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Attachrrent M GENERAL INSTRUCTIONS This is H mu/'ti-purpose standard form. First. it will be used by applicants as a rBquired facesheet for pi"e-app1Ica!lcns and applications submitted in accordance with OM8 Circular A-102. Second, it will be used by Federal agencies to report to cleannghouses on major actions taken on applications rel/iewed by clearinghouses in accordance with OM8 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 ¡:ltBnt 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 A,..-.pJ":-Áinl WIll complete all Items In SectJon I It an Item IS not appilCable,.....me "NA'. if additIOnal space IS neeóaQ. 'nSoef1 an a5tefl5k ..... .¡od us<>. the lemar1<s SðCI1OO on the tJ.ack 01 the form An e~anabon follOwS for each Item. ft~m Ilem 1. Mark app<opnate box Pre-appi.cahon and appilCatlOn 10 Govem~lal unit where g¡gnlhcant and mean,nglul 1m. gu¡Ç,3nce IS In OMB CÀlculal A-102 aOO F~al ageocy p.act c:ouid be oòsefved LIst (){1ly ~argesl unIt or unIts ¡xogr3'n Instn"ctiOn5 Nollhcat,on of Intent guldaoce IS In aHeeted. suen as Slate. county 01 City If ent(e unit C<rculal A-95 and p<ocedur~ irom cteanr>ghouse. ^wh- aHected. lIst 11 rattler than subunlt5 ç;>nt WI!' not use "Report of Fed-f'r/ll ActIon" box. 11. Estimated numbeI 01 pe<sons directly OOnellling from 23 Appi¡çant 5 own centro! number. ,I óeslled P<OjOCt ;(::¡. D.!'" $echon ! is p<epare( 12 Use appIop.1.ate code ~t1er. DehnlOOns are. 33. Number assigned by Stale CI""""9hOuse. or II delegated A New ... sut>mrt1a110l the first lime ta< a new p<oject by Slate. by Bleawxle clea"r,gt1Ouse All requests 10 B Reoewat An extenSion fO/ an add'lIonal funding/ Federal agencies must c0/1Iam th,s ~nhfief if ttIe p<o- b<.;ðget penoó for a plolect havIng no plolected com. gram IS covered by Cllcular A-95 and reqUIred by applica- p>ehon date. bu1 fOl wtllch Federal support must be hie State//lleawlde cleanngnouse procedures. If in ren9weó each year doubt. con5ult your clearinghouse 3b Dale appl.cant notlhed of c>eallr>ghouse .oonllher C R8\f1S1On A mo<:J¡locahon to p<0¡ec1 nature 01 scope wtBet! may result In fund'r>g change (Increase or de- 4a-4h LElgal name of applicant/recIpient, name of primary arg/!- crease) r..za!lonal unIt >Ntllch w,1I unoonake the ass.slance BC!!v- 0 Cor>tlnuatJon. An extenSion far an addrtlonal funding I rty. complete address 01 applicant. and name and ~t penoó lor a p<orect ttIe agency 1n11.ally agreed ta!ephone numbef 01 person who can proV1àe further to fuOO lor 8 de"",1e numbef 01 years InformatIon about thIS request E Augmêf1lalion A reqUIrement for add,tlonal lunds 101 a 5 Employer ~nbhcatiOn numbe1 01 applICant as ass.gned P<0!0C1 p<ev!OUsty awarded funds 10 the same funding! by ,nt&mal Revenue Sefw:e bv<:Jget penoó Pro¡eçt nature aOO scope unChanged 6a Use eau.log of Federal ~IJC A:ss<slance number 13 Amount 19Questad or to be rontnt>u1ed dunng th€ hrsl :¡:>5>gned to pfOgram under '¥hiGh a:SS<Slance is request- urxJog/~t penoó by each contnt>utor. Value of In- eel If more than one program (e.g.. ¡o.n1-tund'ng) wnle k:OO contnt>u1iOns WIll be Included if the actIon IS a '"multiple" aOO expla,n 10 remarks. If unknown. c,le Public ch.a1"'lÇ€ In öoIlar amount of an eXis:'ng grant (8 reviSIon or La"" or U.S Code eug".,.;nlatJon), Indicate only 1he amount of the change 6b Proglam title from Federal Catalog. AbbrfMate i1 neces- For óecreðS6S ef1Close the amount In palentheses If both baSIC aOO supplemental amounts are ">eluded. sary break out In remarks For mul1'ple program funding. use 7. 6nel t,Ue and appropnate Oescnphon of pro¡eçt Fol totals and show program breakouts In remarks Item oot!llCðhon of Intent, centlnlA! In remar1<s sectiOn if neee5. OOhnttiOns: 13a. amount requested from Federal Govem- sary to convey proper clescnpllon ment; 13b. a,-nount applicant WIll contnbute; 13c. amounl 6. Mostly self-€)()lanatOly. "aty" loc!lx1es town. 1ownship or from Slate. if applICant 's no! a Slate; 13d, amount Irom other murndpahty local government, i1 a,opl>eant IS not a local government, 13e, amounl !rom arty other sources, expia,n In remarks. 9. Ctw.<:k the !ype1s) 01 USlStance requested. The deftn;- !JOnS of the terms ant: l<4a. Se« axpW\a toty. A. BaSIc Grant. An anginaf request lor Fedenli funds. l<4b. The drstrict(s) where most 01 actual wori<. will be accom- Th<s wooId not iOCJode any cootJibutJon pw.ióed un- p;.s."Iðd. t1 city-wiòe or SUlI~\0i!d.9. COYerln<J several d,s- r>er a 1WppIernenu.1 grant tT>cts. .....me "CIty-wiòe" or "Su.te-....;oe" B. ~lal G"snt. A reo<:¡ont to iocr- II basic 15. Comp;ete only for ~s (item 12c). or augmenlatJons grant in certaJn CAses \fIIhefe the eìtgible applicant (rtem 12e) cannot :!-lWly ttIe mqu.<ed .......31ch<ng sha,e 01 me 16. ¡i,pp-oXJlT',.ftte cf.tte P'0t0Ct exp.octed to bo!>g<n (usually as- t:o.!l$IC Federal p<"cv",m (eg. 1j;fants !!IW1Irded by the A¡;P"\4ch<an A~I CommtSSion to provide the ~ted 'M1:h ,"!:mated date of avaiLabilrty cl fund'ng) oI:lPPhcant 1\ m.a1dw19 sh;¡re) 17. ESt:ma1ed /'1OJfI'IOer 01 mOt"Iths to comptele pmrect after F~I funds I{fI¡vJlJlabie. C Loan. s.!WI axp<.!l""tOly 18. EstJrnated d4te ~ocatlOf1/a.pphcatJon will be 5tJI)r¡\¡1. D. I "SUlanoe. S;./f ..Jq:JiðMt<:xy. Wd to F~!l1 ~ rf tf)rs P'0f"C! rllQOll"~ c~"r.g. t>oùse r"""""" !1 r~ r~t rðqUlred. Ihls clate WOUld E ~ Ex+>INn DrI remalils p.¡ige ~Iry be :>~~ as clate ,n rtóffi"\ 2b IHAHDAAO /'CO'tOO o. I'M!<: 'I"'... 4- H¡ Exhibi t H- 3. Application for Federal Assistance (Nor,constructicn Pro~;:Ta.¡Ts) (Page 3 of 13) 13