09CH010385 NFS WAIVER SF-424.PDF

OMB Number: 4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
* 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s):
Preapplication New Other
Application Continuation * Other (Specify):
Changed/Corrected Application Revision Budget Revision
* 3. Date Received: 4. Applicant Identifier:
09CH010385
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
N/A 09CH010385
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
* a. Legal Name: MARICOPA, COUNTY OF
* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:
866000472 050391270
d. Address:
* Street1: 234 N Central Ave
Street2: Fl 3
* City: Phoenix
County/Parish: Maricopa County
* State: AZ: Arizona
Province:
* Country: USA: UNITED STATES
* Zip / Postal Code: 85004-0948
e. Organizational Unit:
Department Name: Division Name:
Human Services Early Education
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: Ms. * First Name: Eve
Middle Name:
* Last Name: Del Real
Suffix:
Title: Assistant Director
Organizational Affiliation:
MCHSD Early Education Division
* Telephone Number: (602) 372-3710 Fax Number:
* Email: eve.delreal@maricopa.gov

Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:
County Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
ACF-Head Start
11. Catalog of Federal Domestic Assistance Number:
93.600
CFDA Title:
Head Start
* 12. Funding Opportunity Number:
eGrants-N/A
* Title:
N/A
13. Competition Identification Number:
Not Applicable
Title:
Not Applicable
14. Areas Affected by Project (Cities, Counties, States, etc.):
East Maricopa County
* 15. Descriptive Title of Applicant's Project:
Head Start / Early Head Start COLA and Quality Improvement
Attach supporting documents as specified in agency instructions.

Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant AZ-007 b. Program/Project AZ-005
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
* a. Start Date: 07/01/2020 * b. End Date: 06/30/2021
18. Estimated Funding ($):
* a. Federal 0
* b. Applicant -2,202,051
* c. State
* d. Local
* e. Other 0
* f. Program Income
* g. TOTAL -2,202,051
* 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
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 218, 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: Mr. * First Name: Jack
Middle Name:
* Last Name: Sellers
Suffix:
* Title: Chairman, Maricopa County Board of Supervisor
* Telephone Number: (602) 506-1776 Fax Number:
* Email: sellersj@mail.maricopa.gov
* Signature of Authorized Representative: * Date Signed: