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WIA incentive grant applications, Change 5
Summary ETA updated application instructions for Workforce Investment Act Section 503 incentive grants based on Program Year 2005 performance. It explained eligibility, award amounts, permitted uses, and submission forms. Two attachments provide federal application forms; ETA now labels the change Canceled.
Document
Federal guidance
Agency
U.S. Department of Labor, Employment and Training Administration (ETA)
Document number
TEGL No. 20-01, Change 5
Date issued
May 8, 2007
Status
Withdrawn
ETA lists this program-year change Canceled as of 2026-10-24; its letter prints Rescissions: blank and Expiration Date: Continuing.
Status last verified October 24, 2026
Is this still the rule?
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Accessible letter PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2007/TEGL20-01_Ch5_Acc.pdf
CLASSIFICATION
EMPLOYMENT AND TRAINING ADMINISTRATION WIA/Performance Measures
ADVISORY SYSTEM CORRESPONDENCE SYMBOL
U.S. DEPARTMENT OF LABOR PROTECH
Washington, D.C. 20210 DATE
May 8, 2007
TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 20-01, Change 5
TO: ALL STATE WORKFORCE LIAISONS
ALL STATE WORKFORCE AGENCIES
FROM: EMILY STOVER DeROCCO /s/
Assistant Secretary
SUBJECT: Application Process for Workforce Investment Act (WIA) Section 503
Incentive Grants, Program Year (PY) 2005 Performance
1. Purpose. This guidance letter updates the procedures states should follow to apply
for WIA section 503 Incentive Grants.
2. References. Workforce Investment Act of 1998 (WIA) (Pub. L. 105-220) sections 174,
211, and 503, (29 U.S.C. 2919, 20 U.S.C. 9211, 9273); Training and Employment
Guidance Letter (TEGL) No. 8-99, Negotiating Performance Goals, and Incentives
and Sanctions Process under title I of the Workforce Investment Act (WIA) (March 3,
2000); TEGL No. 14-00, Change 1, Workforce Investment Act Performance Reporting
System (November 19, 2001); TEGL No. 14-03, Performance Reporting Submission
Procedures for the Workforce Investment Act Standardized Record Data (WIASRD)
and the Annual Report under title 1-B of the Workforce Investment Act (November
13, 2003); Training and Employment Notice (TEN) 16-06, Exclusion of the Dislocated
Worker Earnings Measure from Program Year (PY) 2005 Incentive and Sanction
Determinations (November 2, 2006); 20 CFR part 664, 666.200 - 666.230, and
666.205(c); and Carl D. Perkins Vocational and Technical Education Act (Perkins
Act) (Pub. L. 105-332) section 111(a) (20 U.S.C. 2302(9), 2321(a)).
3. Background. Section 503 of the Workforce Investment Act provides for incentive
grants to reward states for successful performance in workforce and education
programs. The provisions authorizing funding for incentive grant awards are found
RESCISSIONS EXPIRATION DATE
Continuing
in WIA section 174(b)(2)(D) for workforce investment services (29 U.S.C.
2919(b)(2)(D)), Adult Education and Family Literacy Act (AEFLA) section 211(a)(3)
for adult education activities (20 U.S.C. 9211(a)(3)), and the Carl D. Perkins
Vocational and Technical Education Act (Perkins Act) section 111(a)(1)(C) for
vocational education activities (20 U.S.C. 2321(a)(1)(c)). Fiscal Year 2006 funding
available for PY 2005 performance totals $16,352,987.
The Department of Labor regulations on incentive awards may be found at 20 CFR
666.200 through 666.230.
4. Eligibility. The list of states eligible to receive incentive grant awards for PY 2005
performance and the amounts of the awards for which they are eligible were
published in the Federal Register on April 30, 2007. Eligibility for a section 503
incentive grant award was determined by state performance under WIA title I,
AEFLA, and Perkins Act programs. States that are eligible for incentive grant
awards have 45 days from the April 30, 2007, Federal Register notice to submit their
applications for these awards.
5. Amount of Incentive Awards. WIA section 503(c)(1) sets the range of incentive
grant awards from $750,000 to $3 million, depending on the amount of appropriated
funds available. If the amount available for grants is insufficient to award the
minimum grant to each eligible state, the minimum and maximum grant amounts
will be adjusted by a uniform percentage as required by WIA section 503(c)(2). For
the PY 2005 performance awards, the criterion for determining the amount of the
incentive grant within this range will be the size of the state’s program, as measured
by the state’s relative share of the combined title I, AEFLA, and Perkins Act formula
grants awarded to that state.
6. Authorized Use of Funds. 20 CFR 666.210 authorizes a state to use its incentive
grant award to carry out an innovative program consistent with the requirements of
any one or more of the programs within title I of WIA, AEFLA, or the Perkins Act.
This provides states greater flexibility in using these funds, and the Governors and
state agencies are not limited to only one type of innovative program.
Incentive grant funds awarded to states will be identified as WIA title V, Program
Year 2006 funds, and must be expended by June 30, 2009.1 Because this timeframe
differs from the typical program timeframes used by AEFLA and the Perkins Act,
cooperation among state agencies to ensure timely expenditure of these funds is
strongly encouraged.
1 Typically, states would have three years to spend a Program Year’s funds. However, because incentive grants, taken from FY 2006
funds, will be awarded at the end of Program Year 2006, states will be given through June 30, 2009, to expend the funds.
States may expend funds for activities authorized under WIA title I, AEFLA, and/or
the Perkins Act. While DOL administrative provisions apply to the statutory life of
the funds, the individual program provisions apply to the use of funds. For
example, if the incentive funds are used for a WIA title I activity for youth services,
the applicable program requirements for youth programs in 20 CFR 664 and WIA
title I would apply to that portion of the funds. If innovative Adult Education and
Literacy and/or Perkins Act programs were planned, the provisions of AEFLA, the
Perkins Act and the Education Department’s General Administrative Regulations
(EDGAR) (34 CFR 74-77, 79-82, 85-86, and 97-99) would apply to that portion of the
funds.
States are encouraged to plan activities that promote cooperation and collaboration
among the agencies administering WIA title I, AEFLA, and Perkins Act programs.
The Secretaries of Labor and Education encourage Governors and their state agency
representatives to take advantage of the broad flexibility Congress intended for
these funds by planning for activities that are:
A. Innovative — Services and activities beyond those the state conducts with its
regular funds from these programs, particularly activities that are
authorized through more than one program.
B. Comprehensive and coordinated — Combined activities and services that are
authorized by different programs.
C. Targeted to improving system performance — Activities that serve the needs and
populations that are likely to result in improving state systems of
employment, training, and education, especially those linking to high-
growth industries and occupations.
The U.S. economy and its labor markets are undergoing changes of historic
proportion. In February 2006, ETA launched the Workforce Innovation in Regional
Economic Development (WIRED) Initiative, focusing on the role of talent
development in driving regional economic competitiveness, increased job growth,
and new opportunities for American workers. The WIRED framework
(http://www.doleta.gov/wired/files/WIRED_Fact_Sheet.pdf) focuses on talent,
infrastructure and investment. States should keep this transformational effort in
mind when planning activities funded by incentive grants. State Departments of
Labor and Education can work together to focus on workforce education and
training projects that facilitate innovative talent development and maximize
opportunities for employment and life-long learning.
7. Application Process. States that qualify must apply by sending an original and two
copies of an application for an incentive grant to the U.S Department of Labor,
which will work with the U.S. Department of Education to review the applications
(electronic transmissions are allowed as long as electronic signatures are included).
The application may take the form of a letter from the Governor to the Assistant
Secretary for Employment and Training (addresses are listed below), and must
include the following:
A. Assurances—The application must include a Standard Form 424
(Application for Federal Assistance) form and assurances that:
1) The state legislature was consulted with respect to the development of
the application.
2) The application was approved by the Governor, the eligible agency for
adult education (as defined in section 203(4) of WIA (20 U.S.C. 9202(4)))
and the state agency responsible for vocational and technical education
programs (as defined in section 3(9) of Perkins Act (20 U.S.C. 2302(9)).
3) The state and the eligible agency, as appropriate, exceeded the state
adjusted levels of performance for WIA title I, the state adjusted levels of
performance for AEFLA, and the performance levels established for
Perkins Act programs.
B. Additional Information—The state must provide a description of the
planned use of the incentive grant as part of the application process to
ensure that the state’s planned activities are authorized under the WIA title
I, AEFLA, and/or Perkins Act, as required by WIA section 503(a). When
describing the planned activities in response to number 2, below, the state
should note which program the authorized activities fall under.
The other descriptive information (see numbers 3 and 4, below) about the
state’s plan is requested for inclusion in the state’s incentive grant
document. The Departments of Labor and Education will use this
information to monitor the use of incentive grants and in reports to
Congress on state performance. (Note: The state’s receipt of an incentive
grant is not contingent on this other descriptive information, but this
information is required for the WIA title V Grant Agreement.) The state
must:
1) Identify the state agency and contact person that will receive and
administer the funds on behalf of all state agencies. The agency may be
the state workforce agency or other entity associated with these funds.
This agency will be responsible for reporting on the use of all funds. If
agencies other than the grant recipient will be undertaking program
activities with the funds, please identify the sub-grantee(s) and the
amount(s) they will be provided.
2) Describe the planned activities. This information should include the
legislative authority for the activity and a description of how the
activities are innovative, comprehensive and coordinated, and targeted
to improving system performance in accordance with the major
objectives set forth in the state’s current WIA Strategic Plan as
appropriate. Include information on how services build on, rather than
duplicate, services offered under the AEFLA and Perkins Act state grants
or WIA title I. Describe how these funds are being used collaboratively
with other partner programs to benefit service to clients.
3) Describe ways in which the activities are related to improving
performance levels on the state indicators of performance for each
different activity planned. For example, describe how the activities will
strengthen the state’s ability to improve literacy levels, increase
employment, increase transitions to further education and training,
and/or improve technical and academic skills.
4) Describe any state consultation with stakeholder groups and the general
public on the use of incentive award funds. States are encouraged to
seek public input on the use of state incentive funding, including that of
representatives of adult education, vocational education programs, and
other workforce system partners.
5) Provide a completed set of the attached Standard Form 424(A) Budget
Sections A, D and E only.
8. Action Required. As explained in 20 CFR 666.205(c), states have 45 days from the
date of publication of the Federal Register notice announcing eligible states and
incentive amounts to submit the required application materials. Applicants are
advised that mail in the Washington, D.C. area may be delayed due to mail
decontamination procedures. Therefore, states are encouraged to submit
applications electronically. Application materials are due by June 14, 2007, and
should be sent to:
Emily Stover DeRocco
Assistant Secretary for Employment and Training
U.S. Department of Labor
200 Constitution Avenue, NW, Room S-5206
Washington, D.C. 20210
Attn: Karen Staha
Or electronically:
[email protected]
Funds must be obligated by June 30, 2007. States are encouraged to submit their
applications prior to the due date. The ETA regional administrators will be
available to provide any technical assistance to states in preparing and expediting
the applications.
9. Attachments. Standard Forms 424 and 424(A).
Attachment 1 PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2007/TEGL20-01_Ch5_Att1.pdf
OMB Approval No. 0348-0044
BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program Catalog of Federal
Estimated Unobligated Funds New or Revised Budget
Function Domestic Assistance
or Activity Number Federal Non-Federal Federal Non-Federal Total
(a) (b) (c) (d) (e) (f) (g)
$ $ $ $ $
1. 0.00
2. 0.00
3. 0.00
4. 0.00
$ $ $ $ $
5. Totals 0.00 0.00 0.00 0.00 0.00
SECTION B - BUDGET CATEGORIES
GRANT PROGRAM, FUNCTION OR ACTIVITY Total
6. Object Class Categories
(1) (2) (3) (4) (5)
$ $ $ $ $
a. Personnel 0.00
b. Fringe Benefits 0.00
c. Travel 0.00
d. Equipment 0.00
e. Supplies 0.00
f. Contractual 0.00
g. Construction 0.00
h. Other 0.00
i. Total Direct Charges (sum of 6a-6h) 0.00 0.00 0.00 0.00 0.00
j. Indirect Charges 0.00
$ $ $ $ $
k. TOTALS (sum of 6i and 6j) 0.00 0.00 0.00 0.00 0.00
7. Program Income $ $ $ $ $ 0.00
Authorized for Local Reproduction Standard Form 424A (Rev. 7-97)
Previous Edition Usable Prescribed by OMB Circular A-102
SECTION C - NON-FEDERAL RESOURCES
(a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS
8. $ $ $ $ 0.00
9. 0.00
10. 0.00
11. 0.00
12. TOTAL (sum of lines 8-11) $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION D - FORECASTED CASH NEEDS
Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
13. Federal
$ 0.00 $ $ $ $
14. Non-Federal 0.00
15. TOTAL (sum of lines 13 and 14) $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program FUTURE FUNDING PERIODS (Years)
(b) First (c) Second (d) Third (e) Fourth
16. $ $ $ $
17.
18.
19.
20. TOTAL (sum of lines 16-19) $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges: 22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Page 2
INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0044), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Instructions
For continuing grant program applications , submit these forms
This form is designed so that application can be made for funds before the end of each funding period as required by the grantor
from one or more grant programs. In preparing the budget, agency. Enter in Columns (c) and (d) the estimated amounts of
adhere to any existing Federal grantor agency guidelines which funds which will remain unobligated at the end of the grant
prescribe how and whether budgeted amounts should be funding period only if the Federal grantor agency instructions
separately shown for different functions or activities within the provide for this. Otherwise, leave these columns blank. Enter in
program. For some programs, grantor agencies may require columns (e) and (f) the amounts of funds needed for the
budgets to be separately shown by function or activity. For other upcoming period. The amount(s) in Column (g) should be the
programs, grantor agencies may require a breakdown by function sum of amounts in Columns (e) and (f).
or activity. Sections A, B, C, and D should include budget
estimates for the whole project except when applying for For supplemental grants and changes to existing grants, do not
assistance which requires Federal authorization in annual or use Columns (c) and (d). Enter in Column (e) the amount of the
other funding period increments. In the latter case, Sections A, B, increase or decrease of Federal funds and enter in Column (f) the
C, and D should provide the budget for the first budget period amount of the increase or decrease of non-Federal funds. In
(usually a year) and Section E should present the need for Column (g) enter the new total budgeted amount (Federal and
Federal assistance in the subsequent budget periods. All non-Federal) which includes the total previous authorized
applications should contain a breakdown by the object class budgeted amounts plus or minus, as appropriate, the amounts
categories shown in Lines a-k of Section B. shown in Columns (e) and (f). The amount(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).
Section A. Budget Summary Lines 1-4 Columns (a) and (b)
Line 5 - Show the totals for all columns used.
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring Section B Budget Categories
a functional or activity breakdown, enter on Line 1 under Column
(a) the Catalog program title and the Catalog number in Column In the column headings (1) through (4), enter the titles of the
(b). same programs, functions, and activities shown on Lines 1-4,
Column (a), Section A. When additional sheets are prepared for
For applications pertaining to a single program requiring budget Section A, provide similar column headings on each sheet. For
amounts by multiple functions or activities, enter the name of each program, function or activity, fill in the total requirements for
each activity or function on each line in Column (a), and enter the funds (both Federal and non-Federal) by object class categories.
Catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a Line 6a-i - Show the totals of Lines 6a to 6h in each column.
breakdown by function or activity, enter the Catalog program title
on each line in Column (a) and the respective Catalog number on Line 6j - Show the amount of indirect cost.
each line in Column (b).
Line 6k - Enter the total of amounts on Lines 6i and 6j. For all
For applications pertaining to multiple programs where one or applications for new grants and continuation grants the total
more programs require a breakdown by function or activity, amount in column (5), Line 6k, should be the same as the total
prepare a separate sheet for each program requiring the amount shown in Section A, Column (g), Line 5. For
breakdown. Additional sheets should be used when one form supplemental grants and changes to grants, the total amount of
does not provide adequate space for all breakdown of data the increase or decrease as shown in Columns (1)-(4), Line 6k
required. However, when more than one sheet is used, the first should be the same as the sum of the amounts in Section A,
page should provide the summary totals by programs. Columns (e) and (f) on Line 5.
Lines 1-4, Columns (c) through (g) Line 7 - Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
For new applications , leave Column (c) and (d) blank. For each amount from the total project amount, Show under the program
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the
project for the first funding period (usually a year).
SF-424A (Rev. 7-97) Page 3
INSTRUCTIONS FOR THE SF-424A (continued)
narrative statement the nature and source of income. The Line 15 - Enter the totals of amounts on Lines 13 and 14.
estimated amount of program income may be considered by the
Federal grantor agency in determining the total amount of the Section E. Budget Estimates of Federal Funds Needed for
grant. Balance of the Project
Section C. Non-Federal Resources Lines 16-19 - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or
Lines 8-11 Enter amounts of non-Federal resources that will be activity is not necessary. For new applications and continuation
used on the grant. If in-kind contributions are included, provide a grant applications, enter in the proper columns amounts of Federal
brief explanation on a separate sheet. funds which will be needed to complete the program or project over
the succeeding funding periods (usually in years). This section
need not be completed for revisions (amendments, changes, or
Column (a) - Enter the program titles identical to supplements) to funds for the current year of existing grants.
Column (a), Section A. A breakdown by function or
activity is not necessary. If more than four lines are needed to list the program titles, submit
additional schedules as necessary.
Column (b) - Enter the contribution to be made by the
applicant. Line 20 - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
Column (c) - Enter the amount of the State’s cash and accordingly and show the overall totals on this line.
in-kind contribution if the applicant is not a State or
State agency. Applicants which are a State or State Section F. Other Budget Information
agencies should leave this column blank.
Line 21 - Use this space to explain amounts for individual direct
Column (d) - Enter the amount of cash and in-kind
object class cost categories that may appear to be out of the
contributions to be made from all other sources.
ordinary or to explain the details as required by the Federal grantor
agency.
Column (e) - Enter totals of Columns (b), (c), and (d).
Line 22 - Enter the type of indirect rate (provisional, predetermined,
final or fixed) that will be in effect during the funding period, the
Line 12 - Enter the total for each of Columns (b)-(e). The amount estimated amount of the base to which the rate is applied, and the
in Column (e) should be equal to the amount on Line 5, Column total indirect expense.
(f), Section A.
Line 23 - Provide any other explanations or comments deemed
Section D. Forecasted Cash Needs necessary.
Line 13 - Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14 - Enter the amount of cash from all other sources needed
by quarter during the first year.
SF-424A (Rev. 7-97) Page 4
Attachment 2 PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2007/TEGL20-01_Ch5_Att2.pdf
APPLICATION FOR Version 7/03
FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier
1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier
Application Pre-application
4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
Construction Construction
Non-Construction Non-Construction
5. APPLICANT INFORMATION
Legal Name: Organizational Unit:
Department:
Organizational DUNS: Division:
Address: Name and telephone number of person to be contacted on matters
Street: involving this application (give area code)
Prefix: First Name:
City: Middle Name
County: Last Name
State: Zip Code Suffix:
Country: Email:
6. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Number (give area code) Fax Number (give area code)
-
8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types)
New Continuation Revision
If Revision, enter appropriate letter(s) in box(es)
(See back of form for description of letters.) Other (specify)
Other (specify) 9. NAME OF FEDERAL AGENCY:
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT:
TITLE (Name of Program):
-
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.):
13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF:
Start Date: Ending Date: a. Applicant b. Project
15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal $ .00 THIS PREAPPLICATION/APPLICATION WAS MADE
a. Yes.
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
b. Applicant $ .00 PROCESS FOR REVIEW ON
c. State $ .00 DATE:
d. Local $ .00 PROGRAM IS NOT COVERED BY E. O. 12372
b. No.
e. Other $ .00 OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
f. Program Income $ .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g. TOTAL $ .00
Yes If “Yes” attach an explanation. No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Authorized Representative
Prefix First Name Middle Name
Last Name Suffix
b. Title c. Telephone Number (give area code)
d. Signature of Authorized Representative e. Date Signed
Previous Edition Usable Standard Form 424 (Rev.9-2003)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE
ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required face sheet for pre-applications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant certification that States which have established a review and comment
procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been given an
opportunity to review the applicant’s submission.
Item: Entry: Item: Entry:
1. Select Type of Submission. 11. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real
property projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary
description of this project.
2. Date application submitted to Federal agency (or State if applicable) 12. List only the largest political entities affected (e.g., State,
and applicant’s control number (if applicable). counties, cities).
3. State use only (if applicable). 13 Enter the proposed start date and end date of the project.
4. Enter Date Received by Federal Agency 14. List the applicant’s Congressional District and any District(s)
Federal identifier number: If this application is a continuation or affected by the program or project
revision to an existing award, enter the present Federal Identifier
number. If for a new project, leave blank.
5. Enter legal name of applicant, name of primary organizational unit 15 Amount requested or to be contributed during the first
(including division, if applicable), which will undertake the funding/budget period by each contributor. Value of in kind
assistance activity, enter the organization’s DUNS number contributions should be included on appropriate lines as
(received from Dun and Bradstreet), enter the complete address of applicable. If the action will result in a dollar change to an
the applicant (including country), and name, telephone number, e- existing award, indicate only the amount of the change. For
mail and fax of the person to contact on matters related to this decreases, enclose the amounts in parentheses. If both basic
application. and supplemental amounts are included, show breakdown on
an attached sheet. For multiple program funding, use totals
and show breakdown using same categories as item 15.
6. Enter Employer Identification Number (EIN) as assigned by the 16. Applicants should contact the State Single Point of Contact
Internal Revenue Service. (SPOC) for Federal Executive Order 12372 to determine
whether the application is subject to the State
intergovernmental review process.
7. Select the appropriate letter in 17. This question applies to the applicant organization, not the
the space provided. I. State Controlled person who signs as the authorized representative. Categories
A. State Institution of Higher of debt include delinquent audit disallowances, loans and
B. County Learning taxes.
C. Municipal J. Private University
D. Township K. Indian Tribe
E. Interstate L. Individual
F. Intermunicipal M. Profit Organization
G. Special District N. Other (Specify)
H. Independent School O. Not for Profit
District Organization
8. Select the type from the following list: 18 To be signed by the authorized representative of the applicant.
• "New" means a new assistance award. A copy of the governing body’s authorization for you to sign
• “Continuation” means an extension for an additional this application as official representative must be on file in the
funding/budget period for a project with a projected completion applicant’s office. (Certain Federal agencies may require that
date. this authorization be submitted as part of the application.)
• “Revision” means any change in the Federal Government’s
financial obligation or contingent liability from an existing
obligation. If a revision enter the appropriate letter:
A. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration
9. Name of Federal agency from which assistance is being requested
with this application.
10. Use the Catalog of Federal Domestic Assistance number and title of
the program under which assistance is requested.
SF-424 (Rev. 7-97) Back
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