Instructions for Completion of Federal Assistance Application for SSA Research and Demonstration Grant Programs

See revised Paperwork Reduction Act and Privacy Act statements below.

Grant Application Package
Opportunity Title:

SSA Revised Budget

Offering Agency:

Social Security Administration

This electronic grants application is intended to
be used to apply for the specific Federal funding
opportunity referenced here.

CFDA Number:
CFDA Description:
Opportunity Number:

If the Federal funding opportunity listed is not
the opportunity for which you want to apply,
close this application package by clicking on the
"Cancel" button at the top of this screen. You
will then need to locate the correct Federal
funding opportunity, download its application
and then apply.

SSA-OAG-0

Competition ID:
Opportunity Open Date:

02/08/2008

Opportunity Close Date:
Agency Contact:

12/31/2030
Gary Stammer
Grants Management Officer
E-mail: gary.stammer@ssa.gov
Phone: 410-965-9501

This opportunity is only open to organizations, applicants who are submitting grant applications on behalf of a company, state, local or
tribal government, academia, or other type of organization.
* Application Filing Name:
Mandatory Documents
Application for Federal Assistance (SF-424)

Move Form to
Complete

Mandatory Documents for Submission

Move Form to
Delete

Optional Documents
Other Attachments Form

Move Form to
Submission List

Optional Documents for Submission
SSA SF424 Section G
Budget Information for Non-Construction Programs

Move Form to
Delete

Instructions

1

Enter a name for the application in the Application Filing Name field.

2

Open and complete all of the documents listed in the "Mandatory Documents" box. Complete the SF-424 form first.

- This application can be completed in its entirety offline; however, you will need to login to the Grants.gov website during the submission process.
- You can save your application at any time by clicking the "Save" button at the top of your screen.
- The "Save & Submit" button will not be functional until all required data fields in the application are completed and you clicked on the "Check Package for Errors" button and
confirmed all data required data fields are completed.

- It is recommended that the SF-424 form be the first form completed for the application package. Data entered on the SF-424 will populate data fields in other mandatory and
optional forms and the user cannot enter data in these fields.
- The forms listed in the "Mandatory Documents" box and "Optional Documents" may be predefined forms, such as SF-424, forms where a document needs to be attached,
such as the Project Narrative or a combination of both. "Mandatory Documents" are required for this application. "Optional Documents" can be used to provide additional
support for this application or may be required for specific types of grant activity. Reference the application package instructions for more information regarding "Optional
Documents".
- To open and complete a form, simply click on the form's name to select the item and then click on the => button. This will move the document to the appropriate "Documents
for Submission" box and the form will be automatically added to your application package. To view the form, scroll down the screen or select the form name and click on the
"Open Form" button to begin completing the required data fields. To remove a form/document from the "Documents for Submission" box, click the document name to select it,
and then click the <= button. This will return the form/document to the "Mandatory Documents" or "Optional Documents" box.
- All documents listed in the "Mandatory Documents" box must be moved to the "Mandatory Documents for Submission" box. When you open a required form, the fields which
must be completed are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a
field, you will receive an error message.

3

Click the "Save & Submit" button to submit your application to Grants.gov.
- Once you have properly completed all required documents and attached any required or optional documentation, save the completed application by clicking on the "Save"
button.
- Click on the "Check Package for Errors" button to ensure that you have completed all required data fields. Correct any errors or if none are found, save the application
package.
- The "Save & Submit" button will become active; click on the "Save & Submit" button to begin the application submission process.
- You will be taken to the applicant login page to enter your Grants.gov username and password. Follow all onscreen instructions for submission.

SECTION G - PERSONNEL

Name and
Position Title
Mr., Mrs. etc.

* First Name

Annual
Salary
Rate
(1)

Middle Name

* Last Name

No.
%
Mos. Time
Budg.
(2)
(3)

Total
Amount
Required
(4)

Jr., Sr. etc.

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

Total Salaries and Wages for this Page

Fringe Benefits

* Position Title(s)

$0.00
* Total for Rate

* Rate(s)

%
%
%
%
%
%
%
%
%
%

Grand Total Salaries and Wages

$0.00

Grand Total Fringe Benefits

$0.00

Grand Total

$0.00

Form SSA-96-BK (03-00)
Destroy Prior Editions

Total Fringe Benefits for this Page

$0.00

Total for this Page

$0.00

SECTION G - PERSONNEL

Name and
Position Title
Mr., Mrs. etc.

* First Name

Annual
Salary
Rate
(1)

Middle Name

* Last Name

Jr., Sr. etc.

No.
%
Mos. Time
Budg.
(2)
(3)

Total
Amount
Required
(4)
$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

$0.00

Position Title

Total Salaries and Wages for this Page

Fringe Benefits

* Position Title(s)

$0.00
* Total for Rate

* Rate(s)

%
%
%
%
%
%
%
%
%
%

Grand Total Salaries and Wages

$0.00

Grand Total Fringe Benefits

$0.00

Grand Total

$0.00

If more than 20 personnel, attach
further personnel information.
Form SSA-96-BK (03-00)
Destroy Prior Editions

Total Fringe Benefits for this Page

$0.00

Total for this Page

$0.00

Add Attachment

Delete Attachment

View Attachment

5.

4.

3.

2.

1.

(b)

(a)

Totals

Catalog of Federal
Domestic Assistance
Number

Grant Program
Function or
Activity

$

$

Federal
(c)

$

$

Non-Federal
(d)

Estimated Unobligated Funds

$

$

SECTION A - BUDGET SUMMARY

Federal
(e)

BUDGET INFORMATION - Non-Construction Programs

$

$

$

$

Total
(g)

Standard Form 424A (Rev. 7- 97)
Prescribed by OMB (Circular A -102) Page 1

Non-Federal
(f)

New or Revised Budget

OMB Approval No. 4040-0006
Expiration Date 07/30/2010

7. Program Income

k. TOTALS (sum of 6i and 6j)

j. Indirect Charges

i. Total Direct Charges (sum of 6a-6h)

h. Other

g. Construction

f. Contractual

e. Supplies

d. Equipment

c. Travel

b. Fringe Benefits

a. Personnel

6. Object Class Categories

$

$

$

$

$

GRANT PROGRAM, FUNCTION OR ACTIVITY
(3)

Authorized for Local Reproduction

$

$

$

$

(2)

(1)

SECTION B - BUDGET CATEGORIES

$

$

$

(4)

Standard Form 424A (Rev. 7- 97)
Prescribed by OMB (Circular A -102) Page 1A

$

$

$

$

$

Total
(5)

$

15. TOTAL (sum of lines 13 and 14)

23. Remarks:

21. Direct Charges:

20. TOTAL (sum of lines 16 - 19)

19.

18.

17.

16.

$

14. Non-Federal

$

$

Total for 1st Year

$

$

1st Quarter

$

$

(c) State

2nd Quarter

SECTION D - FORECASTED CASH NEEDS

$

$

(b) Applicant

$

$

$

$

3rd Quarter

(d) Other Sources

$

$

Authorized for Local Reproduction

22. Indirect Charges:

SECTION F - OTHER BUDGET INFORMATION

$

$

$

$

$

$

$

$

$

$

(e) Fourth

4th Quarter

(e)TOTALS

Standard Form 424A (Rev. 7- 97)
Prescribed by OMB (Circular A -102) Page 2

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
FUTURE FUNDING PERIODS (YEARS)
(d) Third
(b)First
(c) Second

$

13. Federal

12. TOTAL (sum of lines 8-11)

11.

10.

9.

8.

(a) Grant Program

SECTION C - NON-FEDERAL RESOURCES

The following revised PRA Statement will be inserted into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 14 hours
to read the instructions, gather the facts, and answer the questions. SEND OR BRING
THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE.
The office is listed under U. S. Government agencies in your telephone directory or
you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed form.

Privacy Act Statement
Collection and Use of Personal Information
Section 1110 of the Privacy Act, as amended, authorizes us to collect this information.
The information you provide will be used to make a determination on your application
for a grant. Without this information we will be unable to consider your request for a
grant.
Additional information regarding this form, and our programs and systems, is available
on-line at www.socialsecurity.gov or at your local Social Security office.