false true Department of Defense (12) true Program is not covered by E.O. 12372. true New Application 0662096100000 2019-07-01 2020-06-30 0662096100000 1 2019-07-01 2020-06-30 iso4217:USD
OMB Number: 4040-0004 Expiration Date: 12/31/2022

Application for Federal Assistance SF-424

* 1. Type of Submission:
* 2. Type of Application:

State Use Only

d. Address:

e. Organizational Unit:

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

16. Congressional Districts Of:

17. Proposed Project:

18. Estimated Funding ($):

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

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

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)

** 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: