Application Instructions for the Indian Community Development Block Grant (ICDBG) Imminent Threat (IT) Program

PIH-2025-09.pdf

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
WASHINGTON, DC 20410-5000
OFFICE OF PUBLIC AND INDIAN HOUSING
Special Attention of: Notice PIH 2025-09
Administrators, Offices Date Issued: April 16, 2025
of Native American Programs; This Notice remains in effect until amended,
Tribes; Tribally Designated rescinded, or superseded.
Housing Entities (TDHEs) Cross References:
Program Guidance: No. 2018-04
Notices: FR-6301-N-02, FR-6431-N-01
Regulations: 2 CFR 200, 24 CFR Part 1003
Statute: 42 U.S.C. 5301 et seq.
Subject: Application Instructions for the Indian Community Development Block Grant
(ICDBG) Imminent Threat (IT) Program
Contents
1 Basic Information. ................................................................................................................................. 2
1.1 Executive Summary and Program Description............................................................................ 2
1.2 Key Dates. ................................................................................................................................... 3
1.3 Funding Details. .......................................................................................................................... 3
2 Eligibility. ............................................................................................................................................. 3
2.1 Eligible Activities. ....................................................................................................................... 3
2.2 Eligible Applicants. ..................................................................................................................... 5
2.3 Cost Sharing. ............................................................................................................................... 5
3 Program Costs. ...................................................................................................................................... 5
3.1 Allowable Costs. .......................................................................................................................... 5
3.2 Indirect Costs. .............................................................................................................................. 5
3.3 Unallowable Costs. ...................................................................................................................... 6
4 Waivers and Flexibilities Available to ICDBG Grantees Affected by PDDs. ...................................... 6
5 Letter to Proceed. .................................................................................................................................. 6
6 Imminent Threat Application Contents and Submission. ..................................................................... 7
7 Application Review Information. ......................................................................................................... 8
7.1 Application Review Process. ....................................................................................................... 8
7.2 Risk Review. ................................................................................................................................ 9
8 Award Notices. ..................................................................................................................................... 9
9 Post-Award Requirements and Administration. ................................................................................... 9
9.1 Regulatory and Administrative Requirements. ............................................................................ 9
www.hud.gov espanol.hud.gov

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9.2 Reporting. .................................................................................................................................. 10
9.3 Remedies for Noncompliance. .................................................................................................. 10
10 Amending Single Purpose ICDBG Grants to Fund ICDBG-IT Purposes. .................................... 11
11 Paperwork Reduction Act .............................................................................................................. 11
12 Contact Information. ...................................................................................................................... 11
1 Basic Information.
1.1 Executive Summary and Program Description.
This Notice provides Tribes with program requirements and instructions on how to apply for
Indian Community Development Block Grant (ICDBG) Imminent Threat (IT) funding. This
Notice also increases ceilings for ICDBG-IT grants. This Notice supersedes Program Guidance
2018-04, Imminent Threat Grants. The statutory authority for this program is Title 1 of the
Housing and Community Development Act of 1974, as amended (42 U.S.C. 5301 et seq.) and
program regulations are 24 CFR Part 1003.
ICDBG-IT grants must alleviate or remove imminent threats to public health or safety.
Imminent threats are issues that if unresolved or not addressed will have an immediate negative
impact on public health or safety. Imminent threats must be independently verified, must be of a
non-recurring nature, must represent a unique and unusual circumstance, and must impact an
entire service area. See 24 CFR §1003.400.
Eligible applicants are Tribes and Tribal organizations as described in the ICDBG regulations at
24 CFR §1003.5.
ICDBG-IT grants are provided on a first-come, first-served basis until all funds have been
awarded. The U.S. Department of Housing and Urban Development (HUD) reserves the right to
modify application requirements at any time. HUD reserves the right to adjust how funding is
awarded to ensure the needs of Tribes are met, including possibly setting aside a portion of
funding to assist Tribes with the greatest need.
HUD will use your application submissions as a baseline to measure the performance of your
grant, if you are ultimately awarded, in meeting the requirement to alleviate or remove imminent
threats to public health and safety. Reporting requirements are detailed in Section 9.2.
The Funding Assistance Number for this award is 14.862.
Contact your Area Office of Native American Programs or ONAP-ICDBG@hud.gov for
more information about this program.
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1.2 Key Dates.
Applications are accepted and reviewed on a rolling basis. HUD estimates it will take three
months to review your application and make an award determination.
1.3 Funding Details.
Pursuant to annual appropriations and program regulations at 24 CFR Part 1003, Subpart E,
HUD reserves a portion of ICDBG funds for ICDBG-IT grants. The amount available for award
under this Notice is subject to annual Appropriations. Five million dollars has been made
available for this program in previous years, which should fund approximately five awards if the
program continues to be funded at that level.
This Notice increases the grant ceilings based on feedback from Tribal consultations and to
adjust for inflation and the cost of construction. The updated ICDBG-IT grant ceilings are
$750,000 for disasters that are not Presidentially Declared Disasters (PDDs) and $1,500,000 for
PDDs. PDDs are referred to as Major Disaster Declarations by the Federal Emergency
Management Agency (FEMA).
2 Eligibility.
2.1 Eligible Activities.
Activities funded under this Notice must alleviate or remove imminent threats to health or
safety. Imminent threats are issues that if unresolved or not addressed will have an immediate
negative impact on public health or safety. Imminent threats must be independently verified,
must be of a non-recurring nature, must represent a unique and unusual circumstance, and must
impact an entire service area. See 24 CFR §1003.400.
ICDBG-IT grant funds may only be used for the eligible activities listed at 24 CFR §1003,
Subpart C. Activities that are ineligible for funding under a competitive Single Purpose ICDBG
grant are also ineligible for funding under ICDBG-IT (see 24 CFR §1003.207).
Waivers and flexibilities are available for certain activities in areas affected by a PDD (see
Section 4 of this Notice).
ICDBG-IT grants are not subject to the primary program objective to principally serve persons of
low- and moderate-income (see 24 CFR §1003.208 and 24 CFR §1003.200).
Some examples of eligible imminent threat activities are as follows.
Acquisition of real property:
Purchasing land or buildings if necessary to alleviate or remove an imminent threat to health or
safety, for example as part of an improvement (rehabilitation or construction) or clearance
(demolition) activity.
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Public facilities and improvements:
Construction or improvement of public facilities buildings or infrastructure. For example,
rehabilitation or replacement of public facilities or infrastructure that was damaged by a natural
disaster.
Clearance activities:
Demolition or removal of hazardous structures, debris, or materials that pose an immediate risk
to health and safety.
Public services:
Provision of public services (including labor, supplies, materials, and the purchase of personal
property and furnishings) directed toward improving the community's public services and
facilities to address the immediate needs of affected individuals or communities in response to an
imminent threat. Note that proposed public services need to be a new service or a quantifiable
increase in the level of an existing service. The amount of ICDBG funds used for public services
are limited to 15% of the grant.
Interim assistance:
To alleviate emergency conditions threatening public health and safety, ICDBG funds may be
used for repair of streets, sidewalks, publicly owned utilities, and public buildings; clearance of
streets, including snow removal and similar activities; and improvement of private properties.
Relocation assistance:
Providing financial assistance and services to individuals or businesses who must be permanently
or temporarily relocated as a result of an imminent threat.
Housing services:
Providing housing counseling, energy auditing, preparation of work specifications, loan
processing, inspections, tenant selection, management of tenant-based rental assistance and other
services in connection with addressing an imminent threat.
Privately owned utilities:
Funds may be used to acquire, construct, reconstruct, rehabilitate, or install the distribution lines
and facilities of privately owned utilities in connection with an imminent threat.
Homeownership assistance:
Providing financing, downpayment assistance, or closing costs to homeowners who need
assistance as a result of an imminent threat.
Housing rehabilitation:
Repairing housing that has been damaged or is at risk due to an imminent threat. This includes
privately or publicly owned residential buildings and manufactured housing.
New housing construction:
New housing construction to address an imminent threat is eligible. New housing construction
can only be undertaken by a Community-Based Development Organization (CBDO), as
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described in 24 CFR §1003.204, unless an applicable waiver has been granted. Section 122 of
the Housing and Community Development Act of 1974 authorizes HUD to suspend certain
statutory requirements to assist grantees in addressing damage in Presidentially Declared
Disaster areas. See Section 4.
2.2 Eligible Applicants.
Eligible applicants are Tribes and Tribal organizations as described in the ICDBG regulations at
24 CFR §1003.5. Tribal organizations must submit a copy of their eligibility determination with
the application unless they have already submitted such documentation to HUD previously.
There is no limit on the number of applications an eligible applicant can make under this
announcement.
2.3 Cost Sharing.
Cost sharing or matching is not required.
3 Program Costs.
3.1 Allowable Costs.
Costs must fund eligible activities as described in the ICDBG regulations to be allowable costs.
3.2 Indirect Costs.
Note that indirect costs count towards the administration and planning cap. If your application
includes funds for indirect costs, you must include the following documentation, in accordance
with 2 CFR 200 Subpart E:
1. If you are using a federally negotiated indirect cost rate (IDC), then your application
must clearly state the approved rate and distribution base in the Budget Detail and
amount budgeted in the Cost Summary. You must also include a letter stating the
approved IDC rate and distribution base or other documentation from the cognizant
agency showing the approved rate; or
2. If you do not have a negotiated IDC but intend to use an IDC rate at or lower than
the de minimis 15 percent of Modified Total Direct Costs (MTDC) in accordance
with 2 CFR 200.414(f), you must clearly identify this rate in your budget, budget
detail, and cost summary; or
3. If you are awaiting approval of the rate and base by the cognizant agency, then you
must clearly state that a rate and base by the cognizant agency is requested and that
no indirect costs will be charged to the grant unless and until the rate and base is
approved and a letter provided to HUD from the cognizant agency showing approval.
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3.3 Unallowable Costs.
Costs for ineligible activities as described above and in 24 CFR Part 1003 are unallowable costs.
4 Waivers and Flexibilities Available to ICDBG Grantees Affected by PDDs.
Waivers and flexibilities are available to provide relief and emergency assistance for Tribal
communities covered by PDDs. For calendar years 2024 and 2025, see Notice FR-6431-N-01.
For calendar years 2022 and 2023, see Notice FR-6301-N-02. For other calendar years, check
with your Area Office of Native American Programs (ONAP).
Each Notice informs the public about waivers and flexibilities for HUD’s Indian Housing Block
Grant (IHBG), ICDBG, and Native Hawaiian Housing Block Grant programs in areas affected
by PDDs. These flexibilities help grantees overcome challenges in disaster response and
recovery. These provisions do not apply to COVID-relief programs, which have separate
guidelines.
For ICDBG programs, the available waivers and flexibilities include:
Purchasing Equipment: HUD waived 24 CFR 1003.207(b)(1)(i), authorizing the
use of ICDBG grant funds for the purchase of equipment necessary to carry out
ICDBG-eligible activities that assist with clearance, rehabilitation, construction,
and other uses related to housing, public facilities, improvements, and works, and
other disaster recovery related purposes.
Emergency Payments for Up to Six Months: HUD waived 24 CFR 1003.207(b)(4) to
allow ICDBG grant funds to be used to provide emergency payments for low- and
moderate-income individuals or families impacted by a PDD for up to six months, instead
of three months.
For ICDBG-IT, your inclusion of waived items in the application constitutes your notification to
HUD.
A grantee located in an area affected by a PDD may request a waiver or flexibility of a HUD
requirement not listed in the above Notices and receive an expedited review of the request if the
grantee demonstrates that the waiver or flexibility is needed. Upon determination of good cause,
HUD may waive program regulations that are not required by statute. HUD cannot approve your
waiver request if the requirement is statutory. Waiver requests should be submitted via email to
your Area ONAP.
5 Letter to Proceed.
If the threat requires immediate action and you plan to use ICDBG-IT grant funds for related
expenses, you may request a “Letter to Proceed” from HUD, which allows you to incur certain
pre-award costs (see 24 CFR §1003.401(a)). However, issuing a Letter to Proceed does not
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obligate HUD to reimburse any pre-award costs. Reimbursement will only be provided if HUD
approves the application. Pre-award costs are eligible for reimbursement only if the activities do
not alter environmental conditions and are for temporary or permanent improvements limited to
protection, repair, or restoration actions necessary only to control or arrest the effects of
imminent threats or physical deterioration. The costs must meet the ICDBG-IT program criteria
and be within the cost principles of 2 CFR 200 Subpart E. Letter to Proceed requests should be
submitted via email to your Area ONAP.
6 Imminent Threat Application Contents and Submission.
Submit the ICDBG-IT application to ONAP-ICDBG@hud.gov with a copy to your Area ONAP.
Note that ICDBG-IT grant applications cannot be submitted through grants.gov.
Your ICDBG-IT application submission must include the following items listed below. The
forms can be found on the ICDBG page on Codetalk or on HUDCLIPS.
1. Standard Form-424 (Application for Federal Assistance).
2. Tribal Organizations only: A copy of your eligibility determination, unless it is already
on file with HUD.
3. HUD-2880 (Application/Disclosure/Update Report).
4. Detailed budget information. Include a breakdown of costs by line item for the proposed
project. Costs must be eligible, allowable, allocable, reasonable and necessary to
implement the project.
5. HUD-4123 (Cost Summary).
6. HUD-4125 (Implementation Schedule).
7. HUD-424B (Assurances and Certifications).
8. Project Description Summary must include the following:
a. A written description of the proposed eligible project or activity (see Section 2.1,
above).
b. A written statement describing the roles/responsibilities (including partnerships)
and the knowledge/experience of the primary individuals and organizations
involved in the implementation of the project.
c. A written statement describing how your proposed project will be completed
within the timeframe you propose. Note that ICDBG-IT grant funds can be used
for near-term, medium-term, and long-term recovery from imminent threats.
d. A written statement that describes how your proposed project will help alleviate
the imminent threat conditions.
e. A written description of any available waivers and flexibilities you intend to use.
See Section 4, above.
9. Evidence demonstrating that the threat is not recurring in nature. Please note that issues
caused by a lack of maintenance are considered recurring and will not be eligible for
ICDBG-IT grant funding.
10. Evidence that the imminent threat has an impact on an entire service area. Specify the
number of homes/families affected and/or impacted.
11. Letter or other document from a qualified party, not affiliated with the applicant’s
organization, verifying that the threat is urgent, currently exists or will soon arise, and
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requires immediate action to protect lives and reduce health and safety risks. Such parties
could be HUD, the Indian Health Service, Bureau of Indian Affairs, FEMA, State,
county, local officials, or privately employed engineers. Alternatively, HUD may
independently verify the urgency and immediacy of the threat itself by relying on
testimonials, statements, news reports, information shared by other Federal, State, or
local agencies, news reports, and more. In such cases, the applicant should provide HUD
with documentation that can help HUD verify the urgency and immediacy of the threat.
12. You must demonstrate to HUD’s satisfaction that funds to address the threat cannot be
made available from other Tribal or Federal sources including IHBG and program
income. For example, your application can include a written statement that the applicant,
Federal, or Tribal agencies have no funds available or that current funds have been
obligated or otherwise committed for other purposes. Please note that you may not forgo
the use of insurance proceeds in favor of using ICDBG-IT funds. You can, however, use
ICDBG-IT funding toward deductibles or other costs that your insurance company
declines to cover.
You must be registered in the System for Award Management (SAM.gov) and you must
continue to maintain an active registration in SAM.gov with current information at all times
during which you have an active Federal award or an application or plan under consideration by
a Federal agency.
To register, go to SAM.gov Entity Registration and click Get Started. From the same page, you
can also click on the Entity Registration Checklist for the information you will need to register. It
can take several weeks to register in SAM.gov. SAM.gov also provides each organization with a
unique entity identifier (UEI). You must have a valid UEI to apply for funding.
7 Application Review Information.
7.1 Application Review Process.
HUD will review ICDBG-IT grant applications in the order they are received (by date and time).
If your application is missing any required items listed in Section 6: Imminent Threat
Application Contents and Submission, or if any of the submitted materials are incomplete, your
application will be considered incomplete and lose its position relative to other applications. If
your application is incomplete, HUD will notify you promptly and provide guidance on how to
address the deficiencies. Once the deficiencies are corrected, you may resubmit your application
to ONAP-ICDBG@hud.gov, with a copy to your Area ONAP Office, where it will be considered
submitted based on the new date and time of submission.
Once your complete application is submitted, HUD will review the application and contact you
to discuss the application and address any outstanding pre-award conditions. HUD’s merit
review of your application will consist of an evaluation of your submissions. All the
requirements of this Notice must be met to HUD’s satisfaction prior to award. You must resolve
pre-award deficiencies within the timeframe that HUD identifies in the pre-award notice. If you
do not respond within that timeframe, your application will not be funded and will lose its
position with respect to other submitted applications.
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If your application is submitted or reviewed after the current fiscal year funds have been
exhausted, it will retain its position in the queue until funds become available in the next fiscal
year. When additional funds become available, HUD will contact you to confirm that you still
require the funds and that the project is necessary to address the threat. You must respond within
the timeframe specified by HUD. If you fail to respond within that period, your application will
not be funded and will lose its position in relation to other submitted applications.
HUD may provide less funding than the full amount requested in your application. HUD may
also choose to fund only certain activities, projects, or programs proposed in your application.
7.2 Risk Review.
In evaluating risks posed by applicants, HUD may use a risk-based approach in accordance with
2 CFR §200.206, including:
1. Financial stability;
2. Quality of management systems and ability to meet the management standards prescribed
in 2 CFR Part 200;
3. History of performance with managing previous and current Federal awards, including
compliance with reporting requirements and conformance to the terms and conditions of
Federal awards;
4. Reports and findings from audits performed under Subpart F—Audit Requirements of 2
CFR part 200 or the reports and findings of any other available audits;
5. Ability to effectively implement statutory, regulatory, or other requirements imposed on
recipients of Federal awards.
HUD will also review your records in OMB-designated repositories of government-wide data as
noted in 2 CFR 200.206(a).
8 Award Notices.
After HUD reviews your application package, you will receive a funding decision via email. If
funded, HUD will issue a grant agreement to the person designated in item 8f of form SF-424,
with a copy to the person listed as the authorized representative in item 21 of form SF-424, to be
signed. The grant agreement is the official document that obligates funds. HUD will disburse
funds through the HUD electronic Line of Credit Control System (eLOCCS) once your signed
grant agreement is returned.
Any pre-award costs incurred, with or without a Letter to Proceed, are at the applicant’s own risk.
9 Post-Award Requirements and Administration.
9.1 Regulatory and Administrative Requirements.
ICDBG-IT grant recipients must comply with the applicable regulatory requirements of the
ICDBG program at 24 CFR Part 1003.
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Note that the General Administrative, National, and Departmental Policy Requirements and
Terms for HUD’s Financial Assistance Programs and the General Statutory and Regulatory
Requirements Affecting Eligibility for HUD’s Financial Assistance Programs for fiscal year
2025 are posted on the HUD Policies and Regulations website. To receive an award, you must
adhere to the applicable requirements at the time of application. You must also adhere to the
applicable requirements for the life of any award to remain eligible for the award.
Applicants should ensure that no choice limiting actions will occur prior to completion of the
environmental review process, and approval of the Request for Release of Funds where
applicable. A choice limiting action may include but is not limited to real property acquisition,
demolition, disposition, rehabilitation, repair, new construction, site preparation or clearance,
ground disturbance, and leasing. Please refer to the environmental review requirements at 24
CFR Part 58.
9.2 Reporting.
You will be required to report progress on an Annual Status and Evaluation Report (ASER) and
report spending on an SF-425, the Federal Financial Report. Annual reporting is submitted
electronically to HUD in accordance with instructions from your Area ONAP. Note that HUD
may consider your progress on completion of ICDBG-IT project(s) when rating future
competitive proposals (e.g., ICDBG Single Purpose Grants).
You must comply with these reporting requirements to remain eligible for HUD funding. See
Section 9.3.
HUD is implementing new grants management and reporting tools, which will be rolled out for
your use in the near term. As a grantee, you will be required to report on grant performance and
financial activities (including vendor and cash disbursement supporting details for yourself and
your sub-recipients) using these new tools when they are released. HUD will work with you to
support your transition to this new reporting environment. Once implemented, timely reporting
in this new environment will be mandatory. HUD reserves the right to exercise all available
rights and remedies for any noncompliance with these grants management and financial
reporting requirements, to include requiring 100% review or stopping future disbursements
altogether if reporting is not timely submitted.
9.3 Remedies for Noncompliance.
HUD may terminate all or a part of your award as described under 2 CFR 200.340 through
200.343, including to the extent authorized by law, if an award no longer effectuates the program
goals or agency priorities. HUD may also impose specific conditions on your award or take other
remedies as described by 2 CFR 200.339 through 200.343, if you do not comply with your award
terms and conditions.
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10 Amending Single Purpose ICDBG Grants to Fund ICDBG-IT Purposes.
With HUD approval, you may amend an existing Single Purpose ICDBG award to fund
imminent threats towards health and safety (see 24 CFR §1003.305(d)). If you are interested in
amending your current Single Purpose ICDBG awards to include ICDBG-IT activities, contact
your Area ONAP. The process for submitting an amendment to a current ICDBG is explained in
24 CFR §1003.305.
11 Paperwork Reduction Act
The information collection requirements contained in this Notice is approved by the Office of
Management and Budget (OMB) under the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C.
3501 et seq.). In accordance with the PRA, HUD may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless the collection displays a currently valid
OMB control number. The active information collections contained in this Notice are approved
under the PRA OMB Control Numbers 2501-0044 and 2577-0191.
12 Contact Information.
Contact your Area ONAP or email ONAP-ICDBG@hud.gov if you have any questions about the
ICDBG-IT grant application process.
Benjamin Hobbs
Principal Deputy Assistant Secretary
Public and Indian Housing
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HUD_DisclosureUpdateReport_4_0-V4.0 (mandatory).pdf

Applicant/Recipient U.S. Department of Housing OMB Number: 2501-0044
Disclosure/Update Report and Urban Development Expiration Date: 02/28/2027
Applicant/Recipient Information UEI Number: Report Type: INITIAL
1.Applicant/Recipient Name, Address, and Phone (include area code):
*Applicant Name:
*Street1:
Street2:
*City:
County:
*State:
*Zip Code:
*Country:
*Phone:
2.Employer ID Number (do not include individual social security numbers):
*3. HUD Program Name:
*4. Amount of HUD Assistance Requested/Received: $
5.State the name and location (street address, City and State) of the project or activity:
*Project Name:
*Street1:
Street2:
*City:
County:
*State:
*Zip Code:
*Country: USA: UNITED STATES
Part I Threshold Determinations
1. Are you applying for assistance for a specific project or activity? These 2. Have you received or do you expect to receive assistance within
terms do not include formula grants, such as public housing operating the jurisdiction of the Department (HUD), involving the project or
subsidy or CDBG block grants. For further information see 24 CFR activity in this application, in excess of $200,000 during this fiscal
Sec. 4.3. year (Oct. 1-Sep. 30)? For further information, see 24 CFR 4.9.
Yes No Yes No
If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form. However, you must sign the
certification at the end of the report.
Form HUD-2880 (02/23)

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Part II Other Government Assistance Provided or Requested / Expected Sources and Use of Funds.
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit.
Department/State/Local Agency Name:
*Government Agency Name:
Government Agency Address:
*Street1:
Street2:
*City:
County:
*State:
*Zip Code:
*Country:
Type of Assistance: Amount Requested/Provided: $
*Expected Uses of the Funds:
Department/State/Local Agency Name:
*Government Agency Name:
Government Agency Address:
*Street1:
Street2:
*City:
County:
*State:
*Zip Code:
*Country:
Type of Assistance: Amount Requested/Provided: $
*Expected Uses of the Funds:
Note: Use additional pages if necessary. Add Attachment Delete Attachment View Attachment
Form HUD-2880 (02/23)

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Part III Interested Parties. You must disclose:
1.All developers, contractors, or consultants involved in the application for assistance or in the planning, development, or implementation of the
project or activity.
*Alphabetical list of all persons with a
reportable financial interest in the project or Unique Entity ID Type of Participation in *Financial Interest in
activity (for individuals, give the last name first) Project/Activity Project/Activity ($ and %)
$ %
$ %
$ %
$ %
$ %
2.Any other person who has a financial interest in the project or activity for which the assistance is sought that exceeds $50,000 or 10 percent of the
assistance (whichever is lower).
*Alphabetical list of all persons with a
reportable financial interest in the project or City of Residence Type of Participation in Financial Interest in
activity (For individuals, give the last name first) Project/Activity Project/Activity ($ and %)
$ %
$ %
$ %
$ %
$ %
Note: Use additional pages if necessary. Add Attachment Delete Attachment View Attachment
Certification:
I/We, the undersigned, certify under penalty of perjury that the information provided above is true, accurate, and correct. WARNING: Anyone who
knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines,
and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802; 24 CFR §28.10(b)(1)(iii)).
Signature: Date: (mm/dd/yyyy)
Completed Upon Submission to Grants.gov Completed Upon Submission
to Grants.gov
Form HUD-2880 (02/23)

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Instructions Both applicant and recipient disclosures must include all other
government assistance involved with the HUD assistance, as well as
Overview. any other government assistance that was made available before the
A.Coverage. You must complete this report if: request, but that has continuing vitality at the time of the request.
Examples of this latter category include tax credits that provide for a
(1)You are applying for assistance from HUD for a specific project number of years of tax benefits, and grant assistance that continues to
or activity and you have received, or expect to receive, assistance benefit the project at the time of the assistance request.
from HUD in excess of $200,000 during the fiscal year;
The following information must be provided:
(2)You are updating a prior report as discussed below; or
1.Enter the name and address, city, State, and zip code of the
(3)You are submitting an application for assistance to an entity
government agency making the assistance available.
other than HUD, a State or local government if the application is
2.State the type of other government assistance (e.g., loan, grant,
required by statute or regulation to be submitted to HUD for
loan insurance).
approval or for any other purpose.
3.Enter the dollar amount of the other government assistance that is,
B.Update reports (filed by "Recipients" of HUD Assistance): or is expected to be, made available with respect to the project or
General. All recipients of covered assistance must submit update activities for which the HUD assistance is sought (applicants) or has
reports to the Department to reflect substantial changes to the initial been provided (recipients).
applicant disclosure reports. 4.Uses of funds. Each reportable use of funds must clearly identify the
purpose to which they are to be put. Reasonable aggregations may be
Line-by-Line Instructions.
used, such as "total structure" to include a number of structural costs,
Applicant/Recipient Information. such as roof, elevators, exterior masonry, etc.
All applicants for HUD competitive assistance, must complete the
B.Non-Government Assistance. Note that the applicant and recipient
information required in blocks 1-5 of form HUD-2880:
disclosure report must specify all expected sources and uses of funds -
1.Enter the full name, address, city, State, zip code, and telephone
both from HUD and any other source - that have been or are to be,
number (including area code) of the applicant/recipient. Where the
made available for the project or activity. Non-government sources of
applicant/recipient is an individual, the last name, first name, and
Form HUD-2880 funds typically include (but are not limited to)
middle initial must be entered.
foundations and private contributors.
2.Entry of the applicant/recipient's EIN, as appropriate, is optional.
Individuals must not include social security numbers on this form. Part III. Interested Parties.
3.Applicants enter the HUD program name under which the assistance This Part is to be completed by both applicants and recipients filing
is being requested. update reports. Applicants must provide information on:
4.Applicants enter the amount of HUD assistance that is being 1.All developers, contractors, or consultants involved in the application
requested. Recipients enter the amount of HUD assistance that has for the assistance or in the planning, development, or implementation
been provided and to which the update report relates. The amounts are of the project or activity and
those stated in the application or award documentation. NOTE: In the 2.Any other person who has a financial interest in the project or
case of assistance that is provided pursuant to contract over a period activity for which the assistance is sought that exceeds $50,000 or 10
of time (such as project-based assistance under section 8 of the United percent of the assistance (whichever is lower). Note: A financial
States Housing Act of 1937), the amount of assistance to be reported interest means any financial involvement in the project or activity,
includes all amounts that are to be provided over the term of the including (but not limited to) situations in which an individual or entity
contract, irrespective of when they are to be received. has an equity interest in the project or activity, shares in any profit on
5.Applicants enter the name and full address of the project or activity resale or any distribution of surplus cash or other assets of the project
for which the HUD assistance is sought. Recipients enter the name or activity, or receives compensation for any goods or services
and full address of the HUD-assisted project or activity to which the provided in connection with the project or activity. Residency of an
update report relates. The most appropriate government identifying individual in housing for which assistance is being sought is not, by
number must be used (e.g., RFP No.; IFB No.; grant announcement itself, considered a covered financial interest.
No.; or contract, grant, or loan No.) Include prefixes. The information required below must be provided.
1.Enter the full names and addresses. If the person is an entity, the
Part I. Threshold Determinations - Applicants Only
listing must include the full name and address of the entity as well as
Part I contains information to help the applicant determine whether the
the CEO. Please list all names alphabetically.
remainder of the form must be completed. Recipients filing Update
2.Entry of the Unique Entity Identifier (UEI), for non-individuals, or city
Reports should not complete this Part.
of residence, for individuals, for each organization and person listed is
If the answer to either questions 1 or 2 is No, the applicant need not optional.
complete Parts II and III of the report but must sign the certification at 3.Enter the type of participation in the project or activity for each
the end of the form. person listed: i.e., the person's specific role in the project (e.g.,
contractor, consultant, planner, investor).
Part II. Other Government Assistance and Expected Sources and
4.Enter the financial interest in the project or activity for each person
Uses of Funds.
listed. The interest must be expressed both as a dollar amount and as
A.Other Government Assistance. This Part is to be completed by
a percentage of the amount of the HUD assistance involved.
both applicants and recipients for assistance and recipients filing
Note that if any of the source/use information required by this report
update reports. Applicants and recipients must report any other
has been provided elsewhere in this application package, the applicant
government assistance involved in the project or activity for which
need not repeat the information, but need only refer to the form and
assistance is sought. Applicants and recipients must report any other
location to incorporate it into this report. (It is likely that some of the
government assistance involved in the project or activity. Other
information required by this report has been provided on SF 424A, or
government assistance is defined in note 4 on the last page. For
on various budget forms accompanying the application.) If this report
purposes of this definition, other government assistance is expected to
requires information beyond that provided elsewhere in the application
be made available if, based on an assessment of all the circumstances
package, the applicant must include in this report all the additional
involved, there are reasonable grounds to anticipate that the
assistance will be forthcoming.
Form HUD-2880 (02/23)

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information required. Recipients must submit an update report for any 4. "Other government assistance" is defined to include any loan, grant,
change in previously disclosed sources and uses of funds as provided guarantee, insurance, payment, rebate, subsidy, credit, tax benefit, or
in Section I.D.5., above. any other form of direct or indirect assistance from the Federal
government (other than that requested from HUD in the application), a
Notes: State, or a unit of general local government, or any agency or
1. All citations are to 24 CFR Part 4, which was published in the instrumentality thereof, that is, or is expected to be made, available
Federal Register. [April 1, 1996, at 63 Fed. Reg. 14448.] with respect to the project or activities for which the assistance is
2. Assistance means any contract, grant, loan, cooperative agreement, sought.
or other form of assistance, including the insurance or guarantee of a 5. For the purpose of this form and 24 CFR Part 4, "person" means an
loan or mortgage, that is provided with respect to a specific project or individual (including a consultant, lobbyist, or lawyer); corporation;
activity under a program administered by the Department. The term company; association; authority; firm; partnership; society; State, unit
does not include contracts, such as procurements contracts, that are of general local government, or other government entity, or agency
subject to the Fed. Acquisition Regulation (FAR) (48 CFR Chapter 1). thereof (including a public housing agency); Indian tribe; and any other
3. See 24 CFR §4.9 for detailed guidance on how the threshold is organization or group of people.
calculated.
Form HUD-2880 (02/23)

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PerformanceSite_4_0-V4.0 (optional).pdf

OMB Number: 4040-0010
Expiration Date: 12/31/2026
Project/Performance Site Location(s)
I am submitting an application as an individual, and not on behalf of a company, state,
Project/Performance Site Primary Location local or tribal government, academia, or other type of organization.
Organization Name:
UEI:
*Street1:
Street2:
*City: County:
*State:
Province:
*Country: USA: UNITED STATES
ZIP / Postal Code: Project/ Performance Site Congressional District:
I am submitting an application as an individual, and not on behalf of a company, state,
Project/Performance Site Location 1
local or tribal government, academia, or other type of organization.
Organization Name:
UEI:
*Street1:
Street2:
*City: County:
*State:
Province:
*Country: USA: UNITED STATES
ZIP / Postal Code: Project/ Performance Site Congressional District:
Additional Location(s) Add Attachment Delete Attachment View Attachment

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SF424B-V1.1 (optional).pdf

OMB Number: 4040-0007
Expiration Date: 07/31/2028
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 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 (0348-0040), 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.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance Act of 1973, as amended (29 U.S.C. §794), which
and the institutional, managerial and financial capability prohibits discrimination on the basis of handicaps; (d)
(including funds sufficient to pay the non-Federal share the Age Discrimination Act of 1975, as amended (42 U.
of project cost) to ensure proper planning, management S.C. §§6101-6107), which prohibits discrimination on
and completion of the project described in this the basis of age; (e) the Drug Abuse Office and
application. Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
2. Will give the awarding agency, the Comptroller General abuse; (f) the Comprehensive Alcohol Abuse and
of the United States and, if appropriate, the State, Alcoholism Prevention, Treatment and Rehabilitation
through any authorized representative, access to and Act of 1970 (P.L. 91-616), as amended, relating to
the right to examine all records, books, papers, or nondiscrimination on the basis of alcohol abuse or
documents related to the award; and will establish a alcoholism; (g) §§523 and 527 of the Public Health
proper accounting system in accordance with generally Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
accepted accounting standards or agency directives. ee- 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
3. Will establish safeguards to prohibit employees from Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
using their positions for a purpose that constitutes or amended, relating to nondiscrimination in the sale,
presents the appearance of personal or organizational rental or financing of housing; (i) any other
conflict of interest, or personal gain. nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
4. Will initiate and complete the work within the applicable
nondiscrimination statute(s) which may apply to the
time frame after receipt of approval of the awarding
application.
agency.
7. Will comply, or has already complied, with the
5. Will comply with the Intergovernmental Personnel Act of
requirements of Titles II and III of the Uniform
1970 (42 U.S.C. §§4728-4763) relating to prescribed
Relocation Assistance and Real Property Acquisition
standards for merit systems for programs funded under
Policies Act of 1970 (P.L. 91-646) which provide for
one of the 19 statutes or regulations specified in
fair and equitable treatment of persons displaced or
Appendix A of OPM's Standards for a Merit System of
whose property is acquired as a result of Federal or
Personnel Administration (5 C.F.R. 900, Subpart F).
federally-assisted programs. These requirements
apply to all interests in real property acquired for
6. Will comply with all Federal statutes relating to project purposes regardless of Federal participation in
nondiscrimination. These include but are not limited to:
purchases.
(a)Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color 8. Will comply, as applicable, with provisions of the
or national origin; (b) Title IX of the Education Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
Amendments of 1972, as amended (20 U.S.C.§§1681- which limit the political activities of employees whose
1683, and 1685-1686), which prohibits discrimination on principal employment activities are funded in whole
the basis of sex; (c) Section 504 of the Rehabilitation or in part with Federal funds.
Previous Edition Usable Standard Form 424B (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102

---

9. Will comply, as applicable, with the provisions of the Davis- 13. Will assist the awarding agency in assuring compliance
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act with Section 106 of the National Historic Preservation
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Act of 1966, as amended (16 U.S.C. §470), EO 11593
Work Hours and Safety Standards Act (40 U.S.C. §§327- (identification and protection of historic properties), and
333), regarding labor standards for federally-assisted the Archaeological and Historic Preservation Act of
construction subagreements. 1974 (16 U.S.C. §§469a-1 et seq.).
10. Will comply, if applicable, with flood insurance purchase 14. Will comply with P.L. 93-348 regarding the protection of
requirements of Section 102(a) of the Flood Disaster human subjects involved in research, development, and
Protection Act of 1973 (P.L. 93-234) which requires related activities supported by this award of assistance.
recipients in a special flood hazard area to participate in the
15. Will comply with the Laboratory Animal Welfare Act of
program and to purchase flood insurance if the total cost of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
insurable construction and acquisition is $10,000 or more.
seq.) pertaining to the care, handling, and treatment of
11. Will comply with environmental standards which may be warm blooded animals held for research, teaching, or
prescribed pursuant to the following: (a) institution of other activities supported by this award of assistance.
environmental quality control measures under the National
16. Will comply with the Lead-Based Paint Poisoning
Environmental Policy Act of 1969 (P.L. 91-190) and
Prevention Act (42 U.S.C. §§4801 et seq.) which
Executive Order (EO) 11514; (b) notification of violating
prohibits the use of lead-based paint in construction or
facilities pursuant to EO 11738; (c) protection of wetlands
rehabilitation of residence structures.
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
17. Will cause to be performed the required financial and
project consistency with the approved State management
compliance audits in accordance with the Single Audit
program developed under the Coastal Zone Management
Act Amendments of 1996 and OMB Circular No. A-133,
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
"Audits of States, Local Governments, and Non-Profit
Federal actions to State (Clean Air) Implementation Plans
Organizations."
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of 18. Will comply with all applicable requirements of all other
underground sources of drinking water under the Safe Federal laws, executive orders, regulations, and policies
Drinking Water Act of 1974, as amended (P.L. 93-523); governing this program.
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93- 19. Will comply with the requirements of Section 106(g) of
205). the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
12. Will comply with the Wild and Scenic Rivers Act of recipients or a sub-recipient from (1) Engaging in severe
1968 (16 U.S.C. §§1271 et seq.) related to protecting forms of trafficking in persons during the period of time
components or potential components of the national that the award is in effect (2) Procuring a commercial
wild and scenic rivers system. sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
Completed on submission to Grants.gov
APPLICANT ORGANIZATION DATE SUBMITTED
Completed on submission to Grants.gov
Standard Form 424B (Rev. 7-97) Back

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SF424D-V1.1 (optional).pdf

ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009
Expiration Date: 06/30/2028
Public reporting burden for this collection of information is estimated to average 15 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 (0348-0042), 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.
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
NOTE:
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant:, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, 8. Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards of merit systems for programs funded
of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F.R. 900, Subpart F).
2. Will give the awarding agency, the Comptroller General 9. Will comply with the Lead-Based Paint Poisoning
of the United States and, if appropriate, the State, Prevention Act (42 U.S.C. §§4801 et seq.) which
the right to examine all records, books, papers, or prohibits the use of lead-based paint in construction or
documents related to the assistance; and will establish rehabilitation of residence structures.
a proper accounting system in accordance with
10. Will comply with all Federal statutes relating to non-
generally accepted accounting standards or agency
discrimination. These include but are not limited to: (a)
directives.
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
3. Will not dispose of, modify the use of, or change the which prohibits discrimination on the basis of race,
terms of the real property title or other interest in the color or national origin; (b) Title IX of the Education
site and facilities without permission and instructions Amendments of 1972, as amended (20 U.S.C. §§1681
from the awarding agency. Will record the Federal 1683, and 1685-1686), which prohibits discrimination
interest in the title of real property in accordance with on the basis of sex; (c) Section 504 of the
awarding agency directives and will include a covenant Rehabilitation Act of 1973, as amended (29) U.S.C.
in the title of real property acquired in whole or in part §794), which prohibits discrimination on the basis of
with Federal assistance funds to assure handicaps; (d) the Age Discrimination Act of 1975, as
nondiscrimination during the useful life of the project. amended (42 U.S.C. §§6101-6107), which prohibits
4. Will comply with the requirements of the assistance discrimination on the basis of age; (e) the Drug Abuse
awarding agency with regard to the drafting, review and Office and Treatment Act of 1972 (P.L. 92-255), as
approval of construction plans and specifications. amended relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
5. Will provide and maintain competent and adequate Alcoholism Prevention, Treatment and Rehabilitation
engineering supervision at the construction site to Act of 1970 (P.L. 91-616), as amended, relating to
ensure that the complete work conforms with the nondiscrimination on the basis of alcohol abuse or
approved plans and specifications and will furnish alcoholism; (g) §§523 and 527 of the Public Health
progressive reports and such other information as may be Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
required by the assistance awarding agency or State. 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
6. Will initiate and complete the work within the applicable
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
time frame after receipt of approval of the awarding agency.
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
7. Will establish safeguards to prohibit employees from
nondiscrimination provisions in the specific statue(s)
using their positions for a purpose that constitutes or
under which application for Federal assistance is being
presents the appearance of personal or organizational
made; and (j) the requirements of any other
conflict of interest, or personal gain.
nondiscrimination statue(s) which may apply to the
application.
Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97)
Prescribed by OMB Circular A-102

---

11. Will comply, or has already complied, with the Federal actions to State (Clean Air) implementation
requirements of Titles II and III of the Uniform Relocation Plans under Section 176(c) of the Clean Air Act of
Assistance and Real Property Acquisition Policies Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g)
1970 (P.L. 91-646) which provide for fair and equitable protection of underground sources of drinking water
treatment of persons displaced or whose property is under the Safe Drinking Water Act of 1974, as
acquired as a result of Federal and federally-assisted amended (P.L. 93-523); and, (h) protection of
programs. These requirements apply to all interests in real endangered species under the Endangered Species
property acquired for project purposes regardless of Act of 1973, as amended (P.L. 93-205).
Federal participation in purchases.
16. Will comply with the Wild and Scenic Rivers Act of
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
1968 (16 U.S.C. §§1271 et seq.) related to protecting
§§1501-1508 and 7324-7328) which limit the political
components or potential components of the national
activities of employees whose principal employment
wild and scenic rivers system.
activities are funded in whole or in part with Federal funds.
17. Will assist the awarding agency in assuring compliance
13. Will comply, as applicable, with the provisions of the Davis-
with Section 106 of the National Historic Preservation
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
(identification and protection of historic properties), and
Work Hours and Safety Standards Act (40 U.S.C. §§327-
the Archaeological and Historic Preservation Act of
333) regarding labor standards for federally-assisted
1974 (16 U.S.C. §§469a-1 et seq).
construction subagreements.
18. Will cause to be performed the required financial and
14. Will comply with flood insurance purchase requirements of
compliance audits in accordance with the Single Audit
Section 102(a) of the Flood Disaster Protection Act of 1973
Act Amendments of 1996 and OMB Circular No. A-133,
(P.L. 93-234) which requires recipients in a special flood
"Audits of States, Local Governments, and Non-Profit
hazard area to participate in the program and to purchase
Organizations."
flood insurance if the total cost of insurable construction
and acquisition is $10,000 or more. 19. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
15. Will comply with environmental standards which may be
governing this program.
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National 20. Will comply with the requirements of Section 106(g) of
Environmental Policy Act of 1969 (P.L. 91- the Trafficking Victims Protection Act (TVPA) of 2000, as
190) and Executive Order (EO) 11514; (b) notification amended (22 U.S.C. 7104) which prohibits grant award
of violating facilities pursuant to EO 11738; (c) recipients or a sub-recipient from (1) Engaging in severe
protection of wetlands pursuant to EO 11990; (d) forms of trafficking in persons during the period of time
evaluation of flood hazards in floodplains in accordance that the award is in effect (2) Procuring a commercial
with EO 11988; (e) assurance of project consistency sex act during the period of time that the award is in
with the approved State management program effect or (3) Using forced labor in the performance of the
developed under the Coastal Zone Management Act of award or subawards under the award.
1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
Completed on submission to Grants.gov
APPLICANT ORGANIZATION DATE SUBMITTED
Completed on submission to Grants.gov
SF-424D (Rev. 7-97) Back

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SF424_4_0-V4.0 (mandatory).pdf

OMB Number: 4040-0004
Expiration Date: 11/30/2025
Application for Federal Assistance SF-424
1. Type of Submission: 2. Type of Application: * If Revision, select appropriate letter(s):
Preapplication New
Application Continuation * Other (Specify):
Changed/Corrected Application Revision
*3. Date Received: 4.Applicant Identifier:
Completed by Grants.gov upon submission.
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
State Use Only:
6.Date Received by State: 7.State Application Identifier:
8.APPLICANT INFORMATION:
*a. Legal Name:
b. Employer/Taxpayer Identification Number (EIN/TIN): c. UEI:
d.Address:
*Street1:
Street2:
*City:
County/Parish:
*State:
Province:
*Country: USA: UNITED STATES
*Zip / Postal Code:
e.Organizational Unit:
Department Name: Division Name:
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: *First Name:
Middle Name:
*Last Name:
Suffix:
Title:
Organizational Affiliation:
*Telephone Number: Fax Number:
*Email:

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Application for Federal Assistance SF-424
*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. Assistance Listing Number:
Assistance Listing Title:
*12. Funding Opportunity Number:
*Title:
13.Competition Identification Number:
Title:
14.Areas Affected by Project (Cities, Counties, States, etc.):
Add Attachment Delete Attachment View Attachment
*15. Descriptive Title of Applicant's Project:
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments View Attachments

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Application for Federal Assistance SF-424
16.Congressional Districts Of:
a. Applicant b. Program/Project
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment Delete Attachment View Attachment
17.Proposed Project:
a. Start Date: b. End Date:
18.Estimated Funding ($):
*a. Federal
*b. Applicant
*c. State
*d. Local
*e. Other
*f. Program Income
*g. TOTAL
*19. Is Application Subject to Review By State Under Executive Order 12372 Process?
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.
*20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)
Yes No
If "Yes", provide explanation and attach
Add Attachment Delete Attachment View Attachment
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 18, Section 1001)
** I AGREE
** 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:
Prefix: *First Name:
Middle Name:
*Last Name:
Suffix:
*Title:
*Telephone Number: Fax Number:
*Email:
Signature of Authorized Representative: Completed by Grants.gov upon submission. Date Signed: Completed by Grants.gov upon submission.

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SFLLL_2_0-V2.0 (mandatory).pdf

DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 OMB Number: 4040-0013
Expiration Date: 06/30/2028
1. Type of Federal Action: 2. Status of Federal Action: 3.* Report Type:
a. contract a. bid/offer/application a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan
e. loan guarantee
f. loan insurance
4. Name and Address of Reporting Entity:
Prime SubAwardee
* Name
* Street 1 Street 2
* City State Zip
Congressional District, if known:
5.If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
6. Federal Department/Agency: 7. Federal Program Name/Description:
Assistance Listing Number,
if applicable:
8.Federal Action Number, if known: 9.Award Amount, if known:
$
10.a. Name and Address of Lobbying Registrant:
Prefix * First Name Middle Name
* Last Name Suffix
* Street 1 Street 2
* City State Zip
b.Individual Performing Services (including address if different from No. 10a)
Prefix * First Name Middle Name
* Last Name Suffix
* Street 1 Street 2
* City State Zip
11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which
reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to
the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
* Signature:
Completed on submission to Grants.gov
Name: Prefix First Name Middle Name
* Last Name Suffix
Title: Telephone No.: Date: Completed on submission to Grants.gov
Federal Use Only: Authorized for Local Reproduction
Standard Form - LLL (Rev. 7-97)