SF-424 Application for Federal Assistance

OMB Number: 4040-0004
Expiration Date: 03/31/2012

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

* 2. Type of Application:

Preapplication

New

Application

Continuation

Changed/Corrected Application

Revision

* 3. Date Received:

* If Revision, select appropriate letter(s):

* Other (Specify):

4. Applicant Identifier:

02/01/2012

5a. Federal Entity Identifier:

5b. Federal Award Identifier:

State Use Only:
6. Date Received by State:

7. State Application Identifier:

8. APPLICANT INFORMATION:
* a. Legal Name:

North Carolina Housing Coalition

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

* c. Organizational DUNS:

58-1798953

9439217260000

d. Address:
* Street1:

118 St. Mary's St.

Street2:
* City:

Raleigh

County/Parish:
* State:

NC: North Carolina

Province:
* Country:

USA: UNITED STATES

* Zip / Postal Code:

27605-1809

e. Organizational Unit:
Department Name:

Division Name:

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

* First Name:

Chris

Middle Name:
* Last Name:

Estes

Suffix:
Title: Executive Director
Organizational Affiliation:

* Telephone Number: 919-881-0707

Fax Number:

* Email: [email protected]










 

Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:

M: Nonprofit with 501C3 IRS Status (Other than Institution of Higher Education)
Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

US Department of Housing and Urban Development
11. Catalog of Federal Domestic Assistance Number:

14.322
CFDA Title:

Tenant Resource Network Program

* 12. Funding Opportunity Number:

FR-5500-N-31
* Title:

Tenant Resource Network Program (TRN)

13. Competition Identification Number:

TRN-30
Title:

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

Add Attachment

NCHC_Form_424_14AreasAffected.docx

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* 15. Descriptive Title of Applicant's Project:

NCHC_TRN

Attach supporting documents as specified in agency instructions.

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

b. Program/Project

NC-013

NC-all

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

NCHC_Form_424_16CongressionalDistricts.doc

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17. Proposed Project:
* a. Start Date:

* b. End Date:

05/02/2012

05/01/2014

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

300,000.00

* b. Applicant

0.00

* c. State

0.00

* d. Local

0.00

* e. Other

0.00

* f. Program Income

0.00

* g. TOTAL

300,000.00

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

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

.

b. Program is subject to E.O. 12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

Yes

No

If "Yes", provide explanation and attach
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21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** I AGREE
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.

Authorized Representative:
Prefix:

* First Name:

Chris

Middle Name:
* Last Name:

Estes

Suffix:
* Title:

Executive Director

* Telephone Number: 919-881-0707

Fax Number:

* Email: [email protected]
* Signature of Authorized Representative:







Anne Ehlers

* Date Signed:

02/01/2012