SF-424 FY2025 FUNDING APPLICATION.PDF

C-22-22-174-X-13
OMB Number: 4040-0004
Expiration Date: 12/31/2022

Application for Federal Assistance SF-424

* 1, Type of Submission:

[_] Preapplication [_] New

Application

[_] Changed/Corrected Application | [_] Revision |

Continuation

* 2. Type of Application: * If Revision, select appropriate letter(s):

* Other (Specify):

* 3. Date Received:

4. Applicant Identifier:

| [o9cx012079

5a. Federal Entity Identifier:

5b. Federal Award Identifier:

[va

[osc012079

State Use Only:

6. Date Received by State: [sd

7. State Application Identifier: |

8. APPLICANT INFORMATION:

a. Legal Name: [Maricopa, County Of

* b, Employer/Taxpayer Identification Number (EIN/TIN): *c. UEI:

866000472 | [watNFEVYWDDS

d. Address:

* Streett: [234 N Central Ave |
Street2: [r2 3 |

* City: [Phoenix
County/Parish: [mari copa County |

* State: az: Arizona |
Province:

* Country: [usa: UNITED STATES |

* Zip / Postal Code: [ss004-0948

e. Organizational Unit:

Department Name:

Division Name:

Human Services

[zariy Education

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: * First Name: [nixed
Middle Name: |

* Last Name: [Thomas
Suffix: N/A

Title: |Assistant Director

Organizational Affiliation:

[mcesp Early Education Division

“Telephone Number: | (692) 372-3710

Fax Number:

* Email: [nikki .thomas@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:

[acr-Head Start

11. Catalog of Federal Domestic Assistance Number:

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 with the exception of CIty

* 15. Descriptive Title of Applicant's Project:

Head Start and Early Head Start

Attach supporting documents as specified in agency instructions.

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: |97/01/2024 *b. End Date: |06/30/2025

18. Estimated Funding ($):

* a. Federal | 21,817, 858|
* b. Applicant | 5,454, 463]
*c. State |
* d. Local |
* e. Other o|
*f. Program Income |
*g. TOTAL | 27,272,321

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

im a. This application was made available to the State under the Executive Order 12372 Process for review on [se
LC 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)

[_] * 1 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:

Middle Name: | |

* Last Name: [se11ers :

Title: [chairman, Maricopa County Board of Supervisor |

* Telephone Number: (602) 506-3416 | Fax Number:

* Email: [jack.sellers@maricopa.gov

* Signature of Authorized Representative:

* Date Signed: [