Form Library-Discretion Library-Discretionary PIF

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

Revised Library-Discretionary PIF 20210126

IMLS Library – Discretionary Program Information Form

OMB: 3137-0092

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IMLS LIBRARY - DISCRETIONARY PROGRAM INFORMATION FORM

PLEASE NOTE: Information contained within this form may be published online or otherwise shared by IMLS. Therefore, please do not include any sensitive, proprietary, or confidential information.

Section 1. Organizational Financial Information

  1. 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













* 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.

  1. If the Total Revenue amounts declined by more than 15% for any year over year listed OR if there was a deficit of more than 10% of the Total Revenue for two or more years listed above, explain the circumstances in the box below.

Shape1

  1. 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 in the box below. Shape2

  1. Has your organization had single or program-specific audit in the past three years?

Yes

No

Section 2. Agency-Level Goals and Objectives

Select one IMLS agency-level goal that best aligns with your proposed project. Once you have selected a goal, please select one associated objective.

Goal 1: Champion Lifelong Learning

Objective 1.1: Advance shared knowledge and learning opportunities for all.

Objective 1.2: Support the training and professional development of the museum and library workforce.

Goal 2: Strengthen Community Engagement

Objective 2.1: Promote inclusive engagement across diverse audiences.

Objective 2.2: Support community collaboration and foster civic discourse.

Goal 3: Advance Collections Stewardship and Access

Objective 3.1: Support collections care and management.

Objective 3.2: Promote access to museum and library collections.

Section 3. Grant Program

Select the program to which you are applying (A through C). Then for A or B, select one project category that best represents the focus of your project.

A. Native American Library Services: Enhancement Grants

Select one project category:

Digital Services

Educational Programming

Preservation and Revitalization

B. Native Hawaiian Library Services Grants

Select one project category:

Digital Services

Educational Programming

Preservation and Revitalization

C. Native American Library Services: Basic Grants

OMB Control #: 3137-0092, Expiration Date: 08/31/2021

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleIMLS Program Information Form
SubjectIMLS Program Information Form
AuthorTalitha Parker
File Modified0000-00-00
File Created2021-02-19

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