OMB Number: 4040-0004 

Expiration Date: 04/31/2012 

Application for Federal Assistance SF-424 Version 02

*1. Type of Submission 

 

 Preapplication 

 

 Application 

 

 Changed/Corrected Application 

*2. Type of Application *If Revision, select appropriate letter(s): 

 

 New 

 

 Continuation * Other (Specify) 

 

 Revision 

*3. Date Received: 4. Application Identifier: 

 

5a. Federal Entity Identifier: 

 

 

*5b. Federal Award Identifier: 

 

 

State Use Only: 

6. Date Received by State: 7. State Application Identifier: 

8. APPLICANT INFORMATION: 

* a. Legal Name: 

* b. Employer/Taxpayer Identification Number (EIN/TIN): 

 

*c. Organizational DUNS: 

 

d. Address: 

*Street1: 

 Street 2: 

*City: 

 County: 

*State: 

 Province: 

 Country: *Zip/ Postal Code: 

e. Organizational Unit: 

Department Name: 

 

 

 

Division Name: 

 

f. Name and contact information of person to be contacted on matters involving this application: 

 Prefix: First Name: 

 Midd le N a me: 

*Last Name: 

 Suffix: 

 Title: 

 

 Organizational Affiliation: 

 

 

 

 

 

*Telephone Number: Fax Number: 

*Email: 

 

 

 
 OMB Number: 4040-0004 

Expiration Date: 04/31/2012 

Application for Federal Assistance SF-424 Version 02

9. Type of Applicant 1: Select Applicant Type: 

 

 

Type of Applicant 2: Select Applicant Type: 

 

 

Type of Applicant 3: Select Applicant Type: 

 

 

*Other (specify): 

 

*10. Name of Federal Agency: 

 

11. Catalog of Federal Domestic Assistance Number: 

 

 

CFDA Title: 

 

 

 

*12. Funding Opportunity Number: 

 

*Title: 

 

 

 

 

13. Competition Identification Number: 

 

Title: 

 

 

 

 

14. Areas Affected by Project (Cities, Counties, States, etc.): 

 

 

 

 

 

 

*15. Descriptive Title of Applicant’s Project: 

 

 

 

 

 

Attach supporting documents as specified in agency instructions. 

 
OMB Number: 4040-0004 

Expiration Date: 04/31/2012 

Application for Federal Assistance SF-424 Version 02

16. Congressional Districts Of: 

 

*a. Applicant *b. Program/Project: 

 

Attach an additional list of Program/Project Congressional Districts if needed. 

 

 

17. Proposed Project: 

 

*a. Start Date: *b. End Date: 

18. Estimated Funding ($): 

*a. Federal 

*b. Applicant 

*c. State 

*d. Local 

*e. Other 

*f. Program Income 

*g. TOTAL 

*19. Is Application Subject to Review By State Under Executive Order 12372 Process? 

 

 a. This application was made available to the State under the Executive Order 12372 Process for review on 

 b. Program is subject to E.O. 12372 but has not been selected by the State for review. 

 c. Program is not covered by E.O. 12372 

*20. Is the Applicant Delinquent On Any Federal Debt? (If “Yes”, provide explanation.) 

 Yes No 

 

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements 

herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply 

with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject 

me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) 

 

 **I AGREE 

 

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or 

agency specific instructions. 

Authorized Representative: 

Prefix: *First Name: 

 

Midd le N ame: 

 

*Last Name: 

 

Suffix: 

*Title: 

 

*Telephone Number: Fax Number: 

*Email: 

*Signature of Authorized Representative: Date Signed: 

 

 

 
OMB Number: 4040-0004 

Expiration Date: 04/31/2012 

Application for Federal Assistance SF-424 Version 02

*Applicant Federal Debt Delinquency Explanation 

 

The following field should contain an explanation if the Applicant organization is delinquent on any Federal Debt. Maximum 

number of characters that can be entered is 4,000. Try and avoid extra spaces and carriage returns to maximize the availability of 

space. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
INSTRUCTIONS FOR THE SF-424 

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions, searching 

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, 

Paperwork Reduction Project (0348-0043), Washington, DC 20503. 

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED 

BY THE SPONSORING AGENCY. 

This is a standard form (including the continuation sheet) required for use as a cover sheet for submission of preapplications and applications and 

related information under discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the Federal 

agency (agency). Required items are identified with an asterisk on the form and are specified in the instructions below. In addition to the instructions 

provided below, applicants must consult agency instructions to determine specific requirements. 

Item Entry: Item Entry: 

10. Name Of Federal Agency: (Required) Enter the name of the 

Federal agency from which assistance is being requested with 

this application. 

1. Type of Submission: (Required): Select one type of submission in 

accordance with agency instructions. 

Preapplication 

Application

Changed/Corrected Application – If requested by the agency, check 

if this submission is to change or correct a previously submitted 

application. Unless requested by the agency, applicants may not 

use this to submit changes after the closing date.

11. Catalog Of Federal Domestic Assistance Number/Title: 

Enter the Catalog of Federal Domestic Assistance number and 

title of the program under which assistance is requested, as 

found in the program announcement, if applicable. 

12. Funding Opportunity Number/Title: (Required) Enter the 

Funding Opportunity Number and title of the opportunity under 

which assistance is requested, as found in the program 

announcement.

13. Competition Identification Number/Title: Enter the 

Competition Identification Number and title of the competition 

under which assistance is requested, if applicable.

2. Type of Application: (Required) Select one type of application in 

accordance with agency instructions. 

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

first time. 

Continuation - An extension for an additional funding/budget period 

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

renewals. 

Revision - Any change in the Federal Government’s financial 

obligation or contingent liability from an existing obligation. If a 

revision, enter the appropriate letter(s). More than one may be 

selected. If "Other" is selected, please specify in text box provided. 

A. Increase Award B. Decrease Award 

 C. Increase Duration D. Decrease Duration 

 E. Other (specify)

14. Areas Affected By Project: List the areas or entities using 

the categories (e.g., cities, counties, states, etc.) specified in 

agency instructions. Use the continuation sheet to enter 

additional areas, if needed.

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

Federal agency. 

4. Applicant Identifier: Enter the entity identifier assigned by the Federal 

agency, if any, or applicant’s control number, if applicable. 

15. Descriptive Title of Applicant’s Project: (Required) Enter a 

brief descriptive title of the project. If appropriate, attach a 

map showing project location (e.g., construction or real 

property projects). For preapplications, attach a summary 

description of the project.

5a Federal Entity Identifier: Enter the number assigned to your 

organization by the Federal Agency, if any. 

5b. Federal Award Identifier: For new applications leave blank. For a 

continuation or revision to an existing award, enter the previously 

assigned Federal award identifier number. If a changed/corrected 

application, enter the Federal Identifier in accordance with agency 

instructions.

6. Date Received by State: Leave this field blank. This date will be 

assigned by the State, if applicable.

7. State Application Identifier: Leave this field blank. This identifier will 

be assigned by the State, if applicable.

8. 

16. Congressional Districts Of: (Required) 16a. Enter the 

applicant’s Congressional District, and 16b. Enter all District(s) 

affected by the program or project. Enter in the format: 2 

characters State Abbreviation – 3 characters District Number, 

e.g., CA-005 for California 5th district, CA-012 for California 12th

district, NC-103 for North Carolina’s 103rd district. 

If all congressional districts in a state are affected, enter 

“all” for the district number, e.g., MD-all for all 

congressional districts in Maryland. 

If nationwide, i.e. all districts within all states are affected, 

enter US-all. 

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

Applicant Information: Enter the following in accordance with agency 

instructions: 

a. Legal Name: (Required): Enter the legal name of applicant that will 

undertake the assistance activity. This is the name that the organization 

has registered with the Central Contractor Registry. Information on 

registering with CCR may be obtained by visiting the Grants.gov website.

17. Proposed Project Start and End Dates: (Required) Enter the 

proposed start date and end date of the project. 

b. Employer/Taxpayer Number (EIN/TIN): (Required): Enter the 

Employer or Taxpayer Identification Number (EIN or TIN) as assigned by 

the Internal Revenue Service. If your organization is not in the US, enter 

44-4444444. 

c. Organizational DUNS: (Required) Enter the organization’s DUNS or 

DUNS+4 number received from Dun and Bradstreet. Information on 

obtaining a DUNS number may be obtained by visiting the Grants.gov 

website. 

18. Estimated Funding: (Required) Enter the amount requested 

or to be contributed during the first funding/budget period by 

each contributor. Value of in-kind contributions should be 

included on appropriate lines, as applicable. If the action will 

result in a dollar change to an existing award, indicate only the 

amount of the change. For decreases, enclose the amounts in 

parentheses. 

d. Address: Enter the complete address as follows: Street address (Line 

1 required), City (Required), County, State (Required, if country is US), 

Province, Country (Required), Zip/Postal Code (Required, if country is 

US).

e. Organizational Unit: Enter the name of the primary organizational 

unit (and department or division, if applicable) that will undertake the 

19. Is Application Subject to Review by State Under Executive 

Order 12372 Process? Applicants should contact the State 

Single Point of Contact (SPOC) for Federal Executive Order 

12372 to determine whether the application is subject to the 
assistance activity, if applicable. State intergovernmental review process. Select the 

appropriate box. If “a.” is selected, enter the date the 

application was submitted to the State

f. Name and contact information of person to be contacted on 

matters involving this application: Enter the name (First and last name 

required), organizational affiliation (if affiliated with an organization other 

than the applicant organization), telephone number (Required), fax 

number, and email address (Required) of the person to contact on 

matters related to this application. 

20. Is the Applicant Delinquent on any Federal Debt? 

(Required) Select the appropriate box. This question applies to 

the applicant organization, not the person who signs as the 

authorized representative. Categories of debt include 

delinquent audit disallowances, loans and taxes. 

If yes, include an explanation on the continuation sheet. 

 Type of Applicant: (Required) 

Select up to three applicant type(s) in accordance with agency 

instructions.

21. Authorized Representative: (Required) To be signed and 

dated by the authorized representative of the applicant 

organization. Enter the name (First and last name required) 

title (Required), telephone number (Required), fax number, 

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

for the applicant. 

A copy of the governing body’s authorization for you to sign 

this application as the official representative must be on file in 

the applicant’s office. (Certain Federal agencies may require 

that this authorization be submitted as part of the application.) 

9. 

A. State Government 

B. County Government 

C. City or Township Government 

D. Special District Government 

E. Regional Organization 

F. U.S. Territory or Possession 

G. Independent School District 

H. Public/State Controlled 

Institution of Higher Education 

I. Indian/Native American Tribal 

Government (Federally 

Recognized) 

J. Indian/Native American Tribal 

Government (Other than 

Federally Recognized) 

K. Indian/Native American 

Tribally Designated 

Organization 

L. Public/Indian Housing 

Authority 

M. Nonprofit with 501C3 IRS 

Status (Other than Institution 

of Higher Education) 

N. Nonprofit without 501C3 IRS 

Status (Other than Institution 

of Higher Education) 

O. Private Institution of Higher 

Education 

P. Individual 

Q. For-Profit Organization 

(Other than Small Business) 

R. Small Business 

S. Hispanic-serving Institution 

T. Historically Black Colleges 

and Universities (HBCUs) 

U. Tribally Controlled Colleges 

and Universities (TCCUs) 

V. Alaska Native and Native 

Hawaiian Serving Institutions 

W. Non-domestic (non-US) 

Entity 

X. Other (specify)