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~achrrent M 19 EXlshng FliIdefal ider1tificalion number if thIS is not a new reqUilst and dlI'~y rtriates 10 a previous Federai actJon. Otherwise write "NA" Item 20, IndICate Fedefal agency to wtllCh this request is ad. dressed. Street address not required. bu1 do use ZIP. Check appropriate box as to whether Section IV of form contaIns remar1<s and/or addItional remarks are attached. 21. APPLICANT PROCEDURES fOR SECTION II Applicants will always complete items 23a, 23b. and 23c. if clearinghouS<J rev!eW 15 r8qulrEKJ. item 22b must be fully complelEKJ An explanation follows for each item Item 220 us! cleannghouses to wh.ch submitted and show III applopriate blocks the stalus of the.r responses For rn0<8 than three cleanngho\,J5es. cont.nue III remarks sectIon. All Wlltten comments submitted by or through c1eannghouses must be attached Name and t,tle of authorizEKJ representaltYe of legal apphc ant 23a Item 23b Self explanatory 23c. Self explanatory. Nole ApplICant completes only SectIOns I and II. Section III is completEKJ by Federal agencIes. fE.DERAL AGENCY PROCEDURES FOR SECTiON III If appllcant.supplled mformahon In Sections I and II needs no updahng or adjustment to ht the final Federal act,on, th" Federal agency WIll complete Section III only. An explanatIon for each Item tollows: Item 24 Executive department 01 Independent agency havmg pro- gram admm.sllalton responsibIlity Self explanatory Pnmary organIzational Ulllt below departmentleyel havmg drrecl program management responsibility OffIce dlTeclly monltonng the program. Use to Identity non.awald actIons where Federal grant Idenlifler rn Item 30,s not applocable or will not suffIce Complete address of administering offIce shown In item 26 Use 10 Idenltty a....ard actIons where dIfferent from Feder. al apphcalton Idenltlter III lIem 28. Self explanatory. Use remarks seeMn to amploty where appropriate Amount to be contributed dunng the fJrst funding/budget perIOd by each contribulor. Value of in-kind contributions will be included If the acllon is a change in dollar amount. of an ex,sllng grant (a re>nSlOn or augmentation), IndIcate only the amount of change. For decreases. enclose the amount in parentheses. If both basIC and supplemental amounts are included, break out in remarks For multiple program funding. \,Jse totals and show pro. gram breakouts mremari<s. Item dehnitions: 32a, amount awarciEKJ by Fedefal Government; 32b, amount applICant will contribute; 32c. amount rrorn State. if Ilpp!~~nl is not a State; 32d. amount from local ~XlVernment if tlpphcant 15 not a local government; 32e. amount from any other sources, explalll III remarks. 2S 26 2' 28 29 30 31 32 33 Dale action was taken on this request. 34 Date funds \Ntll become available. Item 35. Name and telephone no of agency person who can prOVide more informalion regarding this assistance Date after whIch tunds will no longer be available Check appropnate box as to whether Section IV of fOlm contains FEKJeral remarks and/or attachment of addll.on- al remarks. For use wrth A-95 acllon notices only Name and tele. phone of person who C<in assure that appropnate A-95 8Cllon has been taken--ff same as person shOWn In item 35, wnte "same" If not applicable, write "NA". 36. 37. 38 Federal Agency Procedures-special considerations A. Treasury Circular 1082 compliance. Fe.:Jeral agency "",II assure proper completion of Sections I and III. If Secllon I .S belllg completed by Federal agency. all applicable ,Iems must be fIlled in. Addresses of Stale Information Recaption AgenCIes (SClRA's) are provided by Treasury Department to each agency. This form replaces SF 240. which will no Iofig€f be used. B. OMB Circular A-95 compliance. Federal agency will assure proper completion of Sections I. II, and IiI. This form is required for notifying ail reviewing clearinghouses of IT\8jOl' actions on all proglams reviewed undef A-95. Addresses of State and l!IJ'ea.....Kle cle.lnnghouS8S are providsd by OMS to each agency. Substantive drrterences between applicant's raquesl and/or daaringtx.'Use recommendations. and tfl€ project as finally ll'>\I,vded will be explained in A-95 notif,cations to cleanng. houses. C. Spect.al nole. In most, bu1 not all States. ft1.a A-95 Stale cleanng. house and the (TC 10.32) SClRA SIe ft1.a :same oHlce. In such cases. the A-95 Ilward nollce to the Stale cleannghouse WIll fulfill the TC 1082 award rY.Jtice raquirementto the Stale SClRA. Duphcale ootJflCllhon should be avoided Ex.1U.bit B-3. JI.pplication for Federal Assistance (Nonconstruction Prograws) (Page 4 of 13) lrr~ fOA1lI4.:M I'MJiE 4 (R".. ..77) 14