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~achrren t M Item 19. Existing Federal tdentiflCation nulT1Oef' if this is not a new 20, !ndÍC<lle Fede<"aJ agency to whICh this req~ is ad- request and directly r~tes to It pnMou5 Feéera action, dressed. Street address not required, bot do use ZIP, Otherwise write "NA" 21. Check appropriate box as to whether Section IV of form contains remarks and/OC' additional r8marXs ate attached APPLICANT PROCEDURES FOR SECTION II Applicants will always complete items 23a, 23b, and 23c. If clearinghouse reVIeW IS required, item 22b must be fully completed. An explanatIon follows for each Item. Item Item 220 lis: cleannghouses to wtllch subm/l1e<:J and show In 23b Self explanatory appropnate blocks the status of t~ir responses For more than three cleannghouses, contInue In remarks Self explanatory, section. All wnl1en comments submi11ed by or through 23c. cieannghouses must be al1ached 23a Name and tItle of au1hOfÍze<:J representatIve of legal Note ApplICant completes only SectIons I and II. Section III IS applicant completed by Federal agencies fEDERAL AGENCY PROCEDURES FOR SECTION III If applicant-supphedlnformatlon In Sections I and II ne€ds no updating or adjustment to fit the final Federal action, the, Federal agenq' "",II complete Section III only An explanatIon for each Item follows. l1em Irem 24 Executive department or ,ndependent agency havIng pro- 35 Name and t€llephone no of agency person who can gram adminIstratIon responsibIlity prOVIde more informatIon regarding this assistance. 25 Self explanatory 36 Date atter which funds will no longer be available 26 Pnmary organIzatIonal unIt below department level having 37. C~ck appropnate box as to whether Section IV of ¡orm direct program management responsibility contains Fe<:Jeral remarks andlor attachment of add,hon- 27 OffIce directly momlonng the program. al remarks 28 Use to ,óenhty non-award actIons where Federal grant 38 For use with A-95 action notices only. Name and tele- IdentIfIer In Item 30 IS not appÍlcab!e or will .not suffice phone of person who can assure that appropnate A-95 actIOn has been taken-If same as person shown In l1em 29 Complete address of adminIstering oH,ce shown 'n Item 35, wnte "same", If nol applicable, write "NA", 26 30 Use 10 Idenhfy award achons where different from Feder- Federal Agency Procedures-special considera/fons al appliCation IdentifIer In Item 28. A. Treasury ûrc¡;fa' 1082 compliance. Fe-jeral agency will assure 31 Self explanatory. Use remarks sectIon to amplIfy where proper _completiOn of Sections I and III If .Section I is o,""g appropnate completed by Federal agency, all apphcable items must be filled 32 Amount to be contributed durmg the first fund'ng/buóget in. Addresses of State Information Recaption AgencIes period by each contributor. Value of in-kind contributions (SGIRA's) are provided by Treasury Departm<>nt to each agency W1!1 be Include<:J If the actIOn is a change in dollar ThIs form replaces SF 240. which will no kmger be used. amount of an existing grant (a ravision or at.'9mentation), 8. OMS ûrcv"'r A-95 romp/lance Federal agency will assure Indicate only the amount of change. For decreases. proper comple!J<)n of Sectioos I. II. and III. This form is requ¡(ed enclose t~ amount in parent~sas If both basic and for notifying all reviewing cJ.aaringhouses of major actions on all supplemental amounts are included, break out in remarXs programs reviewed unOOr A-95, Addresses of State and For multiple program funding, use totals and show pro- areawide c!e3ringhouses are prOVIded by OMB to each agency. gram breakou1s in remarks, Item def,nrtions: 328, amour.t Substantive differences between I!IP?licant's raquas! and/or awarded by Federal Government; 320, amount aWÍC<Int daaringhouse recommendatlOf".s, and the proiect as finally will contribute; 32c. amount from State. if ew.jÇilnt is not awarded will be explained in A-95 nolffiœtions to cieanng- a State; 32d, amount froni locai government if applicant I:; houses not a local govemment; 32e. amount from any other C. Spec¡.al =te. In rT1O$l. bot not all States. t/)¡; A-95 State clearlng- sources. explain in rema,ks. !1ouse and the (TC 1082) SCIRA are t/)¡; ¡;sine off,ce. In such 33. Date act,on was taken Of\ this request cases, the A-95 award notICe to the State clearinghouse will fllifiH the TC 1082 award O'Jtice req\.!¡r~t to the State SGrRA. 34 Date funds WIll become av8J;able. Dl.'pI>Cðle notlticahon shouk! be 1i"00ed Exhibi t M- 3 - Application for Federal Assistarlce (Nonconstruction Programs) (Page 4 of 13) In ~ 1'O!'<M U<\ I' M1é 4 (Re-, . - 7 7 } 14