Revised 6/02/09
United States Environmental Protection Agency
Region 9
Application Kit
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Revised 6/02/09
Application Checklist for Awards
Include the original and one copy of the following items in your Application Package. on
to
Application for Federal Assistance (Form SF 424)
ซ http;//www.epa.gov/ogd/AppKit/form/SF424.pdf - (fill &
NOTE: you can also apply by using: http://www.grants.gov/
Budget Information (Form SF 424A) Section A through F
http://www.google.com/search?hl=en&q=http%3A%2F%2Fwww.acf.hhs.gov%2F
programs%2Fofs%2Fgrants%2Fsf424a.pdf&btnG=Google+Search&aq=f&oq=
Budget Detail - Breakdown by Object Class Categories
(LINK TO SAMPLE PAGES 12-14 IN THIS DOC BELOW)
http://www.epa.gov/ogd/forms/adobe/SF424A 1 sec.pdf - (fill &
http://www.epa.gov/ogd/forms/adobe/SF424A%20 2 sec.pdf - (fill &
http://www.epa.gov/ogd/forms/adobe/SF424A Instructions.pdf
http://www.epa.qov/reqion09/fundinq/pdfs/detailed-budqet-609.pdf
Key People List
Complete the enclosed "Key People List" and return it with your application.
http://www.epa.gov/ogd/forms/adobe/5700-54 sec.pdf - (fill &
Work plan
This is an outline of required workplan elements as determined by Region 9.
F-P.A. for
Current Indirect Cost Rate Negotiation Agreement
(Submit Rate and Signature Pages, Sections 1 and 3, along with application)
ASSURANCES/CERTIFICATIONS
Assurances (Form SF424B), with authorized original signature
(all
http:// www.epa.gov/ogd/forms/adobe/ SF424B sec.pdf - (fill &
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Revised 6/02/09
Pre-award Compliance Review Report for All Applicants Requesting Federal
Financial Assistance (EPA Form 4700-4), with authorized original signature (all
http;//www.epa.gov/ogd/forms/adobe/4700-4 sec.pdf - (fill &
Certification Regarding Lobbying, with authorized original signature
to is
http;//www.epa.gov/ogd/AppKit/form/Lobbying sec.pdf - (fill &
Disclosure of Lobbying Activities (Form SF-LLL) with authorized original
signature (not to is less
http://www.epa.gov/ogd/AppKit/form/sflllin sec.pdf^ (fill &
Procurement System Certification (EPA Form 5700-48) with authorized original
signature (SUPERFUND RECIPENTS ONLY)
http://www.epa.gOY/region3/grants/pdf/Frocurement Certification EPA 5700-48.pdf
Include Program/Project Director's Email Address on page 1 of SF424 -
Acknowledgement of Application receipt will be sent to Program/Project Director listed.
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Revised 6/02/09
Region 9 Application Instructions
SUBMISSION
All applicants must apply for Federal financial assistance on Standard Form 424 (revised 7/03). The final application
and work plan should be submitted by the date indicated in the application guidance letter sent to your agency by the
EPA Program Office. All OMB Standard Forms (SF) and Circulars are also available for download at
http://www.whitehouse.gov/omb/grants/index.html
If you are requesting continuation funding for an ongoing Environmental Program Grant under 40 CFR Part 35, your
application must be submitted before your current grant expires. This will allow your program to continue to incur
costs without interruption. However, if the application is received even one day late, your grant funds will be stopped
until a new grant is awarded. This may cause adverse conditions for your program because you will be responsible
for all costs until your new grant is awarded.
Please submit all items noted on the enclosed Application Checklist to:
Carolyn Truong
Grants Management Office, MTS-7
U.S. Environmental Protection Agency
75 Hawthorne Street
San Francisco, CA 94105
HOW TO COMPLETE YOUR APPLICATION FOR FEDERAL ASSISTANCE
Based on the inquiries we frequently receive, we have developed the following information to augment the
instructions in the "Application for Federal Assistance" (Standard Form 424 and 424A). Reading this information in
conjunction with the instructions for the SF-424 and the SF-424A will help ensure that all the necessary information is
included with your submission to EPA. Questions regarding completion of the application forms should be referred
to the Grants Specialist identified on the guidance letter accompanying this application kit.
APPLICATION FOR FEDERAL ASSISTANCE (SF-424)~FACESHEET
Refer to the pre-printed instructions for the SF-424 on the SF-424 form. Complete all items as instructed. If a
particular item does not apply, please indicate N/A.
Item 1: Type of Submission: (Required): Select one type of submission in accordance with agency instructions.
Preapplication
Application
Changed/Corrected Application - If requested by the agency, check if this submission is to change or correct
a previously submitted application. Unless requested by the agency, applicants may not use this to submit
changes after the closing date.
Item 2: Type of Application: (Required) Select one type of application in accordance with agency instructions.
New - An application that is being submitted to an agency for the
first time.
Continuation - An extension for an additional funding/budget period
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Revised 6/02/09
for a project with a projected completion date. This can include
renewals.
Revision - Any change in the Federal Government's financial obligation or contingent liability from an
existing obligation. If a revision, enter the appropriate letter(s). More than one may be selected. If "Other" is selected,
please specify in text box provided.
A. Increase Award B. Decrease Award
C. Increase Duration
D. Decrease Duration
E. Other (specify)
Item 3: Date Received: Leave this field blank. This date will be assigned by the Federal agency.
Item 4: Applicant Identifier: Enter the entity identifier assigned by the Federal agency, if any, or applicant's control
number, if applicable.
Item 5a: Federal Entity Identifier: Enter the number assigned to your organization by the Federal Agency, if any.
Item 5b: Federal Award Identifier: For new applications leave blank. For a continuation or revision to an existing
award, enter the previously assigned Federal award identifier number. If a changed/corrected application, enter the
Federal Identifier in accordance with agency instructions.
Item 6: Date Received by State: Leave this field blank. This date will be assigned by the State, if applicable.
Item 7: State Application Identifier: Leave this field blank. This identifier will be assigned by the State, if applicable.
Item 8: Applicant Information: Enter the following in accordance with agency instructions:
a. Legal Name: (Required): Enter the legal name of applicant that will undertake the assistance activity. This is the
name that the organization has registered with the Central Contractor Registry (Please use the same name on all
applications). Information on registering with CCR may be obtained by visiting the Grants.gov website.
b. Employer/Taxpayer Number (EIN/TIN): (Required): Enter the Employer or Taxpayer Identification Number
(EIN or TIN) as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444.
c. Organizational DUNS: (Required) Enter the organization's DUNS or DUNS+4 number received from Dun and
Bradstreet.
Your organization may obtain a DUNS number by calling Dun & Bradstreet at 1-866-705-5711 or through the
Internet at http://eupdate.dnb.com/requestoptions.html
Information on obtaining a DUNS number may also be obtained by visiting the Grants.gov website.
d. Address: Enter the complete address as follows: Street address (Line 1 required), City (Required), County, State
(Required, if country is US), Province, Country (Required), Zip/Postal Code (Required, if country is US).
e. Organizational Unit: Enter the name of the primary organizational unit (and department or division, if applicable)
that will undertake the assistance activity, if applicable.
f. Name and contact information of person to be contacted on matters involving this application: Enter the name
(First and last name required), organizational affiliation (if affiliated with an organization other than the applicant
organization), telephone number (Required), fax number, and e-mail address (Required) of the person to contact on
matters related to this application.
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Revised 6/02/09
Item 9: Type of Applicant: (Required) Select up to three applicant type(s) in accordance with agency instructions.
A. State Government
B. County Government
C. City or Township Government
D. Special District Government
E. Regional Organization
F. U.S. Territory or Possession
G. Independent School District
H. Public/State Controlled Institution of Higher Education
I. Indian/Native American Tribal Government (Federally Recognized)
J. Indian/Native American Tribal Government (Other than Federally Recognized)
K. Indian/Native American Tribally Designated Organization
L. Public/Indian Housing Authority
M. Nonprofit with 501C3 IRS Status (Other than Institution of Higher Education)
N. Nonprofit without 501C3 IRS Status (Other than Institution of Higher Education)
O. Private Institution of Higher Education
P. Individual
Q. For-Profit Organization (Other than Small Business)
R. Small Business
S. Hispanic-serving Institution
T. Historically Black Colleges and Universities (HBCUs)
U. Tribally Controlled Colleges and Universities (TCCUs)
V. Alaska Native and Native Hawaiian Serving Institutions
W. Non-domestic (non-US) Entity
X. Other (specify)
Item 10: Name Of Federal Agency: (Required) Enter the name of the Federal agency from which assistance is being
requested with this application.
Item 11: Catalog Of Federal Domestic Assistance Number/Title: Enter the Catalog of Federal Domestic
Assistance number and title of the program under which assistance is requested, as found in the program
announcement, if applicable. Refer to the EPA CFDA listing in the website:
http://12.46.245.173/pls/portal30/CATALOG.BROWSE AGENCY PROGRAM RFT.SHOW?p are names=agencv id&p
arg values=34
Item 12: Funding Opportunity Number/Title: (Required) Enter the Funding Opportunity Number and title of the
opportunity under which assistance is requested, as found in the program announcement.
Item 13: Competition Identification Number/Title: Enter the Competition Identification Number and title of the
competition under which assistance is requested, if applicable.
Item 14: Areas Affected By Project: List the areas or entities using the categories (e.g., cities, counties, states, etc.)
specified in agency instructions. Use the continuation sheet to enter additional areas, if needed.
Item 15: Descriptive Title of Applicant's Project: (Required) Enter a brief descriptive title of the project. If
appropriate, attach a map showing project location (e.g., construction or real property projects). For preapplications,
attach a summary
description of the project.
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Item 16: Congressional Districts Of: (Required)
16a. Enter the applicant's Congressional District, and
16b. Enter all Districts) affected by the program or project. Enter in the format: 2 characters State Abbreviation - 3
characters District Number, e.g., CA-005 for California 5th district, CA-012 for California 12th district, NC-103 for
North Carolina's 103rd district.
If all congressional districts in a state are affected, enter "all" for the district number, e.g., MD-all for all
congressional districts in Maryland.
If nationwide, i.e. all districts within all states are affected, enter US-all.
If the program/project is outside the US, enter 00-000.
Item 17: Proposed Project Start and End Dates: (Required) Enter the proposed start date and end date of the
project.
Item 18: Estimated Funding: (Required) Enter the amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind contributions should be included on appropriate lines, as
applicable. If the action will
result in a dollar change to an existing award, indicate only the amount of the change. For decreases, enclose the
amounts in parentheses.
Item 19: Is Application Subject to Review by State Under Executive Order 12372 Process? Applicants should
contact the State Single Point of Contact (SPOC) for Federal Executive Order 12372 to determine whether the
application is subject to the State intergovernmental review process. Select the appropriate box. If "a." is selected,
enter the date the application was submitted to the State. The Office of Management and Budget maintains a list of
SPOCs at this site: http://www.whitehouse.gov/omb/grants/spoc.html
Applicants must submit or fax page 1 of the application (or summary thereof) to the SPOC Intergovernmental
Review. In addition, the fax/submittal date must be entered on page 1 of the SF424, Block#16.
CALIFORNIA NEVADA
Grants Coordination Coordinator
State Clearinghouse Department of Administration
Office of Planning & Research State Clearinghouse
P.O. Box 3044, Room 212 209 E. Musser Street, Room 200
Sacramento, CA 95814-3044 Carson City, Nevada 89701
Telephone: (916)445-0613 Telephone: (775) 684-0222 or 0223
FAX: (916)323-3018 Fax:(775)684-0260
Email: state.clearinghouseฎ opr.ca.gov Email: rtietje@budget.state.nv.us
GUAM NORTH MARIANA ISLANDS
Director Ms. Jacoba T. Seman
Bureau of Budget and Mgmt. Research Federal Programs Coordinator
Office of the Governor Office of Management and Budget
P.O. Box 2950 Office of the Governor
Agana, Guam 96910 Saipan, MP 96950
Telephone: 011-671-472-2285 Telephone: (670) 664-2289
Fax: 011-472-2825 Fax: (670) 664-2272
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Item 20: Is the Applicant Delinquent on any Federal Debt? (Required) Select the appropriate box. This question
applies to the applicant organization, not the person who signs as the authorized representative. Categories of debt
include delinquent audit disallowances, loans and taxes. If yes, include an explanation on the continuation sheet.
Item 21: Authorized Representative: (Required) To be signed and dated by the authorized representative of the
applicant organization. Enter the name (First and last name required) title (Required), telephone number (Required),
fax number,
and email address (Required) of the person authorized to sign
for the applicant. A copy of the governing body's authorization for you to sign this application as the official
representative must be on file in the applicant's office. (Certain Federal agencies may require that this authorization
be submitted as part of the application.)
BUDGET INFORMATION - NON CONSTRUCTION PROGRAMS (SF-424A)
A complete budget must be submitted in order to be considered for federal assistance. The application includes a two-
page sheet, "Budget Information - Non-Construction Programs" (Standard Form 424A), Sections A through F.
Complete Sections A, B and F. Complete Section C if estimated funding includes other sources of non-federal funding
besides the applicant's cost share. Sections D and E are optional.
Section A - Budget Summary
Columns (a), (b), (c), (d), are not required. Complete columns (e), (f), and (g). Complete column (c) if applying for
unobligated federal funds from a prior grant budget (amount must correspond with the unobligated balance of Federal
funds reported on your Financial Status Report).
Section B - Budget Categories
Enter the amounts for the COMBINED Federal and non-Federal funds distributed by object class categories under
column (5) "Total." Columns (1) - (4) may be used to separately identify the amount of Federal funds, recipient
matching contribution, supplemental funds, etc. Column (5), line k total should be the same as the total amount
shown on the SF-424 facesheet under item 15g.
A detailed budget breakdown of column (5) "Total" by object class categories must be prepared and submitted
with the application. A sample budget breakdown is attached. (Other formats may be used.) Refer to our
Instructions under Section F - Other Budget Information.
Section C - Non-Federal Resources
Complete only if other sources of non-Federal funds are budgeted for your project. Amounts should agree with the
amounts budgeted under item 15 on the SF-424 facesheet. Refer to the pre-printed instructions for this item on the SF-
424A.
Section D - Forecasted Cash Needs
Optional. Refer to the pre-printed instructions for this item on the SF-424A
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Revised 6/02/09
Section E - Budget Estimates of Federal Funds Needed for Balance of the Project
Optional. Refer to the pre-printed instructions for this item on the SF-424A.
Section F - Other Budget Information. Guidance for completing a Detailed Budget to Supplement Standard Form
424A, Section B - Budget Categories.
A separate, detailed budget is required and must be attached to your Application. Follow the guidelines below to
support the amounts budgeted under the following object class categories on the SF-424A:
Line 6a- Personnel. List all participants in the program/project by position title, estimated time on the project, and
salary during the project period.
Line 6b - Fringe Benefits. Identify the fringe benefit percentage and apply the percentage to the estimated personnel
costs.
Line 6c - Travel. If travel is budgeted, indicate the general purpose of the travel (e.g., in-State/local travel and out-of
State travel), number of travelers, destination and estimated costs per trip.
Line 6d - Equipment. List all equipment to be purchased and include estimated costs for each item. The Federal
government defines equipment as tangible, non-expendable, personal property having a useful life of more than one
year and an acquisition cost of $5,000 or more per unit. Property, which does not fall into this category, should be
listed as supplies, unless your organization defines equipment at a lower threshold by policy.
Line 6e - Supplies. Identify the estimated costs for general materials and supplies (i.e. office supplies).
Line 6f - Contractual. List and describe each proposed contractual service, the proposed procurement method (i.e.
small purchase, formal advertising, competitive negotiations/RFPs, or non-competitive negotiations/sole source),
and the estimated cost of each contract. EPA may require review of contracts prior to their execution to assure all
costs are reasonable and necessary to the program/project. Applicants should review EPA's regulations concerning
procurement and the need to provide justification for sole source agreements, and documentation of cost and/or price
analysis for contracts and other agreements.
Line 6g - Construction. List proposed construction contracts under item 6f - Contractual.
Line 6h - Other. List all other direct costs, which are not included in the above categories (i.e. telecommunication
expenses, training, etc.).
Line 6i - Total Direct Charges (sum of 6a-6h)
Line 6j - Indirect Charges. Provide an explanation of how indirect charges were calculated for the program/project.
Identify the type of indirect cost rate (provisional, predetermined, final or fixed), the Federal Agency with whom your
rate is negotiated, the rate that is in effect during the grant period and the base to which the rate is applied.
Line 6k - Totals (sum of 6i and 6j)
Indirect costs are allocable to an EPA grant only if supported by an Indirect Cost Rate Agreement, Cost Allocation
Plan, or Indirect Cost Rate Proposal as detailed in OMB Circulars 2 CFR 225, 2 CFR 230, and 2 CFR 220,
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Revised 6/02/09
depending on your organizational type. States, Tribes and educational institutions must submit a copy of their
current Negotiated Indirect Cost Rate Agreement to EPA with their application.
Line 7 - Program Income. If any income is expected to be generated from your program/project, describe the nature,
source and estimated amount. Examples of program income include registration fees collected, income from the sale
of products produced under a grant, and rental fees generated from equipment purchased with grant funds. The EPA
project officer will negotiate the use of the program income with your agency in accordance with Federal regulations.
An example of a properly completed budget detail is included with this document.
ASSURANCES - NON-CONSTRUCTION PROGRAMS (SF-424B)
As an applicant for Federal Financial Assistance, you must assure that you will comply with all applicable Federal
Statutes, Executive Orders, regulations, and policies governing the program/project. The required Assurances must
be signed by the authorized representative who signed the SF-424 Facesheet. An original signature is required.
KEY PEOPLE LIST
Complete the enclosed "Key People List" and return it with your application.
WORK PLAN
Attach a copy of your proposed work plan. Additional information regarding the requirements for an acceptable
work plan may be found in Program guidance, 40 CFR Part 35 Subpart A, and other Parts applicable to your project.
Any questions regarding the work plan or program objectives should be discussed with your EPA Project Officer.
Preaward Compliance Review Report for All Applicants Requesting Federal Financial Assistance
(EPA Form 4700-4)
Complete the Pre-Award Compliance Review Report, EPA Form 4700-4, and return it with your application. If a
recipient receives more than one grant from EPA Region 9, you may choose to complete this form for all EPA Region
9 environmental programs by indicating on the form, under Part II "APPLICABLE TO ALL EPA, REGION 9
GRANTS". This form will be valid for one year from the date it is received by the Grants Management Office. All
applicants should complete roman numerals I through V. If the information in Section VI through IX does not apply
to your project or program, write N/A for "not applicable." The authorized representative is required to sign and
date the form under Section X. Questions regarding completion of the form should be addressed to the Office of Civil
Rights, at (415) 947-4286.
Certification Regarding Lobbying and Disclosure of Lobbying Activities
(Standard Form - SFLLL)
Note: Not applicable to Indian Tribes nor applicants receiving $100,000 or less of Federal assistance.
This requirement generally prohibits recipients of Federal grants, cooperative agreements, contracts, and loans from
using appropriated funds for lobbying the Executive or Legislative Branches of the Federal Government in connection
with a specific grant, cooperative agreement, contract, or loan. Each recipient who requests or receives a Federal
contract, grant, cooperative agreement, loan, or Federal commitment to insure or guarantee a loan, must also disclose
lobbying. Each recipient must file a certification and, if required, a disclosure form with each submission that
10
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initiates agency consideration for the award of a Federal contract, grant or cooperative agreement exceeding
$100.000. Any subcontractors of the recipients receiving Federal funds in excess of $100,000 must also file a
certification form and a disclosure statement, if required.
The authorized representative is required to sign the form(s) which must be filed with each application for Federal
assistance. Your agency may fulfill this requirement by filing an annual certification form with original signatures
with EPA's Grants Management Office. This requirement is established in 40 CFR Part 34.
Procurement Certification (Superfund Recipients Only)
(EPA Form 5700-48)
All recipients of Superfund assistance are required to certify their Procurement System by completing the
Procurement System Certification (EPA Form 5700-48). An applicant may self-certify their Procurement System if
their system complies with 40 CFR 35.6550. The authorized representative is required to sign the certification for
each application for Federal assistance. Your agency may fulfill this requirement by filing an annual certification
form with original signatures with EPA's Grants Management Office. This requirement is established in 40 CFR 35,
SubpartO.
Single Audit Act Requirements (A-133)
All recipients must comply with the Single Audit Act amendments as set forth in OMB Circular A-133, revised June,
2003. The Act requires recipients that expend $500,000 or more in a year in Federal awards from all Federal sources
to have a single audit or a program-specific audit for that year in accordance with the provisions of the Circular.
Recipients that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for
that year, but records must be available for review or audit by appropriate officials of the Federal government.
Audits shall be performed annually, unless the recipient made provisions previously for biennial audits as set forth in
paragraphs (a) and (b) of Section .220 of the Circular. The costs of audits made in accordance with the provisions of
this Circular are allowable charges to Federal awards. However, recipients may not charge the cost of auditing a non-
Federal entity which has Federal awards expended of less than $500,000 (as of December 31, 2003) a year to a
Federal award per Section .230 of A-133.
Audit report requirements and report submission are set forth in Sections .320 and .235 of the Circular. The recipient
shall provide the number of reporting packages described in these sections to the Federal Audit Clearinghouse,
Bureau of the Census, 1201 E. 10th Street, Jeffersonville, IN 47132. http://harvester.census.gov/sac/
OMB Circulars and EPA Regulations
You should be familiar with the Federal requirements that govern Federal grants before you apply. These
requirements often vary depending on your organization type and are established in law, Executive Order, Federal
regulation, and the OMB Circulars.
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OMB Circulars:
2 CFR, Part 220 Principles for Determining Costs Applicable to Grants, Contracts,
(formerly known as A-2i) and other Agreements with Educational Institutions
2 CFR, Part 225 Cost Principles for State, Local and Indian Tribal Governments
(formerly known as A-87)
2 CFR, Part 230 Cost Principles for Non-Profit Organizations
(formerly known as A-122)
A-102 Grants and Cooperative Agreements with State and Local
Governments
2 CFR, Part 215 Grants and Cooperative Agreements with Institutions of
(formerly known as A-I 10) Higher Education, Hospitals, and other Non-Profit Organizations
A-133 Audits of States, Local Governments, and Non-Profit Organizations.
Some applicable EPA Regulations:
40 CFR, Part 30 Uniform Administrative Requirements for Grants and Agreements with Institutions of
Higher Education, Hospitals and Other Non-Profit Institutions
31 Uniform Administrative Requirements for Grants and Cooperative Agreements to State
and Local Governments and Indian Tribes
35 State, Local, and Tribal Assistance
To obtain sections of the 40 Code of Federal Regulations (CFR), Parts 1-49, refer to the website
http://www.epa.gov/epahome/cfr40.htm
To obtain the printed 40 Code of Federal Regulations (CFR), Parts 1-49, you may contact:
Superintendent of Documents (phone# (202) 512-1803)
United States Government Printing Office (USGPO)
P.O. Box 371954
Pittsburgh, PA 15250-7954
Catalog of Federal Domestic Assistance (CFDA) Number:
Block 10 of the SF424 Application requires a CFDA number. A listing of all current EPA assistance programs and
their CFDA numbers can be found at http://www.cfda.gov
EPA numbers begin with 66.001. CFDA numbers are regularly created, so refer to this web site often.
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KEY PEOPLE LIST
Please show street address as well as Post Office Box Number where applicable.
AGENCY/ORGANIZATION DIRECTOR
(Individual who is authorized to sign the assistance agreement application and award acceptance.)
NAME:
TITLE:
ADDRESS:
TELEPHONE: FAX:
EMAIL ADDRESS:
PROGRAM/PROJECT DIRECTOR
(Technical program director or person responsible for the project as a contact person in Block #5 of the application.)
NAME:
TITLE:
ADDRESS:
TELEPHONE: FAX:
EMAIL ADDRESS:
FINANCE DIRECTOR
(Individual responsible for maintaining the accounting and financial management system supporting expenditures, preparing the financial
reports, etc.)
NAME:
TITLE:
ADDRESS:
TELEPHONE: FAX:
EMAIL ADDRESS:
| **An Email Acknowledgement of Application receipt will be sent to Program/Project Director listed on page 1 of Form SF424*
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OPTIONAL FORMAT
SAMPLE BUDGET DETAIL FORMAT
The detail for each object class category must be provided. Formats may vary, but all information below should be
included in your application.
a. PERSONNEL
POSITION
a. Personnel Total
NUMBER
SALARY
WORK
YEARS
AMOUNT
b. FRINGE BENEFITS
BASE
RATE
b. FRINGE BENEFITS TOTAL
%
c. TRAVEL - List trips planned, destination, dates, and the amounts per trip. Please separate local
travel and out-of-state travel.
TRAVEL EXPENSES
AMOUNT
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Explain:
c. TRAVEL TOTAL:
A. EQUIPMENT: Tangible, non-expendable, personal property having a useful life of more than one year and an
acquisition cost of $5,000 or more per unit. Applicant's definition of equipment may be used provided the definition
at least includes all items previously defined above.
ITEM
d. EQUIPMENT TOTAL
NUMBER
COST PER
UNIT
TOTAL
e. SUPPLIES
ITEM
e. SUPPLIES TOTAL
NUMBER
COST PER
UNIT
TOTAL
f. CONTRACTUAL [List each planned contract separately, type of service to be procured, proposed procurement
method (i.e. small purchase, sealed bids, competitive proposals) and the estimated cost]
ITEM
PROCUREMENT
METHOD
TOTAL
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f. CONTRACTUAL TOTAL
g. CONSTRUCTION (N/A)
h. OTHER
ITEM
h. OTHER TOTAL
NUMBER
COST PER
UNIT
TOTAL
i. TOTAL DIRECT COSTS
j. INDIRECT COSTS
k. TOTAL PROPOSED COSTS
FEDERAL FUNDS REQUESTED
RECIPIENT SHARE (MATCH)
$
(BASE $ x RATE % = INDIRECT
COSTS)
$
$
$
16
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RECIPIENT SHARE OF TOTAL PROPOSED
COSTS
FEDERAL SHARE OF TOTAL PROPOSED
COSTS
17
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Region 9
SAMPLE
COMPLETED BUDGET SF424 A AND BUDGET DETAIL
(BREAKDOWN BY OBJECT CLASS CATEGORIES
18
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BUDGET INFORMATION - Non- Construction Programs OMB Appeal NO. OMK-OOM
SECTION A -BUDGET SUMMARY
Grant Program
Function
or Activity
(a)
1. PWSS
2.
3.
4.
5. TOTALS
Catalog of Federal
Domestic Assistance
Number
(b)
66.432
Estimated Unobligated Funds
Federal
(c)
$
Non-Federal
(d)
$
New or Revised Bi
Federal
(e)
$465,000
$465,000
Non-Feden
(f)
$1
$1
SECTION B -BUDGET CATEGORIES
6. OBJECT CLASS CATEGORIES
a. Personnel
b. Fringe Benefits
c. Travel
A. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
i. Total Direct Charges (sum of 6a - 6h)
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
(1) Federal
$233,243
48,981
15,179
20,000
8,650
60,000
0
8,391
394,444
70,556
465,000
(2) Match
$77,750
$16,327
0
32,000
0
0
0
5,404
131,481
23,519
155,000
(3)
$
(4)
7. Program Income
19
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SAMPLE SECTION C - NON-FEDERAL RESOURCES Revised 6/02/09 ^ ^ ^
(a) Grant Program
8. PWSS
9.
10.
11.
12. TOTAL (sum of lines 8 and 11)
13. Federal
14. NonFederal
15. TOTAL (sum of lines 13 and 14)
(b) Applicant
$155,000
155,000.00
(c) State
$
$
(d) Other Source
$
$
SECTION D - FORECASTED CASH NEEDS
(Totalfor 1st Year)
$465,000
$ 155,000
620,000
1st Quarter
116,250
38,750
155,000
2nd Quarter
116,250
38,750
155,000
3rd Quarter
116,250
38,750
155,000
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
16.
17
18.
19.
20. TOTALS (sum of lines 16-19)
FUTURE FUNDING PERIODS (Yeais)
(b) First
$
$0.00
(c) Second
$
$
(d) Third
$
$
SECTION F - OTHER BUDGET INFORMATION
(Attach additional sheets if Necessary)
21. Direct Charges: $525,925
22. Indirect Charges: $94,075
23 . Remarks: Please include anything not fully explained in the budget detail (i.e. Indirect Cost Rate, Base, etc.)
INDIRECT COST RATE = 25%
20
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Revised 6/02/09
OPTIONAL FORMAT
SAMPLE BUDGET DETAIL FORMAT
The detail for each object class category must be provided. Formats may vary, but all information below should be
included in your application.
a. PERSONNEL
POSITION
Lab Assistant 1
Lab Assistant 2
Env. Engineer II
Microbiologist IV
Env. Health Specialist
Chemist III
Health Assistant
a. Personnel Total
NUMBER
2
1
2
1
1
1
1
SALARY
$22,500
20,000
38875
44,000
23,976
50,000
22,331
WORK
YEARS
1
1
1
2
0.33
1
1
AMOUNT
$45,000
20,000
77,750
88,000
7,912
50,000
22,331
$310,993
b. FRINGE BENEFITS
BASE (personnel)
RATE
b. FRINGE BENEFITS TOTAL
$310,993
21%
$65,308
21
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Revised 6/02/09
c. TRAVEL - List trips planned, destination, dates, and the amounts per trip. Please separate local
travel and out-of-state travel.
TRAVEL EXPENSES
OUT-OF-STATE TRAVEL
Philadelphia, PA (2 People)
Las Vegas, NV (1 Person)
Washington, DC (2 People)
San Francisco, CA (3 People)
LOCAL TRAVEL
AMOUNT
$4,437
$1,000
$2,400
$3,000
$4,342
Explain:
-Trips are scheduled to attend the American Water Works Conference, Regional Workshop on New Regulations, Grant
Negotiations, and Grant Workshop.
Out of State Travel - $10,837
Local Travel - $4,342
Based on an estimate for mileage ($.20/mile), $45/day maximum lodging, and $20/day maximum for meals.
Travel total = $15, 179
c. TRAVEL TOTAL: $15,179
d. EQUIPMENT: Tangible, non-expendable, personal property having a useful life of more than one year and an
acquisition cost of $5,000 or more per unit. Applicant's definition of equipment may be used provided the definition
at least includes all items previously defined above.
ITEM
Recycling Composter
Computers
Monitors
Laser Printers
File Cabinets
NUMBER
2
4
4
2
2
COST PER
UNIT
$16,000
1,750
584
1,389
443
TOTAL
$32,000
7,000
2,336
2,778
886
22
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Revised 6/02/09
Water Quality Monitor
A. EQUIPMENT TOTAL
1
7,000
7,000
$52,000
e. SUPPLIES
ITEM
Office Supplies (post-its, pen, paper)
Field Survey Supplies
Lab Supplies (beakers, pipettes)
Software for Computers (MS Office)
Printing Supplies for Brochures
e. SUPPLIES TOTAL
NUMBER
Multiple
Multiple
Multiple
4
Multiple
COST PER
UNIT
Various
Various
Various
$387.50
Various
TOTAL
$1,100
2,600
1,200
1,550
$2,200
$8,650
f. CONTRACTUAL [List each planned contract separately, type of service to be procured, proposed procurement
method (i.e. small purchase, sealed bids, competitive proposals) and the estimated cost]
ITEM
Env. Engineer - Consultant
Hydrologist
GIS Survey
Lab Sample Analysis
f. CONTRACTUAL TOTAL
PROCUREMENT
METHOD
Competitive Proposals
Competitive Proposals
Small Purchase
Small Purchase
TOTAL
$24,100
25,900
3,500
6,500
$60,000
g. CONSTRUCTION (N/A)
23
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h. OTHER
Revised 6/02/09
ITEM
Repairs - Computers
Repairs - Vehicle Maintenance
Phone - Long Distance
(not in Indirect Cost Pool)
Rental of Conference Rooms
(4 days@$l,050/day) for training
Postage
Printing for Reports (Distributed at
Conference)
h. OTHER TOTAL
NUMBER
COST PER
UNIT
TOTAL
$2,500
3,500
1,200
4,200
595
1,800
$13,795
i. TOTAL DIRECT COSTS
j. INDIRECT COSTS
k. TOTAL PROPOSED COSTS
FEDERAL FUNDS REQUESTED
RECIPIENT SHARE (MATCH)
RECIPIENT SHARE OF TOTAL PROPOSED
COSTS
FEDERAL SHARE OF TOTAL PROPOSED
COSTS
$525,925
Base= Personnel and Fringe Benefits
BASE $376,301 x RATE 25% = $94,075
$620,000
$465,000
$155,000
25%
75%
24
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