Supplementary Information Form

OMB Control No 3137-0092, Expiration Date: XX/XX/XXXX

IMLS Supplementary Information Form

PLEASE NOTE: Information contained within this form may be made publicly available.

Section 1. Applicant Information

Refer to the entity listed in Item 5a of the Application for Federal Domestic Assistance – Short Organizational Form (SF-424S) that you are submitting with your application.

Does this entity have an organizational unit that will carry out the activities described in your application?

Helpful Definitions

An organizational unit is governed by a larger administrative body. Examples include university museums and libraries; university schools and departments; and museums and libraries that are units of local or state government. As a result of this arrangement, an organizational unit usually does not have its own Unique Entity Identifier (UEI) and does not have the legal authority to apply for IMLS funding on its own. It works with the larger administrative body, which is referred to as the legal applicant, to submit an application.

A legal applicant has its own Unique Entity Identifier (UEI) and has the legal authority to apply directly for IMLS funding. The name of the legal applicant is listed in Item 5a of the SF-424S. Examples include independently operating museums and libraries; nonprofit organizations that are responsible for the operation of museums or libraries; universities; and units of state or local government that administer museums or libraries. A single legal applicant may have many organizational units, or it may have none.

YES. Check here if the entity identified in Item 5a on the SF-424S submitted with your application has an organizational unit that will carry out the activities described in this application.

NO. Check here if the entity identified in Item 5a on the SF-424S submitted with your application does not have an organizational unit that will carry out the activities described in this application.

(development note: appears only if “No” is selected above)

Select the institution type that most accurately describes the legal applicant:

(development note: appears only if “Yes” is selected above)

Section 2. Financial Information

1. Complete the following table with figures representing the most recently completed fiscal year in the top row, followed by those for the previous year, and concluding with those for the year before that. Provide the information requested for the legal applicant if you have not identified an organizational unit for this application. If you have identified an organizational unit for this application, provide the information requested for that unit.

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.

2. 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.

3. 
   Were there any material weaknesses identified in your prior year’s audit report?

4. 
   Has your organization had a single or program-specific audit in the past three years?

Section 3. Agency-Level Goal and Objective

Refer to Section A1 of the Notice of Funding Opportunity for the program to which you are applying. Select the IMLS agency-level goal that best aligns with your proposed project. Once you have selected a goal, select one associated objective.

(development note: objectives display dynamically only once a goal is selected)

Section 4. Museum Profile

Refer to Section C1 of the Notice of Funding Opportunity for the program to which you are applying. If your organization is eligible to apply for an IMLS grant as a museum, then answer the questions in a through k below.

1. Is your organization a public, tribal, or private nonprofit agency or institution?

Yes

No

2. Is your organization organized on a permanent basis for essentially educational, cultural heritage, or aesthetic purposes?

Yes

No

3. Does your organization own or utilize tangible objects (either animate or inanimate) and care for these objects?

Yes

No

4. Does your organization exhibit these objects to the general public in a facility that you own or operate?

Yes

No

5. What was your institution’s attendance for the 12-month period prior to the application?

Fewer than 1,000

1,000 - 9,999

10,000 - 99,999

100,000 - 999,999

1,000,000 - 9,999,999

10,000,000 +

6. How many days was your institution open to the public during these 12 months?

0 - 119

120 - 249

250 - 365

7. Does your organization use a professional staff (i.e., does your organization employ at least one staff member, or the full-time equivalent, whether paid or unpaid, primarily engaged in the acquisition, care, or exhibition to the public of objects owned or used by the organization)?

Yes

No

8. Number of full-time paid institutional staff:

0

1

2

3

4 - 10

11 - 50

51+

9. Number of full-time unpaid institutional staff:

0

1

2

3

4 - 10

11 - 50

51+

10. Number of part-time paid institutional staff:

0

1

2

3

4 - 10

11 - 50

51+

11. Number of part-time unpaid institutional staff:

0

1

2

3

4 - 10

11 - 50

51+

Section 5. Funding Request

Refer to the Grant Fund and Cost Share totals in Section 10 of the IMLS Budget Form that you are submitting with your application. Enter the amount in dollars you are requesting from IMLS and the amount of non-federal funding you are providing as cost share/match below.

IMLS Funds Requested      

Cost Share/Match Amount*      

Total      

* Enter $0 if the budget includes no cost share/match.

Section 6. Indirect Costs

Refer to the Options for Calculating and Including Costs in a Project Budget in Appendix Three of the Notice of Funding Opportunity for the program to which you are applying. Then select one option below and provide the information requested. Your selection should match the choice you make on the IMLS Budget Form that you are submitting with your application.

	Current indirect cost rate(s) have been negotiated with a federal agency. Select from list:       Rate:       (Development note: user must either enter an expiration date or check the Until Amended checkbox; if one is populated/selected, the other is disabled/cleared) Expiration Date:       Until Amended:
	Indirect cost proposal has been submitted to a federal agency but has not yet been finalized. Select from list:       Rate:      Proposal Date:      
	Applicant chooses a rate not to exceed 10% of Modified Total Direct Costs and declares it is eligible for the 10% rate.
	Applicant chooses not to include indirect costs.

Section 7. Abstract

Refer to the instructions for writing an Abstract in Appendix Three of the Notice of Funding Opportunity for the program to which you are applying. Enter or paste your Abstract below (maximum 3000 characters, including spaces).

PLEASE NOTE: Information contained within this form may be made publicly available.

Section 8. Project Keywords

(Development note: allow no more than 8 selections)

Select from one to eight keywords that best characterize your project from the options below. IMLS may use these keywords as search terms in its compilations describing the agency's grantmaking and/or provide them as tools to help applicants, other awardees, and the public understand more about what IMLS supports.

Accessibility / Universal Design / Inclusive Design [789] Archives Practice / Management / Use [790] Artificial Intelligence / Machine Learning [791] Broadband Access [792] Civic Engagement [793] Civic Technology [794] Collections Care / Conservation / Preservation [795] Collections Management [796] Community Engagement [797] Community Memory / Community History [798] Community Science [799] Crowdsourcing [800] Data Privacy / Security [801] Data Science / Computational Analysis [802] Digital Asset Management [803] Digital Preservation / Curation [804] Diversity, Equity, Inclusion, and Accessibility [805] Early Learning [806] Emergency / Disaster / Crisis Preparedness and Response [807] Environmental Education [808] Family Learning [809] Fellowship / Internship / Mentorship Programs [810] Gaming [811] Institutional Capacity Building [812] Language Preservation / Cultural Revitalization [813] Literacy: Civic [814] Literacy: Digital [815] Literacy: Financial [816] Literacy: Health and Wellness [817] Literacy: Information [818] Museum /Archives / Library Staff Professional Development / Training [826] Museum and Library Partnerships [819] Museum Education Technology [820] Museum Exhibitions [821]

Museum Interpretation [822] Museum Multilingual Programs / Resources [823] Museum Program Evaluations [824] Museum Visitor Services [825] Open Educational Resources [827] Oral History [828] Pre-K-12 Out of School / Summer [829] Pre-K-12 School Programs [830] Public Programs [831] Scholarly Communications [832] School Libraries / Librarianship [833] Services and Programs for Adults [834] Services for Children and Families [835] Services for College Students [836] Services for Emerging Adults [837] Services for English-Language Learners [838] Services for Immigrants / Refugees [839] Services for Incarcerated Individuals / Returning Citizens [840] Services for Individuals who are Neurodivergent [841] Services for Individuals with Disabilities [842] Services for LGBTQIA+ Individuals [843] Services for Older Adults [844] Services for Rural Communities [845] Services for Teens [850] Services for Those below the Poverty Line or Unstably Housed [846] Services for Tribal Communities [847] Services for Urban Communities [848] Services for Veterans / Active-Duty Military [849] Shared Infrastructures / Open-Source Software [851] STEM / STEAM Programming [852] Summer Services [852] Teacher / Educator Professional Development [854] Web Archiving [855] Website Creation / Enhancement [856] Workforce Development [857]