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<br /> ~achrœnt M lIem
<br /> 19. Existing Fec\ef"al ide<'ttification I'\Uf1'1bef if thIs is not a new 20. Indicate Federl1l agency to which this request is ad.
<br /> request and dil'ectly r,¡ ates to II þrEMOUs Federal actJOn. dressed. SlTeet address not required, but do use ZIP.
<br /> OttIeNtise -ne "NA" 21. Check appropriate box as to whether Section IV of form
<br /> contains remarks and/or additional remarks are attached.
<br /> APPLICANT PROCEDURES FOR SECTION II
<br /> AppliCants WIll always complete items 23a. 23b, and 23c. If cleannghouse reVIeW IS required, item 22b must be fully completed. An
<br /> explanation follows for each Item.
<br /> Irem Item
<br /> 220 ust cieannghouses to whlch'lUbmltted and Show In 23b. Sell e~plan<ltory.
<br /> appro¡xiate blocks !tie status of their responses.. For
<br /> more than three cieannghouses, conl>nue ;n remarks 23c Sell explanatory
<br /> :;ectIOf). All wntten comments submItted by Of through
<br /> clearmghouses must be attached.
<br /> 23a Name and t,tle of aU1hOf1zed re¡xesentatlve 01 legal Note Apphcant completes only Se<:tlons I and II. SectIon III IS
<br /> üppllcant completed by Federal agencies.
<br /> fEDERAL AGENCY PROCEDURES FOR SECTION III
<br /> II appilcant.supþlled information In Sechons I and II needs no updatIng or adjustment to ht the final Federal action, thE. Federal agency WIll
<br /> complete St'.ctlon III only An explanat'on for eacn Item follows.
<br /> Irem Item
<br /> 24 Executove department or ,ndependent agency hav,ng pro. 35 Name and telephone no 01 ag€ncy person who can
<br /> gram adm'OIstrat,on responsibIlity ¡XOVIÓe more information regarding this assistance
<br /> 25 Self explanatory. 36. Date ane, whIch funds WIll no longer be available
<br /> 26 Pnmary organ,zahonat un" below department level having 37 Check appropnate box as to whether Section IV of form
<br /> òlfect program management responslb,hty contains Federal remarks and/or attachment 01 addition.
<br /> 2/ Olloce dlfectl~ mon,tonng the ¡xogram. al remar1<s.
<br /> 28 Use to ,dent,ty non-award actions wttere Federal grant 38 For use WIth A-95 action notices only Name and tele.
<br /> IdentIfIer In item 30 IS not applicable or will not suffIce phone 01 person who can assure that appropnate A-95
<br /> actIOn has been taken-If same as person shown in item
<br /> 29 Complete adoress of admlnoster'ng office shown In Item 35, write "same". 11 not applicable, write "NA".
<br /> 26
<br /> 30 Use to ,dentlty award actIOns where different from Feder. Federal Agency Procedures-special considerations
<br /> al applIcation ,denllt,er In Item 28. A. Treasury Circular 1082 compliance. Fe-jeral agency will assure
<br /> 31 Sell explanatory Use remar1<s section to amphty where. proper . completion 01 SectionS I and ilL 11 Section I is belr1g
<br /> appropnate completed by Federal agency, all applicable items must be fltled
<br /> 32. Amount to be contnbuted dunng the first fundlnglbudget in. Addresses 01 State Information Aec"Poon Agencies
<br /> penoo by each contributor. Value of in-kInd confnbutions (SCIRA's) are provided by Treasury ÐepartmerH to each agency.
<br /> W111 be Included II the actlOfl is a change In dollar ThIs form replaces SF 240, wT1lCh will no longer be used.
<br /> amount of an exIstIng grant (8 revision or augmentation), B OMS Cnr::ular A-95 compIJaf1Ce. Federal agenG:y will assure
<br /> IndIcate only the amount of change. For decreases, proper completion 01 Sections I, II, and iiI. This form is required
<br /> enclose the amount in parent~s. If both basiC and for notifying aU reviewing clearinghouses of major actions on all
<br /> supplemental amounts are included, break out in remarks. ¡xograms reviewed under 1\-95. Addresses ot State and
<br /> For multiple program funding. use tolals and show pro. areawide cle.:mnghol..'Ses are prOVIded by 01.18 to each agency
<br /> gram breakouts In',emar1<s. Item dehmtlOfls: 32a, amount Substantive differences between applicant's rsquest and/or
<br /> awarded by Federal Govemment; 32b, amount awhcant clearinghouse n&corTlmeM3t>Ons, and the Pfoject as finally
<br /> will contribute; 32c, amount frem State, if aw"çant is not YN<lrejOO \N111 be explained in ,10,-95 notifications to deanng.
<br /> a State; 32d, amount trom Icad 9O"'emment if applicant IS houses
<br /> not a local government; 32e, amount fTom any oth<!r C. Speaal 0011'1. In m<::>3t. bYt not all Stales. thoe.A-95 State cleanng'
<br /> rources, axpfa," in remarxs. house end the (TC '082) SCIAA 818 the $3me offiCe. In such
<br /> 33 Dille action ""as taken on thIS request. cases, tt-,¿ ,10,-95 3W81d notICe to the State clearinghouse ...111
<br /> fulilll tt>e TC tO82 award ","0Ce raq""'ametlt to the State SCIRA
<br /> 34 Date funds WIll become 8YaiiabJ<>.. ~>Cllte notrllCl1bOn 5hou!d be avo>òed
<br /> Exhibi t 1'1- 3. At'7plication for Fede;:-al Assistance
<br /> (Nonccn3t..ruction Prcx:¡rams)
<br /> (Page of 13)
<br /> iõT~~ ~ 0241".";,0;" ,'R"", 4-11¡
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