SF-424 FOR EHS 09HP000200 Y2.PDF

* 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. Organizational DUNS:
* 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
OMB Number: 4040-0004 
Expiration Date: 10/31/2019
050391270
09HP000200
Early Education
AZ: Arizona
866000472
MARICOPA, COUNTY OF
(602) 372-3710 x3710
Maricopa County Human Services
Maricopa County Human Services
Fl 3
Del Real
09HP000200
N/A
USA: UNITED STATES
Phoenix
Maricopa County
234 N Central Ave
Assistant Director -Early Education Division
85004-0948
Eve
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.):  
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: 	
07/01/2020 	
* b. End Date: 	
06/30/2021 
 
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: 	
Clint 
 
Middle Name: 
* Last Name: 	
Hickman 
Suffix: 
*Title: 	
Chair, Maricopa County Board of Supervisors 
 
*Telephone Number: 	
(602) 	
506-7642 	
Fax Number: 
*Email: 	
CLINT.HICKMAN@Maricopa.Gov 
 
* Signature of Authorized Representative: 	
* Date Signed: