SF-424 CARRY OVER GRANT REQUEST.PDF
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CURIH-K03 OMB Number: 4040-0004 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 [increase Award [X] Application ( Continuation * Other (Specify): O Changed/Corrected Application Revision L * 3. Date Received: 4. Applicant Identifier: [ | [oscx012079 5a. Federal Entity Identifier: 5b. Federal Award Identifier: [n/a [oscH012079 State Use Only: 6. Date Received by State: | 7. State Application Identifier: | 8. APPLICANT INFORMATION: @: Legal Name! [martcopa, COUNTY OF *b. Employer/Taxpayer Identification Number (EIN/TIN): *c, UEI: 866000472 | | [waxaenvywpps d. Address: * Street: [234 N Central Ave Street2: [ra 3 * City: [phoenix County/Parish: [Maricopa County * State: [az: Arizona | Province: [ * Country: [usa: UNITED STATES * Zip / Postal Code: [ss004-0948 e. Organizational Unit: Department Name: Division Name: Human Services [pariy Education f. Name and contact information of person to be contacted on matters involving this application: * First Name: [nickia Middle Name: | “Last Name: | Newnan’ Title: [assistant Director Organizational Affiliation: [ucusp Early Education Division * Telephone Number: (602) 372-3714 Fax Number: * Email: [nickia -newman@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): * 410. 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.): Maricopa County with Exception of the city] * 415. Descriptive Title of Applicant's Project: EHS/HS CARRY OVER FUNDS Attach supporting documents as specified in agency instructions. CRT NWY-KO3 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: |97/01/2023| . *b. End Date: |06/30/2024 18. Estimated Funding ($): *a, Federal 6,283,394] *b. Applicant | 0 | *c. State | ] *d, Local [ | *e, Other [ 0 | *f. Program Income | | *g. TOTAL [ 6,283,394] * 19. Is Application Subject to Review By State Under Executive Order 12372 Process? Oo a. This application was made available to the State under the Executive Order 12372 Process for review on [i]. im 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) DX] ** | 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: Paine e. Ss—~—s™ *FirstName: [c1int | Middle Name: [3, * Last Name: [Hickman | *Title: [chaizman, Maricopa County Board of Supervisor | * Telephone Number: | (602) 506-7642 | Fax Number: | * Email: [erint. hickman@maricopa.gov L | * Signature of Authorized Representative: Ze 7, B ~ Vi * Date Signed: NC WV 2 1 2023 ATTEST; NOV 2 1 2023 letk of the Board 32323,