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U.S. DEPARTMENT OF EDUCATION FORM APPROVED

WASHINGTON, DC 20202-6244 OMB NO. 1810-0657

EXPIRATION DATE: 

IMPACT AID PROGRAM

INSTRUCTIONS FOR COMPLETING APPLICATION FOR DISCRETIONARY 

CONSTRUCTION PROGRAM, SECTION 8007(b), ELEMENTARY AND SECONDARY 

EDUCATION ACT

Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a 

collection of information unless such collection displays a valid OMB control number. 

Public reporting burden for this collection of information is estimated to average 4.5 hours 

per response, including time for reviewing instructions, searching existing data sources, 

gathering and maintaining the data needed, and completing and reviewing the collection of 

information. The obligation to respond to this collection is required to obtain or retain 

benefit (20 USC 7707(b) Elementary and Secondary Education Act, as amended). Send 

comments regarding the burden estimate or any other aspect of this collection of information, 

including suggestions for reducing this burden, to the U.S. Department of Education, Impact 

Aid Program, U.S. Department of Education, 400 Maryland Ave., S.W., Washington, D.C. 

20202-6244 or email ICDocketMgr@ed.gov and reference the OMB Control Number 

1810-0657. 

Please read these instructions and the application notice carefully before you complete the 

application. You should also review the authorizing statute (section 8007(b) of the Elementary

and Secondary Education Act) and regulations (34 CFR Part 222), which provide detailed 

eligibility requirements, definitions of terms, and the specific requirements of various sections of 

the law. The authorizing legislation and regulations are available on the Impact Aid Program 

(IAP) Internet web site, www.ed.gov/offices/OESE/ImpactAid, or from the IAP. If you need 

further assistance in preparing this application please call the IAP at 202/260-3858.

WHO MAY APPLY

A limited number of local educational agencies (LEAs) that are eligible for funding under the 

Impact Aid Program and that meet certain fiscal capacity and effort requirements may apply for 

assistance under the discretionary construction program. See the program regulations at 

34 CFR 222.170 for complete eligibility requirements.

HOW AND WHEN TO APPLY

The deadline for submitting this electronic application is 4:30 p.m., Washington, D.C. time, 

__________________________.

Also, fax the original signed copies of the application cover page to the U.S. Department of 

Education Impact Aid Program by 4:30 p.m., Washington, D.C. time, on the deadline date. An 

applicant for an emergency grant must also submit by fax a signed certification by a local 
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official, on letterhead, that the deficiency in the school facility identified in the application 

threatens the health or safety of the occupants or prevents the use of all or a portion of the 

building. An application cannot be considered timely filed and eligible for consideration for 

funding unless all of these documents are received by the application deadline.

The fax number for the Application Control Center is (866) 799-1272

When an LEA submits the application to the U.S. Department of Education, it must forward a 

complete copy of the application to its state educational agency (SEA). At the same time, if its 

state participates in the Executive Order 12372 review process, it must submit a copy of the 

application to its state's designated single point of contact.

COVER PAGE

(PAGE 1)

Emergency Grant

An applicant that wishes to apply for funding for more than one school facility must submit a 

separate application for each school facility.

Federal Debt Delinquency

Check Yes if the applicant’s organization is delinquent on any Federal debt. (This question 

refers to the applicant’s organization and not to the person who signs as the authorized 

representative. Categories of debt include delinquent audit disallowances, loans and taxes.) 

Otherwise, check No.

Applicant’s DUNS Number

Enter the LEA’s DUNS number that is used on the LEA’s section 8003 or section 8002 

application. This number also may be found on any Impact Aid payment voucher the LEA has 

received since 1999. 

Applicant’s Taxpayer Identification Number

Enter the LEA’s taxpayer identification number as assigned by the Internal Revenue Service.

Applicant’s Impact Aid Number

Enter the LEA’s Impact Aid Number that is used on the LEA’s section 8003 or section 8002 

application. This number also may be found on any Impact Aid payment voucher the LEA has 

received.
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LEA Identification and Address

Make corrections to the LEA name and address information that is displayed, if necessary.

Contact Person

Enter the name, title, phone and fax numbers, and e-mail address of the appropriate person to be 

contacted at the LEA if there are questions regarding this application.

Name of School Facility

Enter the name of the school facility for which funding is requested. An applicant that wishes to 

apply for funding for more than one school facility must submit a separate application for each 

school facility. 

Enrollment 

Enter the total enrollment in this school facility for school year 2010-2011 as of the survey date 

reported on the local educational agency’s fiscal year 2008 application for section 8003. 

Executive Order 12372 Review

Enter the date the LEA’s application was submitted to its state for review. If the applicant’s state 

does not participate in this review process or has not selected this program for review, enter N/A 

(for not applicable). See the appendix for additional information.

Authorized Representative Certification

Enter the name and title of the LEA’s authorized representative. The representative must sign 

and date the cover page of the application, the Impact Aid Program Assurances and 

Certifications page, the Assurances for Construction Programs, and the Additional Department 

of Education Construction Assurances. 

The IAP cannot consider an application for funding unless it is complete and timely filed. This 

means that the forms must be submitted electronically and the signature pages must be faxed by

the application deadline.

ADDITIONAL INFORMATION

(PAGE 2)

Interest in School Facility

Check Own, Lease or Other. If you check Lease, enter the expiration date of the lease. If you 

check Other, provide additional information describing the arrangement for use of the building.
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Type of Special District

If the applicant is a charter school, Alaskan Rural Education Attendance Area, or coterminous 

district, please check the appropriate box.

Age of School Facility

Enter the year the facility was built. If this building has had major renovations or additions since 

the original construction, enter the year and describe the nature of the renovation (e.g., 

replacement of roof, replacement of heating, ventilation and air conditioning system, 

construction of additional classrooms).

Acreage in LEA

Enter the total acres of land within the boundaries of the LEA. Enter the total acres of 

nontaxable Federal property within the boundaries of the LEA. Applicants may include Federal 

property that is not eligible for payments under section 8002 in the second figure.

Bonded Indebtedness

Enter the maximum bonding capacity of the LEA. Enter the amount of bonded debt owed by the 

LEA. Both these amounts must be as of the end of the LEA’s 2003-2007 school year. 

Assessed Value

For each taxing jurisdiction within the LEA, enter the total assessed value of the real property 

(land and improvements) in the LEA that was taxed for school purposes for school year 2010-

2011. Most LEAs have a single taxing jurisdiction and may use just one line on this form to 

enter their data. Some LEAs contain multiple jurisdictions such as townships or are located in 

more than one jurisdiction such as two counties and must use multiple lines on this form.

PROJECT NARRATIVE FOR EMERGENCY GRANT APPLICATION

(PAGE 3)

Enter the proposed start and end dates for the project.

Prepare a complete but succinct description of the proposed project that includes the following 

information:

 Detailed description of the nature and scope of the emergency condition

 Identify which mechanical systems are impacted

 How much of the building is involved
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 Identify the population affected (students, teachers, administrators, etc.)

 Identify the proportion of the building occupants affected by the condition. 

Describe how the emergency condition adversely affects the health, safety and well-being of the 

occupants of the school facility.

Describe any actions the applicant has taken to respond to the emergency condition, and why the 

applicant has been unable to resolve the condition.

Describe how the proposed project will address the emergency condition, and indicate the 

potential effects of delaying the project, including increased future costs.

Describe the proposed project in detail. Provide information on how the proposed project will 

address the emergency condition. Include a timeline of major activities such as design, contract 

solicitation and award, and construction begin and end dates. 

Report other resources available to the LEA that can be used for this project. Include anticipated 

receipts such as state construction grants, which the LEA has not actually yet received. 

Limit the length of the project narrative to the space provided on the form. Do not include 

supplemental drawings, photographs, or other extraneous materials relating to the proposed 

project as the reviewers will not consider them. 

INDEPENDENT CERTIFICATION FOR EMERGENCY GRANT APPLICATION

(PAGE 4)

Enter the name, title and organization of the certifying local official. An application for an 

emergency grant must include a signed statement on this form from an appropriate certifying

official certifying that the deficiency described in the narrative for the proposed project threatens 

the health or safety of the occupants or prevents the use of all or a portion of the building. The 

certifying official must either use the form provided or submit a report on official letterhead. 

Appropriate certifying officials may include individuals such as fire marshals, state building 

inspectors, local zoning officials, military installation officials, Indian Health Services officials, 

or other individuals who are responsible for inspecting school facilities and identifying health 

and safety deficiencies. Certifying officials may not be a staff member of the applicant LEA.
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JUSTIFICATION FOR REBUILDING

(PAGE 5)

An applicant that believes that rebuilding would be less expensive or more cost effective than 

repairing or renovating the existing facility must provide a detailed justification, including cost 

estimates for both alternatives. The applicant may propose rebuilding only if the LEA holds title 

to the existing facility for which funding is requested. Limit the length of this project narrative to 

the space provided on the form. Do not include drawings, designs, or other extraneous 

documents regarding proposed projects because reviewers will not consider them.

COST ESTIMATE TABLE

(PAGE 6)

The data entered on this table should be based on actual estimates. The estimates should take into 

consideration the delay between the application for funds and actual construction. 

On line (a), provide an estimate of the direct costs associated with this project. While there are 

no indirect costs allowed for these projects, a district may be reimbursed for direct costs that are 

necessary and reasonable to the grant. Examples of acceptable direct costs are supplies, 

equipment, advertising, and travel.

On line (b) provide an estimate for the planning and design phase of the project. Examples of 

associated costs are construction feasibility study, building plans and specifications, the creation 

of bid documents, and engineering services. 

On line (c) provide the estimated cost of construction. Examples of costs related to construction 

are the independent construction manager, labor, materials, and equipment costs. 

On line (d) provide estimates for state and local permits, compliance monitoring, taxes, 

contingency planning, and any other miscellaneous costs. 

On line (e) sum lines (a) through (d) and place the sub totals in each column.

On line (f) identify any other available resources from local or state sources. 

Subtract line (f) from line (e) and place the result on (g).
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CHILDREN WHO ATTENDED THIS SCHOOL FACILITY AND WHO WERE 

INCLUDED ON TABLES 1 THROUGH 5 OF THE APPLICANT’S SECTION 8003 

APPLICATION

(PAGES 7 THROUGH 10)

Report on these pages those children included on Tables 1 through 5 of the applicant’s section 

8003 FY 2012 (school year 2010-2011) application who attended the school facility for which 

funding is requested.

ASSURANCES AND CERTIFICATIONS

(PAGES 11 AND SF-424D)

The authorized representative for the LEA should review these assurances and certifications and 

then sign and date each form. The signature of the LEA’s representative commits the applicant 

to the assurances contained in the application, including the assurance that the applicant meets all 

statutory, regulatory and administrative requirements.

FINANCIAL INFORMATION

The Impact Aid Program will request audited financial reports for the preceding three years from 

highly ranked applicants before final award decisions are made. These reports will be used to 

verify the amount of available funds that could be used for this project. In cases where matching 

funds are required, additional documentation of in-kind contributions will be requested at that 

time. The IAP may contact state officials to verify data provided by an LEA in this application 

or in any additional data request, including funds that an LEA may receive from a state school 

construction program.

CONSTRUCTION FEASIBILITY STUDY

For selected applicants requesting funding for new construction, the Impact Aid Program will 

request a feasibility of construction study prior to making an award determination. The 

independent third party study should demonstrate that the area upon which the construction will 

occur is suitable for construction and will be able to sustain the new facility or addition. This 

study should include information to show that the soil it stable and suitable for construction, that 

the existing infrastructure can serve and sustain the new facility. 
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Appendix A

The list below, prepared by the U.S. Department of Education is an unofficial version of the 

State Single Point of Contact (SPOC) List published by the Office of Management and Budget 

(OMB). The Department has made every effort to ensure the accuracy of the information 

contained in this unofficial version. It reflects those changes made by OMB as of 08/15/01. The 

only official and up to date version of the State Single Point of Contact (SPOC) List is posted on 

the Grants Management section of the OMB web site: 

http://www.whitehouse.gov/omb/grants/spoc.html. You may review and/or download the Adobe 

pdf (portable document format) version of this document at the aforementioned site. Please 

include this statement in any reproduction of this unofficial list.

You are strongly encouraged to access the Intergovernmental Review (SPOC List) link to the 

Grants Management Information section of the OMB web page regularly in the course of 

completing grant applications to be submitted to your designated State Single Point of Contact 

(SPOC). If you do not have access to the Internet, please use the list below to contact the office 

or individual listed in order to confirm the State Single Point of Contact (SPOC). 

STATE SINGLE POINTS OF CONTACT (SPOCs)

It is estimated that in 2001, the Federal Government will outlay $305.6 billion in grants to State 

and local governments. Executive Order 12372, “Intergovernmental Review of Federal 

Programs,” was issued with the desire to foster the intergovernmental partnership and strengthen 

federalism by relying on State and local processes for the coordination and review of proposed 

Federal financial assistance and direct Federal development. The Order allows each State to 

designate an entity to perform this function. Below is the official list of those entities. For those 

States that have a home page for their designated entity, a direct link has been provided on the 

official version http://www.whitehouse.gov/omb/grants/spoc.html. 

States that are not listed on this page have chosen not to participate in the intergovernmental 

review process, and therefore do not have a SPOC. If you are located within one of these States, 

you may still send application material directly to a Federal awarding agency.

C
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ARKANSAS

Tracy L. Copeland

Manager, State Clearinghouse

Office of Intergovernmental Services 

Department of Finance and Administration 

1515 W. 7th Street, Room 412 

Little Rock, Arkansas 72203 

Telephone: (501) 682-1074 

FAX: (501) 682-5206 

tlcopeland@dfa.state.ar.us

CALIFORNIA

Grants Coordination 

State Clearinghouse 

Office of Planning and Research

P.O. Box 3044, Room 222 

Sacramento, California 95812-3044 

Telephone: (916) 445-0613 

FAX: (916) 323-3018 

State.clearinghouse@opr.ca.gov 

DELAWARE

Charles H. Hopkins

Executive Department 

Office of the Budget 

540 S. Dupont Highway , 3rd Floor 

Dover, Delaware 19901 

Telephone: (302) 739-3323 

FAX: (302) 739-5661 

chopkins@state.de.us

DISTRICT OF COLUMBIA

Luisa Montero-Diaz

Office of Partnerships and Grants 

Development

Executive Office of the Mayor

District of Columbia Government

414 4th Street, NW, Suite 530 South

Washington, DC 20001

Telephone: (202) 727-8900

FAX: (202) 727-1652

Opgd.eom@dc.gov

FLORIDA

Cindy Cranick

Florida State Clearinghouse

3900 Commonwealth Boulevard

Douglas Building, Mail Station 47

Tallahassee, Florida 32399-2100

Telephone: (850) 922-5438

FAX: (850) 414-0479

clearinghouse@dca.state.fl.us

GEORGIA

Georgia State Clearinghouse

270 Washington Street, SW

Atlanta, Georgia 30334

Telephone: (404) 656-3855

FAX: (404) 656-7901

gach@mail.opb.state.ga.us
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ILLINOIS

Virginia Bova

Department of Commerce and Community

Affairs

James R. Thompson Center

100 West Randolph, Suite 3-400

Chicago, Illinois 60601

Telephone: (312) 814-6028

FAX: (312) 814-8485

vbova@commerce.state.il.us

IOWA

Steven R. McCann

Division of Community and Rural 

Development

Iowa Department of Economic Development

200 East Grand Avenue

Des Moines, Iowa 50309

Telephone: (515) 242-4719

FAX: (515) 242-4809

Steve.mccann@ided.state.ia.us

KENTUCKY

Ron Cook

Department for Local Government

1024 Capital Center Drive, Suite 340

Frankfort, Kentucky 40601

Telephone: (502) 573-2382

FAX: (502) 573-2512

ron.cook@mail.state.ky.us

MAINE

Joyce Benson

State Planning Office

184 State Street

38 State House Station

Augusta, Maine 04333

Telephone: (207) 287-3261

Telephone: (207) 287-1461 (direct)

FAX: (207) 287-6489

Joyce.benson@state.me.us

MARYLAND

Linda Janey

Manager, Clearinghouse and Plan Review Unit

Maryland Office of Planning

301 West Preston Street – Room 1104

Baltimore, Maryland 21201-2305

Telephone: (410) 767-4490

FAX: (410) 767-4480

linda@mail.op.state.md.us

MICHIGAN

Richard Pfaff

Southeast Michigan Council of Governments

535 Griswold, Suite 300

Detroit, Michigan 48226

Telephone: (313) 961-4266

FAX: (313) 961-4869

pfaff@semcog.org
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MISSISSIPPI

Cathy Mallette

Clearinghouse Officer

Department of Finance and Administration

1301 Woolfolk Building, Suite E

501 North West Street

Jackson, Mississippi 39201

Telephone: (601) 359-6762

FAX: (601) 359-6758

MISSOURI

Angela Boessen

Federal Assistance Clearinghouse

Office of Administration

P.O. Box 809

Truman Building, Room 840

Jefferson City, Missouri 65102

Telephone: (573) 751-4834

FAX: (573) 522-4395

igr@mail.oa.state.mo.us

kirchhofft@mail.oa.state.mo.us

NEVADA

Heather Elliott

Department of Administration

State Clearinghouse

209 E. Musser Street, Room 200

Carson City, Nevada 89701

Telephone: (775) 684-0209

FAX: (775) 684-0260

Helliot@govmail.state.nv.us

NEW HAMPSHIRE

Jeffrey H. Taylor

Director

New Hampshire Office of State Planning

Attn: Intergovernmental Review Process

Mike Blake

21⁄2 Beacon Street

Concord, New Hampshire 03301

Telephone: (603) 271-2155

FAX: (603) 271-1728

Jtaylor@osp.state.nh.us

NEW MEXICO

Ken Hughes

Local Government Division

Room 201, Bataan Memorial Building

Santa Fe, New Mexico 87503

Telephone: (505) 827-4370

FAX: (505) 827-4948 

khughes@dfa.state.nm.us

NORTH CAROLINA

Jeanette Furney

Department of Administration

1302 Mail Service Center

Raleigh, North Carolina 27699-1302

Telephone: (919) 807-2323

FAX: (919) 733-9571

jeanette.furney@ncmail.net

NORTH DAKOTA

Jim Boyd

Division of Community Services

600 East Boulevard Ave, Dept 105

Bismarck, North Dakota 58505-0170

Telephone: (701) 328-2094

FAX: (701) 328-2308

jboyd@state.nd.us

RHODE ISLAND

Kevin Nelson

Department of Administration

Statewide Planning Program

One Capitol Hill

Providence Rhode Island 02908-5870

Telephone: (401) 222-2093

FAX: (401) 222-2083

knelson@doa.state.ri.us
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SOUTH CAROLINA

Omeagia Burgess

Budget and Control Board

Office of State Budget

1122 Ladies Street – 12th Floor

Columbia, South Carolina 29201

Telephone: (803) 734-0494

FAX: (803) 734-0645

aburgess@budget.state.sc.us

TEXAS

Denise S. Francis

Director, State Grants Team

Governor’s Office of Budget and Planning

P.O. Box 12428

Austin, Texas 78711

Telephone: (512) 305-9415

FAX: (512) 936-2681

dfrancis@governor.state.tx.us

UTAH

Carolyn Wright

Utah State Clearinghouse

Governor’s Office of Planning and Budget

State Capitol, Room 114

Salt Lake City, Utah 84114

Telephone: (801) 538-1535

FAX: (801) 538-1547

cwright@gov.state.ut.us

WEST VIRGINIA

Fred Cutlip, Director

Community Development Division

West Virginia Development Office

Building #6, Room 553

Charleston, West Virginia 25305

Telephone: (304) 558-4010

FAX: (304) 558-3248

fcutlip@wvdo.org

WISCONSIN

Jeff Smith

Section Chief, Federal/State Relations

Wisconsin Department of Administration

101 East Wilson Street – 6

th Floor

P.O. Box 7868

Madison, Wisconsin 53707

Telephone: (608) 266-0267

FAX: (608) 267-6931

jeffrey.smith@doa.state.wi.us

AMERICAN SAMOA

Pat M. Galea'i

Federal Grants/Programs Coordinator

Office of Federal Programs

Office of the Governor/Department

of Commerce

American Samoa Government

Pago Pago, American Samoa 96799

Telephone: (684) 633-5155

Fax: (684) 633-4195

pmgaleai@samoatelco.com

GUAM

Director

Bureau of Budget and Management Research

Office of the Governor

P.O. Box 2950

Agana, Guam 96910

Telephone: 011-671-472-2285

FAX: 011-671-472-2825

jer@ns.gov.gu

PUERTO RICO

Jose Caballero / Mayra Silva

Puerto Rico Planning Board

Federal Proposals Review Office

Minillas Government Center

P.O. Box 41119

San Juan, Puerto Rico 00940-1119

Telephone: (787) 723-6190

FAX: (787) 722-6783
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NORTHERN MARIANA ISLANDS

Ms. Jacoba T. Seman

Federal Programs Coordinator

Office of Management and Budget

Office of the Governor

Saipan, MP 96950

Telephone: (670) 664-2289

FAX: (670) 664-2272

omb.jseman@saipan.com

VIRGIN ISLANDS

Ira Mills

Director, Office of Management & Budget

# 41 Norre Gade Emancipation Garden 

Station, Second Floor

Saint Thomas, Virgin Islands 00802

Telephone: (340) 774-0750

FAX: (787) 776-0069

Irmills@usvi.org

Changes to this list can be made only after OMB is notified by a State’s officially designated 

representative. E-mail messages can be sent to grants@omb.eop.gov. If you prefer, you may

send correspondence to the following postal address:

Attn: Grants Management

Office of Management and Budget

New Executive Office Building, Suite 6025

725 17th Street, NW

Washington, DC 20503

Please note: Inquiries about obtaining a Federal grant should not be sent to the OMB e-mail or 

postal address shown above. The best source for this information is the Catalog of Federal 

Domestic Assistance (CFDA) [http://www.cfda.gov/].