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1/31/79 AC 150/5900-1B Appendix 1 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 (clearinghouse procedures will govern). APPLICANT PROCEDURES FOR SECTION 1 Applicant will complete all items In Section 1. If an item Is not applicable, write "NA". If additional space is needed, insert an asterisk "e", and use the remarks section on the back of the form. An explanation follows for each item: Item 1. Mark appropriate box. Pre -application and applica- tion guidance is in FMC 74-7 and Federal agency program instructions. Notification of intent guid- ance is in Circular A-95 and procedures from clear- inghouse. Applicant will not use "Report of Federal Action" box. 2a. Applicant's own control number, N desired. 2b. Date Section I Is prepared. 3a. Number assigned by State clearinghouse, cr if dele- gated by State, by areawide clearinghouse. All re- quests to Federal agencies must contain this identi- fier if the program is covered by Circular A-95 and required by applicable State/areawide clearing- house procedures. If in doubt, consult your clear- inghouse. 3b. Date applicant notified of clearinghouse identifier. 4a-4h. Legal name of applicant/recipient, name of primary organizational unit which will undertake the assist- ance activity, complete address of applicant, and name and telephone -number of person who can pro- vide further information about this request. 5. Employer identification number of applicant as as- signed by Internal Revenue Service. 6a. Use Catalog of Federal Domestic Assistance num- ber assigned to program under which assistance is requested. If more than one program (e.g., Joint - funding) write "multiple" and explain In remarks. If unknown, cite Public Law or U.S. Cede. 6b. Program title from Federal Catalog. Abbreviate If necessary. 7. Brief title and appropriate description of project. For notification of intent, continue in remarks sec- tion if necessary to convey proper description. 8. Mostly self-explanatory. "City" includes town, town- ship or other municipality. 9. Check the type(s) of assistance requested. Tho definitions of the terms ere: A. Basic Grant. An original request for Federal funds. This would not include any contribution provided under a supplemental grant. B. 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 Commis- sion to provide the applicant a matching share). C. Loan. Self explanatory. Item D. Insurance. Self explanatory. E. Other. Explain on remarks page. 10. Governmental unit where significant and meaning- ful impact could be observed. List only largest unit or units affected, such as State, county, or city. If entire unit affected, list it rather than subunits. 11. Estimated number of persons directly benefiting from project. 12. Use appropriate code letter. Definitions are: A. New. A submittal for the first time for a new project. B. Renewal. An extension for an additional funding/ budget period for a project having no projected completion date, but for which Federal support must be renewed each year. C. Revision. A modification to project nature or scope which may result in funding change (in- crease or decrease). D. Continuation. An extension for an additional funding/budget period for a project the agency initially agreed to fund for a definite number of years. E. Augmentation. A requirement for additional funds for a project previously awarded funds in the same funding/budget period. Project nature and scope unchanged. 13. Amount requested or to be contributed during the first funding/budget period by each contributor. Value of in -kind contributions will be Included. If the action is a change in dollar amount of an exist- ing grant (a revision or augmentation), indicate only the amount of the change. For decreases en- close the amount in parentheses. If both basic and supplemental amounts are included, breakout in remarks. For multiple program funding, use totals and show program breakouts in remarks. Item defi- nitions: 13a, amount requested from Federal Gov- ernment; 13b, amount applicant will contribute; 13c, amount from State, if applicant is not a State; 13d, amount from local government, if applicant is not a local government; 13e, amount from any other sources, explain in remarks. 14a. Self explanatory. I4b. The district(s) where most of actual work will be accomplished. If city-wide or State-wide, covering several districts, write "city-wide" or "State-wide." 15. Complete only for revisions (item 12c), Or augmen- tations (item 12e). STANDARD FORM 424 PAGE 3 (10-75) 5