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Attachrrent M GENERAL INSTRUCTIONS This is a multi-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 notity 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 intent from applicants to clearinghouses. as an early initial notice thai Federal assistance is to be applied for (clearinghouse procedures will govern). APPLICANT PROCEDURES FOR SECTION I A.~t will complete alllt9m$ in SecbOn I II an item 1$ not applicable. write "NA". II additIOnal space IS oeeöed, Insao\ an aSIe<lsi< ..... IiOO use the remarKS sectIOn on the bilck 01 the lorm. An eJcPlanaÞOn loIlows IOf øach item: Item Item 1. Mar1< appropnate box. Pre-appI¡cabOn and appIocatlOO 10. Governmental unil where S>gnilocanl and meanIngful Im- guidance 1$ in OMB CIrcular A-102 and Federal agency paCI could be obsefved list only a'gest uM or unlt$ program Inslrucl>ons. Nol;tocabon ollnlenl guidance;$ in eHected. such (I!> Stale. county. Of Cl1' II enbfe un\1 Qrculaf "'-95 and procedLlre5 from cleannghouse. Awl" aHected. h!>t il rather than 5Ubunils. cant win not use "Repor1 01 Federal Action" box. 1,. Estimated numbef 01 pei'$On$ dorectly benelltlng from 2a Appllcanl s cnom control numbet. it t\MÍfed ¡:woject 2b. Dale Sect>on I is prepared. 12. Us.e approprial8 code lelter. Dehnibon$ a'e: 3!1. Number 1IS$igned by Stale clearinghou:wt. Of if delegated A. New. A sobmfttallor the l)(St bme for a new project. by Stale. by areaWIde .çleannghouse. All raques.ls to B. Renewal. An extenSIOn 10f' an eådtt>ona fundtngl Federal øgencoes must contain Ihl'$ Idef1tdier if the pro- buðget period let a project having no pro¡ected com- gram ¡50 covered by CIrcular A-95 and requlled by applica- pletion date. but lOt which Federal support must be ble S1ale/areawlde clear¡nghouse prOCedUles. II in renewed each year doubt. consult you, cleannghouse C. ReviSIOn A mod,hcat>on to project nalure Of s<;ope 3b Date applocant notilled 01 clearinghouse (entlllE!(. which may 'MUlt In fundIng change ¡Increase or de. 4a-4h. legal name 01 applocantlrecip.enf. name of primary Ofga- aea5oe). nizatlO/1al UOlI whICh WIn undertake the asSIstance actIvo D. Continuation. An extension fOt an addrtlOt\al h.:ndtngl ity, complete addrtl$s 01 appk;ant. and name and budget period tOf' a project the agency initially 8gt'eed telephone number 01 person who can provide further to fund tor a dew"le num~ ot year$. informattQn about this request E. Augmenlat>On. A reqlJltement IOf addItional lunds for II S. EmplOye< identificatIOn number 01 applicant a$ aS519ned project preYiovsly awa'ded funds in 1he same furldtngl by Intemal Revenue SeMce. budget period. Project nature aOO scope unchanged 68. Use Catalog of Federal Domesbc þ..$SIstance number 13. Amount reQu.)Sled Of' to be contributed dunng ~ Iltsl ass.gned to program under whICh ass;stance is reQu.)St. lundtttg/budgel penod by each contributOf'. Valve of I~ ed. II more than one ¡:wogram (a.g., joint-Iundlng) wnte kiOO contributions win be included ì1 the actTOn is a .'multipfe" and explaon in remar1<s. II unknown. cite PublIC change In dollar amounl 01 an exis:ing grant (a revision or law Of' U.S. Code eugmentat()f'). indocale only tOe amount of the change. 5b. Program title from Federal Catalog. AbbteYiale if neces. For c!9crease$ enclo5oe the 81O0unl In parenlMses. 11 both basic and supp;ernental amounts are Included. sary break out in remar1<s For multIple program fundIng. use 7. Bnel tille and appropriate descriptIOn 01 project. For totals and show p'09ram breakouts In remarks Item notilocat>on 01 intent. continue in remar1<s section il neces- dehntt>Ons: 138. amount requested trom Federal Govern- sary to convey proper descnptlOn men!; 13b. amounl applocant WIll contnbute; 13c. amount B. Mostly self-explanatory. .'City" 'ncluØes town. township ~ from Stale. if applicant IS no! a State; 13d. 1I/TIOtIn! from other municipality. local goyemment if applICant " not a \ocal ~t: 9. ChecII the 1ype(s) of aseitlance requested. The defini- 1311. amount from any other SOUI"ces. expllllO in remar1<5. tions 01 the tørms -: 14a. Self expianatOl'f. Â Basic: Grant. An criginIII ~I for Federal 1und!I. 14b. The cJistric!{s) ~e most of actual worI< will be accom. This would not include IIny conbibution províðed un-. pIished. II city-wide Of Stal~WIde, COY9Ong several ells. øer a supplemental ¡;fant. tncts. write "crty-wide" Of "Stale-wide," B. Supplemental Grant. A rllQUMt to incr8fISØ . basic 15. CompIele only for ~ (item 12c). Of' IWgmerl!aborts grant in certain cases where 1f!e eligible açpIicant frtem 12e). cannot MJpPIy the required matching ahare 01 the 16. Approximal'-' a..le protect expected to begin (usually a.. basic Federal program (9.g" gants awafCød by the AppaLachian ReQiOrIal Cornmit.sion to prt)Yide the IOcialed with M~led date of INailðbílrty of funding) applicant a matmr19 share). 17. Estimated nJmber 01 moothS to compIoete project attef C. loan. Self explanatory. FedtwallunOa ~ av.aulable 18 Estimated (Ùtle pl'"ll-appIICation/appllCðbOn will be SubrM. D. Insurance. S;Ht expianitlOl'f. t.ed 10 Federal DÇjØncy if thos prOØct requortl$ cIeaO"9' house rev>e'W "rev>ew r~1 reQtlf'ed. tt\1$ date WOUld E. Othèf. Explain on rMT\atl\s page. uaually be same as dðte on Item 2b. STANO~ ~ u."A(W; , {- 4.11, Exhibit M-3. Application for Federal Assistance (N:Jnconstruction Programs) (Page 3 of 13) 13