United States Environmental Protection Agency

Region 9

Application Kit

![](media/image1.png){width="2.363888888888889in"
height="2.2944444444444443in"}

Revised 11/14/08

**[Application Checklist for Awards]{.underline}** Revised 11/14/08

**Include the original and one copy of the following items in your
Application Package. (CLICK ON FORM TITLES TO ACCESS FORMS)**

-   **Application for Federal Assistance (Form SF 424)**

<http://www.whitehouse.gov/omb/grants/sf424.pdf> [and MS WORD VERSION of
SF424]{.underline}

***NOTE:* you can also apply by using
[http://www.grants.gov]{.underline} (**electronic application)

-   **Budget Information (Form SF 424A)** Section A through F

[http://www.whitehouse.gov/omb/grants/sf424a.pdf#search=\'SF%20424A](http://www.whitehouse.gov/omb/grants/sf424a.pdf#search='SF 424A)

-   **Budget Detail** -- Breakdown by Object Class Categories

(LINK TO SAMPLE PAGES 12-14 IN THIS DOC BELOW)

-   **Key People List** -- Link to Page in this Doc on page 11

-   **Work plan** - Link to Page in this Doc. on page 11

-   **Current Indirect Cost Rate Negotiation Agreement**

(Submit Rate and Signature Pages, Sections 1 and 3, along with
application)

# [ASSURANCES/CERTIFICATIONS]{.underline}

-   **Assurances (Form SF424B)**, with authorized original signature

(ALL APPLICANTS)

<http://www.acf.hhs.gov/programs/ofs/grants/sf424b.pdf>

> **Preaward Compliance Review Report for All Applicants Requesting
> Federal Financial Assistance (EPA Form 4700-4),** with authorized
> original signature (ALL APPLICANTS)
>
> [http://www.epa.gov/ogdunix1/AppKit/form/EPA%204700-4.pdf](http://www.epa.gov/ogdunix1/AppKit/form/EPA 4700-4.pdf)

-   **[Certification Regarding
    Lobbying](http://www.epa.gov/ogd/AppKit/form/Lobbying.pdf),** with
    authorized original signature (NOT APPLICABLE TO TRIBES)
    <http://www.epa.gov/ogd/AppKit/form/Lobbying.pdf>

-   **Disclosure of Lobbying Activities (Form SF-LLL)** with authorized
    original signature (NOT APPLICABLE TO TRIBES)
    <http://contacts.gsa.gov/webforms.nsf/0/E0F5394ACA9DDC4085256A3E005C7420/$file/sflllin.pdf>

-   **Procurement System Certification ([EPA Form
    5700-48](http://www.epa.gov/region01/brownfields/funding/docs/procurement_cert.pdf))**
    with authorized original signature *(*SUPERFUND RECIPENTS ONLY)
    <http://www.epa.gov/region3/grants/pdf/Procurement_Certification_EPA_5700-48.pdf>

-   **Include Program/Project Director's Email Address on page 1 of
    SF424** - Acknowledgement of Application receipt will be sent to
    Program/Project Director listed.

**[Region 9 Application Instructions]{.underline}** Revised 11/14/08

**SUBMISSION**

All applicants must apply for Federal financial assistance on Standard
Form 424 (revised 7/03). The **final** application and work plan should
be submitted by the date indicated in the application guidance letter
sent to your agency by the EPA Program Office. All OMB Standard Forms
(SF) and Circulars are also available for download at
[[http://www.whitehouse.gov/omb/grants/index.html]{.underline}](http://www.whitehouse.gov/omb/grants/index.html)

If you are requesting continuation funding for an ongoing Environmental
Program Grant under 40 CFR Part 35, your application must be submitted
*[before]{.underline}* your current grant expires. This will allow your
program to continue to incur costs without interruption. However, if the
application is received even one day late, your grant funds will be
stopped until a new grant is awarded. This may cause adverse conditions
for your program because you will be responsible for all costs until
your new grant is awarded*.*

Please submit all items noted on the enclosed Application Checklist to:

**Carolyn Truong**

**Grants Management Office, MTS-7**

##  U.S. Environmental Protection Agency

**75 Hawthorne Street**

**San Francisco, CA 94105**

**HOW TO COMPLETE YOUR APPLICATION FOR FEDERAL ASSISTANCE**

Based on the inquiries we frequently receive, we have developed the
following information to augment the instructions in the "Application
for Federal Assistance" (Standard Form 424 and 424A). Reading this
information in conjunction with the instructions for the SF-424 and the
SF-424A will help ensure that all the necessary information is included
with your submission to EPA. Questions regarding completion of the
application forms should be referred to the Grants Specialist identified
on the guidance letter accompanying this application kit.

**[Application for Federal Assistance
(SF-424)\--Facesheet]{.smallcaps}**

**Refer to the pre-printed instructions for the SF-424 on the SF-424
form. Complete all items as instructed. If a particular item does not
apply, please indicate N/A.**

**Item 1: Type of Submission:** (Required): Select one type of
submission in accordance with agency instructions.

• Preapplication

• Application

> • Changed/Corrected Application -- If requested by the agency, check
> if this submission is to change or correct a previously submitted
> application. Unless requested by the agency, applicants may not use
> this to submit changes after the closing date.

**Item 2: Type of Application**: (Required) Select one type of
application in accordance with agency instructions.

Revised 11/14/08

• New -- An application that is being submitted to an agency for the

first time.

• Continuation - An extension for an additional funding/budget period

for a project with a projected completion date. This can include

renewals.

• Revision - Any change in the Federal Government's financial obligation
or contingent liability from an existing obligation. If a revision,
enter the appropriate letter(s). More than one may be selected. If
\"Other\" is selected, please specify in text box provided.

A. Increase Award B. Decrease Award

C. Increase Duration

D. Decrease Duration

E. Other (specify)

**Item 3: Date Received:** Leave this field blank. This date will be
assigned by the Federal agency.

**Item 4: Applicant Identifier**: Enter the entity identifier assigned
by the Federal agency, if any, or applicant's control number, if
applicable.

**Item 5a: Federal Entity Identifier**: Enter the number assigned to
your organization by the Federal Agency, if any.

**Item 5b: Federal Award Identifier**: For new applications leave blank.
For a continuation or revision to an existing award, enter the
previously assigned Federal award identifier number. If a
changed/corrected application, enter the Federal Identifier in
accordance with agency instructions.

**Item 6:** **Date Received by State:** Leave this field blank. This
date will be assigned by the State, if applicable.

**Item 7:** **State Application Identifier:** Leave this field blank.
This identifier will be assigned by the State, if applicable.

**Item 8:** **Applicant Information**: Enter the following in accordance
with agency instructions:

**a.** **Legal Name**: (Required): Enter the legal name of applicant
that will undertake the assistance activity. This is the name that the
organization has registered with the Central Contractor Registry
***(Please use the same name on all applications)***. Information on
registering with CCR may be obtained by visiting the Grants.gov website.

**b.** **Employer/Taxpayer Number (EIN/TIN):** (Required): Enter the
Employer or Taxpayer Identification Number (EIN or TIN) as assigned by
the Internal Revenue Service. If your organization is not in the US,
enter 44-4444444.

**c. Organizational DUNS**: (Required) Enter the organization's DUNS or
DUNS+4 number received from Dun and Bradstreet.

Your organization may obtain a DUNS number by calling Dun & Bradstreet
at 1-866-705-5711 or through the Internet at
[[http://eupdate.dnb.com/requestoptions.html]{.underline}](http://eupdate.dnb.com/requestoptions.html)

Information on obtaining a DUNS number may also be obtained by visiting
the Grants.govwebsite.

Revised 11/14/08

**d. Address**: Enter the complete address as follows: Street address
(Line 1 required), City (Required), County, State (Required, if country
is US), Province, Country (Required), Zip/Postal Code (Required, if
country is US).

**e. Organizational Unit:** Enter the name of the primary organizational
unit (and department or division, if applicable) that will undertake the
assistance activity, if applicable.

**f. Name and contact information of person to be contacted on matters
involving this application**: Enter the name (First and last name
required), organizational affiliation (if affiliated with an
organization other than the applicant organization), telephone number
(Required), fax number, and e-mail address (Required) of the person to
contact on matters related to this application.

**Item 9:** **Type of Applicant:** (Required) Select up to three
applicant type(s) in accordance with agency instructions.

A. State Government

B. County Government

C. City or Township Government

D. Special District Government

E. Regional Organization

F. U.S. Territory or Possession

G. Independent School District

H. Public/State Controlled Institution of Higher Education

I. Indian/Native American Tribal Government (Federally Recognized)

J. Indian/Native American Tribal Government (Other than Federally
Recognized)

K. Indian/Native American Tribally Designated Organization

L. Public/Indian Housing Authority

M. Nonprofit with 501C3 IRS Status (Other than Institution of Higher
Education)

N. Nonprofit without 501C3 IRS Status (Other than Institution of Higher
Education)

O. Private Institution of Higher Education

P. Individual

Q. For-Profit Organization (Other than Small Business)

R. Small Business

S. Hispanic-serving Institution

T. Historically Black Colleges and Universities (HBCUs)

U. Tribally Controlled Colleges and Universities (TCCUs)

V. Alaska Native and Native Hawaiian Serving Institutions

W. Non-domestic (non-US) Entity

X. Other (specify)

**Item 10: Name Of Federal Agency**: (Required) Enter the name of the
Federal agency from which assistance is being requested with this
application.

Revised 11/14/08

**Item 11:** **Catalog Of Federal Domestic Assistance Number/Title:**
Enter the Catalog of Federal Domestic Assistance number and title of the
program under which assistance is requested, as found in the program
announcement, if applicable. Refer to the EPA CFDA listing in the
website:

[http://12.46.245.173/pls/portal30/CATALOG.BROWSE_AGENCY_PROGRAM_RPT.SHOW?p_arg_names=agency_id&p_arg_values=34]{.underline}

**Item 12: Funding Opportunity Number/Title:** (Required) Enter the
Funding Opportunity Number and title of the opportunity under which
assistance is requested, as found in the program announcement.

**Item 13: Competition Identification Number/Title:** Enter the
Competition Identification Number and title of the competition under
which assistance is requested, if applicable.

**Item 14: Areas Affected By Project:** List the areas or entities using
the categories (e.g., cities, counties, states, etc.) specified in
agency instructions. Use the continuation sheet to enter additional
areas, if needed.

**Item 15: Descriptive Title of Applicant's Project:** (Required) Enter
a brief descriptive title of the project. If appropriate, attach a map
showing project location (e.g., construction or real property projects).
For preapplications, attach a summary

description of the project.

**Item 16: Congressional Districts Of**: (Required)

16a. Enter the applicant's Congressional District, and

16b. Enter all District(s) affected by the program or project. Enter in
the format: 2 characters State Abbreviation -- 3 characters District
Number, e.g., CA-005 for California 5th district, CA-012 for California
12^th^ district, NC-103 for North Carolina's 103rd district.

• If all congressional districts in a state are affected, enter "all"
for the district number, e.g., MD-all for all congressional districts in
Maryland.

• If nationwide, i.e. all districts within all states are affected,
enter US-all.

• If the program/project is outside the US, enter 00-000.

**Item 17: Proposed Project Start and End Dates**: (Required) Enter the
proposed start date and end date of the project.

**Item 18: Estimated Funding:** (Required) Enter the amount requested or
to be contributed during the first funding/budget period by each
contributor. Value of in-kind contributions should be included on
appropriate lines, as applicable. If the action will

result in a dollar change to an existing award, indicate only the amount
of the change. For decreases, enclose the amounts in parentheses.

Revised 11/14/08

**Item 19: Is Application Subject to Review by State Under Executive
Order 12372 Process?** Applicants should contact the State Single Point
of Contact (SPOC) for Federal Executive Order 12372 to determine whether
the application is subject to the State intergovernmental review
process. Select the appropriate box. If "a." is selected, enter the date
the application was submitted to the State. The Office of Management and
Budget maintains a list of SPOCs at this site:
<http://www.whitehouse.gov/omb/grants/spoc.html>

Applicants must submit or fax page 1 of the application (or summary
thereof) to the SPOC Intergovernmental Review. **In addition, the
fax/submittal date must be entered on page 1 of the SF424, Block#16.**

> **CALIFORNIA** **NEVADA**
>
> Grants Coordination Coordinator
>
> State Clearinghouse Department of Administration
>
> Office of Planning & Research State Clearinghouse
>
> P.O. Box 3044, Room 212 209 E. Musser Street, Room 200
>
> Sacramento, CA 95814-3044 Carson City, Nevada 89701
>
> Telephone: (916) 445-0613 Telephone: (775) 684-0222 or 0223
>
> FAX: (916) 323-3018 Fax: (775) 684-0260
>
> Email:
> [**[state.clearinghouse@opr.ca.gov]{.underline}**](mailto:state.clearinghouse@opr.ca.gov)
> Email:
> [**rtietje@budget.state.nv.us**](mailto:rtietje@budget.state.nv.us)
>
> **GUAM** **NORTH MARIANA ISLANDS**
>
> Director Ms. Jacoba T. Seman
>
> Bureau of Budget and Mgmt. Research Federal Programs Coordinator
>
> Office of the Governor Office of Management and Budget
>
> P.O. Box 2950 Office of the Governor
>
> Agana, Guam 96910 Saipan, MP 96950
>
> Telephone: 011-671-472-2285 Telephone: (670) 664-2289
>
> Fax: 011-472-2825 Fax: (670) 664-2272

**Item 20: Is the Applicant Delinquent on any Federal Debt?** (Required)
Select the appropriate box. This question applies to the applicant
organization, not the person who signs as the authorized representative.
Categories of debt include delinquent audit disallowances, loans and
taxes. If yes, include an explanation on the continuation sheet.

**Item 21:** **Authorized Representative**: (Required) To be signed and
dated by the authorized representative of the applicant organization.
Enter the name (First and last name required) title (Required),
telephone number (Required), fax number,

and email address (Required) of the person authorized to sign

for the applicant. A copy of the governing body's authorization for you
to sign this application as the official representative must be on file
in the applicant's office. (Certain Federal agencies may require that
this authorization be submitted as part of the application.)

Revised 11/14/08

**[[Budget Information]{.underline} - Non Construction Programs
(SF-424A)]{.smallcaps}**

A complete budget must be submitted in order to be considered for
federal assistance. The application includes a two-page sheet, \"Budget
Information - Non-Construction Programs\" (Standard Form 424A), Sections
A through F. Complete Sections A, B and F. Complete Section C if
estimated funding includes other sources of non-federal funding besides
the applicant's cost share. Sections D and E are optional.

**Section A - Budget Summary**

Columns (a), (b), (c), (d), are not required. Complete columns (e), (f),
and (g). Complete column (c) if applying for unobligated federal funds
from a prior grant budget (amount must correspond with the unobligated
balance of Federal funds reported on your Financial Status Report).

Revised 11/14/08

**Section B - Budget Categories**

Enter the amounts for the COMBINED Federal and non-Federal funds
distributed by object class categories under column (5) "Total." Columns
(1) - (4) may be used to separately identify the amount of Federal
funds, recipient matching contribution, supplemental funds, etc. Column
(5), line k total should be the same as the total amount shown on the
SF-424 facesheet under item 15g.

**[A detailed budget breakdown of column (5) \"Total\" by object class
categories must be prepared and submitted with the
application.]{.underline} A sample budget breakdown is attached. (Other
formats may be used.) Refer to our Instructions under Section F - Other
Budget Information.**

**Section C - Non-Federal Resources**

Complete only if other sources of non-Federal funds are budgeted for
your project. Amounts should agree with the amounts budgeted under item
15 on the SF-424 facesheet. Refer to the pre-printed instructions for
this item on the SF-424A.

**Section D - Forecasted Cash Needs**

Optional. Refer to the pre-printed instructions for this item on the
SF-424A

**Section E - Budget Estimates of Federal Funds Needed for Balance of
the Project**

Optional. Refer to the pre-printed instructions for this item on the
SF-424A.

**Section F - Other Budget Information. Guidance for completing a
Detailed Budget to Supplement Standard Form 424A, Section B - Budget
Categories.**

A separate, detailed budget is required and must be attached to your
Application. Follow the guidelines below to support the amounts budgeted
under the following object class categories on the SF-424A:

Line 6a- **Personnel**. List all participants in the program/project by
position title, estimated time on the project, and salary during the
project period.

Line 6b - **Fringe Benefits**. Identify the fringe benefit percentage
and apply the percentage to the estimated personnel costs.

Line 6c - **Travel**. If travel is budgeted, indicate the general
purpose of the travel (e.g., in-State/local travel and out-of State
travel), number of travelers, destination and estimated costs per trip.

Line 6d - **Equipment**. List all equipment to be purchased and include
estimated costs for each item. The Federal government defines equipment
as tangible, non-expendable, personal property having a useful life of
more than one year and an acquisition cost of \$5,000 or more per unit.
Property, which does not fall into this category, should be listed as
supplies, unless your organization defines equipment at a lower
threshold by policy.

Line 6e - **Supplies**. Identify the estimated costs for general
materials and supplies (i.e. office supplies).

Revised 11/14/08

Line 6f - **Contractual.** List and describe each proposed contractual
service, the proposed procurement method (i.e. small purchase, formal
advertising, competitive negotiations/RFPs, or non-competitive
negotiations/sole source), and the estimated cost of each contract. EPA
may require review of contracts prior to their execution to assure all
costs are reasonable and necessary to the program/project. Applicants
should review EPA's regulations concerning procurement and the need to
provide justification for sole source agreements, and documentation of
cost and/or price analysis for contracts and other agreements.

Line 6g - **Construction**. List proposed construction contracts under
item 6f - Contractual.

Line 6h - **Other**. List all other direct costs, which are not included
in the above categories (i.e. telecommunication expenses, training,
etc.).

Line 6i - **Total Direct Charges (sum of 6a-6h)**

Line 6j - **Indirect Charges**. Provide an explanation of how indirect
charges were calculated for the program/project. Identify the type of
indirect cost rate (provisional, predetermined, final or fixed), the
Federal Agency with whom your rate is negotiated, the rate that is in
effect during the grant period and the base to which the rate is
applied.

Line 6k - **Totals (sum of 6i and 6j)**

Indirect costs are allocable to an EPA grant only if supported by an
Indirect Cost Rate Agreement, Cost Allocation Plan, or Indirect Cost
Rate Proposal as detailed in OMB Circulars A-87, A-122, and A-21,
depending on your organizational type. States, Tribes and educational
institutions must submit a copy of their current Negotiated Indirect
Cost Rate Agreement to EPA with their application.

Line 7 - **Program Income**. If any income is expected to be generated
from your program/project, describe the nature, source and estimated
amount. Examples of program income include registration fees collected,
income from the sale of products produced under a grant, and rental fees
generated from equipment purchased with grant funds. The EPA project
officer will negotiate the use of the program income with your agency in
accordance with Federal regulations.

[An example of a properly completed budget detail is included with this
document.]{.underline}

Revised 11/14/08

**[Assurances - Non-Construction Programs (SF-424B)]{.smallcaps}**

As an applicant for Federal Financial Assistance, you must assure that
you will comply with all applicable Federal Statutes, Executive Orders,
regulations, and policies governing the program/project. The required
Assurances must be signed by the authorized representative who signed
the SF-424 Facesheet. An original signature is required.

**[Key People List]{.smallcaps}**

Complete the enclosed "Key People List" and return it with your
application.

**[Work plan]{.smallcaps}**

Attach a copy of your proposed work plan. Additional information
regarding the requirements for an acceptable work plan may be found in
Program guidance, 40 CFR Part 35 Subpart A, and other Parts applicable
to your project. Any questions regarding the work plan or program
objectives should be discussed with your EPA Project Officer.

**Preaward Compliance Review Report for All Applicants Requesting
Federal Financial Assistance**

**(EPA Form 4700-4)**

Complete the Pre-Award Compliance Review Report, EPA Form 4700-4, and
return it with your application. If a recipient receives more than one
grant from EPA Region 9, you may choose to complete this form for all
EPA Region 9 environmental programs by indicating on the form, under
Part II "APPLICABLE TO ALL EPA, REGION 9 GRANTS". This form will be
valid for one year from the date it is received by the Grants Management
Office. All applicants should complete roman numerals I through V. If
the information in Section VI through IX does not apply to your project
or program, write N/A for "not applicable." The authorized
representative is required to sign and date the form under Section X.
Questions regarding completion of the form should be addressed to the
Office of Civil Rights, at (415) 947-4286.

**Certification Regarding Lobbying and Disclosure of Lobbying
Activities**

**(Standard Form - SFLLL)**

**Note:** Not applicable to Indian Tribes nor applicants receiving
\$100,000 or less of Federal assistance.

This requirement generally prohibits recipients of Federal grants,
cooperative agreements, contracts, and loans from using appropriated
funds for lobbying the Executive or Legislative Branches of the Federal
Government in connection with a specific grant, cooperative agreement,
contract, or loan. Each recipient who requests or receives a Federal
contract, grant, cooperative agreement, loan, or Federal commitment to
insure or guarantee a loan, must also disclose lobbying. [Each recipient
must file a certification and, if required, a disclosure form with each
submission that]{.underline}

Revised 11/14/08

[initiates agency consideration for the award of a Federal contract,
grant or cooperative agreement exceeding \$100,000.]{.underline} Any
subcontractors of the recipients receiving Federal funds in excess of
\$100,000 must also file a certification form and a disclosure
statement, if required.

The authorized representative is required to sign the form(s) which must
be filed with each application for Federal assistance. Your agency may
fulfill this requirement by filing an annual certification form with
original signatures with EPA\'s Grants Management Office. This
requirement is established in 40 CFR Part 34.

**Procurement Certification ([Superfund Recipients Only]{.underline})**

**(EPA Form 5700-48)**

All recipients of [Superfund]{.underline} assistance are required to
certify their Procurement System by completing the Procurement System
Certification (EPA Form 5700-48). An applicant may self-certify their
Procurement System if their system complies with 40 CFR 35.6550. The
authorized representative is required to sign the certification for each
application for Federal assistance. Your agency may fulfill this
requirement by filing an annual certification form with original
signatures with EPA\'s Grants Management Office. This requirement is
established in 40 CFR 35, Subpart O.

## Single Audit Act Requirements (A-133)

All recipients must comply with the Single Audit Act amendments as set
forth in OMB Circular A-133, revised June, 2003. The Act requires
recipients that expend \$500,000 or more in a year in Federal awards
from all Federal sources to have a single audit or a program-specific
audit for that year in accordance with the provisions of the Circular.
Recipients that expend less than \$500,000 a year in Federal awards are
exempt from Federal audit requirements for that year, but records must
be available for review or audit by appropriate officials of the Federal
government.

Audits shall be performed annually, unless the recipient made provisions
previously for biennial audits as set forth in paragraphs (a) and (b) of
Section .220 of the Circular. The costs of audits made in accordance
with the provisions of this Circular are allowable charges to Federal
awards. However, recipients may not charge the cost of auditing a
non-Federal entity which has Federal awards expended of less than
\$500,000 ( as of December 31, 2003) a year to a Federal award per
Section .230 of A-133.

Audit report requirements and report submission are set forth in
Sections .320 and .235 of the Circular. The recipient shall provide the
number of reporting packages described in these sections to the Federal
Audit Clearinghouse, Bureau of the Census, 1201 E. 10th Street,
Jeffersonville, IN 47132. <http://harvester.census.gov/sac/>

Revised 11/14/08

**OMB Circulars and EPA Regulations**

You should be familiar with the Federal requirements that govern Federal
grants before you apply. These requirements often vary depending on your
organization type and are established in law, Executive Order, Federal
regulation, and the OMB Circulars.

**[OMB Circulars:]{.underline}**

**2 CFR, Part 220** Principles for Determining Costs Applicable to
Grants, Contracts,

**(formerly known as A-21)** and other Agreements with Educational
Institutions

**2 CFR, Part 225** Cost Principles for State, Local and Indian Tribal
Governments

**(formerly known as A-87)**

**2 CFR, Part 230** Cost Principles for Non-Profit Organizations

**(formerly known as A-122)**

**A-102** Grants and Cooperative Agreements with State and Local

> Governments

**2 CFR, Part 215** Grants and Cooperative Agreements with Institutions
of

**(formerly known as A-110)** Higher Education, Hospitals, and other
Non-Profit Organizations

**A-133** Audits of States, Local Governments, and Non-Profit
Organizations.

[**Some applicable EPA Regulations**:]{.underline}

**40 CFR, Part 30** Uniform Administrative Requirements for Grants and
Agreements with Institutions of Higher Education, Hospitals and Other
Non-Profit Institutions

**31** Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments and Indian Tribes

**35** State, Local, and Tribal Assistance

To obtain sections of the 40 Code of Federal Regulations (CFR), Parts
1-49, refer to the website <http://www.epa.gov/epahome/cfr40.htm>

To obtain the printed 40 Code of Federal Regulations (CFR), Parts 1-49,
you may contact:

Superintendent of Documents (phone# (202) 512-1803)

United States Government Printing Office (USGPO)

P.O. Box 371954

Pittsburgh, PA 15250-7954

**Catalog of Federal Domestic Assistance (CFDA) Number:**

Block 10 of the SF424 Application requires a CFDA number. A listing of
all current EPA assistance programs and their CFDA numbers can be found
at [http://www.cfda.gov]{.underline}

EPA numbers begin with 66.001. CFDA numbers are regularly created, so
refer to this web site often.

Revised 11/14/08

**[KEY PEOPLE LIST]{.underline}**

**Please show street address as well as Post Office Box Number where
applicable.**

**[AGENCY/ORGANIZATION DIRECTOR]{.underline}**

**(Individual who is authorized to sign the assistance agreement
application and award acceptance.)**

**NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

## TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 

**EMAIL ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**[PROGRAM/PROJECT DIRECTOR]{.underline}**

(Technical program director or person responsible for the project as a
contact person in Block #5 of the application.)

**NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

## TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 

**EMAIL ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**[FINANCE DIRECTOR]{.underline}**

(Individual responsible for maintaining the accounting and financial
management system supporting expenditures, preparing the financial
reports, etc.)

**NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

## TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 

## EMAIL ADDRESS: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

### \*\*An Email Acknowledgement of Application receipt will be sent to Program/Project Director listed on page 1 of Form SF424\*\*

**OPTIONAL FORMAT** Revised 11/14/08

SAMPLE BUDGET DETAIL FORMAT

*The detail for each object class category must be provided. Formats may
vary, but all information below should be included in your application.*

a\. PERSONNEL

+------------------------+-------+------------+---------+-------------+
| **POSITION**           | **NUM | **SALARY** | #       | **AMOUNT**  |
|                        | BER** |            | ### WOR |             |
|                        |       |            | K YEARS |             |
+------------------------+-------+------------+---------+-------------+
|                        |       |            |         |             |
+------------------------+-------+------------+---------+-------------+
|                        |       |            |         |             |
+------------------------+-------+------------+---------+-------------+
|                        |       |            |         |             |
+------------------------+-------+------------+---------+-------------+
|                        |       |            |         |             |
+------------------------+-------+------------+---------+-------------+
|                        |       |            |         |             |
+------------------------+-------+------------+---------+-------------+
| **a. Personnel Total** |       |            |         |             |
+------------------------+-------+------------+---------+-------------+

b\. FRINGE BENEFITS

+----------------------------------+-----------------------------------+
| ##### BASE                       |                                   |
+----------------------------------+-----------------------------------+
| ##### RATE                       | **%**                             |
+----------------------------------+-----------------------------------+
| **b. FRINGE BENEFITS TOTAL**     |                                   |
+----------------------------------+-----------------------------------+

**c. TRAVEL -- List trips planned, destination, dates, and the amounts
per trip. Please separate local travel and out-of-state travel.**

+---------------------------------------------+------------------------+
| **TRAVEL EXPENSES**                         | **AMOUNT**             |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| **Explain:                                  |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\                 |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                        |
|                                             |                        |
| **\_                                        |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                        |
|                                             |                        |
| **\_                                        |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                        |
|                                             |                        |
| **\_                                        |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                        |
|                                             |                        |
| **c. TRAVEL TOTAL:**                        |                        |
+---------------------------------------------+------------------------+

**d. EQUIPMENT**: Tangible, non-expendable, personal property having a
useful life of more than one year and an acquisition cost of \$5,000 or
more per unit. Applicant's definition of equipment may be used provided
the definition at least includes all items previously defined above.

  ----------------------------- ------------ ----------- -----------------
  **ITEM**                      **NUMBER**   **COST PER  **TOTAL**
                                             UNIT**      

                                                         

                                                         

                                                         

                                                         

  **d. EQUIPMENT TOTAL**                                 
  ----------------------------- ------------ ----------- -----------------

**e. SUPPLIES**

  ----------------------------- ------------ ----------- -----------------
  **ITEM**                      **NUMBER**   **COST PER  **TOTAL**
                                             UNIT**      

                                                         

                                                         

                                                         

  **e. SUPPLIES TOTAL**                                  
  ----------------------------- ------------ ----------- -----------------

**f. CONTRACTUAL** \[List each planned contract separately, type of
service to be procured, **proposed procurement method (i.e. small
purchase, sealed bids, competitive proposals)** and the estimated cost\]

  ---------------------------------- ------------------- ----------------
  **ITEM**                           **PROCUREMENT       **TOTAL**
                                     METHOD**            

                                                         

                                                         

                                                         

                                                         

  **f. CONTRACTUAL TOTAL**                               
  ---------------------------------- ------------------- ----------------

**g. CONSTRUCTION (N/A)**

**h. OTHER**

  ----------------------------- ------------ ----------- -----------------
  **ITEM**                      **NUMBER**   **COST PER  **TOTAL**
                                             UNIT**      

                                                         

                                                         

                                                         

                                                         

  **h. OTHER TOTAL**                                     
  ----------------------------- ------------ ----------- -----------------

  ----------------------------------- -----------------------------------
  **i. TOTAL DIRECT COSTS**           **\$**

  **j. INDIRECT COSTS**               **(BASE \$\_\_\_\_\_\_\_ x RATE
                                      \_\_\_\_% = INDIRECT COSTS)**

  **k. TOTAL PROPOSED COSTS**         **\$**

  **FEDERAL FUNDS REQUESTED**         **\$**

  **RECIPIENT SHARE (MATCH)**         **\$**

  **RECIPIENT SHARE OF TOTAL PROPOSED **%**
  COSTS**                             

  **FEDERAL SHARE OF TOTAL PROPOSED   **%**
  COSTS**                             
  ----------------------------------- -----------------------------------

###### Region 9

###### SAMPLE

COMPLETED BUDGET SF424 A AND BUDGET DETAIL (BREAKDOWN BY OBJECT CLASS
CATEGORIES

+--------+--------+---------+---------+---------+---------+--------+
| **     |        |         |         |         |         |        |
| BUDGET |        |         |         |         |         |        |
| I      |        |         |         |         |         |        |
| NFORMA |        |         |         |         |         |        |
| TION - |        |         |         |         |         |        |
| Non-   |        |         |         |         |         |        |
| Constr |        |         |         |         |         |        |
| uction |        |         |         |         |         |        |
| Prog   |        |         |         |         |         |        |
| rams** |        |         |         |         |         |        |
| **OMB  |        |         |         |         |         |        |
| Ap     |        |         |         |         |         |        |
| proval |        |         |         |         |         |        |
| No.    |        |         |         |         |         |        |
| 0348-  |        |         |         |         |         |        |
| 0044** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **S    |        |         |         |         |         |        |
| ECTION |        |         |         |         |         |        |
| A -    |        |         |         |         |         |        |
| BUDGET |        |         |         |         |         |        |
| SUM    |        |         |         |         |         |        |
| MARY** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| *      | **C    | **Es    |         | **New   |         |        |
| *Grant | atalog | timated |         | or      |         |        |
| Pro    | of     | Unob    |         | Revised |         |        |
| gram** | Fed    | ligated |         | B       |         |        |
|        | eral** | Funds** |         | udget** |         |        |
| **Func |        |         |         |         |         |        |
| tion** | **Do   |         |         |         |         |        |
|        | mestic |         |         |         |         |        |
| **or   | Assist |         |         |         |         |        |
| Acti   | ance** |         |         |         |         |        |
| vity** |        |         |         |         |         |        |
|        | **Nu   |         |         |         |         |        |
| *      | mber** |         |         |         |         |        |
| *(a)** |        |         |         |         |         |        |
|        | *      |         |         |         |         |        |
|        | *(b)** |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
|        |        | **Fe    | *       | **Fe    | *       | **T    |
|        |        | deral** | *Non-Fe | deral** | *Non-Fe | otal** |
|        |        |         | deral** |         | deral** |        |
|        |        | **(c)** |         | **(e)** |         | *      |
|        |        |         | **(d)** |         | **(f)** | *(g)** |
+--------+--------+---------+---------+---------+---------+--------+
| **1.   | **66   | **\$**  | **\$**  | **\$46  | **\$15  | *      |
| PWSS** | .432** |         |         | 5,000** | 5,000** | *\$620 |
|        |        |         |         |         |         | ,000** |
+--------+--------+---------+---------+---------+---------+--------+
| 2\.    |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| 3\.    |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| 4\.    |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| 5\.    |        |         |         | **\$46  | **\$15  | *      |
| **TO   |        |         |         | 5,000** | 5,000** | *\$620 |
| TALS** |        |         |         |         |         | ,000** |
+--------+--------+---------+---------+---------+---------+--------+
| **S    |        |         |         |         |         |        |
| ECTION |        |         |         |         |         |        |
| B -    |        |         |         |         |         |        |
| BUDGET |        |         |         |         |         |        |
| CATEGO |        |         |         |         |         |        |
| RIES** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **6.   |        | **GRANT |         |         |         | **T    |
| OBJECT |        | P       |         |         |         | otal** |
| CLASS  |        | ROGRAM, |         |         |         |        |
| CATEGO |        | F       |         |         |         | *      |
| RIES** |        | UNCTION |         |         |         | *(5)** |
|        |        | OR      |         |         |         |        |
|        |        | ACT     |         |         |         |        |
|        |        | IVITY** |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
|        |        | **(1)** | **(2)** | **(3)** | **(4)** |        |
|        |        | Federal | Match   |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **a.   |        | \$      | \       | **\$**  | **\$**  | \$     |
| Perso  |        | 233,243 | $77,750 |         |         | 3      |
| nnel** |        |         |         |         |         | 10,993 |
+--------+--------+---------+---------+---------+---------+--------+
| **b.   |        | 48,981  | \       |         |         | 65,308 |
| Fringe |        |         | $16,327 |         |         |        |
| Bene   |        |         |         |         |         |        |
| fits** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **c.   |        | 15,179  | 0       |         |         | 15,179 |
| Tr     |        |         |         |         |         |        |
| avel** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **d.   |        | 20,000  | 32,000  |         |         | 52,000 |
| Equip  |        |         |         |         |         |        |
| ment** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **e.   |        | 8,650   | 0       |         |         | 8,650  |
| Supp   |        |         |         |         |         |        |
| lies** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **f.   |        | 60,000  | 0       |         |         | 60,000 |
| C      |        |         |         |         |         |        |
| ontrac |        |         |         |         |         |        |
| tual** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **g.   |        | 0       | 0       |         |         | 0      |
| Co     |        |         |         |         |         |        |
| nstruc |        |         |         |         |         |        |
| tion** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **h.   |        | 8,391   | 5,404   |         |         | 13,795 |
| O      |        |         |         |         |         |        |
| ther** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **i.   |        | 394,444 | 131,481 |         |         | 5      |
| Total  |        |         |         |         |         | 25,925 |
| Direct |        |         |         |         |         |        |
| C      |        |         |         |         |         |        |
| harges |        |         |         |         |         |        |
| (sum   |        |         |         |         |         |        |
| of     |        |         |         |         |         |        |
| 6a -   |        |         |         |         |         |        |
| 6h)**  |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **j.   |        | 70,556  | 23,519  |         |         | 94,075 |
| In     |        |         |         |         |         |        |
| direct |        |         |         |         |         |        |
| Cha    |        |         |         |         |         |        |
| rges** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **k.   |        | 465,000 | 155,000 |         |         | **620  |
| TOTALS |        |         |         |         |         | ,000** |
| (sum   |        |         |         |         |         |        |
| of 6i  |        |         |         |         |         |        |
| and    |        |         |         |         |         |        |
| 6j)**  |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
|        |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+
| **7.   |        | **\$**  | **\$**  | **\$**  | **\$**  | **\$   |
| P      |        |         |         |         |         | 0**    |
| rogram |        |         |         |         |         |        |
| In     |        |         |         |         |         |        |
| come** |        |         |         |         |         |        |
+--------+--------+---------+---------+---------+---------+--------+

+------------------+---------+---------+---------+---------+---------+
| **[SAMPL         |         |         |         |         |         |
| E]{.underline}** |         |         |         |         |         |
| SECTION C -      |         |         |         |         |         |
| NON-FEDERAL      |         |         |         |         |         |
| RESOURCES        |         |         |         |         |         |
| Standard Form    |         |         |         |         |         |
| 424A (4-88)      |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| **(a) Grant      |         | **(b)   | **(c)   | **(d)   | **(e)   |
| Program**        |         | Appl    | State** | Other   | T       |
|                  |         | icant** |         | So      | OTALS** |
|                  |         |         |         | urces** |         |
+------------------+---------+---------+---------+---------+---------+
| 8\. PWSS         |         | \$      | \$      | \$      | 155     |
|                  |         | 155,000 |         |         | ,000.00 |
+------------------+---------+---------+---------+---------+---------+
| 9\.              |         |         |         |         | 0.00    |
+------------------+---------+---------+---------+---------+---------+
| 10\.             |         |         |         |         | 0.00    |
+------------------+---------+---------+---------+---------+---------+
| 11\.             |         |         |         |         | 0.00    |
+------------------+---------+---------+---------+---------+---------+
| 12\. TOTAL (sum  |         | 155     | \$ 0.00 | \$ 0.00 | 155     |
| of lines 8 and   |         | ,000.00 |         |         | ,000.00 |
| 11)              |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| **SECTION D -    |         |         |         |         |         |
| FORECASTED CASH  |         |         |         |         |         |
| NEEDS**          |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 13\. Federal     | *       | **1st   | **2nd   | **3rd   | **4th   |
|                  | *(Total | Qu      | Qu      | Qu      | Qu      |
|                  | for 1st | arter** | arter** | arter** | arter** |
|                  | Year)** |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
|                  | \$      | 116,250 | 116,250 | 116,250 | 116,250 |
|                  | 465,000 |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 14\. NonFederal  | \$      | 38,750  | 38,750  | 38,750  | 38,750  |
|                  | 155,000 |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 15\. TOTAL (sum  | 620,000 | 155,000 | 155,000 | 155,000 | 155,000 |
| of lines 13 and  |         |         |         |         |         |
| 14)              |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| **SECTION E -    |         |         |         |         |         |
| BUDGET ESTIMATES |         |         |         |         |         |
| OF FEDERAL FUNDS |         |         |         |         |         |
| NEEDED FOR       |         |         |         |         |         |
| BALANCE OF THE   |         |         |         |         |         |
| PROJECT**        |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| **(a) Grant      |         | *       |         |         |         |
| Program**        |         | *FUTURE |         |         |         |
|                  |         | FUNDING |         |         |         |
|                  |         | PERIODS |         |         |         |
|                  |         | (Y      |         |         |         |
|                  |         | ears)** |         |         |         |
+------------------+---------+---------+---------+---------+---------+
|                  |         | **(b)   | **(c)   | **(d)   | **(e)   |
|                  |         | First** | S       | Third** | F       |
|                  |         |         | econd** |         | ourth** |
+------------------+---------+---------+---------+---------+---------+
| 16\.             |         | \$      | \$      | \$      | \$      |
+------------------+---------+---------+---------+---------+---------+
| 17               |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 18\.             |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 19\.             |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 20\. TOTALS (sum |         | \$0.00  | \$ 0.00 | \$ 0.00 | \$ 0.00 |
| of lines 16 -    |         |         |         |         |         |
| 19)              |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| **SECTION F -    |         |         |         |         |         |
| OTHER BUDGET     |         |         |         |         |         |
| INFORMATION**    |         |         |         |         |         |
|                  |         |         |         |         |         |
| (Attach          |         |         |         |         |         |
| additional       |         |         |         |         |         |
| sheets if        |         |         |         |         |         |
| Necessary)       |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+
| 21\. Direct      |         |         | 22\.    |         |         |
| Charges:         |         |         | I       |         |         |
| \$525,925        |         |         | ndirect |         |         |
|                  |         |         | C       |         |         |
|                  |         |         | harges: |         |         |
|                  |         |         | \       |         |         |
|                  |         |         | $94,075 |         |         |
+------------------+---------+---------+---------+---------+---------+
| 23\. Remarks:    |         |         |         |         |         |
| *Please include  |         |         |         |         |         |
| anything not     |         |         |         |         |         |
| fully explained  |         |         |         |         |         |
| in the budget    |         |         |         |         |         |
| detail (i.e.     |         |         |         |         |         |
| Indirect Cost    |         |         |         |         |         |
| Rate, Base,      |         |         |         |         |         |
| etc.)*           |         |         |         |         |         |
|                  |         |         |         |         |         |
| **INDIRECT COST  |         |         |         |         |         |
| RATE = 25%**     |         |         |         |         |         |
+------------------+---------+---------+---------+---------+---------+

**OPTIONAL FORMAT**

SAMPLE BUDGET DETAIL FORMAT

*The detail for each object class category must be provided. Formats may
vary, but all information below should be included in your application.*

a\. PERSONNEL

+------------------------+-------+------------+---------+-------------+
| **POSITION**           | **NUM | **SALARY** | #       | **AMOUNT**  |
|                        | BER** |            | ### WOR |             |
|                        |       |            | K YEARS |             |
+------------------------+-------+------------+---------+-------------+
| Lab Assistant 1        | 2     | \$22,500   | 1       | \$45,000    |
+------------------------+-------+------------+---------+-------------+
| Lab Assistant 2        | 1     | 20,000     | 1       | 20,000      |
+------------------------+-------+------------+---------+-------------+
| Env. Engineer II       | 2     | 38875      | 1       | 77,750      |
+------------------------+-------+------------+---------+-------------+
| Microbiologist IV      | 1     | 44,000     | 2       | 88,000      |
+------------------------+-------+------------+---------+-------------+
| Env. Health Specialist | 1     | 23,976     | 0.33    | 7,912       |
+------------------------+-------+------------+---------+-------------+
| Chemist III            | 1     | 50,000     | 1       | 50,000      |
+------------------------+-------+------------+---------+-------------+
| Health Assistant       | 1     | 22,331     | 1       | 22,331      |
+------------------------+-------+------------+---------+-------------+
| **a. Personnel Total** |       |            |         | \$310,993   |
+------------------------+-------+------------+---------+-------------+

b\. FRINGE BENEFITS

+----------------------------------+-----------------------------------+
| ##### BASE (personnel)           | \$310,993                         |
+----------------------------------+-----------------------------------+
| ##### RATE                       | 21%                               |
+----------------------------------+-----------------------------------+
| **b. FRINGE BENEFITS TOTAL**     | \$65,308                          |
+----------------------------------+-----------------------------------+

**c. TRAVEL -- List trips planned, destination, dates, and the amounts
per trip. Please separate local travel and out-of-state travel.**

+---------------------------------------------+------------------------+
| **TRAVEL EXPENSES**                         | **AMOUNT**             |
+---------------------------------------------+------------------------+
| ##### OUT-OF-STATE TRAVEL                   | \$4,437                |
|                                             |                        |
| Philadelphia, PA (2 People)                 |                        |
+---------------------------------------------+------------------------+
| Las Vegas, NV (1 Person)                    | \$1,000                |
+---------------------------------------------+------------------------+
| Washington, DC (2 People)                   | \$2,400                |
+---------------------------------------------+------------------------+
| San Francisco, CA (3 People)                | \$3,000                |
+---------------------------------------------+------------------------+
| LOCAL TRAVEL                                | \$4,342                |
+---------------------------------------------+------------------------+
| **Explain:                                  |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\                 |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                        |
|                                             |                        |
| -Trips are scheduled to attend the American |                        |
| Water Works Conference, Regional Workshop   |                        |
| on New Regulations, Grant Negotiations, and |                        |
| Grant Workshop.                             |                        |
|                                             |                        |
| Out of State Travel - \$10,837              |                        |
|                                             |                        |
| Local Travel - \$4,342                      |                        |
|                                             |                        |
| Based on an estimate for mileage            |                        |
| (\$.20/mile), \$45/day maximum lodging, and |                        |
| \$20/day maximum for meals.                 |                        |
|                                             |                        |
| Travel total = \$15,179                     |                        |
|                                             |                        |
| **c. TRAVEL TOTAL: \$15,179**               |                        |
+---------------------------------------------+------------------------+

**d. EQUIPMENT**: Tangible, non-expendable, personal property having a
useful life of more than one year and an acquisition cost of \$5,000 or
more per unit. Applicant's definition of equipment may be used provided
the definition at least includes all items previously defined above.

  ----------------------------- ------------ ----------- -----------------
  **ITEM**                      **NUMBER**   **COST PER  **TOTAL**
                                             UNIT**      

  Recycling Composter           2            \$16,000    \$32,000

  Computers                     4            1,750       7,000

  Monitors                      4            584         2,336

  Laser Printers                2            1,389       2,778

  File Cabinets                 2            443         886

  Water Quality Monitor         1            7,000       7,000

  **d. EQUIPMENT TOTAL**                                 **\$52,000**
  ----------------------------- ------------ ----------- -----------------

**e. SUPPLIES**

  ----------------------------- ------------ ----------- -----------------
  **ITEM**                      **NUMBER**   **COST PER  **TOTAL**
                                             UNIT**      

  Office Supplies (post-its,    Multiple     Various     \$1,100
  pen, paper)                                            

  Field Survey Supplies         Multiple     Various     2,600

  Lab Supplies (beakers,        Multiple     Various     1,200
  pipettes)                                              

  Software for Computers (MS    4            \$387.50    1,550
  Office)                                                

  Printing Supplies for         Multiple     Various     \$2,200
  Brochures                                              

  **e. SUPPLIES TOTAL**                                  **\$8,650**
  ----------------------------- ------------ ----------- -----------------

**f. CONTRACTUAL** \[List each planned contract separately, type of
service to be procured, **proposed procurement method (i.e. small
purchase, sealed bids, competitive proposals)** and the estimated cost\]

  ------------------------------ ------------------- --------------------
  **ITEM**                       **PROCUREMENT       **TOTAL**
                                 METHOD**            

  Env. Engineer - Consultant     Competitive         \$24,100
                                 Proposals           

  Hydrologist                    Competitive         25,900
                                 Proposals           

  GIS Survey                     Small Purchase      3,500

  Lab Sample Analysis            Small Purchase      6,500

  **f. CONTRACTUAL TOTAL**                           **\$60,000**
  ------------------------------ ------------------- --------------------

**g. CONSTRUCTION (N/A)**

**h. OTHER**

+----------------------------+-----------+----------+-----------------+
| **ITEM**                   | *         | **COST   | **TOTAL**       |
|                            | *NUMBER** | PER      |                 |
|                            |           | UNIT**   |                 |
+----------------------------+-----------+----------+-----------------+
| Repairs -- Computers       |           |          | \$2,500         |
+----------------------------+-----------+----------+-----------------+
| Repairs -- Vehicle         |           |          | 3,500           |
| Maintenance                |           |          |                 |
+----------------------------+-----------+----------+-----------------+
| Phone -- Long Distance     |           |          | 1,200           |
|                            |           |          |                 |
| (not in Indirect Cost      |           |          |                 |
| Pool)                      |           |          |                 |
+----------------------------+-----------+----------+-----------------+
| Rental of Conference Rooms |           |          | 4,200           |
|                            |           |          |                 |
| (4 days@\$1,050/day) for   |           |          |                 |
| training                   |           |          |                 |
+----------------------------+-----------+----------+-----------------+
| Postage                    |           |          | 595             |
+----------------------------+-----------+----------+-----------------+
| Printing for Reports       |           |          | 1,800           |
| (Distributed at            |           |          |                 |
| Conference)                |           |          |                 |
+----------------------------+-----------+----------+-----------------+
| **h. OTHER TOTAL**         |           |          | **\$13,795**    |
+----------------------------+-----------+----------+-----------------+

+----------------------------------+-----------------------------------+
| **i. TOTAL DIRECT COSTS**        | **\$525,925**                     |
+----------------------------------+-----------------------------------+
| **j. INDIRECT COSTS**            | **Base= Personnel and Fringe      |
|                                  | Benefits**                        |
|                                  |                                   |
|                                  | **BASE \$376,301 x RATE 25% =     |
|                                  | \$94,075**                        |
+----------------------------------+-----------------------------------+
| **k. TOTAL PROPOSED COSTS**      | **\$620,000**                     |
+----------------------------------+-----------------------------------+
| **FEDERAL FUNDS REQUESTED**      | **\$465,000**                     |
+----------------------------------+-----------------------------------+
| **RECIPIENT SHARE (MATCH)**      | **\$155,000**                     |
+----------------------------------+-----------------------------------+
| **RECIPIENT SHARE OF TOTAL       | **25%**                           |
| PROPOSED COSTS**                 |                                   |
+----------------------------------+-----------------------------------+
| **FEDERAL SHARE OF TOTAL         | **75%**                           |
| PROPOSED COSTS**                 |                                   |
+----------------------------------+-----------------------------------+