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OMB Control No. 0660-XXX Expiration Date: TBD |
| Table of Funded Project Participants & Unfunded Collaborators |
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| *entries highlighted in grey are examples |
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| Administrative Role |
Organization |
Street Address |
City |
State |
Zip Code |
Details on Role |
Scope of Work Description: |
Scope of Work: Total Project Cost |
Scope of Work: Federal Funding Amount Requested |
Applicant's In-Kind Match Valuation |
Applicant's Cash match |
| Applicant |
Provider XYZ |
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For example, Providers should list route segments by city and state |
$5,000,000.00 |
$3,500,000.00 |
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$1,500,000.00 |
| Applicant |
State Economic Development Dept |
101 Main St |
Capital City |
State |
1010 |
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Grant administrator and fiscal agent for the NTIA MMG program, if awarded. Will manage funds to sub-recipients. |
$37,000.00 |
$37,000.00 |
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Stash, Hannah:
Not sure why this is formatted weird.
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| Agency Disclosure Notice: This information collection is authorized by [OMB control #0660-XXXX]. Public reporting burden for this collection of information is estimated to average one (1) hour or 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to U.S. Department of Commerce, (National Telecommunications and Information Administration, 1401 Constitution Ave. NW, Washington, DC 20230). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. |