Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
2010 4:00PM
p,
EFSP
Agency's Legal Name Agency Principal Agency Contact for Application Questions Agency Contact for EFSP, iffunded Agency physical address Agency tnaiHng address Agency address for services Agency phone Agency fax. ~ Agency email (for individuals above) .
Emergency
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Agency Federal Employer Identification Numbe~'(FErn) Amount of EFSP funding requested by program area (food. !ent~ utilities, etc.)
Agenoy operating budget (total) Agency budget for the program requested (food. rent, utilities, etc.) annual audit area
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$1.50D. ()O
$ $
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government?
If non-profit
Deadlino (date and time) for applications to be received (including contact, mailing address, location for d~livery)
64
Feb.
4.
2010
10: 14AM
No. 1245
P.
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Has the capability to provide em~rgency food mdj or shelter services, Will we funds to suppleme1'\t and extend existing re6()urc~S and not to Substitute or reimburse ongoing programs and service~, Is nonprofit or an agency of govemment Has an accounting system, and will pay aU vendorfl by LRO check, LRO vendor issued credit card or LRO debit card, Will conduct an independent annual review /audit if receiving $25.000 or more in EFSP funds. Unden:tandG that ~;\$h payments (Including peU" caSh)are not eligible under EFSP.
Has a Federal Employer Identification Number (FEIN),
Practices non-discrimination (LROs with a religiolls affiliation will not refuse service to an applicant based on religion- nor engage in religious proselytizing or religious counseling with Fedet'a! ftmds),
Will svend an funds and dose-out the prop-am by my jurisdiclion's selected end-oI-program date <lnd retum any unused funds to the National Board ($5.00 Or more; make checks payabJe to UX\\~ed Way of America/Emergency Food and Shelter National 'BoardFrogram)J
Wilt provide complete documentation of eXpenilesto the Local Board. if requested, no later than one month foIlowjtlg my jurisdictionS selected end-ai-program date, Will comply with the o.ffice of Management and Budget Circi.tlar A-133 if expending $500,000 or m.ore Federal funds .
ill
Will comply with lobbying prohibition certification and disclosurE:of lobbyh\g <lcnviHesif receiving $100,000 or more ill '2FSP lunds, if applicable, and
Has no known EFSP compliance exceptions in this Orany other jurisdiction.
Respo:MibiUties and
Signature;,
PlintName:
Date:
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LROID#:
FEIN#:
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Address:
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City/State/Zip:
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Feb.
4.
2010
10: 14AM
No, 1245
p,
LRO Name
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Name/Signature
Date
NOTE: Standard Form LLL and instructions are available from the National Board
office.