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OMB Number: 4040-0004
C-22-22-1 74-X°O4 Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
* 4, Type of Submission: * 2. Type of Application: * If Revision, select appropriate tetter(s):
[_] Preapplication L_ |New
Application [Continuation * Other (Specify):
[_] Changed/Corrected Application Revision | : |
increase Award |
*3, Date Received: 4. Applicant Identifier:
| | [oscuor2079 |
5a. Federal Entity Identifier: 5b, Federat Award Identifier:
lira | [o9cH012079
State Use Only:
6. Date Received by State: [sd 7. State Application Identifier: |
8. APPLICANT INFORMATION:
*a. Legal Name: [martcopa, COUNTY OF |
*b. Employer/faxpayer Identification Number (EIN/TIN): *c UEL
. [366000472 | [maxameavyiDD9
d. Address:
* Streett: [234 Central Ave
Street2: [pi 3
* city: | Phoenix
County/Parish: [Maricopa County |
* State: az: Arizona
Province: - | |
* Country: [osa: UNITED STATES - |
* Zip / Postal Code: [35004-0948
e. Organizational Unit:
Department Name: Division Name:
Human Services | lrarty Education
f. Name and contact information of person to be contacted on matters involving this application:
Middle Name: | |
“LastName: [pel Real :
Title: [assistant Director
Organizational Affiliation:
[cusp Warly Education Division |
* Telephone Number: | (692) 372-3710 Fax Number: |
* Email: eve -delreal@maricopa.gov |
G-22-22-174-X-O3
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):
* 410. Name of Federal Agency:
lack-Head Start
11. Catalog of Federal Domestic Assistance Number:
93.600
CFDA Title:
Head Start
* 42. Funding Opportunity Number:
eGrants-N/A
* Title:
N/A
13. Competition Identification Number:
fot Applicable
Tithe:
Not Applicable
14. Areas Affected by Project (Cities, Counties, States, efc.):
Maricopa County with Exception of the city|
* 15. Descriptive Title of Applicant's Project:
COLA/CQL
Attach supporting documents as specified in agency instructions.
C-22-22-174-X-or
Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant b. Program/Project AZ-005
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
*a, Start Date: 07/01/2022 *b. End Date: |06/30/2023
18. Estimated Funding ($):
a. Federal | 520, 680]
*b. Applicant | 0 |
*c. State |
*d. Local |
*e. Other | o|
*f. Program Income | |
*g. TOTAL | 520, 680|
*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 [ss
i 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
if"Yes", provide explanation and attach
21. *By signing this application, | 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. | also provide the required assurances** and agree to
comply with any resulting terms if | accept an award. | 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)
[_] * |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: [pina |
Middle Name: | |
* Last Name: [cates |
Suffix: ~
* Title: [chairman, Maricopa County Board of Supervisor |
* Telephone Number: [ (602) 506-7562 | Fax Number: | |
* Email: [pi11.cates@maricopa-gov a z
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ral —
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* Signature of Authorized Representative: A x { J { 9 -{ * Date Signed: MAY ] 9 2022 |
Apron 45% tom: nxne Hoge SHAR
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Deputy Clerkof the Board
MAY 19 2022
R322.