No preview available
HomeMy WebLinkAboutC12-109 Federal Assistance Carryover Application 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 Construction' Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier L Non- Construction L J Non - Construction 08CH0149/08 5. APPLICANT INFORMATION Legal Name: Organizational Unit: Eagle County Health and Human Services HHS: Administration 9 y ii Ea on for Children and Families Organizational DUNS: Division: 08402447 Office of Head Start Address: Name and telephone number of person to be contacted on matters Street: involving this application (give area code) 551 Broadway Prefix: First Name: P.O. Box 660 Rosie City: Middle Name Eagle County: Last Name Eagle Moreno State: Zip 6 31 d e Suffix: Country: Email: United States 6. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Number (give area code) Fax Number (give area code) 8 4— 6 0 0 0 7 6 2 970- 328 -2605 855- 848 -8826 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) r New in Continuation If E Revision b. County 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: Carryover of unobligated expansion funds HHS / ACF / OHS 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: 9 3 — 6 0 Carryover of unobligated expansion funds awarded to sustain — — TITLE (Name of Program): — expansion funding from September 30, 2011 to September 29, 2012. Eagle County Early Childhood Services This grantee's budget period ended December 31, 2011, so is 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): requesting approval of carryover of these funds for 2012. Eagle County, Colorado 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF: Start Date: Ending Date: a. Applicant b. Project 1/1/2012 9/30/2012 Third District Third District 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Federal $ °° a. Yes. THIS PREAPPLICATION /APPLICATION WAS MADE • 208,099 AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 b. Applicant $ 0° PROCESS FOR REVIEW ON c. State $ . °U DATE: d. Local $ ou b. No. 7 PROGRAM IS NOT COVERED BY E. O. 12372 e. Other $ .0° ni OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW f. Program Income $ . 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g. TOTAL $ 208,099 °° Yes If "Yes" attach an explanation. iil 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 Peter Last Name Suffix Runyon b. Title c. Telephone Number (give area code) Board of County Commisioners, Chairperson '? 970-328-8625 d. Signature of Authorized Representative _ ....00 „,- - e. Date Signed 1 J 1311z— Previous Edition Usable .�" St Form 424 (Rev.9 -2003) Authorized for Local Reproduction Prescribed by OMB Circular A -102 Gir2 -LO9