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pdfBank Enterprise
Award Program
FY 2013 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, 1500 Pennsylvania Ave., N.W.,
Washington, DC 20220.
Catalog of Federal Domestic Assistance Number:
21.021
Table of Contents
Introduction and Instructions .............................................................. 3
FY 2013 BEA Program............................................................................................ 3
Changes to the FY 2013 Application Process .................................................... 3
Application Eligibility Factors............................................................................... 4
FDIC-Insured Depositories .................................................................................... 4
Certification Status………………………………………………………………………4
CDFI Program Award Status……………………………………………………….…..4
Prior CDFI Fund Awardees or Allocatees ............................................................... 4
Qualifying Activities ............................................................................................... 5
Priority Factors ...................................................................................................... 6
Eligible CDFI Partners ........................................................................................... 6
Distressed Communities ........................................................................................ 7
Application Submission Requirements and Deadlines .................................... 8
Application Package .............................................................................................. 8
Application Deadlines .......................................................................................... 11
Ensuring that the Application Package Is Complete ............................................ 11
Awardee Notification and the Award Agreement ........................................... 12
Contacting the CDFI Fund .................................................................................. 13
Part I: Grants.Gov .................................................................................. 13
SF- 424 Instructions ............................................................................................ 16
Environmental Review Form .............................................................................. 18
Assurances and Certifications ............................................................................ 19
Certification 1: ETAs or New Branches ........................................................... 23
Certification 2: Certification of Disbursement ............................................... 24
Certification 3: Certification of Integrally Involved CDFI Partners ........... 25
Certification 4: Certification of Baseline Period Qualified Activities.......... 26
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Certification 5: Certification of Persistent Poverty County Activities ......... 27
Applicant Information…….…………………………………………………………..28
Instructions for Worksheet 1: Estimated BEA Award Calculation.............. 29
Worksheet 1: Estimated BEA Award Calculation ........................................... 31
Worksheet 2: Report of Transactions ............................................................... 32
Part II: myCDFIFund Submission ...................................................... 34
CDFI Partners ....................................................................................................... 34
CDFI Partner Registration Instructions ........................................................... 34
Part III: Qualified Activity Documentation...................................... 35
General Information ............................................................................................ 35
Application Checklist: Summary of Required Documentation by Category ........ 36
CDFI Related Activities ....................................................................................... 38
Reporting CDFI Related Activities ....................................................................... 38
Documenting CDFI Related Activities .................................................................. 38
Distressed Community Financing Activities .................................................... 39
Reporting Distressed Community Financing Activities ......................................... 40
Documenting Distressed Community Financing Activities ................................... 40
Service Activities .................................................................................................. 40
Reporting and Documenting Deposit Liabilities ................................................... 41
Reporting and Documenting Community Services .............................................. 41
Reporting and Documenting All Other Service Activities ..................................... 41
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Introduction and Instructions
Capitalized terms (other than titles) are defined in the BEA Program Regulations (12 CFR Part 1806),
the Notice of Funds Availability (NOFA) for the FY 2013 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 CDFI Fund’s mission is to increase economic opportunity and promote community
development investments for underserved populations and in distressed communities in the
United States. 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, 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 2013 BEA Program
Changes to the FY 2013 Application Process
An active System for Awards Management (SAM) 1 account is required to submit Applications
via Grants.gov.
• Applicants are advised to make sure their SAM account is active and valid well in
advance of submitting an Application via Grants.gov and to allow ample time to complete
the entire registration and submission process prior to the application deadline of July
12, 2013.
• The SAM website is: www.SAM.gov
1
The System for Award Management (SAM) replaced the Central Contractor’s Registration (CCR) database that was formerly used
by Applicants.
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Application Eligibility Factors
FDIC-Insured Depository Status
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, 2012 to be eligible for a
FY 2013 BEA Program Award. The Depository Institution Holding Company of an Insured
Depository Institution may not apply on behalf of an Insured Depository Institution.
Applications received from Depository Institution Holding Companies will be disqualified.
Certification Status Applicants can apply as a certified CDFI or non-certified CDFI. To
apply as a certified CDFI, an Applicant must have received its certification designation from the
CDFI Fund by the end of the Assessment Period (December 31, 2012 for the FY 2013 funding
round) and maintain its status as a certified CDFI at the time BEA Program Awards are
announced under the FY 2013 NOFA. Please note that all CDFIs which were originally or most
recently certified prior to February 1, 2010 must apply to the CDFI Fund for recertification no
later than 11:59 PM EST April 1, 2013. Additional information regarding the mandatory CDFI
recertification requirements can be found at: www.cdfifund.gov/cdficert.
CDFI Program Award Status As stated in the NOFA, no CDFI applicant may receive a FY
2013 Bank Enterprise Award if it has: (1) An application pending for Assistance under the FY
2013 round of the Community Development Financial Institutions Program (CDFI Program); (2)
Been awarded assistance from the CDFI Fund under the CDFI Program within the 12-month
period prior to the date the CDFI Fund selects the Applicant to receive a FY 2013 Bank
Enterprise Award, as indicated by the date on the 2013 BEA Notice of Award; or (3) ever
received assistance under the CDFI Program for the same activities for which it is seeking a FY
2013 Bank Enterprise Award. Please note that Applicants may apply for both a CDFI Program
award and a BEA Program Award in FY 2013; however, receiving a FY 2013 CDFI Program
award removes an Applicant from eligibility for a FY 2013 BEA Program Award.
Prior CDFI 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 CDFI 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(s) stated in the NOFA. Please note that
automated systems employed by the CDFI Fund for receipt of reports submitted
electronically typically acknowledge only a report’s receipt; such acknowledgment does not
warrant that the report received was complete and therefore met reporting requirements.
•
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
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
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 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
applicable Application deadline of the NOFA, the CDFI Fund has made a final determination
that such Applicant is in default of a previously executed assistance, award or allocation
agreement(s). Such entities are ineligible to apply for an Award pursuant to the NOFA so
long as the Applicant’s prior award or allocation remains in default status or such other time
period as specified by the CDFI Fund in writing.
•
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 2013
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 2013 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 the applicable 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 the applicable 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 2013 funding round, the Baseline Period
is calendar year 2011 (January 1, 2011 through December 31, 2011), and the Assessment
Period is calendar year 2012 (January 1, 2012 through December 31, 2012).
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;
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
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 2013 NOFA and the
BEA Program Regulations.
When calculating BEA Program Award amounts, the CDFI Fund will count only the amount an
Applicant 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 must 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 29.
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, an
Applicant’s increases in Qualified Activities from the Baseline Period 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 a
current and valid certification designation from the CDFI Fund as of the end of the Assessment
Period (December 31, 2012 for the FY 2013 funding round).
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
However, an Applicant that is a certified 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
All Distressed Community Financing Activities and Service Activities must be provided to: (i)
Eligible Residents that reside in a Distressed Community, or (ii) a business 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
unit that meets certain minimum population, poverty, and unemployment requirements. See
the FY 2013 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.
Each CDFI Partner that is the recipient of CDFI Support Activities must designate a Distressed
Community using the CDFI Fund’s Community Investment Mapping System (CIMS). The CDFI
Partner’s designated Distressed Community must meet the requirements of the BEA Program.
A CDFI Partner may designate an area as a Distressed Community by selecting a Geographic
Unit(s) that 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, however using CIMS will assist in identifying Distressed Communities that
are eligible for BEA Qualified Activities.
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Application Submission Requirements and Deadlines
BEA Program Applications may be submitted only through Grants.gov, the official Federal
government-wide website, as required by Public Law 106-107 and Section 5(a) of the Federal
Financial Assistance Management Improvement Act.
Application Package
The Application Package is organized in three parts – according to the method of submission.
A complete Application must include submission of all three parts as follows:
Part
Application Component
Submission Procedures
Part I.
Grants.gov
Application for Federal Assistance
Mandatory Form (SF) 424
Required for All Applicants. This form
also certifies Applicants to the
Assurances and Certifications provided
on pages 23 -27. The Assurances and
Certifications document is not
submitted.
Submit electronically in Grants.gov
and mail a physically signed copy to
BPD as cover page to paper
attachments (see Part III below).
Electronic Attachments:
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.
• Certification 5. Certification of
Persistent Poverty County Activities.
• Complete MS Word Templates.
• Upload under “Attachments” in
Grants.gov.
• NOTE: Applicants must not alter
the format of the required Word
and Excel Documents. Altered
documents will be rejected and the
Application will be deemed
ineligible.
Excel Charts:
Required for All Applicants:
• Applicant Information.
• Worksheet 1: Estimated BEA Award • Complete MS Excel Template.
Calculation.
• Upload under “Attachments” in
• Worksheet 2: Report of Transactions. Grants.gov.
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Part
Application Component
Part II.
myCDFIFund
Submission
myCDFIFund Account
Registration:
Submission Procedures
Required for all Applicants and CDFI
Partners that received CDFI Support.
Applicants: register Organization and
User accounts via myCDFIFund
according to the instructions on the
CDFI Fund’s website. Complete all
applicable sections of myCDFIFund,
including the “Affiliates” section.
Complete a BEA Signature Page.
CDFI Partners: complete a BEA
Signature Page and register as a
CDFI Partner via myCDFIFund
according to the instructions on the
CDFI Fund’s website and on page 34
of this Application. This process
includes an attached map of the
CDFI Partner’s Distressed
Community.
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Part
Application Component
Submission Procedures
Part III.
• Hard copy of Qualified Activity
Documentation /Other Attachments
Qualified
• Documentation of Qualified
Activity
Activities: as described in Part III.
Documentation
Qualified Activity Documentation.
/ Paper
(pages 35-41)
Attachments
• 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 two hard copy sets of
Qualified Activity documentation to
BPD in the order described below:
Set #1:
• SF-424 (with a physical
signature)
• One unbound copy of the
required documentation for
Qualified Activities (no tabs,
staples or other forms of
binding)
• Documentation from the IRS
of EIN
Set #2:
• SF-424 (with a physical
signature)
• One copy in a 3-ring binder of
the required documentation
for Qualified Activities (tabs,
staples, and other binding are
acceptable)
• Documentation from the IRS
of EIN
Note: Do NOT mail hard copies of any
electronic attachments (Word templates
or Excel charts) that were submitted via
Grants.gov, as noted in Part I; or
signature pages and Distressed
Community maps submitted via
myCDFIFund, as noted in Part II.
BPD’s mailing address is:
Bureau of Public Debt
Bureau of Public Debt Warehouse
& Operations Center Dock 1:
257 Bosley Industrial Park Drive
Parkersburg, WV 26101
Attn: CDFI Fund – BEA Program
Awards Management, A-3-H
(304)480-8071 – phone for
overnight mailings
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Note: 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 II 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 FY 2013 Supplemental Guidance for Applicants and FAQs (Instructions for myCDFIFund
Registration and CDFI Partner Registration section) on the CDFI Fund’s website, under the BEA
Program.
Application Deadlines
The Application Package must be received by the following deadlines (please note that the
electronic submission dates are due two business days prior to the qualified activity
documentation/ paper attachments due date:
•
Part I (Grants.gov): must be submitted through Grants.gov by 11:59 p.m. Eastern Time
(ET) on July 12, 2013.
•
Part II (myCDFIFund Submission): Application materials and CDFI Partner
Registrations must be submitted by 5:00 p.m. Eastern Time (ET) on July 12, 2013.
•
Part III (Qualified Activity 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 July 16, 2013:
Bureau of Public Debt
Bureau of Public Debt Warehouse & Operation Center Dock 1
257 Bosley Industrial Park Drive
Parkersburg, WV 26101
ATTN: CDFI Fund – BEA Program Awards Management, A3-H
(304) 480-8071
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 any required
Application materials 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
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
materials 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 via Grants.gov.
•
The Excel charts are not submitted via Grants.gov.
•
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.
The CDFI Fund encourages Applicants to allow sufficient time to obtain the necessary
numbers and documentation. Do not wait until the last minute to obtain EIN documentation
or a DUNS number. A DUNS number is required for SAM registration and for Grants.gov
submission. Applicants unable to submit their Application to Grants.gov by the deadline due
to failure to obtain a DUNS number and/or SAM registration confirmation will not be allowed
to submit past the deadline.
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 2013 funding round, the CDFI Fund anticipates notifying Applicants selected to
receive an Award on or after September 30, 2013. The CDFI Fund notifies an Applicant’s
designated Authorized Representative of the Award decision (positive or negative) via mail
(hard copy or electronically). 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 within
10 business days.
Each Awardee must also ensure that complete and accurate banking
information is reflected in its System for Award Management (SAM) account on www.sam.gov.
Applicants that receive Awards over $50,000 without Persistent Poverty County commitments
will be subject to compliance and reporting requirements as part of the terms and conditions of
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
the Award Agreement. Applicants that receive Awards with Persistent Poverty County
commitments, regardless of Award size, will be subject to 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 2013 NOFA and BEA Program Regulations.
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.
Contacting the CDFI Fund
The CDFI Fund will respond to Application related questions between the hours of 9:00 a.m.
and 5:00 p.m. ET, through July 10, 2013 (two business days before the electronic 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 July 10, 2013, until after the Application deadline. The CDFI Fund will
respond to technical issues related to myCDFIFund accounts through 5:00 p.m. ET, on July 12,
2013. NOTE: These are not toll free numbers.
Main Office
202-653-0300
www.cdfifund.gov
202-508-0089 fax
General inquiries; phone numbers for
individual CDFI Fund staff; access to
myCDFIFund and program web page.
Note: An Applicant that is unsure about
the disbursement status of any prior
award should contact the CDFI Fund by
sending an e-mail to
[email protected].
Program
Support
202-653-0421
[email protected]
How to complete Application materials.
Compliance & 202-653-0423
Monitoring
Support
[email protected]
Status of compliance with other awards
including outstanding reports.
IT Support
[email protected]
Registering and creating accounts on
myCDFIFund.
202-653-0300
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: Grants.Gov
In compliance with federal regulations, the CDFI Fund requires Applicants to submit the FY
2013 BEA Application using the www.Grants.gov portal, the official website for federal grant
information and applications. The registration process alone can take several days to complete.
Call the Grants.gov support staff if you have any questions about the process. The Grants.gov
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
help desk can be reached at 1-800-518-4726 or via email at [email protected]. If you
experience any technical difficulties submitting the Application via Grants.gov: call
the Grants.gov help desk – do not contact the CDFI Fund.
Not all components of the BEA Program Application are submitted via Grants.gov. Applicants
should read the Application Instructions for completeness and submission requirements.
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. The Assurances and Certifications are provided on pages 19
- 22 of this Application. The SF-424 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; Certification 4, Certification of
Baseline Period Qualified Activities; and Certification 5, Certification of Persistent Poverty County
Activities. Details for completing the SF 424 are on page 16.
For illustrative purposes only, the Environmental Review Form and Application Certifications 1 5 are included in this Application, beginning on page 19.
Required for All Applicants:
− Mandatory Form (SF) 424
− Environmental Review Form
− Assurances and Certifications (certified to by submitting the SF 424)
− Certification 4: Certification of Baseline Period Qualified Activities
o Required for all Applicants.
o Enter dollar values for the Baseline Period of all applicable Qualified Activities as
reported on Worksheet 1: Estimated BEA Award Calculation.
o 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: Estimated BEA Award
Calculation.
− Certification 5: Certification of Persistent Poverty County Activities
o Required for all Applicants.
o Applicants seeking an Award that will commit a minimum and maximum percentage of
the Award deployed to serve populations in Persistent Poverty Counties should enter
percentages for the minimum and maximum commitment.
o Applicants seeking an Award that will not commit a minimum and maximum percentage
of the Award deployed to serve populations in Persistent Poverty Counties should enter
“0%” for the minimum and maximum commitment.
− 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.
CDFI Form: CDFI-0002
- 14 -
FY 2013 BEA Program Application
o
Worksheet 2: Report of Transactions.
As Required:
− Certification 1. ETAs or New Branches:
o
Required for an Applicant seeking an Award for opening ETAs or a new retail branch.
−
o Check the applicable certification.
Certification 2. Certification of Disbursement:
−
Required for an Applicant requesting disbursement for CDFI Related Activities and/or
Distressed Community Financing Activities. Information should match the information
provided on Worksheet 2: Report of Transactions.
Certification 3. Certification of Integrally Involved CDFI Partners:
o
o
Required for an Applicant seeking an Award for CDFI Support Activities.
o
Enter the names of all of CDFI Partners and applicable information.
Excel Charts:
For illustrative purposes only, the Excel charts and instructions are included in this Application,
beginning on page 28. Applicants must access and submit Excel charts via Grants.gov (Part I of
the Application process).
CDFI Form: CDFI-0002
- 15 -
FY 2013 BEA Program Application
SF- 424 Mandatory (Application for Federal Assistance)
Instructions
This form is located in the ‘Mandatory Documents’ box of the downloaded Grant Application Package. To
access the form, select SF-424 Mandatory Form; then click on the ‘Move Form to Complete’ button. The
SF-424 will move to the ‘Mandatory Documents for Submission’ box. Click on the ‘Open Form’ button to
open the form.
Note: Only the fields highlighted in Yellow (on Grants.gov) are mandatory. The other fields are not
required.
In addition to the online submission of this form, a hard copy (with a physical signature) will be mailed to
BPD as stated on page 10.
Required fields are prefaced with an asterisk (*).
Field
Instructions
*1.a. Type of Submission:
*1.b. Frequency
*1.c. Consolidated
Application/Plan/Funding Request
*1.d. Version
*2. Date Received:
3. Applicant Identifier:
4.a. Federal Entity Identifier:
*4.b. Federal Award Identifier:
5. State use only: Date Received by
State
6. State use only: State Application
Identifier
*7.a. Applicant Information: Legal
Name
*7.b. Employer/Taxpayer
Identification Number (EIN/TIN):
*7.c. Organizational DUNS:
*7.d. Address:
7.e. Organizational Unit:
*7.f. Name and contact information
of person to be contacted on matters
involving this Application:
‘Application’ is automatically selected
‘Annual’ is automatically selected
‘No’ is automatically selected
*8.a. Type of Applicant:
*8.b. Additional Description
*9. Name of Federal Agency
10. Catalog of Federal Domestic
Assistance Number / CFDA Title:
11. Areas Affected by Funding
*12. Congressional Districts Of: (a)
CDFI Form: CDFI-0002
‘Initial’ is automatically selected
Automatically filled by the system upon submission – no entry necessary.
Not Applicable – leave blank
Not Applicable – leave blank
Enter 21.021
Not Applicable – leave blank
Not Applicable – leave blank.
Enter the legal name of the Applicant.
Enter the Applicant’s EIN/TIN.
Enter the Applicant’s DUNS.
Complete all fields with Applicant’s mailing address. Include 9-digit zip.
Not Applicable – leave blank.
Enter a Contact Person, other than the Authorized Representative (AR),
who can answer questions about the submission. The Contact Person
(name and contact information) identified here must match a User/Contact
Person information in the Applicant’s myCDFIFund account. Organizational
Affiliation: leave blank.
Select the most appropriate description from list of dropdown options.
Not Applicable – leave blank
Pre-filled – no entry necessary.
Pre-filled – no entries necessary. If not, enter 21.021.
Not Applicable – leave blank
See www.house.gov to find congressional district. Use same for both
- 16 -
FY 2013 BEA Program Application
Applicant; and (b) Program/Project
boxes.
*13. Funding Period: (a) Start Date; Start Date: Enter 01/01/2012; End Date: Enter 12/31/2012
and (b) End Date
*14. Estimated Funding
Enter total Award request for Federal and Total, enter zeroes in other
boxes.
*15. Is Submission Subject to
Select option C.
Review by State:
*16. Is the Applicant Delinquent on Answer and provide Explanation if Yes selected.
Any Federal Debt:
*17. Applicant Certification/
Click the ‘I Agree’ button. Complete all fields for AR information. AR
Authorized Representative:
(name and contact information) must match the Authorized
Representative’s information in the Applicant’s myCDFIFund account.
Worksheet: Consolidate
Not Applicable – leave blank
Application/Plan/Funding Request
Explanation
Worksheet: Applicant Federal Debt Complete if applicable
Delinquent Explanation
CDFI Form: CDFI-0002
- 17 -
FY 2013 BEA Program Application
Environmental Review Form
Note: This form must be completed by all Applicants.
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
1. 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)?
2. Are there any activities proposed in the Application that involve:
(a) Historical or archeological sites listed on the National Register of Historic Places or
that may be eligible for such listing?
(b) Wilderness areas designated or proposed under the Wilderness Act?
(c) Wild or scenic rivers proposed or listed under the Wild and Scenic Rivers Act?
(d) Critical habitats of endangered or threatened species?
(e) Natural landmarks listed on the National Registry of Natural Landmarks?
(f) Coastal barrier resource systems?
(g) Coastal Zone Management Areas?
(h) Sole Source Aquifer Recharge Areas designated by EPA?
(i) Wetlands?
(j) Flood plains?
(k) Prime and unique farmland?
(l) 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 CDFI 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 CDFI Fund Financial Assistance for any action that is not a categorical exclusion.
CDFI Form: CDFI-0002
- 18 -
FY 2013 BEA Program Application
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.
290 ee-3), as amended, relating to confidentiality of
A. Standard Form 424B: Assurances -- Nonalcohol and drug abuse patient records; (h) Title VIII
Construction Programs
of the Civil Rights Act of 1968 (42 U.S.C.3601 et seq.),
As the duly authorized representative of the Applicant, I
as amended, relating to nondiscrimination in the sale,
certify that the Applicant:
rental or financing of housing; (i) any other
1. Has the legal authority to apply for Federal assistance,
nondiscrimination provisions in the specific statute(s)
and the institutional, managerial and financial
under which application for Federal assistance is being
capability (including funds sufficient to pay the nonmade; and (j) the requirements of any other
Federal share of project costs) to ensure proper
nondiscrimination statutes which may apply to the
planning, management and completion of the project
Application.
described in this Application.
7. Will comply, or has already complied, with the
2. Will give the awarding agency, the Comptroller General
requirements of Titles II and III of the Uniform
of the United States, and if appropriate, the State,
Relocation Assistance and Real Property Acquisition
through any authorized representative, access to and
Policies Act of 1970 (P.L. 91-646) which provide for
the right to examine all records, books, papers, or
fair and equitable treatment of persons displaced or
documents related to the award; and will establish a
whose property is acquired as a result of Federal or
proper accounting system in accordance with generally
federally assisted programs. These requirements
accepted accounting standards or agency directives.
apply to all interests in real property acquired for
3. Will establish safeguards to prohibit employees from
project purposes regardless of Federal participation in
using their positions for a purpose that constitutes or
purchases.
presents the appearance of personal or organizational 8. Will comply with the provisions of the Hatch Act (5
conflict of interest, or personal gain.
U.S.C.1501-1508 & 7324-7328) which limit the political
4. Will initiate and complete the work (activities in
activities of employees whose principal employment
Application) within the applicable time frame after
activities are funded in whole or in part with Federal
receipt of approval of the awarding agency.
funds.
5. Will comply with the Intergovernmental Personnel Act 9. Will comply, as applicable, with the provisions of the
of 1970 (42 U.S.C. 4728-4763) relating to prescribed
Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the
standards for merit systems for programs funded
Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and
under one of the nineteen statutes or regulations
the Contract Work Hours and Safety Standards Act (40
specifies in Appendix A of Ohm’s Standards for a Merit
U.S.C. 327-333), regarding labor standards for
System of Personnel Administration (5 CFR 900,
federally assisted construction sub agreements.
Subpart F).
10. Will comply, if applicable, with flood insurance
6. Will comply with all Federal statutes relating to
purchase requirements of Section 102(a) of the Flood
nondiscrimination. These include but are not limited
Disaster Protection Act of 1973 (P.L. 93-234) which
to: (a) Title VI of the Civil Rights Act of 1964 (P.L.88requires recipients in a special flood hazard area to
352) which prohibits discrimination on the basis of
participate in the program and to purchase flood
race, color or national origin; (b) Title IX of the
insurance if the total cost of insurable construction and
Education Amendments of 1972, as amended (20
acquisition is $10,000 or more.
U.S.C.1681-1683, 1685-1686), which prohibits
11. Will comply with environmental standards which may
discrimination on the basis of sex; (c) Section 504 of
be prescribed pursuant to the following: (a) institution
the Rehabilitation Act of 1973, as amended (29
of environmental quality control measures under the
U.S.C.794), which prohibits discrimination on the basis
National Environmental Policy Act of 1969 (P.L.91-190)
of handicaps; (d) the Age Discrimination Act of 1975,
and Executive Order 11514; (b) notification of violating
as amended (42 U.S.C.6101-6107), which prohibits
facilities pursuant to EO 11738; (c) protection of
discrimination on the basis of age; (e) the Drug Abuse
wetlands pursuant to EO 11990; (d) evaluation of
Office and Treatment Act of 1972 (P.L. 92-255), as
flood hazards in floodplains in accordance with EO
amended, relating to nondiscrimination on the basis of
11988; (e) assurance of project consistency with the
drug abuse; (f) the Comprehensive Alcohol Abuse and
approved State management program developed
Alcoholism Prevention, Treatment and Rehabilitation
under the Coastal Zone Management Act of 1972 (16
Act of 1970 (P.L.91-616), as amended, relating to
U.S.C. 1451et seq.); (f) conformity of Federal actions
nondiscrimination on the basis of alcohol abuse or
to State Implementation Plans under Section 176(c) of
alcoholism; (g) Sections 523 and 527 of the Public
the Clean Air Act of 1955, as amended (42 U.S.C. 7401
Health Service Act of 1912 (42 U.S.C. 290 dd-3 and
et seq.); (g) protection of underground sources of
CDFI Form: CDFI-0002
- 19 -
FY 2013 BEA Program Application
12.
13.
14.
15.
16.
17.
18.
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).
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.
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.).
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.
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.
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.
Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act of 1984.
Will comply with all applicable requirements of all
other Federal laws, executive orders, regulations and
policies governing this program.
4.
5.
6.
C. Certification Regarding Debarment, Suspension,
and Other Responsibility Matters -- Primary Covered
Transactions: Instructions for Certification
1.
2.
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 3.
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
4.
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
5.
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);
CDFI Form: CDFI-0002
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;
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
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.
- 20 -
By signing and submitting this Application, the
prospective primary participant (the Applicant) is
providing the certification set out below.
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.
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.
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.
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).
FY 2013 BEA Program Application
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.
2.
E. Certification Regarding Drug-Free Workplace
Requirements
1.
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:
(a) are not presently debarred, suspended, proposed
for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any
Federal department or agency;
(b) 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,
CDFI Form: CDFI-0002
falsification or destruction of records, making false
statements, or receiving stolen property;
(c) 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
(d) 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.
Where the Applicant is unable to certify to any of the
statements in this certification, such Applicant shall
attach an explanation to this proposal.
- 21 -
The Applicant certifies that it will provide a drug-free
workplace by:
(a) 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;
(b) 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 drugfree 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
(c) 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);
(d) 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;
(e) 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;
(f) 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
FY 2013 BEA Program Application
2.
(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
(g) making a good faith effort to continue to maintain
a drug-free workplace through implementation of
subparagraphs (a), (b), (c), (d), (e), and (f).
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:
(a) No Federal appropriated funds have been paid or
2.
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;
CDFI Form: CDFI-0002
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
(c) 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.
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
(b)
- 22 -
FY 2013 BEA Program Application
Certification 1: ETAs or New Branches
Note: This certification is submitted electronically. A separate physical signature is not required.
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.
CDFI Form: CDFI-0002
- 23 -
FY 2013 BEA Program Application
Certification 2: Certification of Disbursement
Note: This certification is submitted electronically. A separate physical signature is not required. This certification must be
completed by all Applicants with disbursement transactions; documentation is required for all transactions greater than
$250,000.
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 / CDFI
Partner
CDFI Form: CDFI-0002
Total Dollar
Dollar
Date Of
Date Of
Date Of Final
Value Or
Amount
Initial
Execution
Disbursement
Amount Of Disbursed To
Disbursement
MM/DD/YY
MM/DD/YY
Transaction
Date
MM/DD/YY
- 24 -
Type Of
Activity
(Abbreviation
Only)
FY 2013 BEA Program Application
Certification 3: Certification of Integrally Involved CDFI Partners
Note: This certification is submitted electronically. A separate physical signature is not required.
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 2013 NOFA and BEA
Program Regulations. 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” as defined
in the FY 2013 NOFA and BEA Program Regulations. 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
CDFI Form: CDFI-0002
City, State
- 25 -
Name of Distressed Community
(name provided in myCDFIFund)
FY 2013 BEA Program Application
Certification 4: Certification of Baseline Period Qualified Activities
Note: This certification must be completed by all Applicants. This certification is submitted electronically. A separate
physical signature is not required.
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 2013 NOFA and BEA Program Regulations. 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
Equity Investments / Equity-Like Loans
CDFI Support Activities
DISTRESSED COMMUNITY FINANCING ACTIVITIES
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
Qualified Activity
($)
Reporting
Deposits
Community Services
Financial Services
Targeted Financial Services
Targeted Retail Savings/Investment Products
Baseline Period
Qualified Activity
($)
Baseline Period
Qualified Activity
($)
Instructions: Enter the dollar values of all Baseline Period activities in the appropriate row. If an 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 rows and check the Reporting box. If an Applicant is not seeking an Award in a
sub-category enter “$0’ in the applicable rows and do not check the Reporting box.
CDFI Form: CDFI-0002
- 26 -
FY 2013 BEA Program Application
Certification 5: Certification of Persistent Poverty County (PPC)
Activities
Note: This certification is submitted electronically. A separate physical signature is not required.
Applicant Name:
The CDFI Fund’s appropriation legislation requires that at least 10 percent of BEA Program Awards be
used for projects that serve populations living in Persistent Poverty Counties 2. The specific counties
that meet the criteria for “Persistent Poverty” and also meet the definition of a BEA Distressed
Community can be found at: www.cdfifund.gov/persistentpoverty.
Please review the counties and respond to the following request:
As an FY 2013 BEA Applicant, please indicate in Table 1 the minimum and maximum percentage of
the Award that your institution will commit to deploying to serve populations in BEA Persistent
Poverty Counties. At the discretion of the CDFI Fund, the Applicant may be required to deploy a
percentage of its Award at or above the minimum indicated below, but not more than the maximum
percentage indicated below.
Criteria
Table 1 –Award Commitment to BEA Persistent Poverty Counties
Minimum BEA Program Award percentage targeted to
Persistent Poverty Counties
Maximum BEA Program Award percentage targeted to
Persistent Poverty Counties
P ercentage of Aw ard Am ount
%
%
Please note that this information will affect the CDFI Fund’s evaluation of Applications and Award
decisions. It will have an impact on an Applicants score and/or ranking, most notably in the instance
that the CDFI Fund should determine, upon an analysis of the final Awardee pool, that it has not
achieved the 10% persistent poverty requirement mandated by Congress. In this case, to ensure
that this Congressional mandate is achieved, Award preference will be given to qualified institutions
that commit to targeting a minimum of 10% of Award activities to Persistent Poverty Counties.
If your institution has committed in Table 1 to deploying a percentage of your BEA Award in a BEA
Persistent Poverty County and is selected to receive a FY 2013 BEA Program Award, the commitment
to serving Persistent Poverty Counties will be incorporated in your institution’s Award Agreement and
performance goals. Your institution will be required to report data for BEA Program Award funds
deployed in Persistent Poverty Counties and maintain proper supporting documentation and records
which are subject to review by the CDFI Fund’s Certification, Compliance Monitoring and Evaluation
unit. Please note, your institution may be held to the minimum or up to the maximum persistent
poverty county commitment.
The appropriation language defined Persistent Poverty Counties as any county that has had 20 percent or more of its
population living in poverty over the past 30 years, as measured by the 1990 and 2000 decennial censuses, and the 2010
American Community Survey census.
2
CDFI Form: CDFI-0002
- 27 -
FY 2013 BEA Program Application
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 12/31/2012 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 12/31/2012.
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 12/31/2012.
Name of Federal Regulator:
State in which the Applicant’s headquarters is physically located:
Indicate which of the following states are within your institution’s service area:
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Fed. St. of Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Northern Mariana Isl.
CDFI Form: CDFI-0002
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Palau
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
- 28 -
FY 2013 BEA Program Application
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Instructions for Worksheet 1: Estimated BEA Award Calculation
CDFI RELATED ACTIVITIES:
Note: If a category results in a decrease in activity from the Baseline Period to the Assessment
Period, there is no need to report the Activities for either Period in that category and “No” can be
selected for the Reporting section (Column A). Otherwise, “Yes” can be selected to report an
increase in activity from the Baseline Period to the Assessment Period.
Line 1:
Line 2:
Line 3:
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.
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.
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:
Note: If a category results in a decrease in activity from the Baseline Period to the Assessment
Period, there is no need to report the Activities for either Period in that category and “No” can be
selected for the Reporting section (Column A). Otherwise, “Yes” can be selected to report an
increase in activity from the Baseline Period to the Assessment Period.
Lines 4-9:
Line 10:
Line 11:
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.
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.
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:
If a category results in a decrease in activity from the Baseline Period to the Assessment Period,
there is no need to report the activities for either Period in that category and “No” can be selected
for the Reporting section (Column A). Otherwise, “Yes” can be selected to report an increase in
activity from the Baseline Period to the Assessment Period. To determine the activity during the
Baseline Period for Deposit accounts, calculate the net change in the amount of eligible Deposit
Liabilities. If the net change of Deposit accounts during the Baseline Period is a negative amount,
then a negative baseline amount may be recorded.
CDFI Form: CDFI-0002
- 29 -
FY 2013 BEA Program Application
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.
CDFI Form: CDFI-0002
- 30 -
FY 2013 BEA Program Application
Worksheet 1: Estimated BEA Award Calculation
A
CDFI RELATED ACTIVITIES
Reporting
B
C
D
E
Baseline Assessment
Change
Award
Period
Period
in
Percent
1/1/111/1/12Activity
12/31/11
12/31/12
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:
A
DISTRESSED COMMUNITY FINANCING ACTIVITIES
Reporting
Yes/No
6.
Affordable Home Mortgage Loans
Affordable Housing Development Loans &
Project Investments
Small Business Loans and Project Investments
7.
Home Improvement Loans
Yes/No
4.
5.
B
C
D
Change
Baseline Assessment
in
Period
Period
Activity
F
Estimated
Award
Amount
E
F
Priority
Factor
Weighted
Value
E
F
Priority
Factor
Weighted
Value
Yes/No
Yes/No
Education Loans
Commercial Real Estate Loans & Project
9.
Investments
10. Total Score:
Yes/No
8.
Yes/No
11. Estimated Award Amount for Distressed Community Financing Activities:
A
SERVICE ACTIVITIES
Reporting
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
B
C
D
Change
Baseline Assessment
in
Period
Period
Activity
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 cells. If the Applicant is not reporting in a sub-category select No in Column A.
•
For partially disbursed transactions, e.g. lines of credit, Assessment Period amounts should only reflect the
amount expected to be disbursed to the borrower within 12 months of the end of the Assessment Period
(by December 31, 2013). Applicants must indicate in the loan documentation how much is planned to be
expended. For Deposit Liabilities, report the dollar value of the net change in Deposit Liabilities from
January 1 to December 31, 2011 in the Baseline Period, and the dollar value of the net change in Deposit
Liabilities from January 1 to December 31, 2012 in the Assessment Period. See Section III, Application
Checklist: Summary of Required Documentation by Category section for more details.
CDFI Form: CDFI-0002
- 31 -
FY 2013 BEA Program Application
Instructions for Worksheet 2: Report of Transactions
Applicants must use this form to report all transactions during the assessment period.
Column
Entry
A: Service
Report each transaction by borrower, investee, grantee, CDFI, or other
Provided/
recipient.
Borrower/ Invested 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. If not fully
or Amount of
disbursed the total dollar value should reflect only the amount that is
Transactions
reasonably expected to be disbursed within 12 months from the end of the
Assessment Period.
Service Activities: report the grand total of each category of activity. Note:
For Deposit Liabilities report the dollar value of the net change in Deposit
Liabilities during the Assessment Period.
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, investee, 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 Form: CDFI-0002
CDFI Equity Investments
CEI
CDFI Equity Like Loans
ELL
- 32 -
FY 2013 BEA Program Application
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
M: Impact
CDFI Form: CDFI-0002
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
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.
- 33 -
FY 2013 BEA Program Application
Part II: myCDFIFund Submission
All Applicants are required to register Organization and User accounts via myCDFIFund according to the
instructions on the CDFI Fund’s website (www.cdfifund.gov). Complete all applicable sections of myCDFIFund,
including the “Affiliates” section. Applicants should ensure that all information in its myCDFIFund account is
current.
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, CDFI 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 “Supplemental Guidance for
Applicants and FAQs” (Instructions for myCDFIFund Registration and CDFI Partner Registration section). 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. Save the Distressed Community with the label as
“BEA DC 2013”. Eligible maps must be deemed qualified. Qualified maps will show a green “Qualified” in
myCDFIFund.
−
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.
Note: If a CDFI Partner has an existing BEA qualified Distressed Community map that represents a Distressed
Community in which it is currently Integrally Involved, the CDFI Partner does not have to create a new map.
The CDFI Partner may save the existing map with the label “BEA DC 2013”.
CDFI Form: CDFI-0002
- 34 -
FY 2013 BEA Program Application
Part III: Qualified Activity Documentation /
PAPER ATTACHMENTS
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 2013 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 investee 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.
•
Refinancing of loans (including fixed rate and adjustable rate mortgages) may be valued only at the
amount of increase to the principal amount of the loan (i.e., the new credit available). Supporting
documentation must be provided to demonstrate the increase in principal amount, in order to meet the
Qualified Activity requirement specified in the FY 2013 NOFA. Transactions that do not indicate the
increase in principal amount may be disqualified in full.
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 2013 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,
2012), subject to dollar amount limitations imposed by the CDFI Fund, and as set forth in the FY 2013 NOFA.
CDFI Form: CDFI-0002
- 35 -
FY 2013 BEA Program Application
Cap on Qualified Activity Amount: In calculating Award amounts, the CDFI Fund will count only the
amount an Applicant 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 must 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 for the purposes of calculating or receiving a BEA Program Award.
Leverage loans used in New Markets Tax Credit structured transactions are considered Distressed Community
Financing Activities.
Application Checklist: Summary of Required Documentation by Category
The checklist below provides a summary of required documentation for Qualified Activities.
instructions on reporting and documenting Qualified Activities follow.
Category
Closing Documents
Disbursement Documents
Other Documentation
• Copies of checks, wire
CDFI Equity: • Investment agreement
Applicants:
transfer
receipts,
and
Equity, Equity• Certification 4: Certification
• Stock purchase certificate
credit/debit slips from the
Like Loans
of Baseline Period Qualified
• Executed/signed equitygeneral ledger
Activities.
like loan agreement
OR
• Signed grant letter
• Internal documentation
(requests for wire transfers
or account print screens)
AND
• Certification 2: Certification
of Disbursement
CDFI
Support:
Loans,
Certificates of
Deposit/Share
Certificates,
TA to CDFI
Partner
• Executed/signed loan
• Copies of checks, wire
transfer receipts, or
agreement (Note: loan
documents must indicate
credit/debit slips from the
general ledger.
the purpose of the loan)
• Executed/signed
promissory note
• Certificate of Deposit
• Share Certificate
OR
• Internal documentation
(requests for wire transfers
or account print screens)
Applicants:
• Certification 3: Certification
of Integrally Involved CDFI
Partners.
• Certification 4: Certification
of Baseline Period Qualified
Activities.
AND
• Certification 2: Certification CDFI Partners:
of Disbursement.
• CDFI Partner Registration
on myCDFIFund (includes
designated BEA-eligible
Distressed Community).
CDFI Form: CDFI-0002
- 36 -
FY 2013 BEA Program Application
Detailed
Category
Distressed
Community
Financing
Activities
Closing Documents
Disbursement Documents
Loans of $250,000 or
more:
Loans of $250,000 or
more:
• Executed/signed loan
agreement
• Copies of cleared checks,
• Executed/signed
promissory note
Other Documentation
Applicants:
wire transfer receipts,
and credit/debit slips
from the general ledger
which indicate the name
of the party receiving the
funds.
• Certification 4: Certification
of Baseline Period Qualified
Activities.
OR
• Internal documentation
(requests for wire transfers
or account print screens)
AND
• Certification 2: Certification
of Disbursement
Service
Activities
Deposit Liabilities: narrative on methodology used to determine that: (1) account holders
are Residents of the Distressed Community; 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 (including an itemized list of costs: staff time and administrative costs) 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.
If external sources are referenced in a narrative, the Applicant must explain how it
reached the conclusion that the cited references are directly related to the Low-and
Moderate-Income residents for which it is claiming to have provided the Financial Services
to.
Important: 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.
Important: In addition to submitting Certification 2: Certification of Disbursement, internal
documentation must indicate the date of disbursement/deposit/wire transfer and the associated
account number(s). Requests or authorizations for disbursements are not acceptable internal
documentation. Internal documentation must indicate that funds were provided to the borrower
and must be authorized by bank personnel.
CDFI Form: CDFI-0002
- 37 -
FY 2013 BEA Program Application
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 2013 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 2013 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). Certificates of Deposits
renewed for a new 3-year term must provide documentation indicating the original date of deposit and
expiration. Renewed Certificates of Deposits that do not indicate the original date of deposit and maturity will
be disqualified. 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 by a bank representative or account print screens
are acceptable documentation if accompanied by a signed Certification 2: Certification of Disbursement and if
it indicates the date of disbursement and account numbers. 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).
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FY 2013 BEA Program Application
Equity-Like Loans: As outlined in the 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.
2. Periodic payments of interest and/or principal may only be made out of the borrower CDFI’s available cash
flow after satisfying all other obligations.
3. Failure to pay principal or interest (except at maturity) will not automatically result in default.
4. 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 ModerateIncome 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 LowIncome).
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
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
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.
Applicants reporting in the Distressed Community Financing Activities category are not required to report in all
subcategories (e.g. Affordable Housing Development) if there is a decrease in that subcategory from the
Baseline period to the Assessment Period.
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 by a bank representative or
account print screens are acceptable if accompanied by a signed Certification of Disbursement and if it
indicates the date of disbursement and account number(s).
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.
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
Reporting and Documenting Deposit Liabilities
•
Calculate the net change in the amount of eligible Deposit Liabilities within the Baseline Period (from
January 1 to December 31, 2011) and within the Assessment Period (from January 1 to December 31,
2012). Report the dollar value of the net change in Deposit Liabilities for each period in the appropriate
columns on Worksheet 1 and for the Assessment Period 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 Assessment Period. Do not report each individual
depositor on Worksheet 2: Report of Transactions – only report the net change for each period.
•
Attach a narrative explaining the methodology
and (2) Deposit Liabilities were accepted at a
are referenced in the narrative, the Applicant
references are directly related to the Low-and
provided the Financial Services to.
used to determine that: (1) account holders are Residents;
location in the Distressed Community. If external sources
must explain how it reached the conclusion that the cited
Moderate-Income residents for which it is claiming to have
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. If
external sources are referenced in the narrative, the Applicant must explain how it reached the conclusion
that the cited references are directly related to the Low-and Moderate-Income residents for which it is
claiming to have provided the Financial Services to.
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
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
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. If external sources are referenced in the narrative, the Applicant must explain how it reached
the conclusion that the cited references are directly related to the Low-and Moderate-Income residents for
which it is claiming to have provided the Financial Services to.
•
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.
CDFI Form: CDFI-0002
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FY 2013 BEA Program Application
| File Type | application/pdf |
| File Title | Community Development Financial Institutions Fund |
| Author | Sowell, Mia |
| File Modified | 2013-06-10 |
| File Created | 2013-05-30 |