7007b application

FORM APPROVED
OMB NO. 1810-0657
EXPIRATION DATE: 9/30/2023

APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b) – ADDITIONAL INFORMATION
Applicant’s Impact Aid Number:
Name of the school facility for which funding is requested:

In the above school facility, on the survey date reported on the LEA’s FY 2021 (school year 2019-2020) Section 7003 Application:
Total Enrollment:
Number of Children Living on Indian Lands:
Number of Children with a Parent in the Uniformed Services:

Paperwork Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number. The valid
OMB control number for this information collection is 1810-0657. Public reporting burden for this
collection of information is estimated to average 6 hours per response, including the time for
reviewing instructions, searching existing data resources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. The obligation to respond to
this collection is required to obtain or retain benefit under 20 USC section 7007(b). If you have
any comments concerning the accuracy of the time estimate, suggestions for improving this
individual collection, or if you have comments or concerns regarding the status of your individual
form, application or survey, please contact: Impact Aid Program, U.S. Department of Education,
400 Maryland Ave., S.W., Washington, D.C. 20202-6244 or email [email protected].

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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b) – ADDITIONAL INFORMATION

… Own

APPLICANT’S INTEREST IN THE SCHOOL FACILITY

… Lease ________________________

… Other

(Expiration date)

If Other, Specify ______________________________________________________________________________________________________________________
TYPE OF SPECIAL DISTRICT
… Charter School … Alaskan Rural Education Attendance Area (REAA) … Coterminous District
AGE OF THE SCHOOL FACILITY

Year of Original Construction ________________

Year(s) and Description(s) of Major Renovation(s)

________________ _______________________________________________________________________
________________ _______________________________________________________________________
________________ _______________________________________________________________________

Square Footage of Existing School Facility

________________

ACREAGE IN LOCAL EDUCATIONAL AGENCY (LEA)
Total Acres Within Boundaries of LEA __________________

Total Acres of Nontaxable Federal Property Within Boundaries of LEA __________________

BONDED INDEBTEDNESS AS OF THE END OF THE AGENCY’S FISCAL YEAR 2019-2020
Maximum Bonding Capacity $______________________________________

Amount of Bonded Debt $_________________________________________

ASSESSED VALUE OF TAXABLE PROPERTY IN LEA
Name of Taxing Jurisdiction (e.g., School District Name, Township
Name, City Name, County Name, etc.)

Total Assessed Value of Real Property (Land and Improvements) That Was
Taxed for School Purposes for school year 2019-2020 on Behalf of the LEA

________________________________________________________________

$_______________________________________________________________

________________________________________________________________

$_______________________________________________________________

________________________________________________________________

$_______________________________________________________________

September 2008

Form Approved: OMB number 1810-0657, Expiration date: 09/30/2023

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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 7007(b) – PROGRAM ASSURANCES AND CERTIFICATIONS
The applicant local educational agency (LEA) declares that it has filed the three certifications in ED Form 80-0013 regarding lobbying,
debarment/suspension/responsibility status, and drug-free workplace with the U.S. Department of Education (Department) as part of its
section 7003 or section 7002 Impact Aid application. As of the date of the signature below, the LEA reaffirms and incorporates by reference
those assurances and certifications with respect to this grant award. The LEA certifies that no circumstances affecting the validity of these
assurances have changed since their previous filing.
With respect to the Certification Regarding Lobbying, the LEA recertifies that no 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 the making or renewal of Federal grants under this program; that the
LEA shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," when required (34 C.F.R. Part 82, Appendix B);
and that the LEA shall require the full certification, as set forth in 34 C.F.R. Part 82, Appendix A, in the award documents for all subawards at
all tiers.
The LEA further agrees to comply with the following Education Department General Administrative Regulations (EDGAR):
34 CFR Part 75 -- Direct Grant Programs, except 75.600 through 75.617
34 CFR Part 77 -- Definitions that Apply to Department Regulations
34 CFR Part 80 -- Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments, including
the procurement provisions
34 CFR Part 81 -- General Education Provisions Act--Enforcement
34 CFR Part 82 -- New Restrictions on Lobbying
34 CFR Part 84 -- Governmentwide Requirements for Drug –Free Workplace (Grants).
34 CFR Part 85 -- Governmentwide Debarment and Suspension (Nonprocurement).

Signature Of Authorized Representative

September 2008

Date

Form Approved: OMB number 1810-0657, Expiration date: 09/30/2023

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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 8007(b) – ADDITIONAL DEPARTMENT OF EDUCATION CONSTRUCTION ASSURANCES

The applicant local educational agency (LEA) further certifies that it will ensure that:
20. It has or will have title or other interest in the project site(s), including right of access, and that the site(s) will continue to be used for educational
purposes after the completion of the project(s).
21. Sufficient funds are available to meet any share of the costs of the repair, renovation, or construction projects that are not covered by this grant.
22. Except for school facilities modifications necessary to render public school facilities accessible in order to comply with the Americans with Disabilities
Act (ADA) of 1990 or section 504 of the Rehabilitation Act of 1973, this grant will be used only to supplement the amount of funds that in the absence of
the Federal funds would be made available from non-Federal sources for school repair and renovation.
23. Except for modifications necessary to meet ADA or section 504 of the Rehabilitation Act standards and asbestos abatement or removal, the grant will
not be used for repair, renovation, or construction of facilities or any part of a facility that will be used for religious worship, instruction, or
proselytization.
24. Competent architectural engineering supervision and inspection will be maintained at the project’s site to ensure that the work conforms to the
drawings and specifications for the approved project.
25. Grant projects will be: (a) functional; (b) economical; and (c) not elaborate in design or extravagant in the use of materials, compared with the facilities
of a similar type constructed in the State or other applicable geographical area.
26. Standards under the Occupational Safety and Health Act of 1970 (P.L. 91-576), or State and local codes, if they are more stringent, will be observed in
the design and completion of the projects.
27. Grant projects will comply with any applicable requirements under the ADA and section 504 of the Rehabilitation Act of 1973 regarding accessibility for
the disabled.
28. As applicable and to the extent feasible, the design and completion of grant project(s) should maximize efficient use of energy. Standard 90.1-1989 and
90.2-1993 of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc. (ASHRAE) will be applied in the design and
completion of the grant projects.
29. It will follow the "Earthquake Hazards Reduction Act of 1977" (P.L. 95-125) and Executive Order 12699, "Seismic Safety of Federal and Federally
Assisted or Regulated New Building Construction," as applicable.
30. If applicable, it will comply with the following Indian Preferences and Opportunities requirements. Section 7(b) of the Indian Self-Determination and
Education Assistance Act of 1975 (P.L. 93-638) requires that, to the greatest extent feasible, the recipient of any grant or contract awarded for the
benefit of Indians give to: (1) Indians, preferences and opportunities for training and employment in connection with the administration of the grant or
contract; and (2) Indian organizations and Indian-owned economic enterprises, as defined in section 3 of the Indian Financing Act of 1974 (P.L. 93-262),
preference in the award of contracts and subcontracts at any level of the administration of the grant project.
31. If it carries out repair, renovation, or construction through a contract, any such contract process ensures the maximum number of qualified bidders,
including small, minority, and women-owned businesses, through full and open competition.
32. The facilities will be operated and maintained in accordance with applicable Federal, State, and local requirements.
33. When the project is completed, sufficient operational funds will be available for effective operation and maintenance of the facilities.
34. Funds received under this program will not be used to supplant other available non-Federal construction money.
35. The grantee shall conduct and submit a Feasibility of Construction report to the Department prior to commencing new construction demonstrating that
the area upon which the construction will take place is suitable for construction and will be able to sustain the new facility or addition.
Signature Of Authorized Representative

September 2008

Date

Form Approved: OMB number 1810-0657, Expiration date: 09/30/2023

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U.S. Department of Education
Impact Aid Program
Washington, D.C. 20202-6244
APPLICATION FOR IMPACT AID DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b)
Catalog of Federal Domestic Assistance #84-041C

INDEPENDENT CERTIFICATION FOR EMERGENCY GRANT APPLICATION
This form must be completed and signed by a local building inspector, a licensed architect, or a licensed engineer, and included as part
of an emergency application for the discretionary construction program. The person providing this certification may not be a member of
the staff of the applicant local educational agency (LEA).

Name :
Title :
Organization :
Street/P.O. Box :
City, State & Zip :
Phone :
For the school facility identified in this application, please:
1. provide your professional and independent assessment of whether the condition is an emergency;
2. describe how the condition adversely affects the health, safety and well-being of occupants of the school facility;
3. describe the urgency of the need to address the condition; and
4. provide any additional comments you believe are relevant.
If you require more space for your narrative, continue on one blank page, using the title on this form.

I certify that these statements are, to the best of my knowledge and belief, true, complete and correct.

SIGNATURE

September 2008

DATE

Form Approved: OMB number 1810-0657, Expiration date: 09/30/2023

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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM – SECTION 8007(b) – COST ESTIMATE TABLE
Please provide a break down of the cost estimates related to this project.
Budget Category
(a)

Non-Federal Share

Requested Federal Share

Total

Direct Project Costs
Supplies
Equipment
Advertisements
Travel/Expenses

(b)

Planning /Design/Engineering/ Environmental Impact Study
Facilities Plan
Environmental Documentation
Plans and Specifications
Bid Documents
Engineering Services

(c)

Construction /Implementation
Independent Construction Manager
Labor
Materials
Equipment
Other (Specify)

(d)

Miscellaneous
Permits
Compliance Monitoring/Oversight/Contingency
Taxes
Other (Specify)

(e)

Project Summary (Sum lines (a) through (d) for each column)

(f)

Available Resources
State
Local

(g)

Total Request (Line (e) minus line (f) for each column)

September 2008

Form Approved: OMB number 1810-0657, Expiration date: 09/30/2023

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