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<br />GENERAL INSTRUCTIONS <br /> <br />Attachrrent M <br /> <br />This is a multi-purpose standard form. First, it will be used by applicants as a required facesheet for <br />pre-apphcations and applicabons submitted in accOfdance with OMS Circular A-102. Second. It will be used by <br />Federal agencies to report to clearinghouses on major actions taken on applications reviewed by clearinghouses <br />in accordance wilh OMS Circular A-95. Third. it will be used by Federal agencies to notify Stales of grants-In'cud <br />awarded in accordance with Treasury Circular 1082. FOtJrth. it may be used. on an optional basis. as a notification <br />of tnlent from applicants to clearinghouses, as an early initial notice that Federal assistance is to be applied for <br />(clearinghouse procedures will govern). <br /> <br />APPLICANT PROCEDURES FOR SECTION I <br /> <br />It-em <br /> <br />...."'Ql.canl "",II complete all Items In SocbOn I If an Item IS nol applICable. write "NA". If addrtJOnaI space is needed. ,nsert an astens;, ..... <br />I'nd use the remar1<s sec!KJn on :he back 01 the form An Ol:r.;.lii'^"")()f\ icjlows for S<\ch itam. <br /> <br />Item <br /> <br />1. Mark appropnate box Pre-apphcatJOn and appllcahon <br />guK!ance IS In OMS c.rcular A-102 and F9d<tral agency <br />pt'C<:}ram 'nstrucllOns NotifICatIOn of Inlent guidance IS ,n <br />G.rcular A-9S and pt'OCedules from cleannghOU$<!. Apph. <br />cant WlII not use "Report 01 Federal ActJon" box. <br /> <br />2a Awhcanl s own control number, If deSired <br /> <br />2D. Date SectIOn I IS pt'apdled <br /> <br />3.a Number aSSIgned by Stale clean"llhouse. 0< If delegated <br />by Stale. by al8a'H1<.lt! c~annghouse All requests to <br />F BOer al agenc.es must contain th,s tdenhher If :he pt'G- <br />gram 's covered by Clfcular A-9:, and reqUired by apphca. <br />ble State/areaw,de cleannghouse pt'ocedures. If ,n <br />doubt. consult yOUI cleannghouse <br /> <br />3b Date apphcant nohfl8O 01 CleannghOuse ,denllf.er. <br /> <br />.(a-4h. L"ljal name 01 apphcant/reclp.ent. name 01 pnmary ()(ga' <br />nlzahonal UOlt which "".11 u~rtake the aSSistance !lC"v. <br />"y. complete addlesS of apphcant. and name and <br />takphone number of pe<,.on who can pt'OVlOe furthe' <br />InformatIOn about th,s req",",st <br /> <br />5. EmplOyer KlenlJhcatoon numbet of apploeant as aSSIgned <br />by Internal Revenue Sefvlce <br /> <br />68. Use Catalog of Federal Domesuc }\.ss.stance number <br />IlSStgned to pt'ogram under whICh aSSistance IS request. <br />ed If more than one pt'oglam (e.g.. jOInt,fundm9l wnte <br />"mulltple" and explam ,n remar..s. If unknown. CIte Publtc <br />Law or US. Code <br /> <br />6b. PIC<:}lam "lie from Federal Catalog. AtlbrlMdle if neces. <br />sary <br /> <br />7. Bnel "lie and 1lW'000000te descnptlOf1 01 pt'0jeCt. FOI <br />notihcahon of ,nlent. conbnue In remarks s.ectlOn II neces. <br />sary to con'ley pt'oper descnptlon. <br /> <br />B. Mostly self-explanafory. ..City" Includes town. townsh<p or <br />other municipality. <br /> <br />9. Check the type(S) of Il88I$l.ance reqt.>e$1ed. The defjni- <br />tions of the tenns are: <br /> <br />A. Basic Grant. An onginal f8qUeSl for Federal funds. <br />This would not include any contnbu1ion prO\Ilded un- <br />00t' a supplemental grant <br /> <br />8. Supplemental Grant. A requMt to oncrease . basic <br />grllnt In C8rtaln CllSeS whefe the eIogiOIe lIPPlicanl <br />cannot wpply Itle f8qU0t'ed matching lIhlIre 01 Itle <br />basic Federal program (e.g.. IoT3nts awatOed by the <br />Appalachian R~I ~ to pI'l:Mje Itle <br />nppIoeant a malctw1g share). <br /> <br />C. Loan. s...If explanalory. <br /> <br />o InsUfance. s.Ht expIaNie<y <br />E Othaf Ex?""n 00 l8'I'Mrlr.S page <br /> <br />10 <br /> <br />Governmental unit whe,e s.gn,hcanl and meaningful 1m. <br />pact COUld be ~ed. list only lalgesl unIt or unllS <br />aHecled. such as State. county. 0' CIty If enltrE' UOIt <br />IIlfected. list ,I ra!tler than subuOlts <br /> <br />Est,mated number of pe<SOns dlfectly benehtmg from <br />~ojoct <br /> <br />Use app<op<iale code letter. Deltnotlons ale: <br /> <br />A. New ^ submittal lor the hrst lime for a new pt'ojecl. <br /> <br />B Aaoewal An eX1enSlon for !In additIonal fundlng/ <br />b<xlget period for a pt'oj<!ct haVing no pt'olected com. <br />pletlOn date. but for wtIich Federal support must be <br />rerttlWed each yea, <br /> <br />C. RevtSlOn A mod,hcaltOn to pt'oJ8Cl nalure or sctlP<> <br />which may result ,n fund.ng Change (Increase or de. <br />crease). <br />O. ConlinuatlOn An elCtenSlOn for an additIOnal lundJl'lg/ <br />budget period for a pt'0jeCl the agency iM18l1y agreed <br />to fund lor iii clefln.te numbet of years <br /> <br />E. AugmentallOll A requ.lemenl tor addltJonalfunds 10f a <br />pt'OjeCt prev>ously a.....arded funds In the same fundlngl <br />budget penod. PrOjeCt natule and scope unchanged <br /> <br />Amounl requested or to be contnbuted dunng the '.'<5t <br />funding/budget peno<l by each contnbutor. Value of In- <br />kInd contnbutlOns Wlil be ,ncluded if the acllon .$ a <br />change In dollar amount 01 an eXIsting glanl (a levlSiOO or <br />augmentatlOll). indicate only !tie amount of !tie Change <br />For decraaS6s enclose the amount In palentheses If <br />both basic and supplemental amounts are Included, <br />break out in remar..s For mulllple program lundlng. use <br />totals and show program breakouts In remarks Hem <br />delll1ltJons: 138. amount requested from Federal GOVl!I'O. <br />menl; 13b. amount apphcant ",,111 contnbute; 13c. amount <br />from State, if appiicant IS not a Stale; 13d. amount from <br />local government. if apploeant IS not a local government. <br />13e. amount from a"", other sources. 8xpiaon to remat1cs <br /> <br />11 <br /> <br />12 <br /> <br />13. <br /> <br />1.(a. <br />Ub. <br /> <br />Self expl&natory. <br /> <br />The d1stnct(s) ..n-e most of actual worir. will be accom- <br />plished. If city-wK>e or Stalo-Wlde. COYenng 5elierat ells. <br />tncts. write "crty-wlde" or "State-wide," <br /> <br />Complete ooJ'f lor ~ (item 12c). or augmentabons <br />(item 12e). <br /> <br />Appiollimate ~te pt'otOCf expected to begin (usually 35- <br />IlOtiated with esbmated date ot .wailabtlity ot IundlO9J <br /> <br />Estlmaled nu<ooe. ot months to ccmpIete PfO!8CI ,1Itler <br />F~allunds _ avJUlable <br /> <br />EIl1,rt"AlltAd OllIe .......1'w1~tJon/,'IW....atJon will be ~t. <br />tIl>d to Feoderal lil9"ncy If trws pt'OjeCt r9QU4(es ck13oog. <br />t>c<JS6 l'e'VleW If revoew r.ol r&q\Jlred. thiS date WOttkl <br />U"'.A.ldlly be same as date ,n l1em 2b <br /> <br />15. <br /> <br />16. <br /> <br />17. <br /> <br />lB. <br /> <br />Sf AJ<<>ARO FOftN ...,.. Jl'AClof J Ij.:!.,.... ,,_ 71j <br /> <br />Exhibi t M- 3. Application for Federal AssistanCe <br />(l'lor.constructio.'1 Prcxjrarrs) <br /> <br />(Pa<Je 3 of 13) <br /> <br />13 <br />