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Home My WebLink AboutC04-417 Colorado Department of Public Health and Environment – Early Head Start~~ APPLICATION FOR FEDERAL ASSISTANCE 2 E SUBMITTED: 12ro2r2ooa Applicant Idenff-- 08CH0149 1. TYPE OF SUBMISSION Application Preapplication 3. DATE RECEIVED BY STATE: State Application Identifier Construction Non-Construction ~ Construction ~ Non-Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier 5. APPLICANT INFORMATION Legal Name: HHS, Eagle County Early Head Start Organizational Unit: Department: Eagle County Health & Human Services Organizational DUNS: 084-024447 Division: Early Childhood Services Address: Name and telephone number of the person to be contacted on matters Street: PO Box 660 involving this application (give area code) 551 Broadway Prefix. Mrs. First Name. Kathleen City: Eagle Middle Name: County: Eagle Last Name: Formash State: CO Zip Code: 81631 Suffix• Country: USA Email kathleen.fonnash@eaglecounty.us 6. EMPLOYER IDENTIFICATION NUMBER (EIN) 8 4 . 6 0 0 0 7 6 2 Phone Number (give area code) 970-328-8858 Fax Number (groe area code) 970-328-8829 8. TYPE OF APPLICATION New ~ Continua^fion B Revision If Revision, enter appropriate letter(s) in box(es): 7. TYPE OF APPLICANT (enter appropriate letter in box) ~B Other (specify) Other (specify) Carry Over Funds 9. NAME OF FEDERAL AGENCY: HHS-ACF 10. CATALOG OF FEDERAL DOMESTIC y 3 6 0 0 ASSISTANCE NUMBER: ^ TITLE (Name of Program)• Early Head Start 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: Carry Over One Time Supplemental Funds for Program Governance 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States etc.): Eagie County, CO 13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF: Start Date: 8I01I2004 Ending Date 7/3112005 a. Applicant3rd District b. Project 3rd District 15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a Federal $ 4,000 00 a YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE b Applicant $ 1,000 .00 EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON c State $ .00 Date d Local $ .00 b. NO X^ PROGRAM IS NOT COVERED BYE 0. 12372 ^ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW e Other $ .00 f Program Income $ 00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g Total $ 5,000 .00 ~ Yes If "Yes," attach an explanation X^ No 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION 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 Chairman First Name Tom Middle Name C. Last Name Stone Suffix b. Title BoCC Chair c. Telephone number 970-328-8506 d Signature of Authonzetl Representative e Date Signed r / ,-ry~ a/ ~„/ V - 5tanaara rorm 4z4 t rcev a-zuusi rrescnoea oy umrs t,ircwar H- i u~ BUDGET INFORMATION -Non-Construction Programs Grant Program Function or Activity (a) 1. Program Operation 2. T&TA 3. 4. 5. Totals SECTION A- BUC?GET SUMMARY Catalog of Federal Estimated Unobligated Funds New or Revised Budget Domestic Assistance Number Federal Non-Federal Federal Non-Federal (b) 93.600 $1,000 93.600 $4,000 $4,000 ~ $1,000 SECTION B • BUDGET CATEGORIES OMB Approval No. 0348-0044 Total $1,000 $4,000 $5,000 GRANT PROGRAM, FUNCTION OR ACTIVITY Total 6.Object Class Categories (1) Program Operation (2) T&TA (3) (4) a. Personnel b. Fringe Benefits c. Travel d. Equipment e. Supplies f. Contractual g. Construction h. Other $4,000 $4,001 i Total Direct Charges (sum of 6a - 6h) $4,000 $4,000 j. Indirect Costs k. TOTALS (sum of 6a - 6j) $4,000 $4,000 7. Program Income 08CH0149 / 0 2004 HHS, Eagle County Early Head Start Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Prescribed by OMB Circular A-102 Supplemental EHS Grant Application Carry Over Funds SECT ION C -NON-FEDERAL RESOURCES (a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS 8. NFS $1,000 $1,000 9. 10. 11. 12. TOTAL (sum of lines 8-11) $1,000 $1,000 SECT ION D -FORECASTED CAS H NEEDS Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 13. Federal $4,000 $1,000 $1,000 $1,000 $1,000 14. Non-Federal $1,000 $250 $250 $250 $250 15. TOTAL (sum of lines 13 -14) $5,000 $1,250 $1,250 $1,250 $1,250 SECTION E -BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PE RIODS (Years) (a) Grant Program (b) First (c) Second (d) Third (e) Fourth 16. 17. 18. 19. 20. TOTAL (sum of lines 16-19) SECTION F -OTHER BUDGET INFORMATION 21. Direct Charges: 22. Indirect Charges: 23. Remarks: Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Paget 08CH0149 / 0 2004 HHS, Eagle County Early Head Start Supplemental EHS Grant Application Carry Over Funds Ea; ounty Early Head Start 2004 Carry Over Request of One-time T/TA funds Budget and Budget Justification: Item Federal Funds Non-Federal Funds Update Materials used for Annual Parent Orientation, Policy Council Retreat, BoCC ongoing training and 400 Staff training Total 400 Policy Council field trip to observe another program, includes travel, room and meals for 3 members 600 Powerpoint presentation Video production costs of at (40hrs (consultant) x $25 = $1000) 1000 least $1,000 Video production 2,000 Total 3,000 TOTAL One-time T/TA funding 4,000 $1,000 Budget Narrative Program year funding has changed. Current program year is five months (August 1, 2004 to December 31, 2004). New funding cycle will be January through December. Due to the short program year, the program was unable to efficiently expend the one time supplemental funds for program governance improvement. The program requests these funds be carried into the year 2005.