FORM APPROVED

OMB NO. 1810 -0036 EXPIRATION DATE: xx/xx/20xx

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. T he time required to complete this informati on collection is estimated to average 1.5 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 acc uracy 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 d irectly 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**  **APPLICATION FOR IMPACT AID, SECTION 800** **2**

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. EDT** **, January** **30, 2014**26941.1



## Contents The Impact Aid Section 8002 Program ................................ ................................ ........................... 3 Who May Apply ................................ ................................ ................................ ............................... 3 When To Apply ................................ ................................ ................................ ................................ 3 Deadline ................................ ................................ ................................ ................................ . 3 Late Applications ................................ ................................ ................................ .................... 3 Amendments ................................ ................................ ................................ .......................... 4 How To Apply ................................ ................................ ................................ ................................ .. 4 Mandatory Forms ................................ ................................ ................................ ........................... 4 Cover Page ................................ ................................ ................................ ................................ ...... 4 Impact Aid and PR/Award Numbers ................................ ................................ ...................... 4 DUNS Number ................................ ................................ ................................ ........................ 5 Applicant Name and Address ................................ ................................ ................................ . 5 Contact Person ................................ ................................ ................................ ....................... 5 Changes in Acreage of Eligible Properties and Changes in Boundaries ................................ 5 Program Assurances and Certifications ................................ ................................ .......................... 5 Authorized Certifying Representative ................................ ................................ ................... 5 Table 1 ................................ ................................ ................................ ................................ ............. 6 Table 2 ................................ ................................ ................................ ................................ ............. 6 Table 3 ................................ ................................ ................................ ................................ ............. 7 Table 4 ................................ ................................ ................................ ................................ ............. 726941.1



## The Impact **Ai d**  **Section 8002 Program** Payments for Federal Property under Section 8002 of the Elementary and Secondary Education Act assist local school districts that have lost a portion of their local tax base because of federal ownership of property. To be eligible, a school district must demonstrate that the federal government has acquired, since 1938, real property with an ass essed valuation of at least 10 percent of all real property in the district at the time of acquisition. Before completing the application, you should review Section 8002 of the Elementary and Secondary Education Act which provides detailed eligibility requ irements, definition of terms, and the specific requirements of P.L. 112 - 239. Due to amendments in P.L. 112 - 239, authorized with the National Defense Authorization Act for Fiscal Year 2013, changes were made to the reporting requirements of Section 8002 of the Impact Aid program. These changes are reflected in Table 1 , Table 3, and Table 4 of the application. You can prepare and submit this application only by using G5 e -Application, the Department of Education’s electronic application system, which is a vailable on the Internet at www. g5.gov . If you need further assistance in preparing this application, p lease call the IAP at 202 - 260- 3858. 

## Who May**Ap ply**  Any local educational agency (LEA) in which the Federal governmen t has acquired significant amounts of local real property since 1938 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 eleme ntary 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 witho ut tuition charge, pursuant to the law of the State in which the LEA is located. 

## When T **o Ap**  **pl y**  **Deadline** —The deadline for submitting this electronic application is :

**January 30, 2014, 11:59**  **p.m., Eastern Daylight**  **Time** An application is timely filed if the I mpact Aid Program receives the application on or before the application deadline, **and** the signature pages a re received by fax or e mail . **The assurances and signature pages are**  **also due**  **by the application deadline.**  **Do not wait until the application d**  **eadline to fax the signature**  **and assurances pages and risk**  **missing the deadline.** Keep your fax machine’s confirmation printout or your e mail receipt to document your timely submission. 

### Late Applications — Applicants can still file for Section 8002 assistanc e up to 60 days after the 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 applications is ... TBA26941.1



### Amendments — Users can submit amendments to their FY 201 5 applications until TBA . 

## How**T o**  **Ap pl**  **y** 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 a re 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 a t 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 repres entative must sign and date the cover page of the application and the Impact Aid Program Assurances and Certifications page. Fax the pages to the Impact Aid Program at (866) 799 - 1272, our toll -free fax number, or scan the pages as a PDF file and send the file by e mail 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 G5 e -Application. Your application is not comp lete until you have submitted the G5 e-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 sa me time you submit it 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 . 

## Manda**tor y**  **Forms** Your application must contain all mandatory forms, including :

• Cover Page • Assurances • Table 1 • Table 3 • Table 4 Table 2: Complete Table 2 if you have revenue from the eligible Federal property. Do not include revenue from Impact Aid or any other Department of Education program. 

## Cov**er Page 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 displayed26941.1

on the screen begins with “GIA” please contact the Impact Aid Prog ram 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 a ssign these numbers for you afte r 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 on this application. 

### Applicant Name a**nd Address** — Your LEA’s name and address will be displayed as they are listed in the Impact Aid Program records . 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 should be for the person on your LEA’s staff who is most knowledgeable about this application. Please be careful to provide an acc urate e mail address. The IAP uses this address to provide applicants with timely information throughout the year. 

### Changes in Acreage of Eligible Prope**rties and Changes in Boundaries** — Check the applicable box on the cover sheet if there has been a change in the number of acres of eligible Federal property that you incl ude on your application. If, for example, ownership of some of the section 8002 property has been transferred from the Federal Government or the Federal Government has acquired additional property in the school district, you should check this box. Check th e applicable box if there have been changes in the geographical boundaries of the LEA, including through a consolidation with one or more other LEAs. If you check either of these boxes, you will need to upload supporting documentation (i.e. , consolidatio n, annexation, dissolution , or deed documentation) . 

## Program A**ssurances and Certifications Authoriz** **ed Certifying**  **Representative** — Enter the name and title of the LEA’s authorized certifying representative. The signature of the LEA’s representative commits the applicant to the assurances contained in the application, including the assurance that the applicant meets all statutory, regulatory, and administrative requirements. The representative must sign and date the printed copies of the Cover Page and the Assurances and Certifications form on or before the filing deadline .26941.1

New applicants must obtain and file the additional assurances and certifications noted on page two of the application by the application deadline. Contact the I mpact Aid Program for additional information . 

## Ta **ble 1** SECTION 8002- ELIGIBLE FEDERAL PROPERTY IN THE LOCAL EDUCATIONAL AGENCY On Table 1 , you will need to list all Section 8002 -eligible Federal property in the LEA. Since all Federal acres in your LEA may not be Section 8002 - eligible, it is essential that you include only Section 8002 acres that have been approved by the I mpact Aid Program . Do not assume that all Federal acres in your LEA are eligible or approved for the purposes of Section 8002. Contact your program analyst if you have any questions concerning the number of approved Section 8002 - eligible acres in your LEA. When the Section 8002 -eligible Federal property is located in more than one jurisdiction, enter the total number of acres in each jurisdiction. 1. In column 1, enter the name of the Section 8002 - eligible Federal property. 2. In column 2, enter the name of the corresponding taxing jurisdicti on. 3. In column 3, enter the number of Federal acres associated with and approved as eligible federal acres for the purposes of the Impact Aid Program. If the total number of Section 8002 - eligible acres has changed from last year’s total (increase or d ecrease), you will need to submit official documentation of this change which will be verified by the Impact Aid Program prior to approval. An example of the documentation required is a deed showing the property has been acquired by the Federal government (increase in acres) or returned to the LEA (decrease in acres). You can only upload one document for each table. If you have more than on e document, you will need to scan those documents into one PDF document and then upload it. 

## Ta **ble 2** REVENUE FROM ELIGIBLE FEDERAL PROPERTY List all revenue from Federal and non - Federal sources during the second preceding fiscal year (e.g., FY 201 2 - 201 3 da ta for the FY 201 5 application) from activities associated with section 8002 - eligible Federal property. If revenue is from Federal programs, provide the name of each Federal program and the name of the Federal agency responsible for administering that program. If only a portion of the Federal property generating the revenue is eligible under S ection 8002, prorate the revenue to reflect the share attributable to the section 8002 - elgible property. For example, if the LEA has 10,000 acres of U.S. Forest Service property that generated $20,000 in timber revenues, but only 2,000 acres are eligible under section 8002, the LEA should report one -fifth (20 percent) of the total, or $4,000, as revenue associated with26941.1

section 8002 - eligble Federal property. Do not report Impact Aid revenue or receipts from other U.S. Department of Education programs on this table. If you receive no other revenue for the Section 8002 -eligible acreage, leave this form blank. 

## Ta **ble 3** TOTAL ACREAGE AND TAXABLE VALUE IN THE LOCAL EDUCATIONAL AGENCY To assist the Secretary in determining the taxable value of the eligible federal property, a n authorized LEA official must obtain the information for columns 2 and 3 and provide the source of the official data, such as a document from a State we bsite or website address . Upload a PDF file of this documentation to the G5 application or fax it to the Impact Aid Program along with the LEA’s signature pages . If the information was obtained directly from a local official (e.g., local tax assessor), you must submit a certification by that official that includes the person’s name, title, email address, and telephone number. If the LEA is located in more than one taxing jurisdiction (e.g., two counties) or contains more than one taxing jurisdiction (e.g., two townships), enter the information for each jurisdiction on a separate l ine . 1. In column 1, enter the name of the taxing jurisdiction. This information mu st match the jurisdictions listed on Table 1. 2. In column 2, enter the total number of acres located in the LEA or taxing jurisdiction. Include all types of property (taxable and non -taxable, including the Federal acres ) in the total acre age amount. 3. In column 3, enter the total taxable value, for the purpose of levying property tax for school purposes for current expenditures, of real property located within the boundaries of the LEA for the prior fiscal year (e.g., for the FY 201 5 application, enter the taxable value for the 201 3 - 2014 year, or the specific value as of January 201 4 ). If the LEA is located in more than one taxing jurisdiction (e.g., two counties) or contains more than one taxing jurisdiction (e.g., two townships), enter the informatio n for each jurisdiction separately. You can only upload one document for each table . If you have more than one document, you will need to scan those documents into one PDF document and then upload it. 

## Ta **ble 4** TAX LEVY INFORMATION Enter the local real pro perty tax levy, in mills or dollars, that was used to raise funds for current operating expenditures for the local educational agency (LEA) for the prior fiscal year (e.g., FY 2012 - 2013 data for the FY 2014 application). Enter a single tax rate for school operations expenditures for all types of real property in the jurisdiction. When funds for current operating expenditures for the LEA are raised by more than one taxing jurisdiction, enter the tax rate information for each additional jurisdiction on a sep arate line. If this page is pre- populated with information provided by your LEA in last year’s application, please update or correct items as needed.