant s own control numbf'..r. If deSired projoct 2b Ollie Section I IS Pfepared 12 Use apPfopnalð COde .etter. DefinitIOns are. $a Number ass.gned by State cleannghouse. Of If deJegated ^. New A ~.al for the first time lor a new project by State, by afaaW1de cleannghouse All requests to B. Renewal ^n e:<ten&lon tOf an addlt,onal fundIng' FeOeral agenCIes must contain th,s tdent,f~ jj It1e- pro.. tx4get pet>Od for a prOJect hm/ing no prOjected com. gram IS covered by C¡rcular Â-95 and reqUIred by applics. plebon date, but fOf which Federal support must bf'.. ble Slate/areawide cleaflnghouse procedures. It in rer>eweO each year doubt. consul! your cleannghouse C. Rev,s¡on A nxx:¡hcalion to pro¡ect nature Of scope 30 Dale apphcant nol,f¡eO of c.eannghouse IdentifIer """,ch rnay resull on fundIng change (Increase or de. 4a-4h Legal name of apphcenllreelp¡ent. name of pnma'Y orga. crease). ruzatlonal unIt whIch will undertake the asSIstance activo D. Continuation. ^n extension for an addí1IOI'\a funding 1 Ity. complete address of appliCant, and name and bu<!get pet>Od for a projeCt the agency Iní4aJIy agraed telephone number of person who can PfOvide further to fund for a definIte number of years. information about thiS request. E. AugmentatiOn A requorement for addllionaJ funds for a 5. Employer tden\JflCatlOn number of applICant as ass.gned Pfoje<:t Pfev1OUsly awarded funds In the same funding' by Intemal Revenue SEtMce. budget pet>Od Project nalu,e and scope unchanged 6.a Use Catalog of Fadet81 Domes!lc Ass.stance number 13. Amount raq\JðStect or to be contnbu1eO dunng the fIrst ass.gneO to program under whICh ass.stance ,s request- lundmg/bu<!get penOO by each contributor. Value of In- eO If more than one program (6.9". joint-funding) WIlte kInd contnì:>utions will be included if the action is a "mult,ple" and explaIn," remaò<s. If unknown. cile Public change In dollar amount of an exIsting grant (il fiNIS/on or Law or U.S Code augmentatIOn), Indicate only the amount 01 the change. 6b Program btle Irom Federal Catalog. Abbf8V1ðte il neces- For decfeases enclose the amount In parentheses If both basic and ~emental amounts are IncludeO. sary break out In rsmaò<s For multIple Pfogram funding. use 7. Bnef tllle and appropnate descnptlOn of prOÐÇt For lotals and show program breakouts In remarks Item noliflC8llon ot Intent. continue In remaò<s section if neces- óehnttlOn:5: 13a. amount requesteO from Federal Govern. sary to convey: proper descnpllon ment; 13b. amount apphcant WIll contribute; 13c. amount 6. Mostly self-expianatOly. ."Cily" Includes town. townshtp Of from State. If applicant IS not a State; 13d. amount Item other municípa¡1y local government, if apphcant is not a local govem"",nt 13a. amount from any 0tf1ef sources, explain In remarks. 9 (;hecf( the type(s) 01 ~ røques1ed. The deliní. bons of the terms are: 14a. Self expianatOly. A. Basic Grant. An Original rec¡uøst. for Federal funds, 14b. The dtslTict(s) where most of actual \I!tOf1( will be accom- This would not inclOOe any contribution provided un- piished. If erty-wiðe Of Stat3-wtde. COYering several d,s. Clef It supplerrlenta! grant. tricts. W'lite ..erty-wide" Of "State-wide:' 'B. Supplemental Grant. A ~t to incr8ðSð a basic 15. CompIet& on;.¡ 101 te'\IÌ$ÍOns (Item 12c). Of 8ugmentabons grant in certain cues where the eligible applicant (Item 12e). cannot supply the requir8d matching ¡¡hare 01 the 16. Approximafe ~!e project e¡q¡ected to begin (usually as- basic Foo.eral program (e.g.. grants _rded by the AppaIact1ian Regional Commi9$.ion to provide the IIOOated wi1h Mt:mated date 01 availability 01 fundIng) appIlCaI1t a matching $hare). 17. Estimated I"IUI'I'!ber 01 mon1tls to complete proeCt after C. Loon. Self axpianatOly. F~al funds ~ available 1B. E!rtJmated dale ~lCalion/appilCabon witt be wbn'llt. D. lr&1rance. SiII1 axplan.atOly. led to Fecleral ogency rf this ptO8C1 r9QUll'ftS cleanng. house f6Wi!W If rev.ew ~, required. thIS date WOuld E Qthèr. E;q;>IAln O!"I ril!<flaÒ<s pag,a ~11y be s.ame as data In Item 2b. ST"-'OOìJIO~U"'AGE 31R... '-771 Exllib i t M- 3. Application for Federal Assistance (t'bnconstructian Prcx;rrams) (Page 3 of 13) 13