Form 3137-0092 FY18 Program Information Sheet

IMLS PROGRAM INFORMATION SHEET
PLEASE NOTE: Information contained within this form may be made publicly available.
1. Applicant Information
a. Legal Name as it appears in SAM.gov (5a from SF424S):
b. Organizational D-U-N-S® Number (5f from SF424S):
c. Expiration date of your SAM.gov registration
d. Organizational Unit Name (if different from Legal
Name):
e. Organizational Unit Address (if different from Legal Name address)
Street 1
Street 2
City

County

Please Select Your State

State

Zip+4/Postal Code

f. Organizational Unit Type (check one):
Academic Library

Library Association

Aquarium

Library Consortium

Arboretum/Botanical Garden

Museum Library

Art Museum

Museum Services
Organization/Association

Children’s/Youth Museum
Community College
Digital Library
Four-year College

Native American Tribe/Alaska
Native/Native Hawaiian
Organization

School Library or School District
applying on behalf of a School
Library or Libraries
Science/Technology Museum
Special Library
Specialized Museum**

Natural History/Anthropology
Museum

State Library

Graduate School of Library and
Information Science

Nature Center

State Museum Library

Planetarium

Zoo

Historic House/Site
Historically Black College or
University (HBCU)

Public Library

General Museum*

Research Library/Archives

History Museum

State Museum Agency

Institution of higher education
other than listed above
Other

* A museum with collections representing two or more disciplines equally (e.g., art and history)
** A museum with collections limited to one narrowly defined discipline (e.g., textiles, maritime, ethnic group)

OMB Control #: 3137-0092, Expiration date: 7/31/2018

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IMLS PROGRAM INFORMATION SHEET
2. Organizational Financial Information
a. Please complete the following table for the Organizational Unit for the three most recently completed fiscal years.
Fiscal Year

Total Revenue*

Total Expenses**

Surplus or Deficit

$0

* For nonprofit tax filers, Total Revenue can be found on Line 12 of the IRS Form 990.
** For nonprofit tax filers, Total Expenses can be found on Line 18 of the IRS Form 990.
b. If you had a budget surplus or deficit greater than 10% of your annual operating budget for two or more of the three
fiscal years listed above, please explain the circumstances of this surplus or deficit in the box below.

c. Were there any material weaknesses identified in your prior year’s audit report?
Yes
No
Not applicable
A material weakness is a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable
possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and corrected
on a timely basis.

If yes, please explain.

d. Has your organization had an A-133 audit in the past three years?
Yes

No

OMB Control #: 3137-0092, Expiration date: 7/31/2018

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IMLS PROGRAM INFORMATION SHEET
Refer to the Notice of Funding Opportunity for descriptions of these options and instructions for how to make selections.
3. Grant Program
a. Laura Bush 21st Century Librarian Program
1. Select one:
Planning Grant
National Forum Grant
Project Grant
Research Grant
2. Select one:
Pre-professional
Masters-level and Doctoral-level Programs
Early Career Development
Continuing Education
3. Select one
Community Anchors
National Digital Platform
Curating Collections
b. National Leadership Grants for Libraries
1. Select one:
Sparks Grant
Planning Grant
National Forum Grant
Project Grant
Research Grant
2. Select one:
Community Anchors
National Digital Platform
Curating Collections
c. Native American/Native Hawaiian Library
Services
1. Select one:
Native American Basic Grant
Native American Enhancement Grant
Native Hawaiian Library Services

d. Museums for America
1. Select one:
Learning Experiences
Community Anchors
Collections Stewardship
2. Select one:
$5,000–$25,000 with no cost share permitted.
$25,001–$250,000 with cost share required.
e. Museums Empowered (an MFA Special Initiative)

1. Select one:
Digital Technology
Diversity and Inclusion
Evaluation
Organizational Management
2. Select one:
$5,000–$25,000 with no cost share permitted.
$25,001–$250,000 with cost share required.
f. National Leadership Grants for Museums
1. Select one:
Advancing Digital Assets and Capacity
Collection Care and Access
Diversity and Inclusion
Professional Development
2. Select one:
Non-research grant, $50,000–$1,000,000 with cost share required.
Research grant, $50,000–$1,000,000 with no cost share required.
Rapid prototyping grant, $5,000–$50,000 with no cost share
required.
g. Museum Grants for African American History and Culture
1. Select one:
$5,000–$25,000 with no cost share permitted.
$25,001–$150,000 with cost share required.

h. Native American/Native Hawaiian Museum Services
4. Performance Goals
Select one of the following three IMLS agency-level goals: (a) Learning, (b) Community, or (c) Content and
Collections. Then select at least one of the performance goals listed beneath it:
a. Learning
Train and develop museum and library professionals
Support communities of practice
Develop and provide inclusive and accessible learning opportunities
b. Community
Strengthen museums and libraries as essential partners in addressing the needs of their communities
c. Content and Collections
Broaden access and expand use of the Nation’s content and collections
Improve management of the Nation’s content and collections
Improve preservation, conservation, and care of the Nation’s content and collections

If you select a performance goal listed beneath Learning or Community for your project, please review in the NOFO the
specific performance measure statement choices and the information you will be required to collect for each.
OMB Control #: 3137-0092, Expiration date: 7/31/2018

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IMLS PROGRAM INFORMATION SHEET
5. Funding Request
a. IMLS funds requested:

b. Cost share amount:

6. Population Served
Please select the target population(s) served by the proposed project:
General Population

Museum and/or Library Professionals

Early Childhood/Preschool (0-5 years)

Native Americans/Alaska Natives/Native Hawaiians

Middle Childhood/Primary School (6-12 years)

People with Mental or Physical Challenges/Disabilities

Adolescents/High School (13-19 years)

People Who Are Low Income/Economically Disadvantaged

Adults

Rural Populations

Aging, Elderly, Senior Citizens (65+ years)

Scholars/Researchers

Ethnic or Racial Minority Populations other than
Native Americans/Native Hawaiians

Unemployed

Families/Intergenerational

Other

Urban Populations

Immigrants/Refugees
Military Families
If other, please specify:
7. Museum Profile (Museum Applicants Only)
a. Is your institution organized on a permanent basis for essentially educational or aesthetic
purposes, and is it either a private not-for-profit organization that has tax-exempt status under
the Internal Revenue Code or a unit of state or local government?

Yes

No

b. Does your institution own or use tangible objects, either animate or inanimate?

Yes

No

c. Does your institution care for these objects?

Yes

No

d. Does your institution exhibit these objects to the general public at least 120 days a year
through facilities your institution owns or operates?

Yes

No

e. Your institution’s attendance for the 12-month period prior to the application

f. Year your institution was first open and exhibiting to the public:
g. Total number of days your institution was open to the public for the 12-month period prior to application:
h. Does your institution employ at least one professional staff member, or the full-time equivalent,
whether paid or unpaid, who is primarily engaged in the acquisition, care, or exhibition to the public of
tangible objects owned or used by your institution?

Yes

i. Number of full-time paid institution staff:
j. Number of full-time unpaid institution staff:
k. Number of part-time paid institution staff:
l. Number of part-time unpaid institution staff:
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No

IMLS PROGRAM INFORMATION SHEET
8. Project Elements (Museums for America Only)
Your response to this question will help us match your application to reviewers with appropriate experience. Make your
choice under the project category that you selected in Question 3 (Grant Program).
LEARNING EXPERIENCES
If you are applying in the Learning Experiences Project Category, select the primary element that is core to your
proposed project from the list below (check only one):
Adult Programs

Interpretation

Digital Media

K-12 Programs, With Schools

Early Learning

K-12 Programs, Out of School

Exhibitions

Professional Development/Training

Family Programs

Public Programs

COMMUNITY ANCHORS
If you are applying in the Community Anchors Project Category, select the primary element that is core to your proposed
project from the list below (check only one):
Audience Research and Evaluation

Community Outreach/Audience Development

Civic Engagement
Community-Driven Exhbitions and Progams
Community-Focused Planning Activities

Digital Media
Professional Development/Training

COLLECTIONS STEWARDSHIP
If
If you
you are
are applying
applying in
in the
the Collections
Collections Stewardship
Stewardship Project
Project Category,
Category, select
select the
the primary element
element that
that is
is core
core to
to your
your proposed
project from the list below (check only one):
Access and Use

Collections Management

Conservation

Database Management

Cataloguing, Inventorying,
Registration

Conservation Environmental
Improvement/Rehousing

Digitization

Collections Information
Management

Conservation Survey

Software Applications
Website Development

Conservation Treatment
Collections Planning

Professional Development/Training

Please identify the material type(s) that will be affected by your project:
Animals, living

Photographic Materials

Animals, preserved

Plants, living

Architecture

Plants, preserved

Books and Paper

Sculpture

Electronic Media

Textiles

Objects

Wooden Artifacts

Paintings

OMB Control #: 3137-0092, Expiration date: 7/31/2018

OMB-CLR-F-0031