APPLICATION 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
Application Continuation * Other (Specify):
Changed/Corrected Application Revision
* 3. Date Received: 4. Applicant Identifier:
09HP0004
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
N/A 09HP0004
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:
Maricopa County 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:
Maricopa County Human Services
* 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:
OHS-HP-19-075
* Title:
NCN Announcement - Region 09 - HP - 2019 - July
13. Competition Identification Number:
OHS-HP-19-075-062060
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
Maricopa County excluding City of Phoenix
* 15. Descriptive Title of Applicant's Project:
Early Head Start-Child Care Partnership
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-003,AZ-005,AZ-008,AZ-009
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
* a. Start Date: 07/01/2019 * b. End Date: 06/30/2020
18. Estimated Funding ($):
* a. Federal 2,693,691
* b. Applicant 673,423
* c. State
* d. Local
* e. Other 0
* f. Program Income
*g.TOTAL 3,367,114
* 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: Bill
Middle Name:
* Last Name: Gates
Suffix:
*Title: Chair, Maricopa County Board of Supervisors
*Telephone Number: (602) 506-7562 Fax Number:
*Email: gatesb@mail.maricopa.gov
* Signature of Authorized Representative: * Date Signed: