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~achrœn t M lIem 19. Existing Federal identiflC8bon I'IU/"1'1bef il this is not a new 20. Indicate Fe<1efal agency to which this request is ad- request and dorectty r.tes to a previoos Federal actIOn. dressed. Street address not requi'ed. but do use ZIP. Otherwise write "NA" 21. Check appropnate box as to whether Section IV of form contains remarks and/or additional remarks 818 attac:hed. APPLICANT PROCEDURES FOR SECTION II ApplICants will always complete items 238. 23b, and 23c. If clÐannghouse review is required. item 220 roost be fully completed. An explanatlOO follows for each item' Item Item 220 ust clearinghouses to whICh submitted and show in 23b. Sell explanatory. appropriate blocks the status 01 their responses. For more than three cleannghouses. continue in remarks 23c. Sell explanatory. sectIOn. All wntten comments submitted by or through cleannghouses must be attached. 23a Name and title of authorizoo representahve 01 legal Note: Applicant completes only Sections I and II. Section III is !:.Wheant comptetoo by Federal agencies. FEDERAL AGENCY PROCEDURES FOR SECTION III II applICant-supplied information in Sections I and II needs no updating Of adjustment to hI the final Fedefal action, th& Fe<1efal agency will complete SectIon III only An explanalion for each item follows: /tem Item 24. Executive department or independent agency having pro- 35. Name and telephone no. of agency person who can gram admtnlstrahon responsibility. provide more information regarding this assistance. 25 Sell explanatory. 36 Date after whICh funds will no longer be available. 26. Pnmary organlzahonal unit below department level having 37. Check appropriate box as to whether Section IV of form dIrect program management responsibility. contains Federal remarks and/or attachment of addltlOn- 27 Ol1lce dITectly montloring the program. el remarks. 28 Use to identIty non.award actions where Federal grant 38. For use with A-95 actloo notices only. Name and tele- identifIer to item 30 IS not applICable or will not suffICe. phone of person who can assure that appropnate A-95 actIOn has been taken-If same as person shOwn In item 29 Complete adoress of adminIstering offIce shown in item 35. wnte "same", If not applicable. write "NA". 26 30 Use to identIfy awa,d actions where dIfferent from Feder- Federal Agency Procedures-special considerations al applicatIon Identlf,er In item 28 A. Tr!tilsury DrClllar 1082 compliance. Fe-jarsl agency will assure 31. Self explanatory- Use remarks section to amplify whe,e proper completion of' Sections I and III. If Section I is beIng appropnate compléioo by Federal agency. all applicable items must be fIlled 32. Amount to be contributoo during the fJrst funding/budget in. Addresses of State Information Recepiion Agencies period by each coolnbuto,. Value 01 in-kind contributions (SCIRA's) are provided by Treasury Oepartmt;flt to each agency. will be included. If the actIOn is a change in dollar This form replaces'SF 240, which will no longer be used. amount of an existing grant (a revision or augmentation), 8. OM8 Circular A-95 compliance. Federal agency will assure tnd,cate only the amount of change. For decreases, proper completion of Sections I. II. and III. This form is requÌled enclose the amount in parentheses. If both basic nnd lor notifying all reviewing clearinghou3es. of major actions on all supplemental amounts are included. break out in remarks. programs reviewed IJOder A-95. Addresses of State and For multiple program funding. use totals and show pro- areawide cle3ringhouses 8Ie provided by OMS to each agency. gram breakouts in remarks. Item ôehnitlOns: 328. amount Substantive differences betwÐen applicant's request and/or awarded by Federal Government; 320, amount applicant clearinghouse recommendatlOlls. and the project as finally will contribute; 32c. amount from State. if applicant is not awarded will be explained in A-95 notitiœtions to clearing- a State; 32d, amount from loCal government if applicant is houses. not a local government; 32e. amount from any other C SpecI8/ note. In most. but not all SL!ltft5. the A-95 State clearing- sources. explaIn in remarks. house and the (TC 1082) SCIRA are the Mme offICe. In such 33. Date action was taken 00 this request. cases. the A-95 a~lard notICe to the Stale clearinghouse will fulfililhe TC 1082 award mt!Ce reql'iternent to the State SCIRA. 34 Date tunds WIll become available, DupjCftle notifjCftbon should be avojded. Exhibit M-3. Application for Federal Assistance (Nonconstruction Prograrrs) (Page 4 of 13) n~fOf'IMU4"--.1R- "-11) 14