FORM APPROVED

OMB NO. 1810-0687 EXPIRATION DATE: 09/30/201 4

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. I f 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. I f you have any comments or concerns regarding the status of your individual submission of this form, write directly to: I mpact 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 201**  **5 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 

## DE**AD LINE:**  **11:59 p.m. EST, Januar** **y 31, 201**  **4**ii



## 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 ................................ ................................ ................................ ................................ ............. 9iii

Table 6 ................................ ................................ ................................ ................................ ........... 10 Tabl e 7 ................................ ................................ ................................ ................................ ........... 11 Table 8 ................................ ................................ ................................ ................................ ........... 11 Table 10 ................................ ................................ ................................ ................................ ......... 12 Housing Undergoing R enovation 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 ................................ ................................ 171



## The **Impact Ai**  **d 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 p ayments 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 regu lat ions (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 Im pact Aid Program (IAP) web sit e 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, whic h 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**Ap ply**  Any LEA that serves significant proporti ons 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 th e 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 **Ap pl**  **y Deadline** 
—The deadline for submitting this electronic application is :

**11:59 p.m.,**  **Eastern Standard T ime,**  **Thursday , January 3**  **1, 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 th e application, submitted by fax or as an e - mail attachment2

 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 wh ich 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 Bu reau 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 e mail receipt to document your timely submission. 

### Lat**e Application s**  — 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 201 5 appli cations is Tuesday, April 1, 2014 . 

### Amendments
— Users can use the G5 e -Application website to modify and update their appli cations until September 30, 2014 . 

## How**to Ap**  **pl y**  Prepare and submit this application by using the U.S. Department of E ducation’s electronic grant application syst em, G5 e-Application, available on line 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 **e mail 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 Certificati ons 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 th e 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 & Instruction s on the Package Information screen in e -Applicatio n. Your application is not complete until you have submitte d the electronic application on line and you have email ed 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 Ai d contact is included in a list on our website at www.ed.gov/about/offices/list/oese/impactaid/searl.html .3



## Mandator**y Forms**  Your application must contain all mandatory forms, inc luding:

• 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) .) • I ndian P olic ies and P rocedures (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. 

## Cov**er 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 p roperly 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 ta ken. 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 Ja nuary 31, but no later than May 14, and submit those data as an amen dment to your application. I t 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 applicat ion 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 prov ide 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 ta x rate of at least 95 percent of their comparable districts’ average5

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; a nd (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 **Ai d**  **Program As** **surances and Certifications Authorized Certifying Representative** 

— Enter the name and title of the LEA’s authorized cert ifying 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, regulato ry, 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 Im pact Aid Program Assurances and Certifications form on or before the filing deadline, January 31, 2014 . 

## General Instructions for T **ables 1 -** **5** Complete these tables to report the number of children associated with the Federal properties in your LEA. If you a re 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 st udent 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 S creen. 

### Eligible Federal Properties
— If you enter properties that are not on the Property Lookup S creen, you must indicate the specific lo cation of each parcel of claimed property by the official n ame, 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 pro perty team at 202 - 260- 3858. The following types of properties are among those that may be claimed:6

**Federal Office Building s**  – Report specific addresses. You do not need to report the Federal agency that employs the parents of children claimed for this c ategory. **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, Natio nal 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 O rde r. 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 clai m 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 t o 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** – Bui ldings 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 c laim a property that is not pre - populated on your application, the IAP staff will contact you later to request the elig ibility 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 prov ided 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. 

## Ta **ble 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 s igned 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 eith er 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 suc h children on your application as if the provision were already enacted. 

## Ta **ble 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 wh o 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 cu rrent written8

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. 

## Ta **ble 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 t he 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 define d in section 8013(7) of the Impact Aid law, and generally means land held in trust for ind ividual 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, o r 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 governm ent official and a9

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. 

## Ta **ble 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. 

## Ta **ble 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 fo reign 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 in10

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 can not count these children toward the basic program eligibility requirement of federall y connected children numbering at least 400 in ADA or three percent of the total number of children in the district, and can not count these children in calculating payment amounts. 

## Ta **ble 6**  MEMBERSHIP AND AVERAGE DAILY ATTENDANCE DATA **Line 1. (A)**  – Enter the number of children enrolled for the current school yea r (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 o ut) under arrangements that meet applicable State requirements. The tuition arrangements th at 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 fo r the pre ceding 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 eligi ble 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 distri ct'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 federal11

property or whose parents are employed on federal property — civilian "F & G" ch ildren — 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. 

## Ta **ble 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.** – Repo rt 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 co st of children with disabilities. **Line 2.** – Report State aid received for all current expenditures for elementary and secondary education purpose s. 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. 

## Ta **ble 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



## Ta **ble 10**  SECTION 8007 (CONSTRUCTION) If your LEA received construction funds under section 8007 in the preceding year you must complete Table 10. T ABLE 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 purpose s. **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 o ut 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 a ccount for all non - construction - related expenditu res (e.g., equipment, instructional materials). **Line 7.** – Report tota l 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. T ABLE 10 b – Report on Condition of Facilities Rate the overall condition of your LEA’s facilities. Choose one number to indicate t he 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 la st 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 Renov**ation 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 thoug h 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, Table s 9 & 11 ha ve been removed from the application and replaced by a single form for FY 201 5 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 a nd last name

2. Official title 3. Military installation or Indian Lands h ousing 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 Renovat ion 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 or14

rebuilding, you must submit the Housing Official Co ntact 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 thou gh 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 deadl ine. 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 I ndian 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 wit h your signature pages. The IPPs must be current and must have been reviewed and approved by your board of edu cation 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 p rovided by the tribe . In addition, you will need to maintain documentati on 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 n eed more information about this requirement. 

## Housing Undergoing Renov**ation 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 t he 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 b e 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 undergoi ng 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. **Li ne 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 lo nger 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



## Ap **pendix 1**  **– Ta**  **bles and Categories** 

**How is the student federally connected? Where is the student counted?**  STUDENT PARENT CATEGORY W EIGHT G ENERAL E DUCATION STUDENTS S PECIAL

E DUCATION STUDENTS (N OT G IFTED ) 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 d oes

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



## Ap **pendix 2 –**  **Using G5 e -** **Ap plication**  **for Section 8003 1.**  **If you have not registered at www.G5.gov**  **as an individu al 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 appli**  **cation. 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 800 7(a)*  Tables 9 and 11, if applicable  A copy of your district’s I PP s 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 applicati on 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 Educationa l Agency Representative List .