State Digital Equity Capacity Grant Program Application

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Overview

Instructions
Application Form

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Sheet 1: Instructions

State Digital Equity Capacity Grant Program Application Form
This form will serve as a tool to capture the State Digital Equity Capacity Grant Program application. Applications from States must be received no later 11:59 p.m. ET on [DATE], 60 days after the issuance the SDECGP NOFO. Applications from U.S. Territories must be received no later 11:59 p.m. ET on July 31, 2024. Per Section II.C.2. of the NOFO, any State or Territory applying for the program must submit an application that contains the information included in this Application Form. States and Territories must submit all project details to NTIA via the NTIA Grants Portal within nine months of the award date. The information collected will be subject to review and approval before the State or Territory may draw down funds to implement the project(s). If you have any further questions, or require technical assistance, please reach out to your assigned Federal Program Officer.
Click on the link below to view the application form.
Application Form

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Sheet 2: Application Form

OMB Control No. XXX-XXXX Expiration Date: TBD

STATE DIGITAL EQUITY CAPACITY GRANT PROGRAM APPLICATION

Fields marked with * are required.

GENERAL APPLICANT INFORMATION

SAM.gov Account *

Upload an export of your profile on SAM.gov, ensuring the active dates of the account are visible.

[File Upload]

Enter the expiration date of your SAM.gov account

Are your representations and certifications to receive Federal Financial Assistance funds in compliance and up to date?

Yes

No

If No, describe the status of obtaining the necessary representations and certifications.

[Field to describe status]

[File Upload field to submit evidence that necessary steps have been taken to obtain up to date and compliant representations and certifications]

Administering Entity (AE) / Administering Organization (AO) *

For the purposes of this application, States will designate an Administering Entity and U.S. Territories will designate an Administering Organization. See definitions set forth in Section I.C of the NOFO. What is the name of the Administering Entity/Organization (AE/AO)?

Is the adminstering entity / organization for this State Digital Equity Capacity Grant the same entity that served as the administering entity / organization for the State Digital Equity Planning Grant?

Yes

No

Describe the entity selected to serve as the administering entity / organization for the State or Territory.

Provide a letter from the governor (or equivalent official) of the State or U.S. Territory that designates the entity to administer the State Digital Equity Capacity Grant Program (i.e., the administering entity/organization).

[File Upload]

Indicate which of the following options describes the relationship between the Applicant (as noted in the SF 424) and the Administering Entity / Administering Organization. *An EIN is the Employer Identification Number issued by the IRS. For more information about EIN numbers, please visit Employer ID Numbers | Internal Revenue Service (irs.gov) [hyperlink: https://www.irs.gov/businesses/small-businesses-self-employed/employer-id-numbers]. **A UEI number is the Unique Entity ID issued through SAM.gov. For more information about UEI numbers, please visit SAM.gov | Duns - Sam UEI [hyperlink: https://sam.gov/content/duns-uei]. ***Please note that where the Administering Entity / Administering Organization does not share the same EIN and UEI with the Applicant, both entities will serve as co-recipients of the State Digital Equity Capacity Grant award made to the Applicant in accord with 47 U.S.C. § 1723(b).

1. The Applicant and Administering Entity / Administering Organization share the same EIN* and UEI** number.

2. The Administering Entity / Administering Organization is a separate entity from the Applicant with a distinct UEI or EIN. Please include both the UEI and EIN for the Administering Entity / Administering Organization.***

[Field to enter UEI for Administering Entity if #2 is selected]

[Field to enter EIN for Administering Entity if #2 is selected]

3. The Administering Entity / Administering Organization does not have its own EIN and UEI and either has not applied to obtain an EIN and UEI or has applied to obtain an EIN and UEI but has not yet received it.

DIGITAL EQUITY PLAN

Digital Equity Plan *

Upload the Digital Equity Plan for the State meeting the requirements of 47 U.S.C. §1723(c) or the Digital Equity Plan for the Territory meeting the requirements of the Digital Planning Grant award of the Territory. The uploaded document must be the formal Digital Equity Plan that was reviewed, cured, and accepted by NTIA as part of the State the Digital Equity Planning Grant Program.

[File Upload]

Amendments to Digital Equity Plan *

Has the Digital Equity Plan of the State or Territory been amended since it was previously submitted to and accepted by NTIA?

Yes

If Yes, respond the subsequent prompts in this section

No

If the Digital Equity Plan of the State or Territory has been amended since it was previously submitted to and accepted by NTIA, upload the amended Digital Equity Plan.

[File Upload]

If the Digital Equity Plan of the State or Territory has been amended since it was previously submitted to and accepted by NTIA, upload a redline version of the Plan that demonstrates the precise changes made (e.g., language removed, language added, sections re-located).”

[File Upload]

PROJECT NARRATIVE

Generally

Executive Summary *

Provide an executive summary of the project(s) and associated activities, the main purpose, and the intended outcomes, using approximately 500 words. Applicants are advised not to incorporate information that concerns business trade secrets or other confidential commercial or financial information as part of the Executive Summary. See 15 C.F.R. §4.9(b) concerning the designation of business information by the applicant.

Digital Equity Plan Elements to be Implemented *

Identify the elements of the Digital Equity Plan to be implemented for this fiscal year's allocation of Capacity funding and whether specific elements of the Plan or specific Covered Populations are being prioritized and the rationale for prioritizing those elements or Covered populations consistent with the needs assessment within the Digital Equity Plan.

Project Plan *

Provide an overall Project Plan that includes: 1) A description of all major project activities and timelines, including key milestones and when each major project activity will start and end. 2) A description of how progress on measurable objectives will be tracked and recorded alongside key milstones.

Updates to DE Plan *

Does the State or Territory intend to use a portion of its allocation (up to 20%) to update its Digital Equity Plan?

Yes

If Yes, respond the subsequent prompts in this section

No

Indicate the activities the State or Territory intends to conduct to update the Plan, and a timeline for updates, including publication for public comment. For any aspects of the Digital Equity Plan that are forthcoming, such as quantitative baseline data, specify how and when those updates will be made.

Ongoing Collaboration Efforts *

Describe the ongoing collaboration efforts the State or Territory will conduct with key stakeholders in the State or Territory as listed at 47 U.S.C. 1723 (c)(1)(D) and in alignment with the State Digital Equity Plan.

Description of Benefit to Covered Populations *

A detailed description of how the State or Territory’s implementation of the Digital Equity Plan, through Digital Equity Capacity Grant Program funding, will benefit each of the Covered Populations located within that State or Territory.

Measuring Success Across Digital Equity Outcomes *

Describe how the State or Territory plans to collect data in alignment with the measurable objectives in the Digital Equity Plan to effectively measure the project’s success across the digital equity outcomes identified at 47 U.S.C. 1723(c)(1)(C): a. economic and workforce development b. education c. health d. civic and social engagement e. delivery of other essential services f. any other digital equity outcomes specified in the Digital Equity Plan

Measuring Benefits to Covered Populations *

Explain how the benefits delivered to the Covered Populations will be measured to the extent not addressed above and describe any other proposed research activities, as applicable.

Evaluation Plan *

Describe the overall plan to evaluate how the proposed projects and activities will achieve the goals of the Digital Equity Plan.

Preventing Waste, Fraud, and Abuse *

Describe the safeguards the applicant will put in place to prevent waste, fraud, and abuse in the implementation of the program.

Subgrantee Selection Process *

Do you plan to use subgrantees to implement grant projects and activities?

Yes

If Yes, respond the subsequent prompts in this section

No

To the extent the applicant intends to use subgrantees to implement grant projects and activities, describe the process by which subgrantees will be selected and the safeguards in place to ensure the selection process fosters a sense of fairness and accountability by being open, transparent, and equitable; and is in compliance with 2 C.F.R. part 200.

Specific Projects

Description of Projects and Activities *

Describe the specific projects and activities proposed to be funded by the State Digital Equity Capacity Grant Program. Complete the form provided, filling out all fields as applicable, and upload it.

[File Upload]

Environmental and Historical Preservation

If any projects propose to install fixed equipment on or in a building, provide the following information:

-

For buildings 50 years or older, upload photographs of proposed installation locations.

[File Upload]

If applicable, upload correspondance with the relevant State Historic Preservation Office or Tribal Historic Preservation Office regarding the potential impacts of the project on historic properties.

[File Upload]

Intention to Submit Additional Projects and/or Project Details *

Do you plan to submit additional projects and/or project details via an updated Specific Projects Form within 9 months from the award start date?

Yes

No

OTHER FUNDING SOURCES

Description of Other Funding *

Describe all other funding sources (including funding applied for) the State or Territory intends to use to implement its Digital Equity Plan, the amount allocated, and the specific DE Plan elements they will fund. Applicants should include in this funding description other Federal programs, State or local government programs, and any private for-profit or not-for-profit funding. This description should also include an explanation as to how this alternative funding is being used in a way that does not supplant, conflict with, or duplicate the activities for which the Capacity Grant funds will be used. If no other funds are anticipated to implement the Digital Equity Plan, indicate as such with "N/A."

[File Upload] Containing the following: Funding type Federal, State, Local, Private For-Profit, Private Not-for-Profit); Description of funding, including the source; Amount allocated; Specific DE Plan elements to be funded; Explanation as to how this funding is being used in a way that does not supplant, conflict with, or duplicate the activities for which the Capacity Grant funds will be used.

BUDGET

Consolidated Budget Form *

Upload the Consolidated Budget Form. All budget amounts must exactly match or reflect across all budget documentation. For example, do not provide estimates or approximate amounts in the Consolidated Budget Form that do not exactly match amounts in the SF-424 and all relevant sections in the application.

[File Upload]

Negotiated Indirect Cost Rate Agreement (NICRA) *

Are indirect costs included in the proposed budget?

Yes

If Yes, respond the subsequent prompts in this section

No

If indirect costs are included in the proposed budget, the applicant must upload a copy of the approved negotiated agreement if this rate was negotiated with a cognizant federal audit agency. If the rate was not established by a cognizant agency, provide a statement to this effect. If the successful applicant includes indirect costs in the budget and has not established an indirect cost rate with a cognizant federal audit agency, the applicant will be required to obtain such a rate in accordance with Section B.06 of the Department of Commerce Financial Assistance Standard Terms and Conditions Dated November 12, 2020. Alternatively, consistent with 2 C.F.R. § 200.414(f), applicants that do not have a current negotiated indirect cost rate may elect to charge indirect costs to an award pursuant to a de minimis rate, in which case a negotiated indirect cost rate agreement is not required. Applicants proposing a de minimis rate pursuant to 2 C.F.R. § 200.414(f) should note this election as part of the budget portion of the application.

[File Upload]

STANDARD FORMS

SF-424: Application for Federal Assistance *

Applicants are required to fill out, directly in the NTIA Grants Portal, an SF-424 Application for Federal Assistance. Applicants are encouraged to fill out the SF-424 template available on the NTIA Grants Portal and on the DE Capacity Program webpage on www.InternetForAll.gov prior to filling out the form in the NTIA Grants Portal.

[Embedded in NGP]

CD-511: Certification Regarding Lobbying *

Applicants must upload a completed Form CD-511 Certification Regarding Lobbying that certifies that Federal funds have not been used and will not be used for lobbying in connection with this request for Federal financial assistance.

[File Upload]

SF-LLL: Disclosure of Lobbying Activities

The Standard Form-LLL- Disclosure of Lobbying Activities must be completed and submitted for those applicants that need to disclose lobbying activities that have been secured to influence the outcome of a Federal action.

[File Upload]

CERTIFICATIONS AND ASSURANCES

Digital Equity Plan Implementation Certification *

Certification that the State or Territory, acting through the administering entity / organization for the State or Territory, shall not later than five (5) years after the date on which the Assistant Secretary awards the Capacity Grant to the State or Territory implement the Digital Equity Plan of the State or Territory and make subgrants in a manner that is consistent with the aims of such Digital Equity Plan.

[Radio Button to Accept]

Supplemental Funds Certification *

Certification that Capacity Grant funds will be used to supplement, not supplant, other Federal or State funds that have been made available to carry out the activities in Digital Equity Plan and the NOFO.

[Radio Button to Accept]

Build America Buy America (BABA) Act Certification *

Certification that the State or Territory, if using Capacity Grant funds for an “infrastructure project” (as defined in 2 C.F.R. 184.3), will abide by the requirements of the Build America Buy America Act (Pub. L. No. 117-58, §§ 70901-52) and by the regulations promulgated thereunder at 2 C.F.R. part 184).

[Radio Button to Accept]

Assurances *

Do you attest to the following assurances? Note that "AE/AO" refers to "Administering Entity / Administering Organization," with "Administering Entity" being applicable for States and "Administering Organization" being applicable for U.S. Territories. I hereby provide the following assurances required under 47 U.S.C. §1723(e):

1. if an entity described in 47 U.S.C. §1724(b) is awarded grant funds under this section (referred to in this subsection as a “covered recipient”), provide that- A. the covered recipient shall use the grant funds in accordance with any applicable statute, regulation, and application procedure; B. the AE/AO for that State or U.S. Territory shall adopt and use proper methods of administering any grant that the covered recipient is awarded, including by i. enforcing any obligation imposed under law on any agency, institution, organization, or other entity that is responsible for carrying out the program to which the grant relates; ii. correcting any deficiency in the operation of a program to which the grant relates, as identified through an audit or another monitoring or evaluation procedure; and iii. adopting written procedures for the receipt and resolution of complaints alleging a violation of law with respect to a program to which the grant relates; and C. the AE/AO for that State or U.S. Territory shall cooperate in carrying out any evaluation— i. of any program that relates to a grant awarded to the covered recipient; and ii. that is carried out by or for the Assistant Secretary or another Federal official;

[Radio Button to Accept]

2. the AE/AO for that State or U.S. Territory shall— A. use fiscal control and fund accounting procedures that ensure the proper disbursement of, and accounting for, any Federal funds that the State is awarded under this section; B. submit to the Assistant Secretary any reports that may be necessary to enable the Assistant Secretary to perform the duties of the Assistant Secretary under this section; C. maintain any records and provide any information to the Assistant Secretary, including those records, that the Assistant Secretary determines is necessary to enable the Assistant Secretary to perform the duties of the Assistant Secretary under this section; and D. with respect to any significant proposed change or amendment to the State Digital Equity Plan for the State, make the change or amendment available for public comment in accordance with subsection (c)(2); and

[Radio Button to Accept]

3. the State, before submitting to the Assistant Secretary the State Digital Equity Plan of the State, has complied with the requirements of subsection (c)(2).

[Radio Button to Accept]

ATTEST AND SUBMIT

Attest and Submit *

By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S Code, Title 218, Section 1001) ** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions

[Checkbox]