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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 Federal Management Circular 74-7. 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 notify 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 that Federal assistance is to be applied for (clearint house procedures will govem). APPLICANT PROCEDURES FOR SECTION I Applicant will complete all items in Section 1. If an item is not applicable,write "NA". If additional space is needed, insert an asterisk "°", and use the remarks section on the back of the form. An explanation follows for each item: R Item Item -; 1. Mark appropriate box. Pre-application and applica- D. Insurance. Self explanatory. tion guidance is in FMC 74-7 and Federal agency E. Other. Explain on remarks page. program instructions. Notification of intent guid- ance is in Circular A-95 and procedures from clear- 10. Governmental unit where significant and meaning- inghouse. Applicant will not use "Report of Federal ful impact could be observed. List only largest unit Action" box. or units affected, such as State, county, or city. If entire unit affected, list it rather than subunits. 2a. Applicant's own control number, if desired. 11. Estimat.d number of persons directly benefiting 2b. Date Section I is prepared. from project. 3a. Number assigned by State clearinghouse, or if dale- 12. Use appropriate code letter. Definitions are: gated by State, by areawida clearinghouse. All re- quests to Fedcrol agancies must contain this identi- A. New. A submittal for the first time for a new fier if the program is covered by Circular A-95 and project required by applicable State/areawide clearing- B. Renewal.An extension for an additional funding/ house precadures. if in doubt, consua your clear- budget period for a project having no projected inghouse. completion date, but for which Federal support �. 3b. Date applicant notified of clearinghouse identifier. must be renewed each year. 4a-4h. Legal nacre of applicant/recipient, name of"rimary C. Revision. A modification to project nature or or,anizatlonal unit which will undertake the assist- scope which may result in funding change (in- ance activity, complete address of applicant, and crease or decrease). name and telephone number of person who can pre- D. Continuation. An extension for an additional vide further information about this request. funding/budget period for a project the agency 5. Emp!cyer identification number of app;icant as as- initially agreed to fund for a definite number of signed by Internal Revenue Service. yeers. Ea. Use Catalog of Fellaral Domestic Assistance rum E. Augmentation. A requirement for additional ber assigned to prcZram under which assistance is funds for a protect previously awarded funds in requested. If more than one program (e.g., joint- the same funding/budget period. Project nature funding) write "multip!e" and explain in remarks. and scope unchanged. If unknown, cite Public Law or U.S.Code. 13. Amount requested or to be contributed during the first funding/budget period by each contributor. 6b. Program title from Federal Catalog. Abbreviate it Value of in-kind contributions will ba included. It necessary. the action is a change in dollar amount of an exist- 7. Erief title and appropri3te description of project. ing grant (a revision or augmentation), indicate For notification of intent, continue in remarks sec- only the amount of the charge. For decreases en- tion if necessary to convey proper description. close the amount in parentheses. If both basic and supplemental amounts are included, breakout in 8. Mostly self-explanatory. "City" includes town,town- remarks. For multiple program funding, use totals ship or other municipality. and show program breakouts in remarks. Item dafi- nitiors: 13a, amount reque:;ted from Federal Gov- 9. ov9. Check the type(s) of assistance requested. Tiie ernment; 13b, amount applicant will contribute; definitions of the terms are: 13c, amount from State, if applicant is not a State; A. Basic Grant. An original request for Federal 13d, amount from Icca 1 g3vernmant, if applicant is funds. This would not include any contribution not a local government; 13e,amount from any other provided under a supplemental grant. sources, explain in ram:rks. B. Supplemental Crant. A request to increase a 14a. Self explanatory. basic grant in certain cases where the eligible applicant cannot supply tha required matching 14b. The district(s) where most of actual Werk will be share cf the basic Fedcrel program (e.g., grants accomplished. If city-wide or State-wide, covering awarded by the Appalachian Regional Commis- several districts, write "city-wide*" or "State-wide." cion to provide the applicant a matching share). 15. Complete only for revisions (item 12c), or augmen- C. Loan. Self explanatory. tations (item 12e). STANDARD FCRM 424 PACE 3 (10-7=)