SF424 BUDGET REVISION REQUEST SIGNED.PDF
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OMB Number: 4040-0004
C-22-21-113-X-00 Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
* 4. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s):
[_] Preapplication [_] New
[_] Continuation * Other (Specify):
Other |
[Budget Revision
[_] Changed/Corrected Application Revision
*3. Date Received: 4. Applicant Identifier:
| 09HE000185, |
5a. Federal Entity Identifier:
5b. Federal Award Identifier:
[iva
[o9nmo00185
State Use Only:
6, Date Received by State: [| 7. State Application Identifier: | — |
8. APPLICANT INFORMATION:
* '
a. Legal Name: [marrcora, COUNTY OF
*b, Employer/Taxpayer Identification Number (EIN/TIN):
*c. Organizational DUNS:
| |[os0391270
866000472
d. Address:
* Streett: [234 N Central Ave |
Street2: [ra 3 |
*City: | Phoenix |
County/Parish: [Maricopa County
* State: laz: Arizona |
Province: | |
* Country: lusa: UNITED STATES |
* Zip / Postal Code: [85004-0948
e. Organizational Unit:
Department Name:
Division Name:
HUMAN SERVICES DEPARTMENT
| EARLY EDUCATION
f. Name and contact information of person to be contacted on matters involving this application:
* First Name: [eve
Middle Name: |
*LastName: |per, REAL
Title: [assrstanr DIRECTOR
Organizational Affiliation:
[mcusp EARLY EDUCATION DIVISION
*Telephone Number: | (692) 372-3700 x23710
Fax Number:
*Email: [eve.delreal@maricopa.gov
C-22-21-113-X-00
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):
* 40. Name of Federal Agency:
[acr-Heaa 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:
Not Applicable
Title:
Not Applicable
14. Areas Affected by Project (Cities, Counties, States, etc.):
EAST AND WEST MARICOPA COUNTY WITH THE exc]
* 15. Descriptive Title of Applicant's Project:
ARP- BUDGET REVISION AND EQUIPMENT REQUEST
Attach supporting documents as specified in agency instructions.
C-22-21-113-X-00
Application for Federal Assistance SF-424
46. 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: | 94/01/2021 “b. End Date:
mated Funding {$):
*a. Federal
* b. Applicant
*f, Pragram Income
|
|
|
|
* 6. Other | o|
[
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*g, TOTAL 0
* 49. 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 Lise
im i>, 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? (lf"Yes,” provide explanation in attachment.)
[] Yes
lf "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)
Xl AGREE
** The list of certifications and assurances, or an interriet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Middle Name: | |
* Last Name: [cates |
* Titles CHAIRMAN, MARICOPA COUNTY BOARD OF SUPERVISOR
* Telephone Number: | (602) 506-1562 Fax Number: | |
* Email: |bill.gates@maricopa.gov z
aa a a a a / "
* Signature of Authorized Representative: Date Signed:
ENO (et | —]
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