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Attachmant M GENERAL INSTRUCTIONS This is a multi-purpose standard form. First. it will be used by applicants as a required facesheel for pre-applications and applications submitted in accordance with OMB Circular A-102. &!cond. it will be used by Federal agencies to report 10 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-In-a,d awarded in accordance with Treasury Circular 1082. Fourth, it may be used, on an optional basis, as a notificat,on of intent from applicants to clearinghouses. as an earty initial notice that Federal assistance is to be applied for (clearinghouse procedures will govern). APPLICANT PROCEDURES FOR SECTION J A."pllcant WIll complete aJlltems In SecbOn I If an Item IS not apøhcabIe, write "NA". It additIOnal space is needed. Inser1 an aste"sk ..." and use the remarks secllOn on the back 01 the lorm An explanatIOn loIlows for each Item. Itøm Item 1. Marl< appropnate box. Pre-appllcalJOn and appllcallOn 10. Governmental unIt where SlgOlflcant and meanIngful ,m. guKldnçe 's In OMB CIrcular A-102 and Fede<al agency pact rould be obsefved. List only largest uno! or uMs ¡xogram instructIOns. NohflCatlOn of ,ntenl guidance IS ,n .sHeeted. such as State. county. 0' CIty. II entICe um! Corcula, A-95 and procedur~ from cleannghouse Awl!- aHected. Itst It rather than subunits can! \¥l1I not use "Report of Federal Acbon" box. ". Estimated number 01 persons directly benehtlng from 2a Appl>eant s own control numbet'. ,I des"ed project 21>. Date SeclJOn I is prepa,ed. 12 Use appropnate code letter. DehnitJons a,e: 3a Numbet' assigned by State cleannghouse. 0< rf delegated A. New A submittal for the first tIme for a new project by State. by areaW1de cleannghouse. All requests to B. Renewal An ex1ens<on 10< an addItional fundIng' Federal agencIes must contaIn thIS ldentrfier il the pro- b\Jðget period for a p,o¡ect having no protected com. gram 's covered by CIrcular A-95 and reqUICed byapphca- pletlOn date. but 10' whIch Feclefal support must be ble State/a,eawtde cleannghouse procedu,es. if in renewed each year doubt. consult you, cleannghouse 3b Date applICant notlhed of cleannghouse Idenbher. C R-SlCn A modIfICatIOn to pro¡ec1 nature or scope whIch may result ,n fund'"9 change (Increase or de. 4a-4h. Legal name 01 applICant/recIpient, name of prllnary orga. crease). nlza!ional Uoot whICh wIll undertake the asSIstance actIvo D. ContInuatIOn. An ex1enSlOn for an additIOnal fundIng/ rty. complete address of applICant and name and budget period for a proteCt the agency initially agreed telephone numbe, 01 pet50n who can provide further to lund for /I clehMe number of years informatIOn about thIs request E. AugmentatIOn. A reqUIrement for add1tlOnal funds for a 5. Employe' identificatIOn number 01 applICant as ass.gned project pr8V1OlJsly awarded lunds In the same funding' by Internal Revenue Service budget period. Project natu'!? and scopeuncnanged 6a. Use Catalog 01 Federat Domesbc ASSIstance number 13. Amount requested or to be contnbuted dunng the IlIst asSJgned to program under wtllCh aSSIstance is ,equest. fundfng/bodget petlOd by each contnbu1or. lIalue 01 In- ed It more than one program (e.g.. joonl-funding) write kInd contr!òutlOns WIll be Included. if the action IS a "multiple" and explalO In remarl<s. It unknown. cite Public change ,n dollar amount of an exls:ing granl (0 revISIOn or Law or US. Code. augmentatIOn), indòcate only the amount of the change. 6b. Program title from Fede<al Catalog. AbbreYIBle if neces- For decr9ðS8S enclose the amount 10 parentheses. If both basic and supplemental amounts are Included. sary. break out In remarl<s For multiple program fundIng. use 7. Bnef tItle and appropnate clescnptlOn of pro¡ect For totals and show program breakouts In rema,ks Item nobflca!ion of Intent. conbnue In remarks section rf neces- ciehnltrons: 138. amount requested from Fede,al Govern- sary to convey proper descnp!ion. ment; , 3D, amount appllCanl WIll contnbute; 13c. amount 8. Moslly self-explanatory. "City" Includes town. townshIp or from State. if applicant IS not a State; 13d. amount from other municipalIty. local \CMIfTVTIBnt. if applicant IS not a local govemment; 9. Chec!( the type(s) of U8istanc:e requested. The deli" 130. amount from al'1)' other sources, expIalfl 1ft remarks. lIOns of the terms are: 1.a. Self explanatory. A. Basic Gran\. An c:riginal n!lqUØSt lot Federal funds. 1.b. The dostricl(s) ..n-e /TIO$t of actual work will be accom- This would not inctude any contribution provided un- pIished. If city.wióe or Stat3-wtde. COYenng several dts- öer a supplemental grant. tricts. write "city....,jde" or "Slate-wide." B. $upplemen1.81 Grant. A request to increase 8 basic 15. CorrØete only lot ~s (Item 12c), or aug<neotabOns grant in certain cases where the eligible 8ppIicant (Item 12e). cannot supply the rec:¡uiroo ma1ching &hare of the 16. Apptoximllte cIIote project expected 10 begin (usœlly as- baSK: Federal program (eg.. gants awatóed by the Appalachtan Regional ComrMSlOn to prtMde the tIOCi8too with esbmated ciate of availability of fundIng) 8W!lCatIt a matd'ling stweì 17. Estimated number of months 10 complete project alter F~ funds are 8ya;lable C. Loan. Self explanatory. 1B. EiJ"rnaled ciate pre-app!ocat.on/appllC8l1On will be sutJn'Iot. D. Insurance. SaIf explanatory teó to Federal I/IQØI1CY rf thIS pro¡ect requores cleanng. house f<'Y>eW r&vIeW r~1 rðq\Jfred. this date WOUld E 0tN>r. ExpIaJn on remat1ls page usually be same as date," 11-em 21>. trrA.NO4IiO I'OtW 42' JoACof J """ ,. '7) Exhibi t M- 3. Application for Federal Assistance (NJnconstruction Programs) (Paqe 3 of 13) 13