Fillable Form SF-424 Application for Federal Assistance

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Form SF-424 Application for Federal Assistance

On average this form takes 22 minutes to complete

The Form SF-424 Application for Federal Assistance form is 3 pages long and contains:

  • 0 signatures
  • 26 check-boxes
  • 77 other fields

Country of origin: US
File type: PDF

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OMB Number: 4040-0004
Expiration Date: 12/31/2019
* 1. Type of Submission:
* 2. Type of Application:
* 3. Date Received:
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier:
7. State Application Identifier:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. Organizational DUNS:
* Street1:
Street2:
* City:
County/Parish:
* State:
Province:
* Country:
* Zip / Postal Code:
Department Name:
Division Name:
Prefix:
* First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:
* Telephone Number:
Fax Number:
* Email:
* If Revision, select appropriate letter(s):
* Other (Specify):
State Use Only:
8. APPLICANT INFORMATION:
d. Address:
e. Organizational Unit:
f. Name and contact information of person to be contacted on matters involving this application:
Application for Federal Assistance SF-424
Preapplication
Application
Changed/Corrected Application
New
Continuation
Revision
USA: UNITED STATES
* 9. Type of Applicant 1: Select Applicant Type:
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
11. Catalog of Federal Domestic Assistance Number:
CFDA Title:
* 12. Funding Opportunity Number:
* Title:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
* 15. Descriptive Title of Applicant's Project:
Attach supporting documents as specified in agency instructions.
Application for Federal Assistance SF-424
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* a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
* f. Program Income
* g. TOTAL
.
Prefix:
* First Name:
Middle Name:
* Last Name:
Suffix:
* Title:
* Telephone Number:
* Email:
Fax Number:
* Signature of Authorized Representative:
* Date Signed:
18. Estimated Funding ($):
21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Application for Federal Assistance SF-424
* a. Applicant
Attach an additional list of Program/Project Congressional Districts if needed.
* b. Program/Project
* a. Start Date:
* b. End Date:
16. Congressional Districts Of:
17. Proposed Project:
a. This application was made available to the State under the Executive Order 12372 Process for review on
b. Program is subject to E.O. 12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
Yes
No
** I AGREE
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
If "Yes", provide explanation and attach
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Form SF-424 Application for Federal Assistance

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Completed 22 February 2020

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