Form CDFI-0002 Bank Enterprise Award Program FY 2010 Application

Bank Enterprise Award Program

FY 2010 Application

OMB Approval No. 1559-0005

CDFI Form: CDFI-0002

Paperwork Reduction Act Notice

This submission requirements package is provided to Applicants for Awards under the Bank Enterprise Award Program. The Estimated average burden associated with this collection of information is 15 hours per respondent, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Department of the Treasury, Community Development Financial Institutions Fund, and 601 Thirteenth Street, N.W., Suite 200- South, Washington, DC 20005.

Catalog of Federal Domestic Assistance Number: 21.021

Table of Contents

Introduction and Instructions 3

FY 2010 BEA Program 3

Changes to the FY 2010 Application 3

Application Eligibility Factors 4

FDIC-Insured Depositories 4

Prior Fund Awardees or Allocatees 4

Qualifying Activities 6

Priority Factors 6

Eligible CDFI Partners 7

Distressed Communities 7

Application Submission Requirements and Deadlines 7

Application Package 7

Application Deadlines 9

Ensuring that the Application Package Is Complete 10

Awardee Notification and the Award Agreement 10

Contacting the CDFI Fund 11

Part I: myCDFIFund Submission 12

Electronic Attachments 12

CDFI Partners 13

CDFI Partner Registration Instructions 13

SF- 424 Instructions 15

Environmental Review Form 16

Assurances and Certifications 17

Certification 1: ETAs or New Branches 21

Certification 2: Certification of Disbursement 22

Certification 3: Certification of Integrally Involved CDFI Partners 23

Certification 4: Certification of Baseline Period Qualified Activities 24

Applicant Information 25

Instructions for Worksheet 1: Estimated BEA Award Calculation 26

Worksheet 1: Estimated BEA Award Calculation 27

Worksheet 2: Report of Transactions 28

Part II: Qualified Activity Documentation 30

General Information 30

Application Checklist: Summary of Required Documentation by Category 31

CDFI Related Activities 33

Reporting CDFI Related Activities 33

Documenting CDFI Related Activities 33

Distressed Community Financing Activities 34

Reporting Distressed Community Financing Activities 35

Documenting Distressed Community Financing Activities 35

Service Activities 36

Reporting and Documenting Deposit Liabilities 36

Reporting and Documenting Community Services 36

Reporting and Documenting All Other Service Activities 36

Introduction and Instructions

Capitalized terms (other than titles) are defined in the BEA Program Regulations, the Notice of Funds Availability (NOFA) for the FY 2010 funding round, the BEA Program Application, or the Supplemental Guidance for Applicants. All of these documents may be downloaded from the CDFI Fund’s website at www.cdfifund.gov. Certain terms used throughout the Application have meanings unique to the BEA Program. The CDFI Fund encourages each Applicant to review the regulations, NOFA, and the Supplemental Guidance to be familiar with these meanings as well as other program requirements.

The mission of the Community Development Financial Institutions Fund (the CDFI Fund) is to expand the capacity of financial institutions to serve populations and communities lacking adequate access to financial products and financial services. The CDFI Fund achieves its mission by directly investing in and supporting Community Development Financial Institutions (CDFIs), Community Development Entities (CDEs), and other financial institutions through the CDFI Program, the Native Initiatives, the New Markets Tax Credit (NMTC) Program, the Financial Education and Counseling (FEC) Pilot Program, the Capital Magnet Fund (CMF), and the Bank Enterprise Award (BEA) Program.

The BEA Program complements the community development activities of banks and thrifts (collectively referred to as banks for purposes of this Application) by providing financial incentives to expand investments in CDFIs and to increase lending, investment, and service activities within Distressed Communities. Providing monetary awards for increasing community development activities leverages the CDFI Fund's dollars and puts more capital to work in Distressed Communities throughout the nation.

Information on the CDFI Fund’s programs can be found on the CDFI Fund’s website at www.cdfifund.gov. From the home page, click on “What We Do”, then “Information for Applicants.” Click on the link for the various programs of interest.

Actual funding for this program is contingent upon available resources. Publication of this Application or the NOFA does not oblige the CDFI Fund or the Department of the Treasury to make any award or to obligate any available funds. Any costs incurred by the Applicants in developing an Application or in anticipation of an Award are done so at the Applicant’s own risk.

FY 2010 BEA Program

Changes to the FY 2010 Application

As stated in the FY 2010 NOFA, priority factors are revised to give priority to banks with assets less than $1.09 billion. The Application Worksheet 1 has been updated to reflect the change in priority factors. Priority factors based on the type of transaction will not be considered.

Applicants seeking an award in the Distressed Community Financing or Service Activities categories do not have to register a designated Distressed Community via its myCDFIFund account. CDFI Partners are still required to register a designated Distressed Community via its myCDFIFund account.

Awardees will be required to submit applications through their myCDFIFund account. Applications will not be available in Grants.gov

Application Eligibility Factors

FDIC-Insured Depositories

The legislation authorizing the BEA Program specifies that eligible Applicants for the BEA Program must be Insured Depository Institutions, as defined in 12 U.S.C. §1813(c)(2). As set forth in the NOFA, an Applicant must be FDIC-insured by December 31, 2009 to be eligible for a FY 2010 BEA Program Award.

Applicants can apply as a certified CDFI or non-certified CDFI. An Applicant must have received certification by the end of the Assessment Period (December 31, 2009 for the FY 2010 funding round) to apply as a CDFI. Previously certified Applicants must have a current and valid certification by the end of the Assessment Period.

Prior Fund Awardees or Allocatees

The BEA Program NOFA includes certain eligibility requirements which generally apply to Applicants that are prior awardees or allocatees under other Fund programs.

• Failure to Meet Reporting Requirements. The CDFI Fund will not consider an application submitted by an Applicant if the Applicant or its Affiliate is a prior CDFI Fund awardee or allocatee under any CDFI Fund program and is not current on the reporting requirements set forth in the previously executed assistance, award or allocation agreement(s), as of the application deadline. Please note that the CDFI Fund only acknowledges the receipt of reports that are complete. As such, incomplete reports or reports that are deficient of required elements will not be recognized as having been received.

• Pending Resolution of Noncompliance. If an Applicant that is a prior awardee or allocatee under any CDFI Fund program: (i) has submitted complete and timely reports to the CDFI Fund that demonstrate noncompliance with a previous assistance, award or allocation agreement, and (ii) the CDFI Fund has yet to make a final determination as to whether the entity is in default of its previous assistance, award or allocation agreement, the CDFI Fund will consider the Applicant’s application under the FY 2010 NOFA pending full resolution, in the sole determination of the CDFI Fund, of the noncompliance. Further, if an Affiliate of the Applicant that is a prior CDFI Fund awardee or allocatee under any CDFI Fund program: (i) has submitted complete and timely reports to the CDFI Fund that demonstrate noncompliance with a previous assistance, award or allocation agreement, and (ii) the CDFI Fund has yet to make a final determination as to whether the entity is in default of its previous assistance, award or allocation agreement, the CDFI Fund will consider the Applicant’s application under the FY 2010 NOFA pending full resolution, in the sole determination of the CDFI Fund, of the noncompliance.

• Default Status. The CDFI Fund will not consider an application submitted by an Applicant that is a prior CDFI Fund awardee or allocatee under any CDFI Fund program if, as of the application deadline, the CDFI Fund has made a final determination that such Applicant is in default of a previously executed assistance, award or allocation agreement(s). Further, an entity is not eligible to apply for an award pursuant to the FY 2010 NOFA if, as of the application deadline, the CDFI Fund has made a final determination that an Affiliate of the Applicant: (i) is a prior CDFI Fund awardee or allocatee under any CDFI Fund program, and (ii) has been determined by the CDFI Fund to be in default of a previously executed assistance, award or allocation agreement(s). Such entities will be ineligible to apply for an award pursuant to the FY 2010 NOFA so long as the Applicant’s, or its Affiliate’s, prior award or allocation remains in default status or such other time period as specified by the CDFI Fund in writing.

• Termination in Default. The CDFI Fund will not consider an application submitted by an Applicant that is a prior CDFI Fund awardee or allocatee under any CDFI Fund program if, within the 12-month period prior to the application deadline, the CDFI Fund has made a final determination that such Applicant’s prior award or allocation terminated in default of the assistance, award or allocation agreement and the CDFI Fund has provided written notification of such determination to such Applicant. Further, an entity is not eligible to apply for an award pursuant to the FY 2010 NOFA if, within the 12-month period prior to the application deadline, the CDFI Fund has made a final determination that an Affiliate of the Applicant is a prior CDFI Fund awardee or allocatee under any CDFI Fund program whose award or allocation terminated in default of the assistance, award or allocation agreement and the CDFI Fund has provided written notification of such determination to the defaulting entity.

• Undisbursed Funds. The CDFI Fund will not consider an application submitted by an Applicant that is a prior CDFI Fund awardee under any CDFI Fund program if the Applicant has a balance of undisbursed funds under said prior award(s), as of the application deadline. Further, an entity is not eligible to apply for an award pursuant to the FY 2010 NOFA if an Affiliate of the Applicant is a prior CDFI Fund awardee under any CDFI Fund program, and has a balance of undisbursed funds under said prior award(s), as of the application deadline. In the case where an Affiliate of the Applicant is a prior CDFI Fund awardee under any CDFI Fund program, and has a balance of undisbursed funds under said prior award(s), as of the application deadline of the FY 2010 NOFA, the CDFI Fund will include the combined awards of the Applicant and such Affiliates when calculating the amount of undisbursed funds.
  
  “Undisbursed funds” is defined as: (i) in the case of prior BEA Program award(s), any balance of award funds equal to or greater than five (5) percent of the total prior BEA Program award(s) that remains undisbursed more than three (3) years after the end of the calendar year in which the CDFI Fund signed an award agreement with the awardee, and (ii) in the case of prior CDFI Program or other CDFI Fund program award(s), any balance of award funds equal to or greater than five (5) percent of the total prior award(s) that remains undisbursed more than two (2) years after the end of the calendar year in which the CDFI Fund signed an assistance agreement with the awardee. Undisbursed funds does not include (i) tax credit allocation authority allocated through the New Markets Tax Credit Program; (ii) any award funds for which the CDFI Fund received a full and complete disbursement request from the awardee as of the application deadline of this NOFA; or (iii) any award funds for an award that has been terminated, expired, rescinded, or deobligated by the CDFI Fund.

Qualifying Activities

The BEA Program Award is based on an Applicant’s increases in Qualified Activities from the Baseline period to the Assessment Period. For the FY 2010 funding round, the Baseline Period is calendar year 2008 (January 1, 2008 through December 31, 2008), and the Assessment Period is calendar year 2009 (January 1, 2009 through December 31, 2009).

Qualified Activities are defined to include CDFI Related Activities, Distressed Community Financing Activities, and Service Activities. CDFI Related Activities include Equity Investments, Equity-Like Loans and CDFI Support Activities (loans, technical assistance, or qualifying deposits). Distressed Community Financing Activities include: Affordable Housing Loans; Affordable Housing Development Loans and related Project Investments; Education Loans; Commercial Real Estate Loans and related Project Investments; Home Improvement Loans; and Small Business Loans and related Project Investments. Service Activities include Deposit Liabilities, Financial Services, Community Services, Targeted Financial Services, and Targeted Retail Savings/Investment Products. For more detail, please see the FY 2010 NOFA and the BEA Interim Rule.

When calculating BEA Program award amounts, the CDFI Fund will count only the amount an Applicant reasonably expects to disburse for a Qualified Activity within 12 months from the end of the Assessment Period. The value of a Qualified Activity for purposes of determining a BEA Program award shall not exceed $10 million in the case of Commercial Real Estate Loans or any CDFI Related Activities (i.e., the total principal amount of the transaction must be $10 million or less to be considered a Qualified Activity), however, the CDFI Fund may consider transactions with a total principal value of over $10 million on a case by case basis. Applicants may include a narrative statement that describes the community benefit of transactions over $10 million for the CDFI Fund’s consideration.

Instructions for reporting and documenting Qualifying Activities can be found on page 30.

Priority Factors

The CDFI Fund ranks Applicants in each category of Qualified Activities according to the following priorities:

1. CDFI Related Activities

2. Distressed Community Financing Activities

3. Service Activities

Applicants in the first priority category will be selected for Awards before Applicants in the second category. Applicants in the first and second categories will be selected for Awards before Applicants in the third priority category. Selection within each priority category will be based on the Applicant’s relative rankings within each category, subject to the availability of funds. Priority in all categories is first given to CDFI Applicants over all other Applicants.

The CDFI Fund determines the actual Award amounts based upon the availability of funds, increases in Qualified Activities from the Baseline to the Assessment Period, and an Applicant’s priority ranking. If an Applicant receives an Award for more than one category, the CDFI Fund will combine the Award amounts into a single BEA Program Award. For more information, see the BEA Program Regulations, 12 CFR part 1806.203(c).

Eligible CDFI Partners

A CDFI that receives an Equity Investment, Equity-like Loan or CDFI Support Activity (loan, technical assistance, or qualifying deposit) from an Applicant is a CDFI Partner. In order for the Applicant to receive an award for its CDFI Related Activities, the CDFI Partner must have current and valid certification as of the end of the Assessment Period (December 31, 2009 for the FY 2010 funding round).

However, an Applicant that is also a CDFI cannot receive credit for any Qualified Activities provided to a CDFI Partner that is also an FDIC-insured depository institution or depository institution holding company.

Distressed Communities

Each CDFI Partner that is the recipient of CDFI Support Activities must designate a Distressed Community. The CDFI Partner’s designated Distressed Community must meet the requirements of the BEA Program. All Distressed Community Financing Activities and Service Activities must be provided to Eligible Residents or businesses located in a Distressed Community. A Distressed Community, defined in the BEA Program Regulations, 12 CFR Part 1806.103(t), and as more fully described in 12 CFR 1806.200, consists of a geographic area with continuous boundaries that is located within the boundaries of one Unit of General Local Government that meets certain minimum population, poverty, and unemployment requirements. See the FY 2010 NOFA for the specific characteristics of a Distressed Community.

A Distressed Community as defined by the BEA Program is not the same as an Investment Area as defined by the CDFI Program. A CDFI Partner may designate an area as a Distressed Community by selecting a Geographic Unit(s) that individually meets the minimum population, poverty, and unemployment requirements. A CDFI Partner may also designate a Distressed Community by selecting two or more contiguous Geographic Units that, in the aggregate, meet the geographic, population, poverty, and unemployment requirements -- provided that no designated Geographic Unit within the Distressed Community has a poverty rate of less than 20 percent.

The CDFI Fund requires all CDFI Partners to register their Distressed Community via their MyCDFIFund account. Applicants seeking an award in the Distressed Community Financing or Service Activities categories do not have to register a designated Distressed Community via its myCDFIFund account.

Application Submission Requirements and Deadlines

Application Package

The 2010 BEA Application is organized in two parts – according to their method of submission:

• Part I – Electronic Application Materials (all submitted through myCDFIFund account as attachments): (i) Standard Form (SF) 424; (ii) Excel and Word documents; and, (iii) Legal forms and Certifications

• Part II – Qualified Activity Documentation and Other Attachments (mailed to BPD)
  
  

Part	Application Component	Submission Procedures
Part I. myCDFIFund	myCDFIFund Account Registration: Required for All Applicants: Required for CDFI Partners that received CDFI Support. Electronic Attachments: Application for Federal Assistance Standard Form (SF) 424 Required for All Applicants:	Applicants: register Organization and User accounts via myCDFIFund according to the instructions on the myCDFIFund’s website. CDFI Partners: complete a BEA Signature page and register as a Partner (including its Distressed Community) via myCDFIFund according to the instructions on the myCDFIFund’s website and on page 13 of this application. Complete PDF template and sign Scan to create a new document Upload in myCDFIFund Attach to the FY 2010 BEA Signature Page
	Word Templates: Required for All Applicants: Environmental Review Form. Assurances and Certifications. As Required: Certification 1. ETAs or New Branches. Certification 2. Certification of Disbursement. Certification 3. Certification of Integrally Involved CDFI Partners. Certification 4. Certification of Baseline Period Qualified Activities.	Complete MS Word Templates Upload in myCDFIFund Attach to the FY 2010 BEA Signature Page
	Excel Charts: Required for All Applicants: Applicant Information. Worksheet 1: Estimated BEA Award Calculation. Worksheet 2: Report of Transactions.	Complete MS Excel Template Upload in myCDFIFund Attach to the FY 2010 BEA Signature Page
Part II. Hard Copy (BPD)	Qualified Activity Documentation /Other Attachments Documentation of Qualified Activities: as described below under Part II. Reporting and Documenting Qualified Activities. Documentation from the Internal Revenue Service (IRS) evidencing that the Applicant itself (i.e., not its parent or Affiliate) has been assigned its own unique Employer/Taxpayer Identification Number (EIN/TIN).	Submit to BPD as follows: One unbound copy of the completed SF-424 as the cover page along with required documentation and attachments. Copies of documentation are acceptable. No tabs, staples, or other forms of binding. One copy of SF-424 and documentation / attachments in a 3-ring binder (tabs, staples, and other binding are acceptable).

All Applicants and CDFI Partners must register User and Organization accounts in myCDFIFund, the CDFI Fund’s Internet-based interface, and submit their Application materials (Part I only) through this interface. As the myCDFIFund account is the CDFI Fund’s primary means of communication with Applicants and Awardees, organizations must make sure that they update the contact information in their myCDFIFund accounts before the applicable Application deadline. For more information on myCDFIFund accounts, please see the “Frequently Asked Questions” link posted at https://www.cdfifund.gov/myCDFI/Help/Help.asp and the 2010 BEA Registration Instructions on the CDFI Fund’s website, under the BEA Program.

Application Deadlines

The Application Package must be received by the following deadlines:

• Part I (myCDFIFund account): Application materials and CDFI Partner Registrations must be submitted by 5:00 p.m. Eastern Time (ET) on April 30, 2010.

• Part II (Documentation / Paper Attachments): must be received by the Bureau of Public Debt (BPD) (at the address specified below) by 5:00 p.m. ET on April 30, 2010:

Bureau of Public Debt

CDFI Fund – Awards Management

200 Third Street, A2-B

Parkersburg, WV 26106

(304) 480-5450

Allow at least 3 business days (i.e., not Saturday or Sunday) for delivery to BPD’s offices in West Virginia.

• Documentation / Paper Attachments will not be accepted at the CDFI Fund’s office in Washington, DC.

• Documentation/Paper Attachments sent by facsimile or e-mail will not be accepted and will be disregarded upon receipt.

• The CDFI Fund will not grant exceptions or waivers for late delivery of documents including, but not limited to, late delivery that is caused by third parties such as the US Postal Service, couriers, or overnight delivery services.

Ensuring that the Application Package Is Complete

An Applicant must complete and submit all required Application materials in such a manner as to comply with all requirements of the BEA Program Regulations, NOFA, and this Application by the applicable deadline. A complete Application Package is one that includes all required material described above. Some items – if missing or incomplete – will result in the immediate rejection of the entire Application. The CDFI Fund will immediately reject an Application Package if:

• The SF-424 is not submitted.

• The SF-424 is not received by BPD as the cover paper to the Documentation/Paper Attachments.

• Documentation of Qualified Activities is not received by BPD by the deadline.

The CDFI Fund will allow three business days for an Applicant to submit the following items if missing or incomplete:

• IRS Documentation of the Applicant’s EIN.

• Environmental Review Form and Assurances and Certifications.

Please be advised that Applicants must provide, as part of its application submission, a Dun and Bradstreet Data Universal Numbering System (DUNS) number and a valid and current Employer Identification Number (EIN), with a letter or other documentation from the Internal Revenue Service (IRS) confirming the EIN.

Do not wait until the last minute to obtain EIN documentation. The CDFI Fund encourages Applicants to allow sufficient time to obtain the necessary numbers and documentation. If the EIN documentation is missing from the initial paper submission of the Application materials, the three days allowed by the CDFI Fund to submit these items may not be sufficient time to obtain them. It is always better to ensure that the initial Application submission contains all required items and documentation.

Awardee Notification and the Award Agreement

For the FY 2010 funding round, the CDFI Fund will notify Applicants selected to receive an Award by September 2010. The CDFI Fund notifies an Applicant of the Award decision (positive or negative) via mail (hard copy or electronically) to the designated Authorized Representative. An Applicant selected to receive an Award will receive a Notice of Award and Award Agreement. The Notice of Award and Award Agreement will contain the general terms and conditions underlying the CDFI Fund’s provision of an Award. The Applicant must execute the Notice of Award and Award Agreement and return it to the CDFI Fund. Each Awardee must also provide the CDFI Fund with complete and accurate banking information on the Automated Clearinghouse (ACH) form provided in the Award Agreement. The ACH form must be returned with the Notice of Award and Award Agreement.

Applicants that receive Awards over $50,000 will be subject to compliance and reporting requirements as part of the terms and conditions of the Award Agreement. More information on the requirements for Awardees can be found in the FY 2010 NOFA and BEA Program Interim Rule.

Contacting the CDFI Fund

The CDFI Fund will respond to questions between the hours of 9:00 a.m. and 5:00 p.m. ET, through April 28, 2010 (two business days before the Application deadline). The CDFI Fund will not respond to phone calls or e-mail inquiries that are received after 5:00 p.m. ET on April 28, 2010. NOTE: These are not toll-free numbers.

Main Office	202-622-8662 202-622-7754 fax	www.cdfifund.gov	General inquiries; phone numbers for individual Fund staff; access to myCDFIFund and program web page.
Program Support	202-622-6355	[email protected]	How to complete Application materials.
Compliance & Monitoring Support	202-622-6330 202-622-6453 fax	[email protected]	Status of compliance with other Awards including outstanding reports.
IT Support	202-622-2455	[email protected]	Registering and creating accounts on myCDFIFund.
Legal Support	If you have any questions or matters that you believe require response by the CDFI Fund’s Office of Legal Counsel, please refer to the document titled “How to Request a Legal Review“, found on the CDFI Fund’s web site at www.cdfifund.gov.

Part I: myCDFIFund Submission

In 2010, Applicants are required to submit the FY 2010 BEA Application through their myCDFIFund account. For those who are new to the process, the following provides basic information for completing the application materials and submitting them through myCDFIFund account.

Electronic Attachments

An Applicant will download the SF-424 and Word and Excel templates from myCDFIFund and save them to their computer. After completing them – as applicable – the Applicant will upload the documents in myCDFIFund, attach them to the FY 2010 BEA Signature page in myCDFIFund and submit as instructed.

SF-424 and Word Templates:

Submitting the SF-424 certifies that the Applicant attests to the information provided in the Environmental Review Form and certifies that the Applicant will comply with the Assurances and Certifications if an Award is made. This signature also attests to the information provided in: Certification 1. ETAs or New Branches; Certification 2. Certification of Disbursement; Certification 3. Certification of Integrally Involved CDFI Partners; and Certification 4. Certification of Baseline Period Qualified Activities. Details for completing the SF 424 are on page 15.

For illustrative purposes only, the Environmental Review Form, Assurances and Certifications, and application Certifications 1 - 4 are included in this application, beginning on page 16. If an Applicant is required to submit Certification 1, Certification 2, Certification 3 and / or Certification 4, it will complete the certification as instructed below and upload via myCDFIFund.

Required for All Applicants:

Standard Form 424

Environmental Review Form

Assurances and Certifications

As Required:

Certification 1. ETAs or New Branches:

• Required for an Applicant seeking an Award for opening ETAs or a new retail branch.

• Check the applicable certification.

Certification 2. Certification of Disbursement:

• Required for an Applicant providing internal documentation of disbursement of CDFI Related Activities and Distressed Community Financing Activities. Information should match the information provided on Worksheet 2: Report of Transactions.

Certification 3. Certification of Integrally Involved CDFI Partners:

• Required for an Applicant seeking an Award for CDFI Support Activities.

• Enter the names of all of CDFI Partners and applicable information.

Certification 4. Certification of Baseline Period Qualified Activities:

• Required for all Applicants.

• Enter dollar values for the Baseline Period of all applicable Qualified Activities as reported on Worksheet 1: Estimated BEA Award Calculation.

• Do not check “Reporting” if not requesting an award based on that particular Qualified Activities category. If not requesting an award in that category, Baseline and Assessment Period values should be $0 on Worksheet 1: Final Estimated BEA Award Calculation.

Excel Charts:

For illustrative purposes only, the Excel charts and instructions are included in this application, beginning on page 25.

Required for All Applicants:

Applicant Information.

Worksheet 1: Estimated BEA Award Calculation. There is only one version of this worksheet. Based on your organization’s CDFI status as indicated on the Applicant Information sheet, the worksheet will automatically calculate the appropriate estimated award amount.

Worksheet 2: Report of Transactions.

CDFI Partners

A CDFI Partner that is the recipient of CDFI Support Activity must designate a BEA-qualified Distressed Community in which it is Integrally Involved and register with the CDFI Fund via its MyCDFIFund account. An Applicant seeking an Award for providing CDFI Support to a CDFI Partner will identify the CDFI Partner by listing its full legal name, city and state, and related Distressed Community on Certification 3: Certification of Integrally Involved CDFI Partners. During the application review process, Fund staff will verify the CDFI Partner is registered via myCDFIFund. Applicants must ensure that all CDFI Partner registration materials have been submitted by the deadline as CDFI Partners will not be contacted regarding missing or incomplete materials. If determined when reviewing an application that an Applicant’s CDFI Partner has not submitted the required BEA Signature Page, BEA-qualified maps, or other required information, the Applicant will not be notified of the missing documentation and the transaction will be disqualified.

CDFI Partner Registration Instructions

CDFI Partner Registration Materials consist of: (1) BEA-Qualifying Distressed Community Maps; and, (2) a BEA Signature Page.

Detailed instructions on registering a Distressed Community and registering as a CDFI Partner are available on the CDFI Fund’s website, under the BEA Program. See the document called “Registration Instructions.” The following is a brief overview of the instructions:

• Step 1. Access your organization’s MyCDFIFund account. Instructions on how to create a myCDFIFund account can be found at https://www.cdfifund.gov/myCDFI/index.asp.

• Step 2: Designate a Distressed Community in CIMS.

• For more information on how to use CIMS, please click on View the Tutorial to help you get started and better understand the myCDFIFund Mapping System under the Mapping homepage. The tutorial contains step-by-step instructions on how to create a Distressed Community map and a corresponding List of Eligible Census Tracts at your desk. Note: A Distressed Community as defined by the BEA Program is not the same as an Investment Area as defined by the CDFI Program and for certification as a CDFI.

• Step 3: Open the BEA Program Signature Page and attach the Distressed Community map created in Step 2.

• Step 4. Sign and submit the completed Signature Page.

SF- 424 Instructions

Required fields are prefaced with an asterisk (*).

Field	Instructions
*1. Type of Submission:	Select Application.
*2. Type of Application:	Select New.
*3. Date Received:	Automatically filled by the system upon submission – no entry necessary.
4. Applicant Identifier:	Automatically filled by the system upon submission – no entry necessary.
5a. Federal Entity Identifier:	Not Applicable – leave blank.
*5b. Federal Award Identifier:	Enter 21.021
6. State use only: Date Received by State:	Not Applicable – leave blank.
7. State use only: State Application Identifier:	Not Applicable – leave blank.
*8a. Applicant Information: Legal Name:	Enter the legal name of the Applicant.
*8b. Employer/Taxpayer Identification Number (EIN/TIN):	Enter the Applicant’s EIN/TIN.
*8c. Organizational DUNS:	Enter the Applicant’s DUNS.
*8d. Address:	Complete all fields with Applicant’s mailing address. Include 9-digit zip.
8e. Organizational Unit:	Not Applicable – leave blank.
*8f. Name and contact information of person to be contacted on matters involving this Application:	Enter a Contact Person, other than the AOR, who can answer questions about the submission. The Contact Person (name and contact information) identified here must match the Contact Person information in the Applicant’s myCDFIFund account. Organizational Affiliation: leave blank.
9. Type of Applicant:	Select the most appropriate description from list of dropdown options.
*10. Name of Federal Agency	Pre-filled – no entry necessary.
11. Catalog of Federal Domestic Assistance Number / CFDA Title:	Pre-filled – no entries necessary.
*12. Funding Opportunity Number / Title:	Number: Enter CDFI-2010-BEA. Title: enter BEA Program 2010.
13. Competition Identification Number:	Not Applicable – leave blank.
14. Areas affected:	Not Applicable – leave blank.
*15. Descriptive Title of Applicant’s Project:	Enter Applicant’s Name and BEA Program Application.
*16. Congressional Districts of Applicant / Program/Project:	See www.house.gov to find congressional district. Use same for both boxes.
*17. Proposed Project	Start Date: Enter 1/1/2009; End Date: Enter 12/31/2009.
*18. Estimated Funding $:	Enter total award request for Federal and Total, enter zeroes in other boxes.
*19. Is Application Subject to Review by State:	Select option C.
*20. Is the Applicant Delinquent:	Answer and provide Explanation if Yes selected.
*21. Applicant Certification / Authorized Representative:	Click the “I agree” button. Complete all fields for AOR information. AOR (name and contact information) must match the Authorized Representative’s information in the Applicant’s myCDFIFund account.

Environmental Review Form

Applicant Name:

The CDFI Fund’s environmental review requirements are set forth in 12 CFR Part 1815. The Applicant should review such regulations carefully before completing this section. In order to assure compliance with those regulations and other requirements related to the environment, the Applicant shall provide the following information:

	YES	NO
Are there any actions proposed in the Application that do not constitute a “categorical exclusion” as defined in 12 CFR 1815.110?
If YES, would any of these actions normally require an environmental impact statement (see 12 CFR 1815.108)?
Are there any activities proposed in the Application that involve:
Historical or archeological sites listed on the National Register of Historic Places or that may be eligible for such listing?
Wilderness areas designated or proposed under the Wilderness Act?
Wild or scenic rivers proposed or listed under the Wild and Scenic Rivers Act?
Critical habitats of endangered or threatened species?
Natural landmarks listed on the National Registry of Natural Landmarks?
Coastal barrier resource systems?
Coastal Zone Management Areas?
Sole Source Aquifer Recharge Areas designated by EPA?
Wetlands?
Flood plains?
Prime and unique farmland?
Properties listed or under consideration for listing on the Environmental Protection Agency’s List of Violating Facilities?

If YES to any of the above questions, attach a detailed description of each action, clearly identifying the category in which the action falls.

NOTIFICATION

As stated in 12 CFR 1815.105, if the CDFI Fund determines that the Application proposes actions which require an environmental assessment or an environmental impact statement, any approval and funding of the Application will be contingent upon:

1. The Applicant supplying to the CDFI Fund all information necessary for the CDFI Fund to perform or have performed any required environmental review;

2. The Applicant not using any Fund Financial Assistance to perform any of the proposed actions in the Application requiring an environmental review until approval is received from the CDFI Fund; and

3. The outcome of the required environmental review.

In addition, as stated in 12 CFR 1815.106, if the CDFI Fund determines that an Application, or any part thereof, is not sufficiently definite to perform a meaningful environmental review prior to approval of the Application, final approval and funding of the Application shall require supplemental environmental review prior to the taking of any action directly using Fund Financial Assistance for any action that is not a categorical exclusion.

Assurances and Certifications

Signing the certification on the SF 424 certifies that the Applicant will comply with the Assurances and Certifications listed below if an Award is made. Certain of these Assurances and Certifications may not be applicable to the Applicant. An Applicant may not modify any of the Assurances and Certifications.

A. Standard Form 424B: Assurances -- Non-Construction Programs

As the duly authorized representative of the Applicant, I certify that the Applicant:

1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning, management and completion of the project described in this Application.

2. Will give the Awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the Award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

4. Will initiate and complete the work (activities in Application) within the applicable time frame after receipt of approval of the Awarding agency.

5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specifies in Appendix A of Ohm’s Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).

6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L.88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.1681-1683, 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C.6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L.91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C.3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which Application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statutes which may apply to the Application.

7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

8. Will comply with the provisions of the Hatch Act (5 U.S.C.1501-1508 & 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), regarding labor standards for federally assisted construction sub agreements.

10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L.91-190) and Executive Order 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451et seq.); (f) conformity of Federal actions to State Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L.93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L.93-205).

12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

13. Will assist the Awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).

14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this Award of assistance.

15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this Award of assistance.

16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence structures.

17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984.

1. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program.

B. Additional Certifications

In addition to the assurances and certifications provided by the Applicant pursuant to OMB Standard Form 424B, the Applicant hereby assures and certifies that:

1. It is duly organized and validly existing under the laws of the jurisdiction in which it was incorporated or otherwise established, and is (or within 30 days will be) authorized to do business in any jurisdiction in which it proposes to undertake activities specified in this Application;

2. Its Board of Directors (or similar governing body) has by proper resolution or similar action authorized the filing of this Application, including all understandings and assurances contained herein, and directed and authorized the person identified as the authorized representative of the Applicant to act in connection with this Application and to provide such additional information as may be required;

3. It will comply with all applicable requirements of the Community Development Banking and Financial Institutions Act of 1994 (the Act) [12 U.S.C. 4701 et seq.], regulations implementing the Act and all other applicable Department of the Treasury regulations and implementing procedures (and any regulations or procedures which are later promulgated to supplement or replace them);

4. It will comply, as applicable and appropriate, with the requirements of OMB Circulars (e.g., A-110 and A-133) and any regulations and circulars which are later promulgated to supplement or replace them, including standards for fund control and accountability;

5. It has not knowingly and willfully made or used a document or writing containing any false, fictitious or fraudulent statement or entry as part of this Application or any related document, correspondence or communication. (The Applicant and its authorized representative should be aware that, under 18 U.S.C. 1001, whoever knowingly and willfully makes or uses such document or writing shall be fined or imprisoned for not more than five years, or both); and

6. The information in this Application, and in these assurances and certifications in support of the Application, is true and correct to the best of the Applicant’s knowledge and belief and the filing of this Application has been duly authorized.

C. Certification Regarding Debarment, Suspension, and Other Responsibility Matters -- Primary Covered Transactions: Instructions for Certification

1. By signing and submitting this Application, the prospective primary participant (the Applicant) is providing the certification set out below.

2. The inability of a person to provide the certification required below will not necessarily result in the denial of participation in this covered transaction. The prospective Applicant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the CDFI Fund’s determination whether to enter into this transaction (approval and funding of the Application). However, failure of the Applicant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.

3. This certification is a material representation of fact upon which reliance is placed when the CDFI Fund determines to enter into this transaction. If it is later determined that the Applicant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the CDFI Fund may terminate this transaction for cause or default.

4. The Applicant shall provide immediate written notice to the CDFI Fund if at any time the Applicant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. The terms “covered transactions,” “debarred,” “suspended,” “ineligible,” “lower tier covered transaction,” “participant,” “person,” “primary covered transaction,” “principal,” “proposal”, and “voluntarily excluded,” as used in this clause (certification), have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the CDFI Fund for assistance in obtaining a copy of those regulations (31 CFR part 19).

6. The Applicant agrees by submitting this Application that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the CDFI Fund.

7. The Applicant further agrees by submitting this Application that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction,” to be provided by the CDFI Fund, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions (see 31 CFR part 19, Appendix B).

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the No procurement List.

9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the CDFI Fund may terminate this transaction for cause or default.

D. Certification Regarding Debarment, Suspension, and Other Responsibility Matters -- Primary Covered Transactions

1. The prospective primary participant (the Applicant) certifies to the best of its knowledge and belief, that it and its principals:

are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

have not within a three-year period preceding this Application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

Have not within a three-year period preceding this Application had one or more public transactions (Federal, State or local) terminated for cause or default.

2. Where the Applicant is unable to certify to any of the statements in this certification, such Applicant shall attach an explanation to this proposal.

E. Certification Regarding Drug-Free Workplace Requirements

1. The Applicant certifies that it will provide a drug-free workplace by:

1. publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the Applicant’s workplace and specifying the actions that will be taken against employee for violations of such prohibition;

establishing a drug-free awareness program to inform employees about:

(i) the dangers of drug abuse in the workplace;

(ii) the Applicant’s policy of maintaining a drug-free workplace;

(iii) any available drug counseling, rehabilitation, and employee assistance program;

(iv) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace

making it a requirement that each employee to be engaged in the performance of the Award be given a copy of the statement required by subparagraph (a);

notifying the employee in the statement required by subparagraph (a) that, as a condition of employment in such grant, the employee will:

(i) abide by the terms of the statement; and

(ii) notify the employer of any criminal drug use statute conviction for a violation occurring in the workplace no later than five calendar days after such conviction;

notifying the granting agency in writing, within ten calendar days after receiving notice of a conviction under subparagraph (d) (ii) from an employee or otherwise receiving actual notice of such conviction;

taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(ii), with respect to any employee who is so convicted:

(i) taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

(ii) requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and

making a good faith effort to continue to maintain a drug-free workplace through implementation of subparagraphs (a), (b), (c), (d), (e), and (f).

2. The Applicant may insert in the space provided below the site(s) for the performance of work (activities carried out by the Applicant) to be done in connection with the Award (Place of Performance (Street Address, City, County, State and zip Code)): Not Applicable

F. Certification Regarding Lobbying

1. The Applicant certifies, to the best of its knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the Applicant, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the Awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement;

If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Application, the undersigned shall complete and submit Standard Form LLL, “Disclosure Form to Report Lobbying, “ in accordance with its instructions; and

The Applicant shall require that the language of this certification be included in the Award documents for all sub-awards of all tiers (including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose accordingly.

2. This certification is a material representation of fact upon which reliance is placed when this transaction is made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure

Certification 1: ETAs or New Branches

Applicant Name:

Signing the certification on the SF 424 certifies that the Applicant has complied with the conditions listed below (as applicable for the checked activities).

Electronic Transfer Accounts (ETAs)

The Applicant does hereby certify that (i) the Applicant has entered into, and is in compliance with, the Financial Agency Agreement with the Treasury Department; and (ii) each ETA for which the Applicant is seeking a BEA Award possesses ALL of the characteristics listed below:

Is an individually owned account at a Federally-insured financial institution;

Permits a minimum of four cash withdrawals and four balance inquiries per month, which are included in the monthly fee, through any combination of proprietary ATM transactions and/or over-the-counter transactions;

Allows access to the insured depository institution’s on-line point-of-sale network (if any);

Requires no minimum balance except as required by Federal or state law;

Provides a monthly statement;

Provides the same consumer protections that are available to other account holders at the financial institution;

Is offered only to individuals receiving Federal benefit, wage, salary, or retirement payments;

Allows set-off only for fees directly related to the account; and

Is subject to a maximum monthly account-servicing fee of $3.00.

Is in compliance with its Financial Agency Agreement with the U.S. Department of Treasury.

Certification for Opening Retail Branches

The Applicant does hereby certify that on _______ (date), it opened a new branch office located at:

___________________________________________________________________________.

The Applicant has not operated an office in the same census tract in which it is opening such new office within the three years prior to opening said branch on the aforementioned date; and such new office will remain in operation for at least the next five years.

Certification 2: Certification of Disbursement

Applicant Name:

Signing the certification on the SF 424 certifies that the documentation which the Applicant has provided to the CDFI Fund evidencing a disbursement of the proceeds of the loan(s) to the borrower(s) listed below, in the amounts listed below, is true and accurate. This Certification is incorporated into the Award Agreement by and between the Applicant and the CDFI Fund, and made a material part thereof.

Service Provided / Borrower / Invested	Total Dollar Value Or Amount Of Transaction	Amount Disbursed To Date	Date Of Execution MM/DD/YY	Date Of Initial Disbursement MM/DD/YY	Date Of Final Disbursement MM/DD/YY	Type Of Activity (Abbreviation Only)

Certification 3: Certification of Integrally Involved CDFI Partners

Applicant Name:

CDFI Partners that receive CDFI Support Activity (loan, technical assistance, or qualifying deposit) from an Applicant must be Integrally Involved in a Distressed Community as defined in the FY 2010 NOFA and BEA Program Interim Rule. Signing the certification on the SF 424 certifies that the Applicant has verified that the CDFI Partners listed below have been found to be Integrally Involved in a Distressed Community. This Certification is incorporated into the Award Agreement by and between the Applicant and the CDFI Fund, and made a material part thereof.

CDFI Partner	City, State	Name of Distressed Community

Certification 4: Certification of Baseline Period Qualified Activities

Applicant Name:

An Applicant that includes a dollar value for an Assessment Period Qualified Activity must report the corresponding Baseline Period Qualified Activity. Signing the certification on the SF 424 certifies that the Applicant has verified that the transactions included in the Baseline Period dollar values listed below are Qualified Activities as defined in the 2010 NOFA and BEA Program Interim Rule. This Certification is incorporated into the Award Agreement by and between the Applicant and the CDFI Fund, and made a material part thereof.

CDFI RELATED ACTIVITIES
		Reporting	Baseline Period
	Equity Investments / Equity-Like Loans	
	CDFI Support Activities	
DISTRESSED COMMUNITY FINANCING ACTIVITIES
		Reporting	Baseline Period
	Affordable Home Mortgage Loans	
	Affordable Housing Development Loans & Project Investments	
	Small Business Loans and Project Investments	
	Home Improvement Loans	
	Education Loans	
	Commercial Real Estate Loans & Project Investments	
SERVICE ACTIVITIES
		Reporting	Baseline Period
	Deposits	
	Community Services	
	Financial Services	
	Targeted Financial Services	
	Targeted Retail Savings/Investment Products	

Remember: If the Applicant has carried out activity in a sub-category during the Assessment Period but no activity during the Baseline Period write “0” in the applicable columns and check the Reporting box. If the Applicant is not seeking an award in a sub-category enter “0’ in the applicable columns and do not check the Reporting box.

Applicant Information

Applicant Organization Name:
Taxpayer/Employer Identification Number (EIN):
FDIC Certificate Number:
How many hours did it take you to complete this Application?
Applicant’s Total Assets (in thousands) from 12/31/2009 Call Report or TFR.						$
Indicate whether any of the following apply to your institution:
Minority Bank. An institution classified by the FDIC as a Minority Depository Institution as of 12/31/2009.
Community Bank. Any institution that identifies itself as a “community bank” should check this item.
Certified CDFI. An institution certified as a CDFI by the CDFI Fund as of 12/31/2009.
Applicant's Type of Charter:
State in which the Applicant’s headquarters is physically located:
Indicate which of the following states are within your institution’s service area:
Alaska	No			Mississippi			No
Alabama	No			Montana			No
Arkansas	No			North Carolina			No
American Samoa	No			North Dakota			No
Arizona	No			Nebraska			No
California	No			New Hampshire			No
Colorado	No			New Jersey			No
Connecticut	No			New Mexico			No
District of Columbia	No			Nevada			No
Delaware	No			New York			No
Florida	No			Ohio			No
Fed. St. of Micronesia	No			Oklahoma			No
Georgia	No			Oregon			No
Guam	No			Pennsylvania			No
Hawaii	No			Puerto Rico			No
Iowa	No			Palau			No
Idaho	No			Rhode Island			No
Illinois	No			South Carolina			No
Indiana	No			South Dakota			No
Kansas	No			Tennessee			No
Kentucky	No			Texas			No
Louisiana	No			Utah			No
Massachusetts	No			Virginia			No
Maryland	No			Virgin Islands			No
Maine	No			Vermont			No
Marshall Islands	No			Washington			No
Michigan	No			Wisconsin			No
Minnesota	No			West Virginia			No
Missouri	No			Wyoming			No
Northern Mariana Isl.	No

Instructions for Worksheet 1: Estimated BEA Award Calculation

CDFI RELATED ACTIVITIES:
Line 1:	List the dollar value of Equity Investments / Equity-Like Loans for the Baseline Period (Column B) and Assessment Period (Column C). Subtract the value in Column B from the value in Column C and list the result in Column D to yield the change in Qualified Activities. Multiply the amount in Column D by 15% and list the product in Column F to yield the Estimated Award Amount for Equity Investments / Equity-Like Loans.
Line 2:	List the dollar value of CDFI Support Activities for the Baseline Period (Column B) and Assessment Period (Column C). Subtract the value in Column B from the value in Column C and list the result in Column D to yield the change in Qualified Activities. Multiply the amount in Column D by the applicable Award percentage in Column E (18% if the Applicant is a CDFI or 6% if the Applicant is not a CDFI) and list the product in Column F to yield the Estimated Award Amount for CDFI Support Activities.
Line 3:	Add the values listed on lines 1 and 2 of Column F to yield the Estimated Award Amount for CDFI Related Activities.
DISTRESSED COMMUNITY FINANCING ACTIVITIES:
Lines 4-9:	List the dollar value of each sub-category of Distressed Community Financing Activities for the Baseline Period in Column B and for the Assessment Period in Column C. Subtract the value in Column B from the value in Column C for each sub-category of activity and list the result in Column D to yield the change in Qualified Activities. Multiply the amount in Column D for each line by the corresponding Priority Factor in Column E to yield a weighted value. List the weighted value of each sub-category of activity in Column F.
Line 10:	Add the values listed on lines 4 to 9 of Column F to yield a Total Score. List the Total Score in Column F, Line 10.
Line 11:	Multiply the Total Score (Column F, line 10) by the applicable Award percentage (3% if the Applicant is not a CDFI or 9% if the Applicant is a CDFI) to yield an Estimated Award Amount for Distressed Community Financing Activities. List the Estimated Award Amount in Column F, Line 11
SERVICE ACTIVITIES:
Lines 12-16:	List the dollar value of each sub-category of Service Activity for the Baseline Period in Column B and for the Assessment Period in Column C. Subtract the value in Column B from the value in Column C for each sub-category of activity and list the result in Column D to yield the change in Qualified Activities. Multiply the amount in Column D for each line by the corresponding Priority Factor in Column E to yield a weighted value. List the weighted value of each sub-category of activity in Column F.
Line 17:	Add the values listed on lines 12 to 16 of Column F to yield a Total Score. List the Total Score in Column F, Line 17.
Line 18:	Multiply the Total Score (Column F, Line 17) by the applicable Award percentage (3% if the Applicant is not a CDFI or 9% if the Applicant is a CDFI) to yield an Estimated Award Amount for Service Activities. List the Estimated Award Amount in Column F, Line 18.

Worksheet 1: Estimated BEA Award Calculation

CDFI RELATED ACTIVITIES		A	B	C	D	E	F
		Reporting	Baseline Period	Assent Period	Change in Activity	Award Percent	Estimated Award Amount
1.	Equity Investments / Equity-Like Loans	Yes/No				15%
2.	CDFI Support Activities	Yes/No				6% / 18%
3.	Estimated Award Amount for CDFI Related Activities:
DISTRESSED COMMUNITY FINANCING ACTIVITIES		A	B	C	D	E	F
		Reporting	Baseline Period	Assent Period	Change in Activity	Priority Factor	Weighted Value
4.	Affordable Home Mortgage Loans	Yes/No
5.	Affordable Housing Development Loans & Project Investments	Yes/No
6.	Small Business Loans and Project Investments	Yes/No
7.	Home Improvement Loans	Yes/No
8.	Education Loans	Yes/No
9.	Commercial Real Estate Loans & Project Investments	Yes/No
10.	Total Score:
11.	Estimated Award Amount for Distressed Community Financing Activities:
SERVICE ACTIVITIES		A	B	C	D	E	F
		Reporting	Baseline Period	Assent Period	Change in Activity	Priority Factor	Weighted Value
12.	Deposits	Yes/No
13.	Community Services	Yes/No
14.	Financial Services	Yes/No
15.	Targeted Financial Services	Yes/No
16.	Targeted Retail Savings/Investment Products	Yes/No
17.	Total Score:
18.	Estimated Award Amount for Service Activities:

Remember:

• If the Applicant has carried out no activity in a sub-category during the Baseline Period, write “0” in the applicable columns. If the Applicant is not reporting in a sub-category and select No in Column A.

• Assessment Period amounts should only reflect the amount expected to be disbursed within 12 months of the end of the Assessment Period (December 31, 2009).

Worksheet 2: Report of Transactions

Applicants must use this form to report all transactions.

Column	Entry
A: Service Provided/ Borrower/ Invested	Report each transaction by borrower, invested, grantee, CDFI, or other recipient. Service Activities: report each transaction carried out during the Assessment Period by the service provided.
B: Total Dollar Value	Report the total original dollar amount of each transaction. Service Activities: report the grand total of each category of activity.
C: Amount Disbursed to Date	List total dollar amount disbursed on each transaction by the end of the Assessment Period. For Service Activities, TA to CDFIs, and Financing Activities less than $250,000: record same figure as Column B.
D: Street Address	For each Distressed Financing Activity transaction, enter the borrower’s street address or the location of the property (real estate loans).
E: City	For each Distressed Financing Activity transaction, enter the city of the borrower or the property (real estate loans).
F: State	For each Distressed Financing Activity transaction, enter the state of the borrower or property (real estate loans).
G: Zip Code	For each Distressed Financing Activity transaction, enter the zip code of the borrower or the property (real estate loans).
H: Census Tract	For CDFI Related Activities: leave blank. For each other transaction, list the census tract (including state and county code) where the borrower, invested, grantee, or property is located.
I: Execution Date	List the date the activity occurred or the transaction was closed.
J: Initial Disbursement Date	List the date the Applicant made the initial disbursement. Leave blank if no initial disbursement has been made.
K: Final Disbursement Date	List the date the Applicant made the final disbursement. For Service Activities, TA to CDFIs, and Financing Activities less than $250,000: record same figure as Column J. For CDFI Related Activities (except TA) and Distressed Community Financing transactions over $250,000 leave blank if not fully disbursed.
L: Type of Activity	List the type of each transaction using the abbreviations provided below:
	CDFI Equity Investments / Equity-Like Loans	CEI
	CDFI Equity Like Loans	ELL
	CDFI Grants	CG
	CDFI Loans	LNS
	CDFI Deposits / Shares	DS
	TA provided to CDFIs	TAC
	Affordable Housing Mortgage Loans	AHM
	Affordable Housing Development Loans and Project Investments	AHD
	Commercial Real Estate Loans and Project Investments	CRE
	Education Loans	EDU
	Home Improvement Loans	HIL
	Small Business Loans and Project Investments	SBL
	Deposit Liabilities	D
	Financial Services	FS
	Targeted Financial Services	TFS
	Targeted Savings Products	TSP
	Community Services	CS
M: Impact	For Distressed Community Financing and Service Activities, provide the number of the appropriate measure for each transaction: Affordable Housing Development: Total number of units developed or rehabilitated as part of the transaction. Small Business: Total number of full-time equivalent jobs created or maintained by borrower. Commercial Real Estate: Total number of commercial real estate properties acquired, developed or rehabilitated. Financial Services and Targeted Financial Services: Number of accounts opened, checks cashed, etc. as a result of the related program funded with the Award Targeted Retail Savings/Investment Products: Number of products developed with funds from the Award, sold or opened. Community Services: Number of individuals who received the identified service funded with the Award.

Part II: Qualified Activity Documentation

General Information

The following details the requirements for reporting and documenting Qualified Activities. Applicants should use this guidance in conjunction with the instructions for each worksheet as well as the BEA Program Regulations, FY 2010 NOFA, and the Supplemental Guidance for Applicants (all available on the CDFI Fund’s website). The BEA Program regulations contain definitions of all Qualified Activities.

Activities of the Applicant: To be eligible for BEA Program consideration, the Applicant or a Subsidiary of the Applicant must originate all Qualified Activities. Transactions carried out by Affiliates are not eligible. Loans brokered through another institution or loans purchased by the Applicant from another institution are not eligible for BEA Program consideration. If you are unsure of the eligibility of any Subsidiary or Affiliate, contact the CDFI Fund for clarification.

Arms-length transactions: To be considered an eligible Qualified Activity, each loan and investment must be an arms-length transaction with a third party that is not an Affiliate of the Applicant.

What to Report: All reported amounts should be rounded to the nearest dollar. For both the Baseline Period and the Assessment Period, report all Qualified Activities that were closed during the applicable period. To be considered Closed:

• The transaction must have been executed on a date within the applicable Assessment Period; and

• The Applicant and the borrower or invested must have entered into a legally binding agreement that specifies the final terms and conditions of the transaction; and

• An initial cash disbursement of loan or investment proceeds must have occurred in a manner that is consistent with customary business practices and is reasonable given the nature of the transaction (as determined by the CDFI Fund). If it is normal business practice to make no initial disbursement at closing (as is typical for lines of credit or construction loans), the Applicant must provide a brief narrative stating such and demonstrating that the borrower had access to the proceeds, subject to reasonable conditions (such as meeting certain project milestones), beginning at closing.

Face value: For term loans, each transaction must be reported at the total principal dollar amount of the closed loan or investment, subject to the dollar amount and time limitations imposed by the CDFI Fund, and as set forth in the FY 2010 NOFA. For lines of credit (including construction lines of credit), each transaction should be reported at the maximum amount of credit available through the instrument, subject to dollar amount and time limitations imposed by the CDFI Fund. For transactions that are not fully disbursed as of the end of the Assessment Period, the amount reported should only reflect the amount expected to be disbursed within 12 months of the end of the applicable Assessment Period (December 31, 2010), subject to dollar amount limitations imposed by the CDFI Fund, and as set forth in the FY 2010 NOFA.

Cap on Qualified Activity Amount: In calculating Award amounts, the CDFI Fund will count only the amount an Applicant reasonably expects to disburse on a transaction within 12 months from the end of the Assessment Period, but in no event shall the value of a Qualified Activity for purposes of determining a BEA Program Award exceed $10 million in the case of Commercial Real Estate Loans or any CDFI Related Activities (i.e., the total principal amount of the transaction must be $10 million or less to be considered a Qualified Activity). However, the CDFI Fund may consider transactions with a total principal value of over $10 million on a case by case basis. Applicants may include a narrative statement that describes the community benefit of transactions over $10 million for the CDFI Fund’s consideration.

Low-Income Housing Tax Credits; New Markets Tax Credits: Investments for which the Applicant receives federal Low-Income Housing Tax Credits or New Markets Tax Credits as an investor are not considered Qualified Activities. If an Applicant is providing a loan or an investment for a project in which Low-Income Housing Tax Credits or New Markets Tax Credits are a part of the financing package, the activity will be considered a Qualified Activity -- provided that the Applicant and/or any of its Affiliates do not have a ownership stake in the subject project and have not received Low-Income Housing Tax Credits or New Markets Tax Credits in exchange for the investment.

Application Checklist: Summary of Required Documentation by Category

The checklist below provides a summary of required documentation for Qualified Activities. Detailed instructions on reporting and documenting Qualified Activities follow.

Category	Closing Documents	Disbursement Documents	Other Documentation
CDFI Equity: Equity, Equity-Like Loans	Investment agreement Stock purchase certificate Executed/signed equity-like loan agreement Signed grant letter	Copies of checks, wire transfer receipts, and credit/debit slips from the general ledger OR Internal documentation (requests for wire transfers or account print screens) AND Certification 2. Certification of Disbursement	Applicants: Certification 4. Certification of Baseline Period Qualified Activities.
CDFI Support: Loans, Certificates of Deposit/Share Certificates, TA to CDFI Partner	Executed/signed loan agreement Executed/signed promissory note Certificate of Deposit Share Certificate	Copies of checks, wire transfer receipts, or credit/debit slips from the general ledger. OR Internal documentation (requests for wire transfers or account print screens) AND Certification 2. Certification of Disbursement.	Applicants: Certification 3. Certification of Integrally Involved CDFI Partners and Certification 4. Certification of Baseline Period Qualified Activities. CDFI Partners: CDFI Partner Registration on myCDFIFund (includes designated BEA-eligible Distressed Community).
Distressed Community Financing Activities	Loans of $250,000 or more: Executed/signed loan agreement Executed/signed promissory note	Loans of $250,000 or more: Copies of cleared checks, wire transfer receipts, and credit/debit slips from the general ledger OR Internal documentation (requests for wire transfers or account print screens) AND Certification 2. Certification of Disbursement	Applicants: Certification 4. Certification of Baseline Period Qualified Activities
Service Activities	Deposit Liabilities: narrative on methodology used to determine that: (1) account holders are Residents; and (2) Deposit Liabilities were accepted at a location in the Distressed Community. Community Services: narrative describing the methodology used to: (1) derive the value, and (2) determine that Community Services provided to LMI Residents, new small businesses, LMI homeowners, or homeowners in the Distressed Community. Targeted Financial Services; New Branch: Certification 1: ETA or New Branch. Certification 4: Certification of Baseline Period Qualified Activities

Applicants will not be contacted regarding missing required documentation for any Qualified Activities. If a Qualified Activity does not have the required documentation, the transaction will be disqualified.

CDFI Related Activities

Eligible CDFI Related Activities consists of Equity Investments, Equity-Like Loans, and CDFI Support Activities. An Equity Investment is defined as assistance provided by an Applicant or its Subsidiary to a certified CDFI in the form of a grant, a stock purchase, a purchase of a partnership interest, a purchase of a limited liability company membership interest, or any other investment deemed to be an Equity Investment by the CDFI Fund. Equity-Like Loan is defined as a loan that has been made under certain terms and conditions that give it equity-like characteristics (see the FY 2010 NOFA for terms and conditions). A CDFI Support Activity is defined as assistance provided by an Applicant or its Subsidiary to a certified CDFI that is Integrally Involved in a Distressed Community, in the form of the origination of a loan, technical assistance, or deposits (see the FY 2010 NOFA for terms and conditions).

Reporting CDFI Related Activities

On Worksheet 1: Applicant must report the total dollar value of all qualified CDFI Related Activities closed during the Baseline Period and the Assessment Period. Calculate the total dollar value of each category by summing the total principal amount of each grant, investment, deposit, or loan closed during the applicable period. Calculate the dollar amount of Technical Assistance provided to a CDFI Partner during the applicable period by summing the administrative costs of providing such services.

For the purpose of reporting an Applicant’s Baseline Period activities on Worksheet 1, the Applicant must report all CDFI Related Activities that it engaged in with any certified CDFI that would have qualified as an eligible CDFI Partner according to the BEA Program regulations and applicable NOFA during the Baseline Period -- not just new activities engaged in with specific CDFIs during the Assessment Period.

On Worksheet 2: Applicants report the dollar value of each individual transaction. For Technical Assistance to a CDFI Partner, list the dollar value of each unit of Technical Assistance of according to each CDFI Partner recipient. See instructions for Worksheet 2: Report of Transactions for additional required information.

Documenting CDFI Related Activities

Closing Documents: For all CDFI Related Activities (except Technical Assistance provided to CDFIs), provide documentation demonstrating that the transaction closed during the Assessment Period. Such documentation must include a legally binding agreement between the Applicant and the CDFI Partner (e.g., grant letter, loan agreement, promissory note, investment agreement, or stock purchase agreement). Document Technical Assistance provided to CDFIs by providing an itemized list of the administrative costs of providing such services.

Disbursement Documents: For all CDFI Related Activities (except Technical Assistance provided to CDFIs), provide documentation demonstrating that an initial disbursement occurred during the Assessment Period in a manner consistent with customary business practices and that was reasonable given the nature of the transaction. Acceptable documentation includes copies of checks, wire transfer receipts, and credit/debit slips from the general ledger. Internal requests for wire transfers or account print screens are acceptable documentation if accompanied by a signed Certification 2: Certification of Disbursement. If the Applicant has not made a disbursement on a transaction closed within the Assessment Period, provide a narrative describing: (1) why making no initial disbursement was customary business practice and reasonable given the nature of the transaction, and (2) that funds were available at the CDFI Partner’s discretion at closing, subject to reasonable conditions (such as meeting project milestones).

Equity-Like Loans: For purposes of this NOFA, Equity-Like Loans must meet the following characteristics:

1. At the end of the initial term, the loan must have a definite rolling maturity date that is automatically extended if the CDFI continues to be financially sound and carry out a community development mission – unless the borrower and the bank mutually agree to terminate the agreement.

Periodic payments of interest and/or principal may only be made out of the CDFI borrower’s available cash flow after satisfying all other obligations.

Failure to pay principal or interest (except at maturity) will not automatically result in default.

The loan must be subordinated to all other debt except for other Equity-Like Loans.

Note: the CDFI Fund reserves the right to determine, in its sole discretion and on a case-by-case basis, if an instrument meets the above-stated characteristics of an Equity-Like Loan.

Distressed Community Financing Activities

Eligible Distressed Community Financing Activities include Affordable Housing Development Loans and related Project Investments; Affordable Housing Loans; Education Loans; Home Improvement Loans; Commercial Real Estate Loans and related Project Investments; and Small Business Loans and related Project Investments.

Affordable Housing Development Loans and related Project Investments: In order to be considered Qualified Activities, Affordable Housing Development Loans and Related Project Investments must be loans or investments to finance the acquisition, construction, and/or development of single- or multi-family residential real property, located in a BEA Distressed Community and where at least 60 percent of the units in such property are affordable to Low- and Moderate-Income individuals. For purposes of this Application, affordable is defined as a unit that is or will be sold or rented to a Low- and Moderate-Income Individual.

Affordable Housing Mortgage Loans: In order to be considered a Qualified Activity, an Affordable Housing Mortgage Loan must be located in a BEA Distressed Community and made to a Low- and Moderate-Income Resident. An Applicant may determine the total dollar value of such loans closed during the Baseline Period and the Assessment Period using one of the following methods (an Applicant may use different methods for the Baseline and Assessment Periods):

• Exact Count Method: Collect income data on each mortgage borrower. Use this data to determine which mortgage borrowers are Low- and Moderate-Income Residents. Count only those mortgage loans where the borrower is a Low- and Moderate-Income Resident.

• Certification Method: Count the number of mortgage borrowers that the Applicant reasonably believes are Low- and Moderate-Income Residents. Provide a brief analytical narrative with information describing how this determination was made (e.g., all borrowers for a certain mortgage loan must pre-qualify as Low-Income).

Education Loans: In order to be considered a Qualified Activity, an Education Loan must be a loan provided to a student, who is a resident in a BEA Distressed Community for the purpose of financing either college or vocational education.

Home Improvement Loans: In order to be considered a Qualified Activity, a Home Improvement Loan must be a loan provided to a borrower located in a BEA Distressed Community for the purpose of improving the borrower’s primary residence.

Commercial Real Estate Loans and related Project Investments: In order to be considered a Qualified Activity, a Commercial Real Estate Loan must be a loan secured by real estate and used to finance the acquisition or rehabilitation of a building, or the acquisition, construction and or development of property located in a BEA Distressed Community and used for commercial purposes.

Small Business Loans and related Project Investments: In order to be considered a Qualified Activity, a Small Business Loan must be a loan used for commercial or industrial purposes (other than an Affordable Housing Loan, Affordable Housing Development Loan, Commercial Real Estate Loan, Home Improvement Loan) to a business or farm that meets the size eligibility standards of the Small Business Administration’s Development Company of Small Business Investment Company programs (13 CFR 121.301) or has gross annual revenues of $1 million or less AND is located in a BEA Distressed Community.

Reporting Distressed Community Financing Activities

On Worksheet 1: An Applicant must report the total dollar value of all qualified Distressed Community Financing Activities closed during the Baseline Period and the Assessment Period. Calculate the total dollar value of each category by summing the total principal amount of each transaction closed during the applicable period. Report the total dollar value of each category on the applicable line of Worksheet 1.

On Worksheet 2: An Applicant must report the total dollar value of each individual loan or investment. See instructions for Worksheet 2: Report of Transactions for additional required information.

Documenting Distressed Community Financing Activities

Closing Documents: For transactions with a principal value of greater than or equal to $250,000, the Applicant shall provide documentation showing that the transaction closed during the Assessment Period. Such documentation must consist of a legally binding agreement between the Applicant and the borrower/invested/recipient (e.g., loan agreement, promissory note, investment agreement, or stock purchase agreement).

Disbursement Documents: For transactions with a principal value of greater than or equal to $250,000, the Applicant shall provide documentation showing that an initial disbursement occurred during the Assessment Period in a manner that was consistent with customary business practices and reasonable given the nature of the transaction. Acceptable documentation includes copies of checks, wire transfer receipts, and credit/debit slips from the general ledger. Internal requests for wire transfers or account print screens are acceptable if accompanied by a signed Certification of Disbursement.

Service Activities

Service Activities include: Deposit Liabilities; Financial Services; Community Services; Targeted Financial Services; and Targeted Retail Savings/Investment Products. The BEA Program regulations, applicable NOFA, and Supplemental Guidance for Applicants contain definitions of these Qualified Activities. An Applicant may only include Financial Services, Targeted Financial Services, and Targeted Retail Savings/Investment Products provided to Low- and Moderate-Income Residents.

Reporting and Documenting Deposit Liabilities

• Calculate the net change in the amount of eligible Deposit Liabilities within the Baseline Period and within the Assessment Period.

• Report the dollar value of the net change in Deposit Liabilities for each period in the appropriate column on Worksheet 1, Line 12 and on Worksheet 2: Report of Transactions. Do not report the total dollar value of Deposit Liabilities as of the last day of each applicable period – instead calculate the net change over the course of the applicable period. Do not report each individual depositor on Worksheet 2: Report of Transactions – only report the net change for each period from the Deposit Liabilities Calculation Worksheet.

• Attach a narrative explaining the methodology used to determine that: (1) account holders are Residents; and (2) Deposit Liabilities were accepted at a location in the Distressed Community.

Reporting and Documenting Community Services

• Calculate the total dollar value of providing the Community Service by determining the administrative cost of providing the activity. For staff time, use the number of hours contributed times the staff person’s hourly salary. For other administrative costs, the Applicant should report the actual cost.

• Report the total dollar value of all Community Service Activities for each period on Worksheet 1, Line 13. Report the dollar value of each individual Community Service Activity on Worksheet 2: Report of Transactions.

• Submit a narrative describing the methodology used to: (1) derive the value, and (2) determine that the Applicant provided the Community Service to Low- and Moderate-Income Residents, newly-formed small businesses, Low- and Moderate-Income homeowners, or homeowners in the Distressed Community.

Reporting and Documenting All Other Service Activities

• Determine the total dollar value of Financial Services, Targeted Financial Services, and Targeted Retail Savings/Investment Products provided to Low- and Moderate-Income Residents during the Baseline Period and Assessment Period using one of the following methods:

• Exact Count Method: Collect income data on each recipient of the specified activity. Use this data to determine which recipients are Low- and Moderate-Income Residents. Multiply this number by (i) the per unit value specified in the NOFA, or (ii) if the activity is not specified in the NOFA, by the Applicant’s estimate of the per unit value.

• Certification Method: Take the number of recipients that the Applicant reasonably believes are Low- and Moderate-Income Residents and multiply it by (i) the per unit value specified in the NOFA, or (ii) if the activity is not specified in the NOFA, by the Applicant’s estimate of the per unit value. The Applicant must provide a brief analytical narrative with information describing how this determination was made.

• Report the combined total dollar value of Financial Services, Targeted Financial Services, and Targeted Retail Savings/Investment Products on the applicable line of Worksheet 1 and on Worksheet 2: Report of Transactions. Do not report the value of each individual service activity separately on Worksheet 2: Report of Transactions (i.e., do not list each check cashed or new account opened separately on its own line on the Report of Transaction). In the first column, indicate the transaction according to the type (e.g., “checks cashed” or “new accounts opened”).

• For Financial Services, if using a per unit value not prescribed in the NOFA, provide a narrative statement that describes the methodology used to derive the value. The CDFI Fund will determine if this value is acceptable.

• An Applicant seeking an Award for providing Targeted Financial Services or for opening a new retail branch must complete and submit Certification 1: ETA or New Branches.