HomeMy WebLinkAboutC12-156 Application for Carryover Unobligated Funds APPLICATION FOR Version 7/03
FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier
March 13, 2012
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 EII Non- Construction 08CH0149/08
5. APPLICANT INFORMATION
Legal Name: Organizational Unit:
Eagle County Health and Human Services HHS: Administration Deppartment:
9 y ii
Ea on for Children and Families
Organizational DUNS: Division:
084024447 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 Code Suffix:
CO 81631
Country: Email:
United States rosie.moreno @eaglecounty.us
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)
I ? New ;Li Continuation I Revision 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 Expansion funds hhs / ACF / OHS
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
9 3 – 6 0 p Carryover of unobligated expansion funds awarded to sustain
TITLE (Name of Program): — — — — — expansion funding from September 30, 2011 to September 29, 2012 per
Eagle County Early Childhood Services Amendment to FAA dated September 11, 2011. This grantees budget
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): period ended December 31, 2011, so is requesting ap for 1
carryover of these funds for the 2012 budget period.
Eagle County, Colorado
13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF:
Start Date: Ending Date: a. Applicant b. Project
1/1/2012 9/29/12 Third District Third District
15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. Federal $ 0° THIS PREAPPLICATION /APPLICATION WAS MADE
208,099 • a. Yes. � l AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
b. Applicant $ 0° PROCESS FOR REVIEW ON
52,025 .
c. State $ . °0 DATE:
d. Local $ 00
b. No i;j PROGRAM IS NOT COVERED BY E. O. 12372
e. Other $ .00 r OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
f. Program Income $ .°° 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g. TOTAL $ 260,124 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
Peter
Last Name Suffix
Runyon
b. Title c. Telephone Number
p (give area code)
Board of County Commissioners, Chairperson 970 - 328 -8625
d. Signature of Authorized Representative J , P ., e. Date Signed r; I , I ,
Previous Edition Usable "J l Standard Form 424 (Rev.9 -2003)
Authorized for Local Reproduction Prescribed by OMB Circular A -102
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