Form IMLS Supplementary IMLS Supplementary IMLS Supplementary Information Form FY22

Generic Clearance for IMLS Grant Forms: Budget Form, Library and Museum Program Information Form, and Digital Product Form, EGMS PIS Supplementary Sheet, eGMS Abstract form

IMLS Supplementary Information Form FY22 without codes 20201203

IMLS Supplementary Information Form FY22

OMB: 3137-0092

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IMLS SUPPLEMENTARY INFORMATION FORM [Note: This will be a dynamic form so answers to certain questions will determine what questions the applicant sees next.]

PLEASE NOTE: Information contained within this form may be made publicly available.


Applicant Information

Does the legal applicant identified on the SF-424S have an organizational

unit that is performing the activities described in the application?

o Yes o No


[If Yes is selected…]


Provide the following information for the organizational unit performing the activities described in the application


Organizational Unit


Address line 1


Address line 2


City


State


Postal code


Country



Select the institution type that most accurately describes the organizational unit:

Archives

V



[If No is selected…]


Select the institution type that most accurately describes the organizational unit:

Archives

V



Funding Request


IMLS funds requested


Cost share/match amount*


Total costs


*Enter $0 if the budget includes no cost share/match.











Indirect Cost Rate


The budget includes indirect costs: O Yes O No


O The indirect cost rate has been negotiated with a federal agency. Select from list below.


List of agencies

V


Rate


Expiration Date




O The indirect cost rate does not exceed the 10% de minimis rate.


Audience(s) Served


Select the primary audience(s) to be served by the activities described in the application. Choose no more than three. If you choose General Population, do not choose any others.


O

General Population

O

Museum and/or Library professionals

O

Early childhood/preschool (0-5 years)

O

Native Americans, Native Hawaiians, or Native Alaskans

O

Middle childhood/primary school (6-12 years)

O

People with mental/physical challenges or disabilities

O

Adolescents/High school (13-19 years)

O

People who are low income or economically disadvantaged

O

Adults

O

Rural populations

O

Aging, elderly, senior citizens (65+ years)

O

Scholars/Researchers

O

Ethnic, radial minority populations other than Native Americans, Native Hawaiians, or Native Alaskans

O

Unemployed

O

Family/ Intergenerational

O

Urban populations

O

Immigrants/Refugees

O

Other

O

Military families







Abstract


Enter or paste your abstract below (maximum 3000 characters).


PLEASE NOTE: Information contained within this form may be made publicly available.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSandra Narva
File Modified0000-00-00
File Created2021-02-19

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