CDFI-0002 BEA Application

DRAFT – Pre-decisional

Bank Enterprise Award Program

FY 2014 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 4

FY 2014 Updates 4

Application Submission Process 4

Persistent Poverty Counties 5

Pay For Success 5

Application Eligibility Factors 5

FDIC-Insured Depository Status 5

Certification Status 5

CDFI Program Award Status 6

Prior CDFI Fund Awardees or Allocatees 6

Qualifying Activities 7

Priority Factors 8

Eligible CDFI Partners 8

Distressed Communities 8

Application Submission Requirements and Deadlines 9

Application Package 9

Submission Requirements 12

Application Deadlines 12

Ensuring that the Application Package Is Complete 12

Awardee Notification and the Award Agreement 13

Contacting the CDFI Fund 13

Part I: Grants.Gov 14

Application Materials Submitted via Grants.gov 14

1. Standard Form (SF) - 424 Mandatory Form – Required for all Applicants: 14

2. Word Documents - Required for All Applicants: 15

3. Word Documents – Submitted As Required: 15

4. Excel Charts – Required for All Applicants: 15

Instructions for Uploading Documents to Grants.gov 16

Standard Form (SF) - 424 Mandatory Form (Application for Federal Assistance) Instructions 17

Environmental Review Form 19

Assurances and Certifications 20

Certification 1: ETAs or New Branches 24

Certification 2: Certification of Disbursement 25

Certification 3: Certification of Integrally Involved CDFI Partners 26

Certification 4: Certification of Baseline Period Qualified Activities 27

Applicant Information 28

Instructions for Worksheet 1: Estimated BEA Award Calculation 29

Worksheet 1: Estimated BEA Award Calculation 31

Instructions for Worksheet 2: Report of Transactions 32

Part II: myCDFIFund Submission 34

CDFI Partners 34

Qualified Activity Documentation - General Information 35

What to Report 35

Summary of Documentation by Category and Activity Type 36

Qualified Activity Documentation - CDFI Related Activities 39

Reporting CDFI Related Activities 39

Documenting CDFI Related Activities 39

Qualified Activity Documentation - Distressed Community Financing Activities 40

Reporting Distressed Community Financing Activities 41

Documenting Distressed Community Financing Activities 41

Qualified Activity Documentation - Service Activities 42

Reporting and Documenting Deposit Liabilities 42

Reporting and Documenting Community Services 42

Reporting and Documenting All Other Service Activities 42

Instructions for Uploading Qualified Activity Documentation and Distressed Community Maps 43

Steps to Upload Documents 44

Type of Files and Naming Conventions 44

Introduction and Instructions

Capitalized terms (other than titles) are defined in the BEA Program Regulations (12 CFR Part 1806), the Notice of Funding Availability (NOFA) for the FY 2014 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, the CDFI Bond Guarantee (BG) 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 2014 Updates

Application Submission Process

Important updates have been made to the BEA Program Application process. Most notably, the BEA Program Application’s submission requirements have been updated to eliminate the requirement that Applicants mail hard copies of application materials. Applicants applying for consideration under the FY 2014 BEA NOFA will no longer be required to print and mail any application materials, including Qualified Activity documentation. The FY 2014 BEA Program Application submission process is completely paperless.

Qualified Activity documentation will now be submitted via the CDFI Fund’s Bank Enterprise Award (BEA) Program myCDFIFund Signature Page interface. Please make sure to thoroughly read these instructions and follow the guidance that has been provided. Contact information has been provided on page 13 of these instructions. Applicants are encouraged to contact the CDFI Fund’s BEA Program office with questions or for technical assistance.

Additional changes to the FY 2014 BEA Program Application process include:

• Assurances and Certifications have been included as part of the Grants.gov application package.

• Applicants are no longer required to submit EIN documentation as part of the Grants.gov application package.

Persistent Poverty Counties¹

The CDFI Fund no longer requires BEA awardees to use at least 10 percent of their BEA Program Awards for activities that serve populations living in Persistent Poverty Counties (PPCs). As a result, FY 2014 BEA Program Applicants will not be asked to indicate a PPC commitment.. Prior BEA Program awardees that committed to deploying a percentage of their prior awards in PPCs are still required to fulfill those commitments.

Pay For Success²

The CDFI Fund is seeking to track the number and approximate dollar amount of Pay for Success initiatives that BEA Program Applicants have participated in. This information is being collected and tracked for informational purposes only and will not affect the application review or award determination processes.

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, 2013 to be eligible for a FY 2014 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, 2013 for the FY 2014 funding round) and maintain its status as a certified CDFI at the time BEA Program Awards are announced under the FY 2014 NOFA. Please note that additional information regarding certification 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 2014 BEA Program Award if it has: (1) An application pending for assistance under the FY 2014 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 2014 BEA Program Award, as indicated by the date on the 2014 BEA Notice of Award; or (3) Ever received assistance under the CDFI Program for the same activities for which it is seeking a FY 2014 BEA Program Award. Please note that Applicants may apply for both a CDFI Program award and a BEA Program Award in FY 2014; however, receiving a FY 2014 CDFI Program award removes an Applicant from eligibility for a FY 2014 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.

• 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, allocation agreement, bond loan agreement, agreement to guarantee and (ii) the CDFI Fund has yet to make a final determination as to whether the entity is in default of its previous 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 agreement, award agreement, allocation agreement, bond loan agreement, or agreement to guarantee. Such entities will be 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 2014 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 2014 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, or (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 the 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 2014 funding round, the Baseline Period is calendar year 2012 (January 1, 2012 through December 31, 2012), and the Assessment Period is calendar year 2013 (January 1, 2013 through December 31, 2013).

Qualified Activities are defined to include CDFI Related Activities, Distressed Community Financing Activities, and Service Activities. CDFI Related Activities include Equity Investments, Equity-Like Loans and CDFI Support Activities (loans, technical assistance, or qualifying deposits). Distressed Community Financing Activities include: Affordable Housing Loans; Affordable Housing Development Loans and related Project Investments; Education Loans; Commercial Real Estate Loans and related Project Investments; Home Improvement Loans; and Small Business Loans and related Project Investments. Service Activities include Deposit Liabilities, Financial Services, Community Services, Targeted Financial Services, and Targeted Retail Savings/Investment Products. For more detail, please see the FY 2014 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 36.

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 with Qualified Activities in the first priority category will be selected for Awards before Applicants with Qualified Activities in the second category. Applicants with Qualified Activities in the first and second categories will be selected for Awards before Applicants with Qualified Activities 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, 2013 for the FY 2014 funding round).

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 2014 BEA 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. Applicants are encouraged to use the CDFI Fund’s Information and Mapping System (CIMS) to determine if transactions are in Distressed Communities labeled as “Fully Qualified”.

Each CDFI Partner that is the recipient of CDFI Support Activities must designate a Distressed Community and save using CIMS. The CDFI Partner’s designated Distressed Community must meet the BEA Program requirements. A CDFI Partner may designate an area as a Distressed Community by selecting a census tract that meets the minimum population, poverty, and unemployment requirements. A CDFI Partner may also designate a Distressed Community by selecting two or more contiguous census tracts that, in the aggregate, meet minimum geographic, population, poverty, and unemployment requirements.

The CDFI Fund requires all CDFI Partners to associate their Distressed Community map via the BEA Signature Page in their myCDFIFund account. Applicants seeking an Award in the Distressed Community Financing or Service Activities categories do not have to associate a designated Distressed Community via myCDFIFund, however, Applicants are strongly encouraged to use CIMS to identify Distressed Communities that are eligible for BEA Qualified Activities.

NOTE: For the FY 2014 BEA Program funding round, applicants will have the choice to use either the legacy (2000) or updated (2006-2010) eligibility data to determine if a transaction or activity occurred in a BEA Distressed Community. Both data sets (legacy and updated) are available in CIMS.

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. All Applicants and CDFI Partners are required to register and complete a BEA Signature Page in myCDFIFund. Applicants providing Qualified Activity documentation are required to upload documents via myCDFIFund.

Application Package

The Application Package is organized according to the method of submission. A complete Application must include submission of each part listed in the table below:

Part	Application Component	Submission Procedures
Part I. Grants.gov	Application for Federal Assistance Mandatory Form - (SF) 424 Mandatory - Required for All Applicants: By completing the SF-424, applicants are certifying their agreement to BEA Program Assurances and Certifications provided on pages 19-22 of this document. The Assurances and Certifications document are provided for review and reference purposes and do not need to be submitted separately. Word Documents - Required for All Applicants: Environmental Review Form Certification 4: Certification of Baseline Period Qualified Activities Word Documents – Submitted As Applicable: Certification 1: ETAs or New Branches Certification 2: Certification of Disbursement Certification 3: Certification of Integrally Involved CDFI Partners Excel Charts - Required for All Applicants: Applicant Information Worksheet 1: Estimated BEA Award Calculation Worksheet 2: Report of Transactions	Submit electronically via Grants.gov Submit electronically via Grants.gov: Follow file naming conventions (additional guidance provided on page 16) Submit electronically via Grants.gov: Follow file naming conventions (additional guidance provided on page 16) Submit electronically via Grants.gov: Follow file naming conventions (additional guidance provided on page 16)
Part II. myCDFIFund	myCDFIFund Account Registration: Required for all Applicants and CDFI Partners Documentation of Qualified Activities - Required for All Applicants: As described in Part II. Qualified Activity Documentation (pages 36-46)	Applicants: Register the 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: Register or confirm the Organization is registered in myCDFIFund, according to the instructions on the CDFI Fund’s website and on page 35 of this Application. Complete a BEA Signature Page. Associate a Distressed Community map(s) in CIMS to the BEA Signature Page(if applicable). Follow file naming conventions (additional guidance provided on pages 45-46). Submit electronically: Upload under “Attachments”. Follow file naming conventions (additional guidance provided on pages 45-46)

NOTE:

• Applicants must not alter the format of the required Word and Excel Documents noted in Part I (Grants.gov) of the Application package. Altered documents will be rejected and the Application will be deemed ineligible.

• 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 to update its contact and user account information in myCDFIFund 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 2014 Supplemental Guidance for Applicants and FAQs (Instructions for myCDFIFund Registration and CDFI Partner Registration section) on the BEA page of the CDFI Fund’s website.

Submission Requirements

An active System for Awards Management (SAM)³ account is required to submit Applications via Grants.gov. Each Applicant is advised to make sure its 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 May 27, 2014. The SAM website is: www.SAM.gov.

Please be advised that in order to submit an application an Applicant must have a current and valid Dun and Bradstreet Data Universal Numbering System (DUNS) number and Employer Identification Number (EIN).

The CDFI Fund advises Applicants to allow sufficient time to obtain this information. A DUNS number is required for SAM registration and for Grants.gov submission. Applicants unable to submit their Applications via 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 application deadline.

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 upload due date:

• Part I (Grants.gov): must be submitted through Grants.gov by 11:59 p.m. Eastern Time (ET) on May 27, 2014.

• Part II (myCDFIFund Submission): myCDFIFund account registration, BEA Signature Page and documentation of Qualified Activities must be submitted by 5:00 p.m. Eastern Time (ET) on May 29, 2014.

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 FY 2014 NOFA, BEA Program Regulations, and this Application by the applicable deadlines. A complete Application Package is one that includes all required 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:

• Environmental Review Form is not submitted via Grants.gov

• Certification 4: Certification of Baseline Period Qualified Activities is not submitted via Grants.gov

• Excel charts are not submitted via Grants.gov

• Signature Page is not submitted via myCDFIFund

Awardee Notification and the Award Agreement

For the FY 2014 funding round, the CDFI Fund anticipates notifying Applicants selected to receive an Award on or before September 30, 2014. The CDFI Fund will notify an Applicant’s designated Authorized Representative of the Award decision (positive or negative) via email. 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 contingent upon the receipt of the CDFI Fund’s BEA Program Award. The Notice of Award and Award Agreement must be executed and returned to the CDFI Fund within 10 business days. It is the Awardee’s responsibility to ensure that complete and accurate banking information is reflected in its System for Award Management (SAM) account on www.Sam.gov.

Applicants that receive BEA Program Awards over $50,000 will be subject to compliance and reporting requirements. Applicants that receive BEA Program Awards of $50,000 or less will be subject to compliance requirements but not reporting requirements. Compliance and reporting requirements will be included as terms and conditions of the Award Agreement and made contingent to receipt of the Award. More information on the requirements for Awardees can be found in the FY 2014 NOFA and BEA Program Regulations.

Actual funding for theBEA 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 May 23, 2014 (two business days before the Grants.gov 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 May 23, 2014, until after the Grants.gov Application deadline.

The CDFI Fund will respond to technical issues related to myCDFIFund accounts through 5:00 p.m. ET, on May 27, 2014.

Please note that these are not toll free numbers.

CDFI Fund Main Office	202-653-0300 202-508-0089 fax	www.cdfifund.gov	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].
BEA Program Office Support	202-653-0421	[email protected]	How to complete Application materials.
Compliance & Monitoring Office Support	202-653-0423	[email protected]	Status of compliance with other awards including outstanding reports.
IT Office Support	202-653-0300	[email protected]	Registering and creating accounts on myCDFIFund.
Legal Office 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 their FY 2014 BEA Program 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 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.

Application Materials Submitted via Grants.gov

1. Standard Form (SF) - 424 Mandatory Form – Required for all Applicants:

The SF-424 Mandatory Form (SF-424) is required for all Applicants. Electronically signing and submitting the SF-424 certifies that the Applicant attests that the information in the application is true, complete, and accurate, and also certifies that the Applicant will comply with the Assurances and Certifications, if an Award is made. The Assurances and Certifications have been provided as part of the Grant.gov package. A copy has also been provided on pages 20-23 of this document. The SF-424 signature also attests to the information provided in the Environmental Review Form, Excel Charts, and applicable certifications including: Certification 1, ETAs or New Branches; Certification 2, Certification of Disbursement; Certification 3, Certification of Integrally Involved CDFI Partners; and Certification 4, Certification of Baseline Period Qualified Activities. Details for completing the SF-424 are on pages 17-18. Please note a separate submission of the SF-424 with a physical signature is no longer required.

2. Word Documents - Required for All Applicants:

For illustrative purposes only, the Environmental Review Form and Certifications 4: Certification of Baseline Period Qualified Activities are included in this Application, beginning on page 19. Submission of these documents must occur in Grants.gov.

• Environmental Review Form

• Certification 4: Certification of Baseline Period Qualified Activities

  • Required for all Applicants

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

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

3. Word Documents – Submitted As Required:

For illustrative purposes only, Certifications 1-3 are included in this Application, beginning on page 24. Submission of these documents must occur in Grants.gov.

• Certification 1. ETAs or New Branches:

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

• Check the applicable certification

• Certification 2. Certification of Disbursement:

• Required for an Applicant 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:

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

• Enter the names of all CDFI Partners and applicable information

4. Excel Charts – Required for All Applicants:

For illustrative purposes only, the Excel charts and instructions are included in this Application, beginning on page 29. Applicants must access and submit Excel charts via Grants.gov (Part I of the Application process). Submission of these documents must occur in Grants.gov.

• Applicant Information

• Worksheet 1: Estimated BEA Award Calculation

  • Will automatically calculate the appropriate estimated award amount, based on your organization’s CDFI status and CRA asset size indicated in the Applicant Information sheet

• Worksheet 2: Report of Transactions

Instructions for Uploading Documents to Grants.gov

When uploading documents into Grants.gov, please be sure to: (1) upload each document individually; and (2) ensure the file names follow the file naming conventions provided below. Acceptable file extensions are: .pdf; .doc; .docx; .xls; and .xlsx. The Environmental Review Form and Certifications 1-4 are acceptable in .pdf, .doc, or .docx format. The Excel charts must be in .xls or .xlsx format.

It is important that Applicants not deviate from the File Naming Conventions reflected in the following table, as the CDFI Fund intends to use this information to determine the completeness of applications. Please note a separate SF-424 with a physical signature is no longer required.

Document	File Naming Convention	Required
Environmental Review Form	Environmental Review Form	Yes
Certification 1: ETA or New Branches	Certification 1	No, only if applicable.
Certification 2: Certification of Disbursement	Certification 2	No, only if applicable.
Certification 3: Certification of Integrally Involved CDFI Partners	Certification 3	No, only if applicable.
Certification 4: Certification of Baseline Period Qualified Activities	Certification 4	Yes
Excel Charts: Applicant Information, Worksheet 1: Estimate BEA Award Calculation, and Worksheet 2: Report of Transactions	Excel Charts	Yes

Standard Form (SF) - 424 Mandatory Form (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.

Required fields are prefaced with an asterisk (*).

Field	Instructions
*1.a. Type of Submission:	‘Application’ is automatically selected
*1.b. Frequency	‘Annual’ is automatically selected
*1.c. Consolidated Application/Plan/Funding Request	‘No’ is automatically selected
*1.d. Version	‘Initial’ is automatically selected
*2. Date Received:	Automatically filled by the system upon submission – no entry necessary.
3. Applicant Identifier:	Not Applicable – leave blank
4.a. Federal Entity Identifier:	Not Applicable – leave blank
*4.b. Federal Award Identifier:	Enter 21.021
5. State use only: Date Received by State	Not Applicable – leave blank
6. State use only: State Application Identifier	Not Applicable – leave blank.
*7.a. Applicant Information: Legal Name	Enter the legal name of the Applicant.
*7.b. Employer/Taxpayer Identification Number (EIN/TIN):	Enter the Applicant’s EIN/TIN.
*7.c. Organizational DUNS:	Enter the Applicant’s DUNS.
*7.d. Address:	Complete all fields with Applicant’s mailing address. Include 9-digit zip.
7.e. Organizational Unit:	Not Applicable – leave blank.
*7.f. Name and contact information of person to be contacted on matters involving this Application:	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.
*8.a. Type of Applicant:	Select the most appropriate description from list of dropdown options.
*8.b. Additional Description	Not Applicable – leave blank
*9. Name of Federal Agency	Pre-filled – no entry necessary.
10. Catalog of Federal Domestic Assistance Number / CFDA Title:	Pre-filled – no entries necessary. If not, enter 21.021.
11. Descriptive Title of Applicant’s Project	Enter the category description of Qualified Activities which are being considered for a BEA Program Award (e.g., CDFI Related Activities, Distressed Community Financing Activities, Service Activities).
12. Areas Affected by Funding	Not Applicable – leave blank
*13. Congressional Districts Of: (a) Applicant; and (b) Program/Project	See www.house.gov to find congressional district. Use same for both boxes.
*14. Funding Period: (a) Start Date; and (b) End Date	Start Date: Enter 01/01/2013; End Date: Enter 12/31/2013
*15. Estimated Funding	Enter total Award request for Federal and Total, enter zeroes in other boxes.
*16. Is Submission Subject to Review by State:	Select option C.
*17. Is the Applicant Delinquent on Any Federal Debt:	Answer and provide Explanation if Yes selected.
*18. Applicant Certification/ Authorized Representative:	Click the ‘I Agree’ button. Complete all fields for AR information. AR (name and contact information) must match the Authorized Representative’s information in the Applicant’s myCDFIFund account.
Worksheet: Consolidated Application/Plan/Funding Request Explanation	Not Applicable – leave blank
Worksheet: Applicant Federal Debt Delinquent Explanation	Complete if applicable

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
Are there any actions proposed in the Application that do not constitute a “categorical exclusion” as defined in 12 CFR 1815.110?
If YES, would any of these actions normally require an environmental impact statement (see 12 CFR 1815.108)?
Are there any activities proposed in the Application that involve:
Historical or archaeological sites listed on the National Register of Historic Places, or that may be eligible for such listing?
Wilderness areas designated or proposed under the Wilderness Act?
Wild or scenic rivers proposed or listed under the Wild and Scenic Rivers Act?
Critical habitats of endangered or threatened species?
Natural landmarks listed on the National Registry of Natural Landmarks?
Coastal barrier resource systems?
Coastal Zone Management Areas?
Sole Source Aquifer Recharge Areas designated by EPA?
Wetlands?
Flood plains?
Prime and unique farmland?
Properties listed or under consideration for listing on the Environmental Protection Agency’s List of Violating Facilities?

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

NOTIFICATION

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

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

2. The Applicant not using any 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.

Assurances and Certifications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

B. Additional Certifications

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

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

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

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

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

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

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

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

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

8. 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.

9. 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.

10. 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.

11. 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).

12. 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.

13. 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).

14. 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.

15. 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.

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

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

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

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

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

3. 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

4. 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.

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

E. Certification Regarding Drug-Free Workplace Requirements

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

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

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

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

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

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

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

3. 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);

4. 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;

5. 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;

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

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

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

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

20. 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

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

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

9. 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

10. 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.

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

Certification 1: ETAs or New Branches

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.

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.

Applicant Name:

Signing the certification on the SF-424 certifies that the transactions and supporting documentation (if applicable) 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	Total Dollar Value Or Amount Of Transaction	Dollar Amount Disbursed To Date	Date Of Execution MM/DD/YY	Date Of Initial Disbursement MM/DD/YY	Date Of Final Disbursement MM/DD/YY	Type Of Activity (Abbreviation Only)

Certification 3: Certification of Integrally Involved CDFI Partners

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 2014 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 2014 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	City, State	Name of Distressed Community (map name provided in CIMS/ BEA Signature Page)

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 2014 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	Baseline Period Qualified Activity ($)
	Equity Investments / Equity-Like Loans	
	CDFI Support Activities	
DISTRESSED COMMUNITY FINANCING ACTIVITIES
		Reporting	Baseline Period Qualified Activity ($)
	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 ($)
	Deposits	
	Community Services	
	Financial Services	
	Targeted Financial Services	
	Targeted Retail Savings/Investment Products	

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.

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 12/31/2013 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 12/31/2013.
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 12/31/2013.
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	No			Mississippi			No
Alabama	No			Montana			No
Arkansas	No			North Carolina			No
American Samoa	No			North Dakota			No
Arizona	No			Nebraska			No
California	No			New Hampshire			No
Colorado	No			New Jersey			No
Connecticut	No			New Mexico			No
District of Columbia	No			Nevada			No
Delaware	No			New York			No
Florida	No			Ohio			No
Fed. St. of Micronesia	No			Oklahoma			No
Georgia	No			Oregon			No
Guam	No			Pennsylvania			No
Hawaii	No			Puerto Rico			No
Iowa	No			Palau			No
Idaho	No			Rhode Island			No
Illinois	No			South Carolina			No
Indiana	No			South Dakota			No
Kansas	No			Tennessee			No
Kentucky	No			Texas			No
Louisiana	No			Utah			No
Massachusetts	No			Virginia			No
Maryland	No			Virgin Islands			No
Maine	No			Vermont			No
Marshall Islands	No			Washington			No
Michigan	No			Wisconsin			No
Minnesota	No			West Virginia			No
Missouri	No			Wyoming			No
Northern Mariana Isl.	No

Instructions for Worksheet 1: Estimated BEA Award Calculation

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

Worksheet 1: Estimated BEA Award Calculation

CDFI RELATED ACTIVITIES		A	B	C	D	E	F
		Reporting	Baseline Period 1/1/12-12/31/12	Assessment Period 1/1/13-12/31/13	Change in Activity	Award Percent	Estimated Award Amount
1.	Equity Investments / Equity-Like Loans	Yes/No				15%
2.	CDFI Support Activities	Yes/No				6% / 18%
3.	Estimated Award Amount for CDFI Related Activities:
DISTRESSED COMMUNITY FINANCING ACTIVITIES		A	B	C	D	E	F
		Reporting	Baseline Period	Assessment Period	Change in Activity	Priority Factor	Weighted Value
4.	Affordable Home Mortgage Loans	Yes/No
5.	Affordable Housing Development Loans & Project Investments	Yes/No
6.	Small Business Loans and Project Investments	Yes/No
7.	Home Improvement Loans	Yes/No
8.	Education Loans	Yes/No
9.	Commercial Real Estate Loans & Project Investments	Yes/No
10.	Total Score:
11.	Estimated Award Amount for Distressed Community Financing Activities:
SERVICE ACTIVITIES		A	B	C	D	E	F
		Reporting	Baseline Period	Assessment Period	Change in Activity	Priority Factor	Weighted Value
12.	Deposits	Yes/No
13.	Community Services	Yes/No
14.	Financial Services	Yes/No
15.	Targeted Financial Services	Yes/No
16.	Targeted Retail Savings/Investment Products	Yes/No
17.	Total Score:
18.	Estimated Award Amount for Service Activities:

Remember:

• If the Applicant has carried out no activity in a sub-category during the Baseline Period, write “$0” in the applicable 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, 2014). 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, 2012 in the Baseline Period, and the dollar value of the net change in Deposit Liabilities from January 1 to December 31, 2013 in the Assessment Period. See Part II, Summary of Documentation by Category and Activity Type for more details.

Instructions for Worksheet 2: Report of Transactions

Applicants must use this form to report all transactions during the assessment period.

Column	Entry
A: Service Provided/ Borrower/ Invested	Report each transaction by borrower, investee, grantee, CDFI, or other recipient. Service Activities: report each transaction carried out during the Assessment Period by the service provided.
B: Total Dollar Value or Amount of Transactions	Report the total original dollar amount of each transaction. If not fully disbursed, the total dollar value should reflect only the amount that is 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 Community Financing Activity transaction, enter the borrower’s street address or the location of the property (real estate loans).
E: City	For each Distressed Community Financing Activity transaction, enter the city of the borrower or the property (real estate loans).
F: State	For each Distressed Community Financing Activity transaction, enter the state of the borrower or property (real estate loans).
G: Zip Code	For each Distressed Community 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 Equity Investments	CEI
	CDFI Equity Like Loans	ELL
	CDFI Grants	CG
	CDFI Loans	LNS
	CDFI Deposits / Shares	DS
	TA provided to CDFIs	TAC
	Affordable Housing Mortgage Loans	AHM
	Affordable Housing Development Loans and Project Investments	AHD
	Commercial Real Estate Loans and Project Investments	CRE
	Education Loans	EDU
	Home Improvement Loans	HIL
	Small Business Loans and Project Investments	SBL
	Deposit Liabilities	D
	Financial Services	FS
	Targeted Financial Services	TFS
	Targeted Savings Products	TSP
	Community Services	CS
M: Impact	For Distressed Community Financing and Service Activities, provide the number of the appropriate measure for each transaction: Affordable Housing Development: Total number of units developed or rehabilitated as part of the transaction. Small Business: Total number of full-time equivalent jobs created or maintained by borrower. Commercial Real Estate: Total number of commercial real estate properties acquired, developed or rehabilitated. Financial Services and Targeted Financial Services: Number of accounts opened, checks cashed, etc. as a result of the related program funded with the Award. Targeted Retail Savings/Investment Products: Number of products developed with funds from the Award, sold or opened. Community Services: Number of individuals who received the identified service funded with the Award.

Part II: 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.

All Applicants are required to complete a BEA Signature Page via the CDFI Fund’s BEA Program myCDFIFund Signature Page interface. The following documents must be submitted through the myCDFIFund Signature Page interface:

• BEA Signature Page;

• Qualified Activity documentation; and

• Distressed Community Map (only applies to CDFI Partners which are required to associate a map via CIMS interface)

CDFI Partners

A CDFI Partner that is the recipient of CDFI Support Activity must designate a BEA Distressed Community in which it is Integrally Involved and submit a BEA Program Signature Page via its myCDFIFund account. CDFI Partners designate a BEA Distressed Community by creating a BEA Distressed Community Map using the CDFI Fund’s CIMS mapping system. The Distressed Community Map is attached to and submitted along with the BEA Program Signature Page. Basic instructions have been provided below:

• Step 1: Access your organization’s myCDFIFund account.

• Step 2: Open the BEA Program Signature Page

• Step 3: Associate the Distressed Community map(s) with your BEA Program Signature Page. Please note that associating Distressed Community maps to your BEA Program Signature Page is done through CIMS. The BEA Program Signature Page must have been previously created or opened in order to associate the map(s).

• Step 4: Sign and submit the completed BEA Program Signature Page.

CDFI Partners are not required to submit Statements of Integral Involvement with their BEA Program Signature Page and BEA Distressed Community map(s). Applicants will be required to certify that all CDFI Partners meet the definition of Integrally Involved as stated in the applicable NOFA. Applicants are encouraged to have CDFI Partners complete the Statement of Integral Involvement (Statement) for their records, but they are not required to submit the Statement with their application.

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 Program Signature Page, BEA Distressed Community map(s), or other required information, the Applicant will not be notified of the missing documentation and the transaction will be disqualified.

Additional instructions on designating a BEA Distressed Community and submitting a BEA Program Signature Page can be found in the FY 2014 Supplemental Guidance and Frequently Asked Questions document located on the BEA page of the CDFI Fund’s website.

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. Also, 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 2014”.

Qualified Activity Documentation - General Information

The following details the requirements for reporting and documenting Qualified Activities greater than $250,000. Applicants should use this guidance in conjunction with the instructions for each worksheet as well as the BEA Program Regulations, FY 2014 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’s BEA Program office 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 2014 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 2014 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, 2013), subject to dollar amount limitations imposed by the CDFI Fund, and as set forth in the FY 2014 NOFA.

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 and 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.

Summary of Documentation by Category and Activity Type

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

Category	Closing Documents	Disbursement Documents	Other Documentation
CDFI Equity: Equity, Equity-Like Loans	Investment agreement Stock purchase certificate Executed/signed equity-like loan agreement Signed grant letter	Copies of checks, wire transfer receipts, and credit/debit slips from the general ledger OR Internal documentation (requests for wire transfers and account print screens) AND Certification 2: Certification of Disbursement	Applicants: Certification 4: Certification of Baseline Period Qualified Activities.
CDFI Support: Loans, Certificates of Deposit/Share Certificates, TA to CDFI Partner	Executed/signed loan agreement (Note: loan documents must indicate the purpose of the loan) Executed/signed promissory note Certificate of Deposit Share Certificate	Copies of checks, wire transfer receipts, or credit/debit slips from the general ledger. OR Internal documentation (requests for wire transfers and account print screens) AND Certification 2: Certification of Disbursement.	Applicants: Certification 3: Certification of Integrally Involved CDFI Partners. Certification 4: Certification of Baseline Period Qualified Activities. CDFI Partners: CDFI Partner Registration on myCDFIFund (includes designated BEA-eligible Distressed Community map(s)).
Distressed Community Financing Activities	Loans of $250,000 or more: Executed/signed loan agreement Executed/signed promissory note	Loans of $250,000 or more: Copies of cleared checks, wire transfer receipts, and credit/debit slips from the general ledger which indicate the name of the party receiving the funds. OR Internal documentation (requests for wire transfers and account print screens) AND Certification 2: Certification of Disbursement	Applicants: Certification 4: Certification of Baseline Period Qualified Activities.
Service Activities	Deposit Liabilities: narrative on methodology used to determine that: (1) account holders are Residents 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 solely acceptable internal documentation. Internal documentation must indicate that funds were provided to the borrower and must be authorized by bank personnel.

Qualified Activity Documentation - 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 2014 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 2014 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 and account print screens are acceptable documentation if accompanied by a signed Certification 2: Certification of Disbursement and if the documentation 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).

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.

1. 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.

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

3. 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.

Qualified Activity Documentation - Distressed Community Financing Activities

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

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

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

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

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

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

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

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

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

Reporting Distressed Community Financing Activities

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

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 and account print screens are acceptable if accompanied by a signed Certification of Disbursement and if the documentation indicates the date of disbursement and account number(s).

Qualified Activity Documentation - Service Activities

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

Reporting and Documenting Deposit Liabilities

• Calculate the net change in the amount of eligible Deposit Liabilities within the Baseline Period (from January 1 to December 31, 2012) and within the Assessment Period (from January 1 to December 31, 2013). 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 used to determine that: (1) account holders are Residents; and (2) Deposit Liabilities were accepted at a location 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 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 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.

Instructions for Uploading Qualified Activity Documentation and Distressed Community Maps

Qualified Activity documentation and Distressed Community maps must be submitted electronically through the myCDFIFund Signature Page interface. Applicants will attach Qualified Activity to their BEA Program Signature Page using the File Uploading Interface system. Step by step instructions have been provided below.

When uploading documents using the “Upload Documents” tab please remember to: (1) select the appropriate “Type of file” based on category and BEA Qualified Activity type being uploaded; and (2) follow the file naming conventions guidance. A list of categories and BEA Qualified Activity types has been provided in the table below. Documents uploaded will be organized as follows: (1) CDFI Related Activities; (2) Distressed Community Financing Activities; and (3) Service Activities.

The File Uploading Interface system will only accept the following file extensions: .pdf; .doc; .docx; .xls; and .xlsx. Please note that uploading a file with an identical file name will overwrite a previously uploaded file with the same name. Also, myCDFIFund cannot accept files larger than 15MB. Files that are larger than 15MB will need to be uploaded in multiple parts. Guidance for naming files that are uploaded in multiple parts can be found in the naming conventions table below. Applicants are strongly encouraged to scan or save documents in the lowest possible resolution to speed upload times and minimize the need to save single files in multiple parts.

Applicants are advised not to upload documentation containing information that could be considered Personally Identifiable Information (PII) of an individual (e.g., social security numbers, birthdates, etc.). The CDFI Fund is not responsible for any PII inadvertently uploaded into CDFI Fund systems by Applicants.

Steps to Upload Documents

1. Click on the “Upload Documents” link located on the left side navigation tool bar.

2. Click on the “Upload Attachments” link in the middle of the page to open the File Uploading Interface.

3. The File Uploading Interface will open in a new window.

4. Use the “Type of file” dropdown box located on the left side to select the appropriate category and BEA Qualified Activity type.

5. Use the “Browse” button to locate the file.
   
   

6. Select the file with the appropriate file name.

7. Click on the “Upload” button to upload the file.

Successfully uploaded files will be listed below. Files can be deleted by clicking on the “Delete” link on the left side of the file.

Type of Files and Naming Conventions

The File Uploading Interface allows Applicants to select the Type of File based on the specific Category and Activity Type of the file being uploaded. Applicants must follow the File Naming Convention guidance in the table below. Do not use spaces to separate Borrower/Investee Name from Category and the Category from the Activity Type - use periods (.) instead.

For large files that need to be uploaded in multiple parts, please follow the File Naming Convention guidance and add a number to the beginning of the file name. Continue with the numbering as many times as needed to upload the entire file.

For example, a smaller file name would be:

BorrowerLastNameFirstInitial_Category_ActivityType

A larger file would be numbered and uploaded in multiple parts. For example:

1BorrowerLastNameFirstInitial_Category_ActivityType; 2BorrowerLastNameFirstInitial_Category_ActivityType; 3BorrowerLastNameFirstInitial_Category_ActivityType; etc.

Type of File	File Naming Convention	Example
1a-CDFI Related – Equity Investment	RecipientCDFIName_Category_ActivityType	ABCCDFI_CDFI_CEI
1b-CDFI Related – Equity Like Loan	RecipientCDFIName_Category_ActivityType	ABCCDFI_CDFI_ELL
1c-CDFI Related – Grants	RecipientCDFIName_Category_ActivityType	ABCCDFI_CDFI_CG
1d-CDFI Related – Loans	RecipientCDFIName_Category_ActivityType	ABCCDFI_CDFI_LNS
1e-CDFI Related – Deposits/Shares	RecipientCDFIName_Category_ActivityType	ABCCDFI_CDFI_DS
1e-CDFI Related – Technical Assistance	RecipientCDFIName_Category_ActivityType	ABCCDFI_CDFI_TAC
2a-DCFA – Affordable Housing Mortgage Loans	BorrowerLastNameFirstInitial_Category_ActivityType	DoeJ_DCFA_AHM
2b-DCFA – Affordable Housing Development Loans	BorrowerName_Category_ActivityType	ABCLLC_DCFA_AHD
2c-DCFA – Small Business Loans	BorrowerName_Category_ActivityType	ABCINC_DCFA_SBL
2d-DCFA – Home Improvement Loans	BorrowerLastNameFirstInitial_Category_ActivityType	DoeJ_DCFA_HIL
2e-DCFA – Education Loans	BorrowerLastNameFirstInitial_Category_ActivityType	DoeJ_DCFA_EDU
2f-DCFA – Commercial Real Estate	BorrowerName_Category_ActivityType	ABCINC_DCFA_CRE
3a-Service Activities – Deposits	ServiceActivitesNarrative_Category_ActivityType	DepositsNarrative_SA_D
3b-Service Activities – Community Services	ServiceActivitesNarrative_Category_ActivityType	ServiceActivitiesNarrative_SA_CS
3c-Service Activities – Financial Services	ServiceActivitesNarrative_Category_ActivityType	ServiceActivitiesNarrative_SA_FS
3d-Service Activities – Targeted Financial Services	ServiceActivitesNarrative_Category_ActivityType	ServicesActivitiesNarrative_SA_TFS
3e-Service Activities - Targeted Savings Products	ServiceActivitesNarrative_Category_ActivityType	ServicesActivitesNarrative_SA_TSP

1 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.

2The Pay for Success initiative leverages philanthropic and other private investors to provide services for a target population that measurably improves the lives of individuals while also spending taxpayer dollars wisely. The government (Federal, state or local) works with a financing organization where private investors provide up-front funding to help achieve a specific result for a target population to measurably improve individuals’ lives. The government only pays if the agreed upon goal is achieved.

(Source: http://www.whitehouse.gov/omb/factsheet/paying-for-success)

3 The System for Award Management (SAM) replaced the Central Contractor’s Registration (CCR) database that was formerly used by Applicants.