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GENERAL INSTRUCTIONS fOR THE SF-424 This is a standard form used by applicants as a required facesheet for pre applications and applications submitted in accord<:: with OMB Circular A-102. It will be used by Federal agencies to obtain applicant certification that states which have establishf review and comment procedure in response to Executive Order 12372 and have selected the program to be included in : process have been given an opportunity to review the appLicant's submission. APPLICANT PROCEDURES FOR SECTION I Applicant wIll comøtete all ~ in Section WIIh the exception of Box J. "State A/.4Jhcation IdenlJtier." If an item is not applicable, wrIte "NA" If addItional s¡ is needed, Insert an asterisk ". 'd use Section IV An explanation follows for each Item: ftam 1. Item Mark appropnatf' OMB Circular this form? not reqUIre. Applicant's ow. Date SectIon I is p, Number assIgned by . Date assigned by Siale. Legal name of applIcant, nan, undenake the assistance actlYl.. name and telephone number of . tnformahon about this request Employer Identlheallon Number (EIN) v. Internal Revenue ServIce Use CaIaJog of Federal DomestIC AssIstance \ to program under which assistance IS reque~ program (eg, loint funding). check "multiple" ar. IV " unknown, cite Public Law 01 U.S. Code Program title Irom CFDA Abbreviate If necessary Use Section IV to provide a summary desenpllon of lt1é appropnate, I e., If prOlect attects particular sites as, for L construction or real properly prOlects. allach a map showtt,. proectlocallon "C.ty" Includes town, township or other municipality. list only largest unit or UllltS affected, such as State, county, or city. Estimated number 01 persons directly ~nef¡tlng trom prOtect. Check the type(s) 01 assistance requested A BasIc Gram-an onglnal request for Federal funds. 8. Supplemental Grant -.a request to Increase a basic grant In certain cases where the eligible applicant cannot supply the required matching share of the basIc Federal program (e.g., grants awarded by the Appalachian Regional CommissIon to provide the applicant a matchmg share) E. Other Expla," In Section IV Amount requested or to be contnbuted dunng the !Irsl funding/budget penod by each COnlf/Qulor Value of ,"-kind contnbutlons should be Included If the action IS a change In dollar amount of an exlsllng grant 'n and application are described In 'ncy program Instructions. Use of 'e optIon. Federal agencies do (a reVISion or augmentation under Item 14), indicate only the amour the change. For decreases. enclose the amount In parentheses. it ~ baSIC and supplemental amounts are Included. breakout in Seetlor For multiple program funding. use totals and show program breakc In Section IV. 12a-amount requested trom Federa! Govem(T'., 12b--amounl applicant will contribute. 12c-amount from StatE applicant is not a State. 12d-amount from local governmen: applicant IS not a local government. 12e-amounl from any c: sources. explain In Section IV The distflct(s) where most of action work will be accomplished II c wide or State-wide. covenng several districts. wnte "city-wIde" "State-wide." A. New. A subminal for project not previously funded. B. Renewal. An extension lor an additlonallunding/budget perred te project having no projected completion date, but lor which FeCE support must be renewed each year. C. Revision. A modifIcation to prolect nature or scope which may res in funding change (increase or decrease). D. Continuation. An extension for an additional fundmg/budget pen for a project with a prOJected completion dale 'ugmantation A requirement for additional funds for a pro!€ 'riOUSly awarded funds In the same funding/budget perle 'I nature and scope unchanged. date protect expecled 10 begin (usually associated Wi ')f availabIlity ollul1dmg). ')f months 10 complete project after Federal func "'":,,, 2b. 3a -? (:' ~ (:' -? 3b- 4a-4h. 13b. 't which will 'ant, and further 14. ;.. /' 0 0 ^ 5. 6a. \S' (/ \S' ~ ..0 " ..0 ~ ( V (:' \S' ~ f' (:' C' 1.- ;.. ;.. / 0 "9 1.- ( IS' 6b. 7. 8. 9. 10. IT. / 1.- \S' )-. // -? / (/ (' )-. / 0 1.- ..s' 11. 18. 's (Item t4c), or augmentations (Item 14e) "In must be submitted to Federal agene , conSlderatiOIl. / // II. 19 Namt. addres~ which the ExIsting Fedel- and directly rek "NA" Check appropriate b, remarks and/or addltlof" . agency to which this request. 'sible the name 01 the offIce \, 20. . thIs IS not a new reQues ~tjon. Otherwise. WnlE 12. 21 of form contains APPLICANT PROCEDURES FOR SECTION II Applicants WIll always complete ellher Item 22a or 22b and Items 23a and 23b. 22a Complete if appjlcahon IS subJect to Executive Order 12372 (Stale 22b review and comment) 23a Check if application IS nol subject \0 E L. , '2. Name and IUle of authorIzed representatIvE: .Jf legal applicant. FEDERAL AGENCY' PROCEDURES FOR SECTION III Applicant completes only Sections I and II Section III IS completed by Federal agencIes. 26. 27 28 Use to Identify award actions Use Section IV 10 amplify where approprtate Amount to be contributed dunng the fIrst funding/budget penod by each contrtbulor Value 01 to kind contrIbutions WIll be Included. " the action IS a change In dollar amount 01 an existing grant (a reVISion or augmentation uñder Ilem 14), IndIcate only the amount of change. For decreases, enclose the amount In parentheses. II both basIc and supplemental amounts are Included, breakout In Section IV For multIple program fUndIng, use totals and show program breakouts in Section IV. 28a-amount awarded by Federal Government. 28b--amount applIcant wIll contrIbute 28c-amount Irom State, If applicant is nor a State 2Bd-amount Irom local government. if applicant is not a local govern- ment. 28e-amount from any other sources. explain In Section IV. Date action was taken on this request. Date fuflds will become avadable. Name and telephone number of agency person who can provide more information regarding this assistance. Date after which funds will no longer be available for obligation. Check appropnate box as to whether Section IV of lorm conlains Federal remarks and/or anachment of IIrlrtilinn,,1 rø""...kc 29 30. 31 32. 33. CJD-3