State Digital Equity Capacity Grant Program Specific Pro

Application for State Digital Equity Capacity Grant Program

2.5.24 DRAFT_DE Capacity Application_Specific Projects Form_State Terr.xlsx

OMB: 0660-0054

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Specific Projects
Dropdown Lists

Sheet 1: Instructions







State Digital Equity Capacity Grant Program
Specific Projects Application Form
This form will serve as a tool to capture specific project details for 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 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).

Applicants should enter into this form information pertaining to all projects the State or Territory intends to implement in this fiscal year's allocation. Projects for which an applicant indicates they will subgrant funds will require additional details on the State or Territory's subgrantees.

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 specific projects application form.

Specific Projects


Sheet 2: Specific Projects


Specific Projects































































Applicant Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Project Level Subgrantee Level Subgrantee Level Subgrantee Level Subgrantee Level

State / Territory Project Project ID Primary Digital Equity Outcome Secondary Digital Equity Outcome Executive Summary Project Activities Environmental and Historical Preservation (EHP) Build America Buy America (BABA) Act Barriers to be Addressed Measurable Objectives Covered Populations Served Geographies Alignment to DE Plan Anticipated Outputs Anticipated Start Date Anticipated End Date Project Duration Funding Amount Implemented Directly or via Subgrant? Subgrantee Legal Name Legal Identifiers of Subgrantee Subgrantee Capacity Designation of Subgrantee as WBE, MBE, Small Business

Individuals who live in covered households (i.e., with an income no more than 150 percent of the federal poverty threshold) Aging individuals Incarcerated individuals Veterans Individuals with disabilities Individuals with a language barrier Individuals who are members of a racial or ethnic minority group Individuals who primarily reside in a rural area

Write the postal abbreviation for your State or Territory (i.e., AL for Alabama)
Provide a unique ID for the project using the following stucture where [XX] is two digits, starting with 01:
[State or Territory Postal Code]-Capacity Grant Project-[XX]		 Select the primary digital equity outcome for the project Select the secondary digital equity outcome for the project In 2-3 sentences, provide a brief executive summary of the specific activity or set of activities the project intends to complete or implement, where the project will be carried out, and the expected beneficiaries of the project. List the specific activity or set of activities the project intends to complete or implement Does the project propose to install fixed equipment on or in a building? If Yes, provide the location of the building and year of original construction in the field directly below and also upload the documentation required in the NTIA Grants Portal for EHP. Is the project an “infrastructure project” (as defined in 2 C.F.R. 184.3), and thus is subject to and must abide by BABA? List the barrier(s) to digital equity the project will address List the measurable objectives to be pursued and the data to be collected to demonstrate success in meeting these objectives, including quantitative baseline data. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. Provide the estimated number of individuals to be served for each covered population. List the specific geographies to be served (if not State- or Territory-wide) Description of how the proposed project or activity will be evaluated to determine successful implementation of the Digital Equity Plan of the State or Territory, including specific references to the Digital Equity Plan and quantitative baseline data. Provide estimates of the anticipated outputs of the activity or project (For example, the number of hours of training to be provided, the number of curricula to be developed, or the number of devices to be provided). Insert the anticipated start date for this project Insert the anticipated end date for this project Do not enter or edit text below.
The project duration will auto-populate based on the anticipated start and end dates.		 Insert the amount of funding that will be used for this project Indicate whether the State or Territory will implement the project directly or will subgrant funds to implement the project. (Note that additional details must be provided in the following columns for projects implemented through subgrants). If the project will be implemented through a subgrant, insert the name of the entity that will implement the proposed project (if known at the time of application) If the project will be implemented through a subgrant, insert the UEI of the subgrantee If the project will be implemented through a subgrant, insert the EIN of the subgrantee If the project will be implemented through a subgrant, describe the subgrantee's capacity to manage the project for which it will receive a subgrant If the project will be implemented through a subgrant, select if the subgrantee is a women's business enterprise, minority business enterprise, or small business
Example AL Birmingham Laptop Distribution Program AL-Capacity Grant Project-01 Civic and Social Engagement Economic and Workforce Development Open-ended text Open-ended text No
No Open-ended text Open-ended text 10,000 5,000 0 100 100 100 4,000 0 Open-ended text Open-ended text Open-ended text 9/1/2024 7/30/2025 0 years, 10 months, 29 days $150,000.00 Subgrant University of Alabama at Birmingham 123456789101 123456789 Open-ended text MBE

AL Mental Health Online Resource Portal AL-Capacity Grant Project-02 Health
Open-ended text Open-ended text No Open-ended text No Open-ended text Open-ended text 10,000 5,000 500 100 100 100 4,000 1,000 Open-ended text Open-ended text Open-ended text 9/15/2024 7/15/2029 4 years, 10 months, 14 days $220,000.00 Directly by the State / Territory





AL Library Computer Class AL-Capacity Grant Project-03 Economic and Workforce Development
Open-ended text Open-ended text No Open-ended text No Open-ended text Open-ended text 10,000 5,000 0 100 100 100 4,000 1,000 Open-ended text Open-ended text Open-ended text 10/1/2024 6/30/2029 4 years, 8 months, 29 days $90,000.00 Subgrant Montgomery Library 111098765432 987654321 Open-ended text N/A




































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































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