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WORKSPACE FORM This Workspace form is one of the forms you need to complete prior to submitting your Application Package. This form can be completed in its entirety offline using Adobe Reader. You can save your form by clicking the "Save" button and see any errors by clicking the “Check For Errors” button. In-progress and completed forms can be uploaded at any time to Grants.gov using the Workspace feature. When you open a form, required fields are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a field, you will receive an error message. Additional instructions and FAQs about the Application Package can be found in the Grants.gov Applicants tab. 1-800-518-4726 SUPPORT@GRANTS.GOV OPPORTUNITY & PACKAGE DETAILS: Opportunity Number: CDC-RFA-OE22-2203 Opportunity Title: Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems Opportunity Package ID: PKG00275054 CFDA Number: 93.967 CFDA Description: CDC's Collaboration with Academia to Strengthen Public Health Competition ID: CDC-RFA-OE22-2203 Competition Title: Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems Opening Date: 07/22/2022 Closing Date: 08/15/2022 Agency: Centers for Disease Control - CSELS Contact Information: Jonathan Carlson APPLICANT & WORKSPACE DETAILS: Workspace ID: WS00934810 Application Filing Name: Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems UEI: LM85MG1513K5 Organization: MARICOPA, COUNTY OF Form Name: Application for Federal Assistance (SF-424) Form Version: 4.0 Requirement: Mandatory Download Date/Time: Aug 08, 2022 12:51:18 PM EDT Form State: No Errors FORM ACTIONS: OMB Number: 4040-0004 Expiration Date: 12/31/2022 * 1. Type of Submission: * 2. Type of Application: * 3. Date Received: 4. Applicant Identifier: 5a. Federal Entity Identifier: 5b. Federal Award Identifier: 6. Date Received by State: 7. State Application Identifier: * a. Legal Name: * b. Employer/Taxpayer Identification Number (EIN/TIN): * c. UEI: * Street1: Street2: * City: County/Parish: * State: Province: * Country: * Zip / Postal Code: Department Name: Division Name: Prefix: * First Name: Middle Name: * Last Name: Suffix: Title: Organizational Affiliation: * Telephone Number: Fax Number: * Email: * If Revision, select appropriate letter(s): * Other (Specify): State Use Only: 8. APPLICANT INFORMATION: d. Address: e. Organizational Unit: f. Name and contact information of person to be contacted on matters involving this application: Application for Federal Assistance SF-424 Preapplication Application Changed/Corrected Application New Continuation Revision Completed by Grants.gov upon submission. 86-6000472 Maricopa County 86-6000472 LM85MG1513K5 4041 N Central Ave Suite 1400 Phoenix Maricopa County AZ: Arizona USA: UNITED STATES 85012-3314 Department of Public Health Program Operations Jeanene Fowler Program Operations Administrator Maricopa County Department of Public Health 602-506-4926 Jeanene.Fowler@maricopa.gov * 9. Type of Applicant 1: Select Applicant Type: Type of Applicant 2: Select Applicant Type: Type of Applicant 3: Select Applicant Type: * Other (specify): * 10. Name of Federal Agency: 11. Catalog of Federal Domestic Assistance Number: CFDA Title: * 12. Funding Opportunity Number: * Title: 13. Competition Identification Number: Title: 14. Areas Affected by Project (Cities, Counties, States, etc.): * 15. Descriptive Title of Applicant's Project: Attach supporting documents as specified in agency instructions. Application for Federal Assistance SF-424 B: County Government Centers for Disease Control - CSELS 93.967 CDC's Collaboration with Academia to Strengthen Public Health CDC-RFA-OE22-2203 Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems CDC-RFA-OE22-2203 Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems Investment to build capacity and strengthen infrastructure and systems related to workforce and foundational capabilities. View Attachments Delete Attachments Add Attachments View Attachment Delete Attachment Add Attachment * a. Federal * b. Applicant * c. State * d. Local * e. Other * f. Program Income * g. TOTAL . Prefix: * First Name: Middle Name: * Last Name: Suffix: * Title: * Telephone Number: * Email: Fax Number: * Signature of Authorized Representative: * Date Signed: 18. Estimated Funding ($): 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 18, Section 1001) ** 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: Application for Federal Assistance SF-424 * a. Applicant Attach an additional list of Program/Project Congressional Districts if needed. * b. Program/Project * a. Start Date: * b. End Date: 16. Congressional Districts Of: 17. Proposed Project: AZ-003 AZ-003 Congressional Districts.pdf Add Attachment Delete Attachment View Attachment 11/01/2022 08/31/2027 39,691,230.00 0.00 0.00 0.00 0.00 0.00 39,691,230.00 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. Yes No Add Attachment Delete Attachment View Attachment ** I AGREE Dejanee Lambert Contract Analyst 602-526-8787 dejanee.lambert@maricopa.gov Completed by Grants.gov upon submission. * 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) * 19. Is Application Subject to Review By State Under Executive Order 12372 Process? Completed by Grants.gov upon submission. If "Yes", provide explanation and attach