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At t.a chrren t M GENERAL INSTRUCTIONS This is a mutti-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 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--ItHI(j 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 ~""()IIcant ...11 complete aJlllems In Secbon III an lIem IS not appItc:abIe. \lll\'lte "NA". If adórbonal space is neeóed. Inset1 an asteflsk .,... lind use !tie remar\l.s section on \he back 01 the form An explanation follows for each lIem: Item Item 1. Mark approprIate box Pre-apphcallOn and appltcabon 10. Governmental unot wne.e sognlllCant and meanIngful ,m. gul{1ance IS In OMB c.rcula, A-102 and Federal agency pact could be oI:>se<ved Lisl only Ia'gest unot or UnIts program Instf1JCtlOOs. NobflcatlOn oIlnlent guidance IS In aHKted. such as Stale. county. or CIty. If enbre unit Ûfcular A-95 and procedures from cleannghouse. Awl.. aHeeted. Itst II ra!l'ler than subunIts canl WIll not use "Report of Feóeral ActIOn" box. 11. Eshmated I'1tJmber of persons dIrectly benehtlng trom 2a AppliCant s own cont,oI number, If desIred project. 2b. Date SectIOn I IS prepared. 12. Use apprcpnata COOe fel1er. DellllrtJOns are: 38. Number as.'Iigned by Slate clearinghouse. or ¡ delegated A. New A suòmrttal lor the first !lIne for a new protK:t. by Slate. by a,eaW>de clearinghouse All requests to a. R9f1!iIW81 An eX'lens.on for an addlhonal fuOOmg/ Federal agencoes fl'lfJSI contain ttlts ldenhloer it \tie pro. boðget pef1OÓ fOf a project having no prOjected com- gram IS cove,ed by c.,cular A-95 and reqUIred by applica- platoOn date. b<Jt 1°' whICh Federal support must be ble State/areawide cleannghouse procedures II in renewed each year doubt. consul! your cleannghouse 3b Date applICant nolofted of cleannghouse identifier C ReviSIOn A modificatIOn to protect nature or scope whICh may resull ,n fundIng change (Illcrease or de- 048-4h legal name 01 apphcant/reclp.art1. name ot pnmary orga- crease). nlZBbenal unl! whIch WIll undertaÌ<e the asSIstance achv- D ContinuatIOn. An extenSIon for an additIOnal fundrng/ fly. compiete address of appliCant. and name and budget period for a projeCt Ihe agency Inibally agreed telephone oombet of person who can provide further to fund for a de"nlte number of years IIIformatlOn about this request. E. Augmentabon. A reqUIrement tor additIOnal tunds lor a 5. EmplOyer tdentlhcatlOO oomber of applicant as aSSIQned prOØCt pr8Y1OUsIy awarded funds in !tie same fundtng; by Intemal Revenue Sefvlce budget penod. Project nature and scope unChanged 6a. Use Catalog ot Federal DomesbC Asstslance number 13. Amount requested or to be contnbuled dunng !tie hf'51 BtSSIQned to progtam under whICh aSSIstance is request- fundIng/budget penod by each contnbulor Velue 01 In- ed II more than one progtam (e.g.. pnl-Iunding' ",,"te kind contributIOns WIll be included if \tie action IS a "multlple" and explain in remarks. "unknown. ole Publtc change ,n dollar amounl of an eXls:ing gran1 (a r!!VISlOn or law 0' U.S Code. augmentalJon). indicate only the amount 01 \he Change. 6b. Program btle trom Federal Catalog. Abbreviate if neces- For decreases enclOse the amounl In parentheses. " both basic and supølemental amounts are included. sary break ou1 in remar1<s For multiple program fundIng. use 7. B,oel title and appropriate descripltOn of project. For 10lals end. show program breakouts In remarks Item notillCalion 01 Intent, continue In remarks ~ if neces- defInItIons: 13a. amounl reQuested trom Federal Govern- sary 10 convey proper descnplton ment; 13b, amount appltcanl WlI1 contr;bute; 13c. amounl 8. Mostly self-elt)lanatory. "erty.. Includes town, township or from State, if apølicant IS nol a Stale; 13<:1. amount from o!l'ler municipallly. local goyemmenl, II applICAnt IS nol a local gowmment; 9. Check \he 1ype(s) 01 as'll8taoce requested. The de!ini- 138, amount from any other sources. expIaWl WI remarics. bons of the terms 81'8: 104a. Self explanatory. A. Basic Gr*1l An onginaI request for Fedenli funds. 14b. The dlsbíct(s) wtlere most of actual work WIll be accom- This would not iN:Iude any contribution pI'O\IIded uo- piished. If city-wiòe or Stat3-WlØe, COYØring several dls. oer a supplemental grant. tricts. write "city-wiòe" or "State-wide." B. ~tal Gr8nl A requesl to increase . baSIc 15. Comp!ele 0I"tIy for I"IM:sIOns (item 12cl. or augmetltallons granl in certJun cues wtIere the eligible awÞcant (item 12e). cannot supply the requored matching share of the 16 Açproximate dIIte project expected to begin (usually 8S- baSIC Federal program (e.g., ¡¡ran\$ awarded by the Awalachian Regional Comrniuion to proo.;oe the scx:iated with esllmated date of IMIJlability of funding). ÐWocanl a matching :share). 17. Ellllmaled number 01 monlhs 10 complete prqect after Fec\o:)ral Junds are 8VaiIabIa C Loan. s.I! axptanalory 18. E!Jtimal9d date proe-appItcalJon/apJlocabOn will be sutIrñtt. D. Insuranœ. Self oxpIanatory. tee! 10 Federal DgenCY if thIS pro¡ect rflqUores Cleanng- !'louse ~ If r/!Nte'W r":>l HIQutred, thIS Clate WOUld E. 0Ihèr Explain on r~s page ~11y be :JarT\e as date In Item 2b nAHOoUIO~G"'_'R.. ..77, Exhibit M-3. Application for Federal Assistance (tbnconstruction Prograrrs) (Pa<je 3 of 13) 13