Form SF-424 Application for Federal Assistance

Evaluate the Effects of the National Scenic Byways Program Grants

FullSampleApplication2

National scenic byways program

OMB: 2125-0611

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2125-0611 can be found here:

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OMB Number: 4040-0004
Expiration Date: 07/31/2006

Version 02

Application for Federal Assistance SF-424
* 1. Type of Submission:

* 2. Type of Application:

Preapplication

New

Application

Continuation

Changed/Corrected Application

Revision

* If Revision, select appropriate letter(s):

* Other (Specify)

* 3. Date Received:

4. Applicant Identifier:

Completed by Grants.gov upon submission.

NSB12345

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: Scenic Byway 12 Committee
* b. Employer/Taxpayer Identification Number (EIN/TIN):

* c. Organizational DUNS:

12-12345678

123456789

d. Address:
* Street1:

P.O. Box 132

Street2:

105 So. Sutherland Ct.

* City:

Tropic

County:
* State:

UT: Utah

Province:
* Country:

USA: UNITED STATES

* Zip / Postal Code:

84776

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:

John

Middle Name: C.
* Last Name:

Holland

Suffix:
Title:

Byway Coordinator

Organizational Affiliation:
Scenic Byway 12 Committee
* Telephone Number: 435-679-8987
* Email:

[email protected]

Fax Number:

OMB Number: 4040-0004
Expiration Date: 07/31/2006

Application for Federal Assistance SF-424
9. Type of Applicant 1: Select Applicant Type:
N: Nonprofit without 501C3 IRS Status (Other than Institution of Higher Education)
Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:
Department
of Health Administration
and Human Services
Federal Highway

11. Catalog of Federal Domestic Assistance Number:
10.001
CFDA Title:
Program
NationalTitle
Scenic

Byways Program

* 12. Funding Opportunity Number:
OPP-NUM
* Title:
Opp
2007Title
NSBP Grants

13. Competition Identification Number:
CID1
Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):
(General location edited for length because the max is 250 characters -- full text in attachment) ... Garfield, Wayne Counties, Bryce
Canyon National Park, Staircase-Escalante National Monument, three state parks, and Glen Canyon ...

* 15. Descriptive Title of Applicant's Project:
Hwy 12 All-American Road - Corridor Management Plan Implementation - Year 4

Attach supporting documents as specified in agency instructions.
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Version 02

OMB Number: 4040-0004
Expiration Date: 07/31/2006

Version 02

Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant

UT02

* b. Program/Project

UT02

Attach an additional list of Program/Project Congressional Districts if needed.
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17. Proposed Project:
* a. Start Date:

07/01/2006

* b. End Date: 07/02/2009

18. Estimated Funding ($):
* a. Federal

25,000

* b. Applicant

6,250

* c. State

0.00

* d. Local

0.00

* e. Other

0.00
0.00

* f. Program Income

31,250

* 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

Explanation

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:

Mr.

Middle Name:

* Last Name:

Holland

* First Name:

John

Suffix:
* Title:

Byway Coordinator

* Telephone Number: 435-679-8987
* Email:

Fax Number:

[email protected]

* Signature of Authorized Representative:
Authorized for Local Reproduction

Completed by Grants.gov upon submission.

* Date Signed:

Completed by Grants.gov upon submission.

Standard Form 424 (Revised 10/2005)
Prescribed by OMB Circular A-102

OMB Number: 4040-0004
Expiration Date: 07/31/2006

Application for Federal Assistance SF-424
* 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.

Version 02

OMB Number: 4040-0003
Expiration Date:09/30/2005
Version 01

Project Abstract
The Project Abstract must not exceed one page and must contain a summary of the proposed activity suitable for dissemination to the
public. It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed.
It should be informative to other persons working in the same or related fields and insofar as possible understandable to a technically
literate lay reader. This Abstract must not include any proprietary/confidential information.

* Please click the add attachment button to complete this entry.
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Project Abstract.pdf

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OMB Number: 4040-0003
Expiration Date: 09/30/2005

Key Contacts Form
* Applicant Organization Name:

Scenic Byway 12 Committee
Enter the individual's role on the project (e.g., project manager, fiscal contact).

* Contact 1 Project Role: Project Coordinator
Prefix:
* First Name:

Mr.
John

Middle Name: C.
* Last Name:

Holland

Suffix:
Title:

Byway Coordinator

Organizational Affiliation:
Scenic Byway 12 Commitee
* Street1:
Street2:
* City:

P.O. Box 132
105 So. Sutherland Ct.
Tropic

County:
* State:

UT: Utah

Province:
* Country:
* Zip / Postal Code:

USA: UNITED STATES
84776

* Telephone Number: 435-679-8987
Fax:
* Email: [email protected]
Enter the individual's role on the project (e.g., project manager, fiscal contact).

* Contact 2 Project Role:
Prefix:
* First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:

* Street1:
Street2:
* City:
County:
* State:

UT: Utah

Province:
* Country:
* Zip / Postal Code:
* Telephone Number:
Fax:
* Email:

USA: UNITED STATES

Version 01

OMB Number: 4040-0003
Expiration Date: 09/30/2005
Enter the individual's role on the project (e.g., project manager, fiscal contact).

* Contact 3 Project Role:
Prefix:
* First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:

* Street1:
Street2:
* City:
County:
* State:
Province:
* Country:
* Zip / Postal Code:
* Telephone Number:
Fax:
* Email:
Enter the individual's role on the project (e.g., project manager, fiscal contact).

* Contact 4 Project Role:
Prefix:
* First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:

* Street1:
Street2:
* City:
County:
* State:
Province:
* Country:
* Zip / Postal Code:
* Telephone Number:
Fax:
* Email:

Version 01

OMB Number: XXXX-XXXX
Expiration Date: MM/DD/YYYY

Work Plan
7/1/2006
1. Estimated Establish funding agreement with state
Note: Tasks starting before this date are not eligible for funding, and cannot be counted toward matching funds.
Describe the tasks in the work plan:
2
a. Describe this task or milestone:

General Administration

b. Name of person or organization responsible for carrying out task:
c. How long will this task take to complete?

Byway Coordinator

12 months

d. Justify how this project task contribute to project completion: (800 character limit - about 133 words)
This fourth year seed grant will fund administrative activities and expenses (travel, supplies, printing, etc.). The Coordinators
responsibilities include:
1) Preparing correspondence as necessary
2) Preparing and distributing documents and reports as necessary
3) Assisting with Scenic Byway 12 meetings as necessary
4) Maintaining the Scenic Byway 12 Web site
5) Provide a central point of contact in the Byway organization
6) Oversee the work of contractors as needed
3
a. Describe this task or milestone:

Marketing Master Plan

b. Name of person or organization responsible for carrying out task:
c. How long will this task take to complete?

Byway Coordinator

months

d. Justify how this project task contribute to project completion: (800 character limit - about 133 words)
With our Scenic Byway 12 signage and interpretation project moving ahead it is time now to begin a second major initiative outlined
in our CMP, marketing the Byway. Our byway organization includes representatives of area business, federal, state, and local
government, and citizens. The broad variety of interests and perspectives represented in the Sce regarding promotion. Developing a
sensible marketing plan that meets the needs of all byway stakeholders will take a concerted effort to include the ideas and opinions
as many people as possible.
Our marketing planning efforts will begin with fundraising. Next, a request for proposals will allow the Scenic Byway 12 Committee
to identify a third party organization with the necessary expertise to develop a comprehensive marketing plan.
4
a. Describe this task or milestone:

Public Outreach

b. Name of person or organization responsible for carrying out task:
c. How long will this task take to complete?

Byway Coordinator

months

d. Justify how this project task contribute to project completion: (800 character limit - about 133 words)
The Scenic Byway 12 Committee will continue its campaign of public outreach in FY 2006. The Coordinator will conduct the
following activities:
1) Assist byway communities with recognizing grant opportunities and provide specific guidance to facilitate successful grant
applications.
2) Seek to strengthen community support by facilitating community meetings and attending community and council meetings as
needed.
3) Produce news releases as necessary or as requested by Scenic Byway 12 Committee.
4) Keep volunteers and other interested individuals and organizations informed of Byway activities and initiativ

5
a. Describe this task or milestone:

Signage and Interpretation Plan Implementation

b. Name of person or organization responsible for carrying out task:
c. How long will this task take to complete?

Scenic Byway 12 Committee

months

d. Justify how this project task contribute to project completion: (800 character limit - about 133 words)
With our signage and interpretation master planning document complete in early 2006 we are seeking grants and other funding to
begin the design and construction phases of the project. Working with Utah Department of Transportation and our other byway
partners we will move ahead with our goal to completely update signage an interpretive facilities on Scenic Byway 12.

6
a. Describe this task or milestone:
b. Name of person or organization responsible for carrying out task:
c. How long will this task take to complete?

months