FORM APPROVED

OMB NO. 1810-0687

EXPIRATION DATE: 09/30/2014

Paperwork 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. The valid OMB 

control number for this information collection is 1810-0036. The time required to complete this information 

collection is estimated to average 6.5 hour per response, including the time to review instructions, search existing 

data resources, gather the data needed, and complete and review the information collection. If you have any 

comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: 

U.S. Department of Education, Washington, D.C. 20202-4651. If you have any comments or concerns regarding 

the status of your individual submission of this form, write directly to: Impact Aid Program, U.S. Department of 

Education, 400 Maryland Ave., S.W., Washington, D.C. 20202-6244.

U.S. DEPARTMENT OF EDUCATION

IMPACT AID PROGRAM

INSTRUCTIONS FOR COMPLETING THE

FY 2015 e-APPLICATION FOR 

IMPACT AID, SECTION 8003

PROGRAM CONTACT INFORMATION

Phone: 202-260-3858

Toll-Free Fax: 866-799-1272

Email: Impact.Aid@ed.gov

DEADLINE: 11:59 p.m. EST, January 31, 2014
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Contents

The Impact Aid Section 8003 Program ........................................................................................... 1

Who May Apply............................................................................................................................... 1

When to Apply ................................................................................................................................ 1

Deadline................................................................................................................................. 1

Late Applications.................................................................................................................... 2

Amendments.......................................................................................................................... 2

How to Apply................................................................................................................................... 2

Mandatory Forms ........................................................................................................................... 3

Cover Page ...................................................................................................................................... 3

Pre-populated Information.................................................................................................... 3

Membership Survey Date ...................................................................................................... 3

Survey Forms or Source Check .............................................................................................. 4

Original Application or Amendment...................................................................................... 4

Impact Aid and PR/Award Numbers...................................................................................... 4

DUNS Number........................................................................................................................ 4

Applicant Name and Address ................................................................................................ 4

Contact Person....................................................................................................................... 4

Section 8003(b)(2) Heavily Impacted Districts...................................................................... 4

Impact Aid Program Assurances and Certifications........................................................................ 5

General Instructions for Tables 1-5 ................................................................................................ 5

Eligible Federal Properties..................................................................................................... 5

Federal Office Buildings................................................................................................ 6

Ships.............................................................................................................................. 6

Uniformed Services....................................................................................................... 6

Accredited Foreign Military .......................................................................................... 6

United States Postal Service (USPS) Buildings.............................................................. 6

Property Owned by Foreign Governments or International Organizations................. 6

Indian Lands.................................................................................................................. 6

Pre-Kindergarten Children..................................................................................................... 7

Table 1............................................................................................................................................. 7

Table 2............................................................................................................................................. 7

Table 3............................................................................................................................................. 8

Table 4............................................................................................................................................. 9

Table 5............................................................................................................................................. 9
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Table 6........................................................................................................................................... 10

Table 7........................................................................................................................................... 11

Table 8........................................................................................................................................... 11

Table 10......................................................................................................................................... 12

Housing Undergoing Renovation or Rebuilding ........................................................................... 13

Indian Policies and Procedures..................................................................................................... 14

Housing Undergoing Renovation or Rebuilding Certification....................................................... 14

Appendix 1 – Tables and Categories............................................................................................. 16

Appendix 2 – Using G5 e-Application for Section 8003................................................................ 17
1

The Impact Aid Section 8003 Program

Section 8003 grants are for local educational agencies (LEAs) that educate federally connected 

children. These may be the children of members of the uniformed services, children who live 

on Indian lands, children who live on federal property or federally subsidized low rent housing, 

and children whose parents work on federal property. Section 8003 grants include additional 

payments for federally connected children who receive special education services under the 

Individuals with Disabilities Education Act (IDEA).

You should review the authorizing statute (Section 8003 of the Elementary and Secondary 

Education Act) and regulations (34 CFR Part 222), as they 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) 

website at www.ed.gov/programs/8003/legislation.html. 

You can prepare and submit this application only by using G5 e-Application, the Department of 

Education’s electronic application system, which is available on the Internet at www.g5.gov. If 

you need further assistance in preparing this application, please call the Impact Aid Program 

(IAP) at 202-260-3858.

Who May Apply

Any LEA that serves significant proportions of federally connected children may apply for 

assistance. The term “LEA” means a board of education or other legally constituted local school 

authority that has administrative control and direction of free public elementary and secondary 

education through grade 12 in a county, township, independent or other school district located 

within a State. An eligible LEA must provide free public elementary and/or secondary 

education, under public supervision and direction without tuition charge, pursuant to the law of 

the State in which the LEA is located. The term "LEA" includes any State agency that directly 

operates and maintains facilities for providing free public education.

When to Apply

Deadline—The deadline for submitting this electronic application is:

11:59 p.m., Eastern Standard Time, Thursday, January 31, 2014.

An application is timely filed if the IAP receives the entire application package by the deadline. 

All of the following must be received by the deadline:

 The electronic application, submitted on-line via G5 e-Application, the Department of 

Education’s electronic application system

 The signed cover page of the application, submitted by fax or as an e-mail attachment

 The signed Impact Aid Program assurances and certifications page of the application, 

submitted by fax or as an e-mail attachment
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 Only for those applicants that submit data for military installation housing undergoing 

renovation or rebuilding: Table 9 signed by the authorized representative of the military 

installation on which the housing is located, submitted by fax or as an e-mail attachment

 Only for those applicants that submit data for Indian housing undergoing renovation or 

rebuilding: Table 11 signed by the appropriate officials for the tribal housing and the 

Bureau of Indian Affairs, submitted by fax or as an e-mail attachment

Do not wait until the last day to fax the signature pages, and risk missing the deadline. Keep 

your fax machine’s confirmation printout or your email receipt to document your timely 

submission.

Late Applications— Applicants can still file for Section 8003 assistance up to 60 days after 

the regular application deadline. Applicants that file within this window will have payments for 

that fiscal year reduced by 10%. The late application deadline for FY 2015 applications is 

Tuesday, April 1, 2014.

Amendments— Users can use the G5 e-Application website to modify and update their 

applications until September 30, 2014. 

How to Apply

Prepare and submit this application by using the U.S. Department of Education’s electronic 

grant application system, G5 e-Application, available online at www.G5.gov. If you are not 

already a registered user, you must register on this web site to begin the electronic grant 

application process. Whether you are a new user or have used this web site in the past, we 

urge you to log on to the site and familiarize yourself with it at your earliest convenience, and 

to complete the application process well before the due date.

After submitting the electronic application, you must email or fax to the Impact Aid Program all 

forms for which signatures are required. Your authorized representative must sign and date 

the cover page of the application and the Impact Aid Program Assurances and Certifications 

page. If you submit Table 9 or Table 11, the appropriate officials must sign and date those 

forms according to the instructions on the forms. After signing, fax the pages to the Impact Aid 

Program at 866-799-1272, our toll-free fax number, or scan the pages to a PDF file and send the 

file by email to Impact.Aid@ed.gov. If you choose to fax the forms, use the cover sheet from 

the list of Documents & Instructions on the Package Information screen in e-Application. Your 

application is not complete until you have submitted the electronic application online and you 

have emailed or faxed all pages with signatures to the Impact Aid Program. 

In addition, you must forward a complete copy of the application to your State educational 

agency (SEA) at the same time you submit it electronically to the U.S. Department of Education. 

Use the transmittal form from the list of Documents & Instructions on the Package Information 

screen in G5 e-Application. Your SEA Impact Aid contact is included in a list on our website at 

www.ed.gov/about/offices/list/oese/impactaid/searl.html.
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Mandatory Forms

Your application must contain all mandatory forms, including:

• the Cover Page

• the Section 8003 Assurances

• one or more of Tables 1 through 5

• Table 6

• Table 7, if it is displayed (This form is required if your LEA claimed children with 

disabilities on Table 1 or Table 2 on your FY 2013 application.)

• Table 8, if it is displayed (This form is required if your LEA operates buildings 

owned by the U.S. Department of Education.)

• Table 10, if it is displayed (This form is required if your LEA receives construction 

payments under Section 8007(a).)

• Indian Policies and Procedures (which must be dated with a date of review no 

earlier than February 1, 2013) or IPP waiver, if you claim children living on Indian 

lands in your application

Tables 9 and 11 are optional for all applicants. Do not enter any data on these forms unless you 

plan to submit them.

Cover Page

Pre-populated Information—If your LEA has applied for Impact Aid in previous years, most 

of the items on the cover page will be “pre-populated,” that is, copied from your LEA’s 

application from last year. If any of this information has changed or is missing, make the 

necessary corrections before submitting this year’s application. Many LEAs have similar names; 

please pay careful attention to your LEA’s name and address to be certain that we have your 

LEA properly identified. 

New applicants must complete the requested information on the cover page. On data entry 

screens in G5 e-Application, items marked with an asterisk are mandatory.

Membership Survey Date—Enter the date that the membership survey was taken. The 

membership survey must be taken no earlier than the fourth day of the regular school year and

on or before January 31, 2014.

You are allowed to take a second membership survey after January 31, but no later than 

May 14, and submit those data as an amendment to your application. It is beneficial to your 

school district to conduct a second membership survey only if your LEA experiences a large 

increase in the number of eligible federally connected children after your first survey date and 

no later than May 14. The results of the two surveys are averaged and usually only produce a 

small change. As a result, LEAs rarely conduct second membership surveys.
4

If your LEA conducts a second membership survey, you must submit an amended application to 

IAP by September 30, 2013. Also, send a copy of the amendment to your SEA.

Survey Forms or Source Check—Check one or both of these boxes to indicate how you 

collected the information to verify the eligibility of students you report on Tables 1-5. 

Original Application or Amendment—The G5 e-Application system will automatically 

identify your application as an original or amendment. 

Impact Aid and PR/Award Numbers—Your Impact Aid Number and PR/Award Number 

will be pre-populated if you previously have applied for Impact Aid. If your LEA previously has 

applied for Impact Aid and any of these numbers is blank or the Impact Aid Number displayed 

on the screen begins with “GIA” please contact the Impact Aid Program at 202-260-3858 before 

continuing so that we may be certain your application has been correctly pre-populated.

If your LEA has not received Impact Aid previously, these numbers may be blank or the Impact 

Aid Number may begin with “GIA.” The Impact Aid Program will assign these numbers for you 

after you submit your application.

DUNS Number—If you do not know your LEA’s DUNS Number or if you would like to verify 

the number displayed on the application screen, call Dun and Bradstreet, Inc. at 800-333-0505

or visit their website to obtain or check the number. The DUNS Number on the application 

should be assigned to the same name and address that is printed on this application. 

Applicant Name and Address—Your LEA’s name and address will be displayed as they are 

listed in the Impact Aid information system. The name should be your LEA’s legal name and the 

address should be the mailing address of your school district offices. We use this address to 

mail information to you.

Contact Person—The Contact Person information you provide should be for the person on 

your LEA’s staff who is most knowledgeable about this application and the data used to create 

it. Please be careful to provide an accurate email address. The IAP uses this address to provide 

applicants with timely information throughout the year, including vouchers documenting 

payments to your LEA. Additional contacts, to whom we also send copies of payment vouchers,

can be added by sending an email to Impact.Aid@ed.gov.

Section 8003(b)(2) Heavily Impacted Districts—Check this box if your LEA is requesting 

funds as a heavily impacted district. Section 8003(b) (2) provides a special payment calculation 

for basic support payments for eligible LEAs. If you check the box to apply for funding under 

Section 8003(b) (2), you will be asked to submit additional information needed to determine 

whether your LEA is eligible. 

To be eligible for this provision, LEAs that have not previously been eligible must have, among 

other requirements: (1) a tax rate of at least 95 percent of their comparable districts’ average 
5

tax rate; (2) eligible federally connected children equal to at least 50 percent (or for those LEAs 

ineligible to claim civilian "F & G" children, 40 percent) of their total enrollment; and (3) either 

350 or more students in total enrollment and a per pupil expenditure of less than the State 

average or fewer than 350 students enrolled with a per pupil expenditure of less than that of 

one or three comparable districts in the State. In addition, new LEAs must be determined 

eligible for two consecutive years in order to receive payment in the second year.

Impact Aid Program Assurances and Certifications

Authorized Certifying Representative—Enter the name and title of the LEA’s authorized 

certifying representative. The signature of the LEA’s representative commits the LEA to the 

declarations on this document, including:

 Incorporation by reference of all other assurances documents, and 

 Assurance that the applicant meets all statutory, regulatory, and administrative 

requirements for this grant program

New applicants must obtain and file the referenced assurance documents by the application 

deadline. Contact the IAP for additional information.

The representative must sign and date the printed Impact Aid Program Assurances and 

Certifications form on or before the filing deadline, January 31, 2014.

General Instructions for Tables 1-5

Complete these tables to report the number of children associated with the Federal properties 

in your LEA. If you are a recurring applicant, we have pre-populated the Federal properties 

claimed on your previous application. Record the number of federally connected children 

associated with each property in the columns labeled Number of Children on Survey Date. 

Each student gets counted only once. Children with disabilities reported on tables 1 and 2 

should not be included in student counts on other tables. If no children are connected with a 

specific property in the current year, place a zero in that column. 

You may also add other Federal properties in addition to those listed on Tables 1 through 5 by 

using the drop down button on any blank row on each table to open the Property Lookup 

Screen. If a property you wish to list is not on the Property Lookup Screen, you may enter the 

name and address of the property in the name and address fields at the bottom of the Property 

Lookup Screen. 

Eligible Federal Properties—If you enter properties that are not on the Property Lookup 

Screen, you must indicate the specific location of each parcel of claimed property by the official 

name, street address, city, and state. The name of a government agency or a post office box 

number is not sufficient identifying information. If you need additional assistance, contact the 

IAP property team at 202-260-3858. The following types of properties are among those that 

may be claimed: 
6

Federal Office Buildings – Report specific addresses. You do not need to report the Federal 

agency that employs the parents of children claimed for this category.

Ships – Eligibility of ships is determined on the basis of homeport assignments in that state. 

If you claim children who have civilian parents employed on ships, you must furnish the 

name, hull number, and the controlling Federal agency. For each ship, click the drop down 

button on a blank row and enter the ship’s information in the name and address fields at 

the bottom of the Property Lookup screen. After you submit your application, an Impact 

Aid Program property specialist may contact you for additional information.

Uniformed Services – Use “Uniformed Services” instead of a “work on” property to claim 

children who have a parent on active duty in the uniformed services of the United States 

(Army, Navy, Air Force, Marine Corps, Coast Guard, National Oceanic and Atmospheric 

Administration and U.S. Public Health Service). 

Children with a parent in the Reserves or the National Guard generally are not eligible 

unless the parent is on active duty on your survey date as a result of a Presidential Order. 

You can claim dependents of National Guard members and Reservists who have been 

activated pursuant to a Presidential Executive Order 13223 of September 14, 2001, as 

amended, and under authority of Title 10, United States Code (U.S.C.). You cannot claim 

children whose parents are activated after the survey date or whose activation ended 

before the survey date. You must document the service member’s activation with a copy of 

each member’s orders or a certification from a Service component of the service member’s 

activation. Personally identifying information such as dates of birth and Social Security 

numbers should be redacted. Dependent students of National Guard members who remain 

under the command and control of the State Governor are not eligible to be counted for 

Impact Aid. 

Accredited Foreign Military – You may claim children in this category who have a parent 

who is both an accredited foreign government official and a foreign military officer.

United States Postal Service (USPS) Buildings – Buildings under the jurisdiction of the USPS 

in which more than 50 percent of the floor area is used for postal services are not eligible. 

Federal Office Buildings under the jurisdiction of the General Services Administration are 

eligible in their entirety regardless of floor area assignments.

Property Owned by Foreign Governments or International Organizations – Any property 

owned by a foreign government or by an international organization that is not subject to 

real property taxation may be claimed.

Indian Lands – Applicants will be required to submit documentation of the eligibility of any 

new Indian land property that is claimed. If you claim a property that is not pre-populated 

on your application, the IAP staff will contact you later to request the eligibility 

documentation. In all but a few cases, eligible Indian Lands must be held in trust or 

restricted status.
7

Pre-Kindergarten Children 

You may claim pre-kindergarten children on Tables 1 through 5 if they are federally connected 

children who are provided a free public education by your LEA. It does not matter whether 

pre-kindergarten education is included in your State’s definition of elementary and secondary 

education. However, the education of the children must be provided at public expense. This 

means that neither the child nor the parent can be charged tuition. In addition, Federal funds 

other than Impact Aid (e.g., Head Start, IDEA) must not provide a substantial portion of the cost 

of the education program for the children claimed. Please contact the Impact Aid Program if 

you need assistance.

Table 1

CHILDREN WITH DISABILITIES WHO: (1) reside on eligible Federal property and have a parent on 

active duty in the uniformed services of the United States; or (2) reside on eligible Federal 

property with a parent who is both an accredited foreign government official and a foreign 

military officer; or (3) reside on eligible Indian lands.

Report on Table 1 federally connected children enrolled on the survey date in State approved 

education programs for children with disabilities. These children must have current written 

individualized education programs (IEPs) that are signed and in effect on the survey date. Do 

not include children who have IEPs solely because they are included in gifted and talented 

programs.

These may be children who reside on eligible Federal property (including low rent housing) and 

have a parent on active duty in the uniformed services of the United States, children who reside 

on Federal property and have a parent who is both an accredited foreign government official 

and a foreign military officer, and children who reside on eligible Indian lands. 

In recent years, the Congress has included authority in annual appropriations language allowing 

applicants to include on Table 1 any student who is attending a school in the LEA but who is no 

longer living on federal property due to the deployment of either both parents or the parent 

having sole custody of the child. The property on which the student formerly resided should be 

reported as the federal property of residence. Further, this language has allowed children who 

continue to live on Federal property after the death of the parent in the uniformed services to 

be included on Table 1. While the Congress will not complete appropriations for FY 2014 that 

may include these provisions until after the application deadline, we recommend that you 

include such children on your application as if the provision were already enacted.

Table 2

CHILDREN WITH DISABILITIES WHO DO NOT RESIDE ON FEDERAL PROPERTY BUT: (1) have a 

parent on active duty in the uniformed services of the United States; or (2) have a parent who is 

both an accredited foreign government official and a foreign military officer.

Report on Table 2 federally connected children enrolled on the survey date in State-approved 

education programs for children with disabilities. These children must have current written 
8

individualized education programs (IEPs) that are signed and in effect on the survey date. Do 

not include children who have IEPs solely because they are included in gifted and talented 

programs. Summarize the children in the following categories:

– Children with disabilities who do not reside on Federal property but have a parent on active 

duty in the uniformed services of the United States. 

– Children with disabilities who do not reside on Federal property but have a parent who is 

both an accredited foreign government official and a foreign military officer.

Table 3

CHILDREN WHO: (1) reside on eligible Federal property with a parent employed on eligible 

Federal property located at least partly within the school district; or (2) reside on eligible Federal 

property and have a parent on active duty in the uniformed services of the United States; or (3) 

reside on eligible Federal property and have a parent who is both an accredited foreign 

government official and a foreign military officer; or (4) reside on eligible Indian lands (no 

parental employment required).

Report on this table federally connected children who both live on and whose parents work on 

Federal property, including children living on Indian lands.

Columns (1) and (2) – Report the eligible Federal property on which the children resided on the 

survey date:

– Children who reside on eligible Federal property (including low rent housing) with a parent 

employed on eligible Federal property located at least partly within the school district.

– Children who reside on eligible Federal property (including low rent housing) who have a 

parent who is both an accredited foreign government official and a foreign military officer.

– Children who reside on eligible Federal property (including low rent housing) and who have a 

parent on active duty in the uniformed services of the United States. 

– Children who reside on Indian lands. “Indian lands” is defined in section 8013(7) of the 

Impact Aid law, and generally means land held in trust for individual Indians or Indian tribes 

(trust property), land held by individual Indians or Indian tribes subject to restrictions on 

alienation (restricted land), land conveyed under the Alaska Native Claims Settlement Act to a 

Native individual, Native group, or village or regional corporation, or public land owned by the 

United States that is designated for the sole use and benefit of individual Indians or Indian 

tribes. The IAP will work with you to verify new Indian land property reported on your 

application. 

Columns (3) and (4) – Report the eligible Federal property on which the parent was employed 

on the survey date. For children who have a parent in the uniformed services of the United 

States or who have a parent who is both an accredited foreign government official and a 
9

foreign military officer, select "Uniformed Services" or "Accredited Foreign Military," 

respectively. 

Column (5) – Report the number of children associated with the residence and employment 

locations identified in Columns 1 through 4.

Table 4

CHILDREN WHO reside on eligible Federal property, but whose parents are not employed on 

Federal property.

Report on this table the number of children, listed by property, in the following categories:

– Children who reside in low rent housing and whose parent is not employed on Federal 

property; and

– Children who reside on eligible Federal property and whose parent is not employed on 

Federal property. 

Do not report on Table 4 children residing on eligible Indian lands who do not have a parent 

employed on federal property. Report those children on Table 3.

Table 5

CHILDREN WHO DO NOT RESIDE ON FEDERAL PROPERTY BUT: (1) reside with a parent employed 

on Federal property; or (2) have a parent on active duty in the uniformed services of the United 

States; or (3) have a parent who is both an accredited foreign government official and a foreign 

military officer.

Report on this table the number of children, listed by property, in the following categories:

– Children who do not reside on Federal property but have a parent who is employed on 

eligible Federal property situated in whole or in part in the State in which the school district is 

located (See the note below about the number of children you need for this category). 

– Children who do not reside on Federal property but have a parent on active duty in the 

uniformed services (List these children as "Uniformed Services" instead of with an actual 

property).

– Children who do not reside on Federal property but have a parent who is both an accredited 

foreign government official and a foreign military officer (List these children as "Accredited 

Foreign Military" instead of with an actual property).

Note regarding Table 4 and Table 5: To receive a payment for children who reside on Federal 

property (other than low rent housing) with a parent not employed on Federal property, or 

who do not reside on Federal property but have a parent employed on Federal property in the 

State, your LEA must have a total number of such children equal to or greater than 1,000 in 
10

average daily attendance (ADA) or equal to or greater than 10 percent of your total ADA. If 

your LEA does not meet this minimum requirement, the Impact Aid Program cannot count 

these children toward the basic program eligibility requirement of federally connected children 

numbering at least 400 in ADA or three percent of the total number of children in the district, 

and cannot count these children in calculating payment amounts.

Table 6

MEMBERSHIP AND AVERAGE DAILY ATTENDANCE DATA

Line 1.(A) – Enter the number of children enrolled for the current school year (SY 2013-2014) in 

schools operated by the LEA on the survey date. Do not include students for whom tuition is 

paid to attend school outside the LEA. Those students should be reported on line 1. (D). 

Line 1.(B) – Enter the number of children for whom the applicant receives or contracts to 

receive payments (tuition-in) from parents, other districts, Federal programs other than Impact 

Aid, or other sources if such payments constitute a substantial portion of the children's 

educational cost, under arrangements that meet applicable State requirements.

Line 1.(D) – Enter the number of children for whom the applicant pays other LEAs or other 

educational entities the cost of free public education (tuition out) under arrangements that 

meet applicable State requirements. The tuition arrangements that an LEA makes for its 

tuition-out students must genuinely reflect the district’s responsibility for educating those 

children.

Line 2.(A) – Enter the actual ADA for the preceding regular school year (2012-2013) of children 

reported on Line 1.(E) of this table. Include tuition-out ADA; but exclude tuition-in ADA. This 

figure must be a total for the end of the school year. It is not the attendance data for the 

survey date alone. Do not report summer school ADA in this number.

Applicants from States that do not collect average daily attendance do not have to complete 

line 2. (A) unless you plan to show that your attendance rate is higher than the rate negotiated 

between your State and the U.S. Department of Education.

Line 2. (B) – If your LEA provides a program of free public summer school, enter the hours of 

summer school attendance for the preceding school year (Summer 2012). However, if your 

state is a negotiated rate state, it is not necessary to report this data.

Line 2. (C) – Enter the number of days in the regular school year. 

Line 3. – The sum of the numbers of students you enter on Tables 1 through 5 is displayed on 

Line 3 for your information. To be eligible for a payment under section 8003, a local school 

district must educate at least 400 eligible federally connected children in average daily 

attendance, or the eligible federally connected children must make up at least three percent of 

the school district's total average daily attendance. Applications that do not meet this basic 

eligibility requirement are not eligible for payment. In addition, children who reside on federal 
11

property or whose parents are employed on federal property—civilian "F & G" children—must 

number at least 1,000 in average daily attendance or make up at least 10 percent of the school 

district’s average daily attendance in order to be eligible for payment.

Table 7

FISCAL REPORT ON EXPENDITURES OF ADDITIONAL FUNDS PROVIDED FOR CHILDREN WITH 

DISABILITIES

If your LEA claimed children with disabilities on last year’s application you must complete Table 

7, reporting your LEA’s revenue and expenditure data for the preceding fiscal year. The U.S. 

Department of Education reviews these data to ensure your compliance with the program 

regulations. Under 34 CFR § 222.53, you must be able to demonstrate that your additional 

expenditures for federally connected CWD were at least equal to the amount of your section 

8003(d) payment.

Line 1. – Report additional expenditures for educational services for all children with disabilities 

beyond standard educational costs. Such expenditures may include facilities modification costs 

(e.g., ramps and accessible rest rooms), additional administrative costs, assessment costs, 

counselors or social workers, special teachers, aides and other staff, transportation, 

homebound programs and hospital programs. Do not include expenditures for gifted and 

talented children or expenditures for the regular educational cost of children with disabilities.

Line 2. – Report State aid received for all current expenditures for elementary and secondary 

education purposes. Include State aid for State-approved educational programs for children 

with disabilities.

Line 3. – Report all State aid received specifically for children with disabilities. Do not include 

State aid for gifted and talented children.

Line 4. – Report total funds received from Part B of the Individuals with Disabilities Education 

Act (IDEA, U.S.C. 1400 et seq.).

Line 5. – Report any federal or private aid received for children with disabilities that is not taken 

into account in Lines 1 to 4. This may include, for example, Medicaid payments. 

Line 6. – Report the total number of children with disabilities in the LEA’s membership, both 

federally connected and not federally connected, with current signed IEPs in effect on the IDEA 

count date. Do not include children who have IEPs solely because they are in gifted and 

talented programs.

Table 8

CHILDREN WHO ATTEND SCHOOLS OWNED BY THE U.S. DEPARTMENT OF EDUCATION

This table is provided only to applicant LEAs that use buildings owned by the Department of 

Education.
12

Table 10

SECTION 8007 (CONSTRUCTION)

If your LEA received construction funds under section 8007 in the preceding year you must 

complete Table 10. 

TABLE 10 a – Fiscal Report on Expenditures of All Construction Related Funds and Accounts

Report revenues and expenditures for all construction related activities. Refer to the capital 

outlays budget summary in your LEA’s audited annual financial report. 

Line 1. – Report all construction funds and accounts available for construction purposes. 

Line 2. – Report all section 8007 receipts received in the preceding fiscal year.

Line 3. – Report any other funds and grants received that can be used for construction 

purposes. 

Line 4. – Report transfers into this fund. 

Line 5. – Report transfers out of this fund. 

Line 6. – Use this line if your construction funds are included in your general fund or other 

specialized fund that combines general and construction expenditures. Also, use this line to 

account for all non-construction-related expenditures (e.g., equipment, instructional materials). 

Line 7. – Report total expenditures for construction-related activities, including: the preparation 

of drawings and specification for school facilities; erecting, building, acquiring, altering, 

remodeling, repairing or extending school facilities; and inspecting and supervising the 

construction of school facilities.

Line 8. – If you include your debt service in your total expenditures (line 7), DO NOT record it on 

this line. 

Line 9. – The system will calculate the total on Line 9 as:

Line 1 + Line 2 + Line 3 + Line 4 Line 5 - Line 6 - Line 7 - Line 8.

TABLE 10 b – Report on Condition of Facilities

Rate the overall condition of your LEA’s facilities. Choose one number to indicate the overall 

condition of your LEA’s facilities. This number should represent both the physical condition of 

the facilities and the ability of the buildings to meet the functional requirements of instructional 

programs. 
13

If your LEA completed Table 10 on last year’s application, be sure to refer to the rating score 

you previously reported. If the overall condition of your facilities is better this year, the score 

might stay the same or go up. If the condition is worse, the score might go down from the 

previous year.

Housing Undergoing Renovation or Rebuilding

MILITARY OR INDIAN LANDS HOUSING UNDERGOING RENOVATION OR REBUILDING

This is an optional table that may be submitted by applicant LEAs where housing on a military 

installation or on Indian lands is temporarily unavailable for occupancy because it is undergoing 

renovation or rebuilding. The Impact Aid Program uses this information to determine whether 

some number of children who do not reside in these units may be categorized as though they 

reside on a military installation or Indian lands in calculating payments for this application. The 

effect of categorizing these students in this way will be to increase the LEA’s maximum basic 

support payment. 

Due to a change in the Impact Aid statute, Tables 9 & 11 have been removed from the 

application and replaced by a single form for FY 2015 and subsequent applications. The LEA 

does not enter any specific property addresses on this table. The LEA must identify the housing 

official’s:

1. First and last name

2. Official title

3. Military installation or Indian Lands housing area

4. Email address

5. Phone number

6. Fax number

If you are providing information for more than one military installation, provide a separate form

for each. 

To upload the form, you will see an application form labeled “Housing Undergoing Renovation 

or Rebuilding” where you will upload the document “HOUSING UNDERGOING RENOVATION 

OR REBUILDING – HOUSING OFFICIAL CONTACT INFORMATION” for your housing official(s). 

You will find this form on the right hand side of the screen, under the application instructions. 

To be considered under this provision, you must complete this form and upload it on this table.

OMB No. 1810-0687 Exp. 9/30/2014

Military and/or Indian Lands Housing Undergoing Renovation or Rebuilding

If you want the Impact Aid Program to consider housing on a military installation or on Indian 

lands that is temporarily unavailable for occupancy because it is undergoing renovation or 
14

rebuilding, you must submit the Housing Official Contact Information Form with your Section 

8003 Impact Aid application. The Impact Aid Program will contact the housing official identified 

on this form to determine whether some number of children who do not reside in these units 

may be categorized as though they reside on a military installation or Indian lands in calculating 

payments for this application. Contact the Impact Aid Program by phone at (202)260-1357 or 

via email at Impact.Aid@ed.gov if you need more information about this requirement.

Attachment:

Title: 

File: 

 Form Complete

Enter the title of the form in the first block and the stored location of the form in the second 

block. Click the upload button and the form will attach to your application. This form must be 

submitted with your application on or by the application deadline. Contact the Impact Aid 

Program by phone at (202)260-1357 or via email at Impact.Aid@ed.gov if you need more 

information about this requirement.

Indian Policies and Procedures

If you claim children residing on Indian lands, you must submit a copy of your current Indian 

Policies and Procedures (IPPs) or, in lieu of IPPs, a waiver statement from your tribe(s). Your 

submission must be updated annually. Fax these documents or email them as PDF attachments 

along with your signature pages. The IPPs must be current and must have been reviewed and 

approved by your board of education within the last year (after January 31, 2013). If you 

submit a waiver statement in lieu of IPPs, it must be for the current year and provided by the 

tribe. In addition, you will need to maintain documentation of compliance regarding the eight

statutory requirements. You do not need to submit the documentation at the time of 

application. Contact the IAP by phone at 202-260-3858 if you need more information about this 

requirement.

Housing Undergoing Renovation or Rebuilding Certification

On January 3, 2013 President Obama signed the National Defense Authorization Act for Fiscal 

Year 2013 into law. This law contains technical changes to the Impact Aid Program for 

provisions related to Military and Indian Lands Housing Undergoing Renovation or Rebuilding, 

which is reported on Tables 9 and 11 of the FY 2014 Impact Aid application. 

Upload
15

The new Housing Undergoing Renovation and Rebuilding will be sent to any housing official 

designated on 

Table 9 or Table 11 for FY 2014. The housing official will verify the information provided on the 

form, estimate the number of school age children who would have resided in the housing had it 

not been undergoing renovation or rebuilding. Under the new provisions, housing unavailable 

for the purposes of sustainment activities or that is inactive for less than 30 days is not 

eligible to be included on this form.

Line 1 – Verify the contact person named on Line 1 is the appropriate person for providing and 

certifying information related to ongoing housing projects.

Line 2 – Verify the title of the contact person listed on Line 1.

Line 3 – Verify the name of the military installation or Indian lands housing area.

Line 4 – Verify the email address of the housing official. 

Line 5 – Verify the phone number of the housing official. 

Line 6 – Enter the estimated number of school-age children who would have resided in the 

housing had it not been undergoing renovation or rebuilding. We have provided a suggested 

methodology for your use, although you may certify a number of school-aged children based on 

your records. 

Step 1 : number of school age children (see line 9) ÷ number of occupied units = average 

number of school age children per unit.

Step 2: average number of school age children per unit x the number of units undergoing 

renovation or rebuilding on the survey date = average number of school age children that 

would have resided in the housing had it not been undergoing renovation or rebuilding.

Line 7 – Enter the date the construction project began. If there are multiple overlapping

construction projects, please enter the earliest project start date. 

Line 8 – The survey date is provided by the school district. This is the date you should use to 

determine the number of units vacant due to renovation or rebuilding projects lasting longer 

than 30 days and that are not sustainment projects.

Line 9 – The number of school age children residing in military or Indian Lands housing on the 

survey date. This number may be used in calculating Step 1 of Line 6 above. 
16

Appendix 1 – Tables and Categories

How is the student federally connected? Where is the student counted?

STUDENT PARENT CATEGORY WEIGHT

GENERAL 

EDUCATION 

STUDENTS

SPECIAL 

EDUCATION 

STUDENTS

(NOT GIFTED)

Resides on 

Federal property

Civilian who works 

on federal property 

in the LEA

A(i) 1.00 → Table 3

Resides on 

Federal property

Foreign military 

officer and 

accredited foreign 

gov’t official

A(ii) 1.00 → Table 3 Table 1

Resides on 

Federal property

Is in U.S. uniformed 

service B 1.00 → Table 3 Table 1

Resides on Indian 

Lands C 1.25 → Table 3 Table 1

Does not reside

on Federal 

property

Is in U.S. uniformed 

service D(i) 0.20 → Table 5 Table 2

Does not reside

on Federal 

property

Foreign military 

officer and 

accredited foreign 

gov’t official

D(ii) 0.20 → Table 5 Table 2

Resides in Low 

Rent Housing

Does not work on 

Federal property E 0.10 → Table 4

Resides on 

Federal property

Civilian who does 

not work on 

Federal property

F 0.05 → Table 4

Does not reside

on Federal 

property

Works on Federal 

property in same 

county as LEA

G(i) 0.05 → Table 5

Does not reside

on Federal 

property

Works on Federal 

property in same 

state as LEA

G(ii) 0.05 → Table 5

The categories above correspond to the categories you will see on your payment voucher. Each 

category of student has a specific weight when calculating final payments according to the

Impact Aid law.
17

Appendix 2 – Using G5 e-Application for Section 8003

1. If you have not registered at www.G5.gov as an individual Impact Aid user, do so.

Visit G5 Help for a tutorial on how to register. Double-click “G5 for Impact Aid 

Applicants,” then “Impact Aid Applications,” then “Register as an Impact Aid User.”

2. Log in to www.G5.gov to begin or continue your application.

3. Prepare and submit the application by January 31, 2014, 11:59 p.m. EST.

Visit G5 Help for a tutorial on navigating the application. Double-click “G5 for Impact 

Aid Applicants,” then “Impact Aid Applications,” then “Complete and Submit an Impact 

Aid Application.”

A complete application includes the following:

 Cover Page, signed and dated 

 Impact Aid Program Assurances and Certifications, signed and dated

 One or more of Tables 1-5, as applicable 

 Table 6

 Table 7, if your LEA claimed children with disabilities on Table 1 or Table 2*

 Table 8, if your LEA operates buildings owned by the U.S. Department of 

Education*

 Table 10, if your LEA received construction payments under Section 8007(a)*

 Tables 9 and 11, if applicable

 A copy of your district’s IPPs or waiver, signed and dated, if applicable

*Tables 7, 8 and 10 will automatically display as part of your LEA’s application package if 

you are required to complete them.

4. Email (Impact.Aid@ed.gov) or fax (866-799-1272) all application pages for which 

signatures are required by January 31, 2014, 11:59 p.m. EST.

 Your application will not be considered complete until IAP receives the electronic 

application and signed and dated forms.

 Your Authorized Representative must sign and date the required Cover Page and 

Assurances and Certifications page by January 31, 2014.

 If you submit Table 9 or Table 11, the appropriate official must sign those pages

by January 31, 2014. 

 If faxing, use the “Fax Cover Sheet” provided on the Package Information tab.

 If emailing, please save and attach the forms in PDF format.

5. Forward a complete copy of your application to your State Educational Agency (SEA).

 Use the transmittal sheet provided on the Package Information tab

 Find your SEA’s contact information on our web site at State Educational Agency 

Representative List.