Broadband Technology Opportunities Program
Federal Grant Application – Sustainable Broadband Adoption (Track 3)
Table of Contents
A. General Application Information 2
E. Project Benefits – Sustainable Broadband Adoption 7
G. Project Budget & Sustainability 11
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1-A. Name, Address, and Federal ID for Applicant |
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i. Legal Name: |
ii. Employer/Taxpayer Identification Number (EIN/TIN): |
Street 1: Street 2: City: County: State: Province: Country: Zip/Postal Code:
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1-B. Name and Contact Information of Person to be Contacted on Matters Involving this Application |
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Prefix: *First Name: Middle Name: *Last Name: Suffix: Title: |
Telephone Number: ___________ Fax Number: ___________ Email: ___________ Other (Specify): ___________
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1-C. Other Required Identification Numbers |
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i. Organizational DUNS: |
ii. CCR : |
iii. Funding Opportunity Number: |
iv. Catalog of Federal Domestic Assistance Number:
CFDA Title:
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1-D. Organization Classification |
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Please classify your organization. (Note: If there are multiple sponsoring organizations, designate the lead applicant that would enter into a Grant agreement with the Agency and assume operational and financial responsibility should an award be made).
Local, State, or Other Government Entity
Not for Profit Entity
For Profit Corporation
Other
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1-E. Applicant Federal Debt Delinquency Explanation |
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Is the Applicant Delinquent On Any Federal Debt? Yes No (If “Yes”, provide explanation.) ____________________________________________________________
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1-F. Congressional Districts of: |
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Provide three or four sentences that concisely describe the proposed project. Your answer will be published on recovery.gov and broadbandusa.gov to illustrate the types of proposals received. [Limit 500 characters]
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Classify the particular project type for which you are seeking federal funding. |
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Project ID: (auto generated) |
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Project ID: (auto generated) |
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Project ID: (auto generated) |
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Please identify any other applications that you have submitted to BIP or BTOP
Project Type: _________________ ID Number: ________________ |
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*a. Federal *b. Applicant *c. State *d. Local *e. Other *f. Program Income *g. TOTAL |
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Eligibility Factors. As a prerequisite to a full review against the evaluation criteria, each application must satisfy a number of Eligibility Factors. These verify an applicant’s basic compliance with mandatory program requirements. Failure to comply with all Eligibility Factors WILL RESULT IN IMMEDIATE REJECTION OF YOUR APPLICATION. Please see the Grant Guidance for a detailed explanation of how each Eligibility Factor will be verified.
This application satisfies all of the Eligibility Factors listed below:
Yes
No
The application must be completed fully, and all required supplemental documentation must be attached.
Applicants must commit to substantially completing their Project (as defined in the NOFA) within two years of the award date, and completing the Project within three years of the award date.
Applicants must credibly demonstrate that their Project advances at least one of the five statutory purposes for BTOP.
Applicant is providing matching funds of at least 20 percent towards to the total eligible project costs or is requesting a waiver of the matching requirement
Yes, Providing at Least 20% Match
No, Requesting Waiver
Applicants must demonstrate that but for Federal funding they would not have been able to complete their project during the grant period.
Applicants must demonstrate that the proposed project is technically feasible.
The budget for the project must be reasonable and all costs must be eligible.
Direction for Written Responses: Pages limits are designated for all requested written responses. Per instructions in the NOFA, please use 12 point font with one-inch margins.
Executive Summary of Overall Proposal: Please provide an Executive Summary of the proposed Project. The Executive Summary should be a brief description of the Project, and address the following topics. [Two Page Limit]
A statement of the problem or need your project addresses with regard to improving broadband service adoption rates
Your overall approach to addressing the need, and [for Sustainable Adoption projects] how your approach is innovative
Area(s) to be served; population of the target area(s), including demographic information; and [for Public Computer Centers] the estimated number of potential users of your public computer center(s) or [for Sustainable Adoption projects] the estimated number of potential broadband subscribers your project will reach
Qualifications
of the applicant that demonstrate the ability to implement the
project and achieve its intended results
Jobs to be saved or created
Overall cost of the proposed project
Project Purpose: Recovery Act & BTOP Objectives |
Project
Purpose:
Referring to Application Guidance for this section, in a
comprehensive overview of your Project, please clearly and concisely
describe the following. Please provide specific data and relevant
analysis to support your claims. [Two Page Limit]
The significance of the problem to be addressed
The degree to which the proposed solution effectively addresses the problem and could be replicated by other organizations
The degree to which both the problem and proposed solution advance one or more of the five BTOP statutory purposes
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If your Project incorporates more than one BTOP program category (Broadband Infrastructure, Public Computer Centers, and Sustainable Broadband Adoption) or statutory purpose (listed above), please describe how this Project will reinforce your other program objectives.
Recovery Act and Other Governmental Collaboration. Describe how your project will leverage Recovery Act or other federal or state developmental programs. Please identify the programs themselves and the dollar value associated with each. In addition, describe how the collaboration can lead to greater project efficiencies. [One Page Limit]
Enhanced Services for Health Care Delivery, Education and Children. If applicable, describe how your project will enhance broadband service for health care delivery, education, and children as contemplated by the Recovery Act. Projects would need to demonstrate that they go beyond providing access to broadband to include more robust educational, health care, or related broadband service delivery. [One Page Limit]
Small and Disadvantaged Business Involvement. If applicable, indicate whether you have established agreements in principle to create relationships with any socially and economically disadvantaged small business concern, as defined by Section 8(a) of the Small Business Act, 15 USC 637, that may include a sub-awardee, contractor, subcontractor, or vendor. [1/2 Page Limit, plus attachments]
Sustainable Broadband Adoption Project: Overall Program Benefits |
Answer the questions in the following Section E to the extent applicable.
Innovative Approach. Please describe how your approach to the problem of increasing broadband adoption rates is innovative, and explain why it improves upon conventional approaches to encouraging adoption. Programs may provide broadband education, awareness, training, access, equipment and/or support. [One Page Limit]
Household Subscribers. How many total new home subscribers (household accounts) to broadband do you expect to generate through use of BTOP funds over the entire life of the program funded?____________
Institutional Subscribers. How many total new business and/or institutional subscribers to broadband do you expect to generate through use of BTOP funds over the entire life of the program funded?____________
Users of Public Access Facilities. How many total users of broadband in public computer centers or users of broadband outside the home (e.g., in a community colleges) do you expect to generate through use of BTOP funds over the entire life of the program funded? _________________
Population
Demographics.
Indicate the demographic category or categories your program will
serve by completing the questions below.
Age distribution [Checkboxes with Census-level age categories]
Ethnicity or ethnicities [Checkboxes with Census-level ethnicity categories]
Gender [Checkbox Male / Female]
Median Household Income [Checkboxes with Census data]
Educational levels [Box select: None, elementary, middle, secondary, college, masters, doctorate/post-doctorate]
Disabilities status [physically disability, other disabilities]
Unemployment rate
Speakers of English as a second language, or non-English-speaking status
People Trained/Educated. If you intend to provide training or education, how many people in total will your program(s) reach? _______
Scope of Training/Education Programs. How many hours of training do you expect to provide per person on average for each participant in your training program(s), through completion of training for that individual? If you will offer multiple programs, provide estimates for each program. _________
Instructors. How many (FTE) instructors/facilitators will you employ for broadband and digital literacy training purposes, and what are their qualifications (training and experience)? ___________________ [ One Page Limit]
Equipment Purchased. How many broadband-related equipment units (e.g. computers, wireless devices) do you intend to purchase overall?_______________
Cost of Devices. What is the total up-front cost of this equipment?_________
Loan Program Participants. If you are providing an equipment purchase or loan program, for how many households, businesses and/or institutions do you expect to provide equipment or computers?
Households_______________ Businesses_____________ Institutions____________
Loan Cost to Borrower. If you are employing a loan program for purchases of service or equipment, what will be the total cost to the typical customer you assist over the life of the loan, including all interest and fees? ________________
Target Population, Awareness Campaign. If you are conducting an awareness campaign, how many people do you expect your campaign will reach ? ______________
Awareness Campaign Methods. Briefly describe the targeting, media, and messaging strategies your awareness campaign will employ. [Two Page Limit]
Measuring Campaign Impact. Describe how you will measure the impact of the awareness campaign. [One Page Limit]
Total Cost Per New Subscriber. What is the total cost of your project per new subscriber (household, individual, or institutional) or new end-user?
Technical Viability |
Technology Strategy. For Sustainable Adoption projects: Explain the mechanics and operational details of you r project and how your approach is an effective and appropriate means of creating sustainable adoption in your target population. Explain how your innovative solution(s) would be feasible in other situations. [Two Page Limit] For Public Computer Center projects: Please describe the overall technology plan you intend to deploy in your program. If appropriate, please include engineering certifications for broadband network WAN / LAN build-outs, what primary types of network equipment and technology you plan to use, and how you will ensure a reliable, secure, and user-friendly system for the public users of your broadband access facilities. [Two Page Limit]
Organizational Capability |
Management Team Resumes. Provide resumes and/or biographical summaries for the members of your senior management team and project team, emphasizing skills and experience relevant to the proposed program. Please refer to specific projects and outcomes that demonstrate the team’s ability to execute this project based on past experience, and to manage federal funds effectively. [Each resume can be up to one page; limit biographical summaries to 1/2 page.]
Organizational Readiness. Please describe key factors that demonstrate your organization will be prepared to implement, operate, and sustain your project using federal funds. Include past experience in managing projects of comparable size and complexity. [One Page Limit]
Organizational Chart. Please attach a chart describing how the project team relates to the overall structure of your organization.
Community Involvement |
Key Partners. Provide a list of key partners (from the public, private and non-profit sectors), including community anchor institutions and public safety entities, community organizations, vendors or contributors of in-kind or cash support, and/or other resources which are integral to the success of this project. For each, include the name and title of a contact person, the organization’s name, and its role in or contribution to the project. Support from partners may include funding, educational or training services, technical advice or support, outreach, facilities, or other products or services.
Partnering with Disadvantaged Businesses: If applicable, indicate whether you have established agreements in principle to partner with socially and economically disadvantaged small businesses (SDB), as defined by Section 8(a) of the Small Business Act, 15 USC § 637. Please list the company, a contact person, and briefly describe the partnership purpose. [Limit ½ Page]
Ability to Start Promptly & Timeline |
Project Timeline and Challenges. Please provide a detailed implementation plan on a quarterly basis that shows the phases of the project and establishes key milestones. Include such activities as construction, staffing and hiring, resource development, staff training, equipment purchases, and installation. Also, include a description of key challenges or risks to the timely completion of the project, including any mitigation plans to address the risks. [Two Page Limit]
Licenses and Regulatory Approvals. If applicable, please list any local, state, or federal licenses and regulatory approvals required to complete your project, and indicate the status of each.
Legal Opinion. Please attach a legal opinion that addresses the Applicant’s ability to enter into the award agreement and briefly describe any relevant pending litigation matters.
Project Profile: Budget and Budget Narrative |
Budget Narrative. Please provide a narrative that explains the project budget (as proposed on SF-424 A and/or SF-424 C) and spending plan (timeline) in sufficient detail for reviewers to determine whether the expenditures are necessary and appropriate to the solution you are proposing. [Two Page Limit]
Budget Reasonableness. Concisely and convincingly explain why the costs you propose are reasonable to carry out your project, are eligible, and the allocation of funds will be sufficient to complete the tasks outlined in the project plan. Provide any relevant data and summaries of your analysis. [One Page Limit]
Demonstration of Financial Need. Provide documentation that the project would not have been implemented during the grant period without federal grant assistance. This documentation may consist of, but is not limited to, such items as a denial of funding from a public or private lending institution, denial of a funding request from a foundation or other organization, or a current fiscal year budget that shows the lack of available revenue options for funding the project.
Historical Financial Statements. Provide detailed organization financial statements for the last two years: a) Income Statement; b) Balance Sheet; and c) Statement of Cash Flows. If your organization was established less than two years ago, provide all available information.
Project Profile: Long Term Sustainability |
Sustainability. For Sustainable Adoption programs: Please indicate whether and how the project will be sustained beyond the funding period. Also discuss how the projected increases in broadband adoption rates will be sustained beyond the grant period. For Public Computer Center programs: Explain how your project will enable your centers to sustain themselves, providing ongoing services and maintaining community support beyond the scope of this grant. [One Page Limit]
Project Profile: Outside Leverage |
Matching Funds. If you have not requested a waiver of this requirement, please describe the matching funds (both cash and in-kind) you plan to devote to this project and document their source(s), include the percentage of your matching funds and whether the match is all cash. Attach letters of commitment from proposed sources, if applicable. If you have requested a waiver of the matching requirement, provide a letter attachment clearly defining your need. An applicant applying for a waiver should submit complete financial documentation, including its assets, liabilities, operating expenses and revenues, and any other documents that would demonstrate financial need, such as a denial of funding from a public or private lending institution.
Unjust Enrichment. Please state whether this project is receiving, or if you have applied for, any Federal support for non-recurring costs in the area for which you are seeking an award. If so, please state how much and from which federal program.
Disclosure of Federal and/or State Funding Sources. Please disclose the source and amount of other federal or state funding received or requested for activities or projects to which this project relates. Please specify all Universal Service Fund (USF) funding delineated by specific program.
Buy American. Are you seeking a waiver of the Buy American provision?
YES (please provide your legal justification for the waiver)
NO
SECTION 1- To be completed for those projects historically shown not to create significant environmental impacts to the human or natural environment. Any answer of “No” or “Unknown” may require additional documentation or review.
a. Is the proposed action solely a procurement action for materials intended to be installed, stored or operated in an existing building or structure?
Yes
No
Not Applicable
b. If the proposed action involves procurement of electronic equipment, will the equipment be disposed of in an environmentally sound manner at the end of its useful life?
Yes
No
Not Applicable
c. Does the proposed action involve only minor interior renovations to a structure, facility, or installation?
Yes
No
Not Applicable
d. Is the proposed action solely for the production and/or distribution of informational materials, brochures, or newsletters?
Yes
No
Not Applicable
e. Does the proposed action consist solely of training, teaching, or meeting facilitation at an existing facility or structure?
Yes
No
Not Applicable
Certifications and Signature
(i) I certify that I am authorized to submit this grant application on behalf of the eligible entity(ies) listed on this application, that I have examined this application, that all of the information and responses in this application, including certifications, and forms submitted, all of which are part of this grant application, are material representations of fact and true and correct to the best of my knowledge, that the entity(ies) that is requesting grant funding pursuant to this application and any subgrantees and subcontractors will comply with the terms, conditions, purposes, and federal requirements of the grant program; that no kickbacks were paid to anyone; and that a false, fictitious, or fraudulent statements or claims on this application are grounds for denial or termination of a grant award, and/or possible punishment by a fine or imprisonment as provided in 18 U.S.C. § 1001 and civil violations of the False Claims Act.
(ii) I certify that the entity(ies) I represent have and will comply with all applicable federal, state, and local laws, rules, regulations, ordinances, codes, orders and programmatic rules and requirements relating to the project. I acknowledge that failure to do so may result in rejection or deobligation of the grant or loan award. I acknowledge that failure to comply with all federal and program rules could result in civil or criminal prosecution by the appropriate law enforcement authorities.
(iii) I certify that the entity(ies) I represent has and will comply with all applicable administrative and federal statutory, regulatory, and policy requirements set forth in the Department of Commerce Pre-Award Notification Requirements for Grants and Cooperative Agreements (“DOC Pre-Award Notification”), published in the Federal Register on February 11, 2008 (73 FR 7696), as amended; DOC Financial Assistance Standard Terms and Conditions (Mar. 8, 2009), the Department of Commerce American Recovery and Reinvestment Act Award Terms (Apr. 9, 2009); and any Special Award Terms and Conditions that are included by the Grants Officer in the award.
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(iv) If requesting BTOP funding, I certify that the entity(ies) I represent has secured access to pay the 20% of total project cost or has petitioned the Assistant Secretary of NTIA for a waiver of the matching requirement or received a waiver.
Signature of authorized person _____________________________Date_______________________
Print name of authorized person _______________________________________________________
Title or position _____________________________________________________________________
Other Federal Forms and Certification Requirements
SF-424A, Budget Information—Non-Construction Programs
SF-424B, Assurances—Non-Construction Programs
SF-424C, Budget Information—Construction Programs
SF-424D Assurances—Construction Programs
CD-346, Applicant for Funding Assistance
CD-511, Certification Regarding Lobbying
CD-512, Certification Regarding Lobbying—Lower-Tier Covered Transactions
SF-LLL, Disclosure of Lobbying Activities
Legal Opinion
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| File Type | application/msword |
| File Title | Table of Contents |
| Author | taxali |
| File Modified | 2009-07-02 |
| File Created | 2009-07-02 |