Grant Plan

TAB 0: Landing Page/Program Information

Welcome to the U.S. Department of the Treasury’s (Treasury) submission portal for the Coronavirus Capital Projects Fund (CPF) Grant Plan. This portal is for use only by Recipients that are States, territories, and freely associated states. Recipients must submit Grant Plans by September 24, 2022, providing information on the Recipient’s intended uses of CPF funds. Treasury may publicly share information contained in the Grant Plan.

Recipients should refer to the “Guidance for the Coronavirus Capital Projects Fund for States, Territories and Freely Associated States” (Guidance) when completing a Grant Plan. Defined terms used in this portal that are not defined in it shall have the meanings ascribed to them in the Guidance.

The Grant Plan is organized in the following categories:

• Executive Summary

• Allocation Table

• Program Plan(s)

  • Program Questionnaire

  • Program Summary

  • Program Budget

  • Pre-Award Cost Annex (As Applicable)

Each Program Plan is intended to provide more detailed information on a particular type of Capital Project(s) the Recipient intends to undertake and constitutes an Eligible Applicant’s request for funding for those types of Capital Projects. For example, a State might file a Grant Plan that indicates that it intends to spend funding on broadband deployment throughout the State, and a Program Plan that provides detailed information on its deployment plan for only some of the counties in the State. Later, it could file another Program Plan detailing its deployment plans for other counties in the State.

After submitting a Grant Plan, which must include at least one Program Plan, Recipients may submit additional Program Plans on a rolling basis so that Recipients can seek funding for a particular type of Capital Project (or Projects) when the Recipient is ready. All Program Plans must be submitted by September 24, 2022. Treasury will assess and approve each Program Plan separately and will separately provide access to funds for each Program Plan when approved. For example, a Recipient with two Program Plans may submit, receive Treasury approval, and have access to funds for one Program Plan in December 2021, and then submit, receive Treasury approval, and have access to funds for the second Program Plan in March 2022.

TAB 1: User Instructions

After completing this form, please click on the DocuSign button to sign and submit the Grant Plan.

Recipients will have an opportunity to revise and resubmit portions of their Program Plans that Treasury determines do not meet the criteria set out in guidance or requires additional information to make a determination. Treasury staff will reach out to your designated point of contact with any questions or clarifications as they review the submitted plans.

For further clarification and examples for questions asked below, please review the FAQ document on the Capital Projects Fund website. Terms carry the meaning defined in the CPF guidance.

TAB 2: Executive Summary

Provide an Executive Summary not to exceed two pages. At a minimum, the Executive Summary should include a paragraph for each of the following:

• A brief description of the objectives(s) intended to be achieved with the CPF grant funds, and the Programs expected to be funded. This may be used by Treasury to publicly describe the grant.

• A narrative explaining the Recipient’s rationale for allocating funds as proposed with its Allocation Table, and how the specific Programs were identified in pursuit of the stated objectives.

• A description of the Recipient’s approach for identifying critical needs and the communities to be served by the capital assets, addressing the following questions:

  • What processes did you undertake and factors did you consider in identifying critical needs?

  • How has community engagement and public participation informed the Recipient’s approach for spending CPF grant funds and planning for implementation and operation of capital assets?

  • How was equity considered in the selection of programs and the distribution of funds?

Treasury will consider any additional relevant information that the Recipient wishes to submit.

[File Upload for Executive Summary]

[Submit]

TAB 3: Allocation Table

As described in CPF Guidance, Recipients may use grant funds for one or more types of eligible projects, listed in the table below. Recipients should group one or more related projects and activities into a Program (e.g., one Program may consist of a state broadband grant program, another Program may consist of a digital device loan program, and another Program may consist of the construction of several multi-purpose community facilities meeting certain criteria). Each Program must align with not more than one of the following eligible use types, though a Recipient may submit more than one Program per eligible use.

Program Uses Table

Use Code	Use Type
Presumptively Eligible Projects
1A	Broadband Infrastructure Projects
1B	Digital Connectivity Technology Projects
1C	Multi-Purpose Community Facilities
Alternative Uses (Require Case-by-Case Treasury Evaluation)
2	Other

Each Program should be included in the Allocation Table; the prompts below will allow you to enter the data for the table. Additional detailed information for each Program will be required as part of the Program Plans which Recipients may also supplement with attachments. Treasury may share Allocation Tables with the public by, for example, posting them on its website.

[Note to developer: All non-autopopulated fields must be changeable in the future at Treasury’s discretion]

Box 1: Grant Amount

[auto-populated based on approved application]

[Recipients should be able to add multiple entries with the following fields. The goal is to generate a table (like the one that follows) that will be immediately viewable by the Recipient, and runnable in SF reporting for Treasury users]

Box 2: Program ID

[auto-populated sequential letters]

Box 3: Program Title - a short but descriptive identifier for the proposed Program. If it is an established program, use the actual program name.

[Text Field]

Box 4: Use Code - “Use Code” – Select the correct Program use, as identified in the Program Uses Table, above. Uses are described in detail in the Guidance.

[radio select of the options in the above “Program Use Table”]

5: Program Budgets

Box 5a: Program Administrative Costs

[$s user entry, may not exceed approved amount of Program Administrative Costs or 5% of award, whichever is greater]

Box 5b: Project Costs

[$s user entry]

Box 6. Proposed Start Date

[Date]

Box 7: Estimated Substantial Completion Date

[Date]

Box 8a: Program Description

[Text box up to 256 char?]

Box 8b: Program Objectives

Please provide one sentence that outlines the stated objective of this Program. For example, a Program objective might be “invest in broadband infrastructure projects to serve rural households in counties with poverty scores of X”

[Text box up to 256 char?]

Box 9: Program Status

[Tied to review: either Not Started, Draft, Submitted, Under Review, Approved]

Box 11: General Grant Administration: Program Administrative Costs that are not associated with any single Program.

[$s user entry]

[FOR DISPLAY ON FINAL TABLE ONLY]

10: Total Budget for All Programs

Box 10a: Total Administrative Costs of all Programs

[autopopulate sum of all lines 5a]

Box 10b: Total Project Costs of all Programs

[autopopulate sum of all lines 5b]

[Next page shows how the finished auto-generated table should look]

1. Approved Grant Amount: $_________

	3. Program Title	4. Use Code (see instructions)	Program Budget		6. Proposed Start Date	7. Estimated Substantial Completion Date	8a. Program Description	8b. Program Objectives	9. Program Status
2. ID			5a. Program Administrative Costs	5b. Project Costs
A.	State Broadband Development Grant Program	1A		$40,000,000	01/01/2022	12/31/2023	Multi-line textbox, up to 256 characters	Multi-line textbox, up to 256 characters
B.	Constructing 6 Multi-Purpose Community Health Facilities	2A		$25,000,000	04/01/2022	12/31/2022
C.
D.
E.
F.
G.	General Grant Administration		11. General Grant Administration	N/A
Total Budget for All Projects			10a. $X00,000,000	10b. $X00,000,000

TAB 4

Upload a Program Plan for each Program listed in the CPF Grant Budget, based on the following forms: Use Code 1A, Use Code 1B, Use Code 1C, Use Code 2. Forms are specific by use type. At a minimum, the Program Plan should include a completed Program Plan Questionnaire, a Program Narrative, and a Program Budget. Individual project-level details are not expected nor necessary in the Program Plans.

Treasury will consider any additional relevant information that the recipient wishes to submit.

[File Upload]

Use Code 1A

Use Code 1A Questionnaire

Program Identifier: [Based on the Allocation table?]

Program Title: [Based on the Allocation table?]

How will the recipient implement the Program? (picklist = direct implementation, competitive sub-grant program, formula sub-grant program, other)

Will the Program deliver speeds of 100/100 or higher? [yes/no]

• If no, will this program deliver speeds of 100/20 and be scalable to speeds of 100/100? [yes/no]

  • If no, this program is not eligible under this use code.

• If no, describe the conditions that make the speed standards of 100/100 impracticable to implement. [text entry]

Is the program designed to deliver service to households and businesses lacking access to wireline service at speeds of 100/20? [Yes/No]

Will the Recipient ensure that the service provider for a completed Capital Projects Fund-funded Broadband Infrastructure Project participate in federal programs that provide low-income consumers with subsidies on broadband internet access services as required in the Guidance, including ensuring that completed service offerings funded by the Capital Projects Fund allow subscribers in the service area to utilize the Federal Communications Commission’s (FCC) Emergency Broadband Benefit (EBB) program as well as other program(s) that Treasury identifies that service providers must participate in in accordance with the Guidance? [Yes/No]

Will CPF grant funds for this Program be used to cover costs incurred after March 15, 2021, but prior to execution of the Grant Agreement? [Yes/No]

• If yes, you must provide the information requested under the Pre-Award Cost Annex

Program Narrative

Program Summary

Provide a description of the Program (approximately 2 – 3 pages), including the Program objectives, target capital assets, and the program’s history, if applicable. This should also describe the Recipient’s approach for carrying out the program, including the program’s project eligibility and selection criteria, as well as its application process, as appropriate.

Describe the Program timeline and list Program milestones to be achieved each year.

List the Program Website, guidance documents, or rules, if applicable. Provide links or attachments if available.

Eligibility

Explain why the communities identified to be served by Broadband Infrastructure Projects have a critical need for those projects as is related to access, affordability, reliability, and/or consistency. Recipients are encouraged to invest in projects that are designed to provide service to households and businesses.

What quantitative and qualitative data informed this Program Plan?

How has, or how will the Recipient identify communities with critical needs? In the response, describe any community engagement and public participation that has informed the identification of critical need for this Program, including efforts to solicit input from and/or partner with communities. How was equity considered in the design of this program and how will equity be considered in the selection of projects and the distribution of funds?

How is the program designed so that it does not duplicate investments from enforceable federal or state funding commitments for reliable wireline service at speeds of at least 100 Mbps of download speed and 20 Mbps of upload speed? (e.g., program requirement, state law, process).

Program Administration

Describe the Recipient’s approach for ensuring compliance with award requirements, including performance measurement and subrecipient monitoring. The narrative should also discuss the Recipient’s institutional, managerial, and financial capability necessary to ensure proper planning, management, and completion of any such Project.

How will you incorporate participation of and engagement with the communities with critical needs to shape Program implementation and operations?

Program Budget

Specify the amounts of funds that the Recipient proposes to allocate to each of the following elements. The budget should include line items and sub-totals for which information is available and appropriate for the types of activities anticipated for the program. These estimates may be approximations but more detailed and accurate information will be required in reporting.

Eligible costs must adhere to eligible uses as outlined in CPF guidance and are determined in accordance with the cost principles identified in 2 C.F.R. Part 200, including Subpart E of such regulations for states and non-profit organizations. Federal funds committed to an award may only be used to cover allowable costs incurred during the period of performance and for allowable closeout costs incurred during the grant closeout process. Detailed descriptions of each eligible cost element can be found in the Guidance.

PROGRAM BUDGET
Program Administrative Costs
	2021	2022	2023	2024	2025	2026
2a. Administering the CPF funds (by the Recipient)
2b. Technical assistance to potential sub-recipients
2c. Complying with grant administration and audit requirements
2d. Community Engagement
2e.
2f.
2g.
2. Total Program Administrative Costs (not to exceed amounts listed in source of funding)
Project Costs
3a.vi.
3a.vii.
3a.viii.
3a.ix
3 Total Project Costs

PRE-AWARD COST ANNEX

This annex is only required if you answered “Yes” to question 5 of the Program Questionnaire. Complete the table below for program costs incurred after March 15, 2021 but prior to execution of the grant agreement (“Pre-Award Costs”)

Does the applicant provide reasonable assurance that the intended source of funds for the Pre-Award Costs was the CPF Grant? (Yes/No)

Submit an attachment describing each project that includes Pre-Award project costs. Also describe the current source of funding for the project and how the CPF funding was contemplated to be used in coordination with current sources of funding.

PRE-AWARD COSTS	Amount ($s)
3a. Recipient Project Costs (Total)
3a.ii. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments.
3a.iii. Personnel Costs
3a.iv. Repair, rehabilitation, construction, and improvement, of facilities
3a.v. Acquisition of real property, leases, and related
3a.vi Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3a.vii. Ancillary costs necessary to operationalize and put assets to full use
3a.viii. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.
3b. Subgrant Project Costs (Total)
3b.i. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments. (Do not include costs from #1 above)
3b.ii Personnel Costs
3b.iii. Repair, rehabilitation, construction, and improvement, of facilities
3b.iv. Acquisition of real property, leases, and related
3b.v Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3b.vi. Ancillary costs necessary to operationalize and put assets to full use
3b.vi. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.

Use Code 1B

Use Code 1B Questionnaire

Program Identifier: [Based on the Allocation table?]

Program Title: [Based on the Allocation table?]

How will the Recipient implement the Program? (picklist = direct implementation, competitive sub-grant program, formula sub-grant program, other)

Will the devices be used to connect to broadband internet? [Yes/No]

• If no, this program is not eligible under this use code.
  
  

Has affordability been identified as a barrier to access to the internet? [Yes/No]

• If no, this program is not eligible under this use code.
  
  

Will funds be used solely to purchase devices deemed eligible by the Guidance (e.g., laptops, tablets, desktop personal computers, and equipment and devices necessary for public wi-fi infrastructure development)? [Yes/No]

• If no, this program is not eligible under this use code.

Will ownership of the assets be maintained by the Recipient or a subrecipient? [Yes/No]

• If no, this program is not eligible under this use code.

Will CPF grant funds for this program be used to cover costs incurred after March 15, 2021, but prior to execution of the Grant Agreement? [Yes/No]

• If yes, you must provide the information requested under the Pre-Award Cost Annex

Program Narrative

Program Summary

Provide a description of the program (approximately 2 – 3 pages), including the program objectives, target capital assets, and the program’s history, if applicable. This should also describe the Recipient’s approach for carrying out the program, including the program’s project eligibility and selection criteria, as well as its application process, as appropriate.

Describe the program timeline and list program milestones to be achieved each year.

List the Program Website, guidance documents, or rules, if applicable. Provide links or attachments if available.

Eligibility

Explain why the communities identified to be served by Digital Connectivity Technology Projects have a critical need for those projects. Please refer to the guidance for more information on what should be included in this response.

What quantitative and qualitative data informed this Program Plan?

How has, or how will the Recipient identify communities with critical needs? In the response, describe any community engagement and public participation that has informed the identification of critical need for this Program, including efforts to solicit input from and/or partner with communities. How was equity considered in the design of this program and how will equity be considered in the selection of projects and the distribution of funds?

Program Administration

Describe the Recipient’s approach for ensuring compliance with award requirements, including subrecipient monitoring. The narrative should also discuss the Recipient’s institutional, managerial, and financial capability necessary to ensure proper planning, management, and completion of any such Project.

How will you incorporate participation of and engagement with the communities with critical needs to shape Program implementation and operations?

Program Budget

Specify the amounts of funds that the Recipient proposes to allocate to each of the following elements. The budget should include line items and sub-totals for which information is available and appropriate for the types of activities anticipated for the program. These estimates may be approximations but more detailed and accurate information will be required in reporting.

Eligible costs must adhere to eligible uses as outlined in CPF guidance and are determined in accordance with the cost principles identified in 2 C.F.R. Part 200, including Subpart E of such regulations for states and non-profit organizations. Federal funds committed to an award may only be used to cover allowable costs incurred during the period of performance and for allowable closeout costs incurred during the grant closeout process. Detailed descriptions of each eligible cost element can be found in the Guidance.

PROGRAM BUDGET
Program Administrative Costs
	2021	2022	2023	2024	2025	2026
2a. Administering the CPF funds (by the Recipient)
2b. Technical assistance to potential subrecipients
2c. Complying with grant administration and audit requirements
2d. Community Engagement
2e.
2f.
2g.
2. Total Program Administrative Costs (not to exceed amounts listed in source of funding)
Project Costs
3a.vi.
3a.vii.
3a.viii.
3a.ix
3 Total Project Costs

PRE-AWARD COST ANNEX

This annex is only required if you answered “Yes” to question 5 of the Program Questionnaire. Complete the table below for program costs incurred after March 15, 2021 but prior to execution of the grant agreement (“Pre-Award Costs”)

Does the applicant provide reasonable assurance that the intended source of funds for the Pre-Award Costs was the CPF Grant? (Yes/No)

Submit an attachment describing each project that includes Pre-Award project costs. Also describe the current source of funding for the project and how the CPF funding was contemplated to be used in coordination with current sources of funding.

PRE-AWARD COSTS	Amount ($s)
3a. Recipient Project Costs (Total)
3a.ii. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments.
3a.iii. Personnel Costs
3a.iv. Repair, rehabilitation, construction, and improvement, of facilities
3a.v. Acquisition of real property, leases, and related
3a.vi Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3a.vii. Ancillary costs necessary to operationalize and put assets to full use
3a.viii. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.
3b. Subgrant Project Costs (Total)
3b.i. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments. (Do not include costs from #1 above)
3b.ii Personnel Costs
3b.iii. Repair, rehabilitation, construction, and improvement, of facilities
3b.iv. Acquisition of real property, leases, and related
3b.v Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3b.vi. Ancillary costs necessary to operationalize and put assets to full use
3b.vi. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.

Use Code 1C

Use Code 1C Questionnaire

Program Identifier: [Based on the Allocation table?]

Program Title: [Based on the Allocation table?]

How will the Recipient implement the Program? (picklist = direct implementation, competitive sub-grant program, formula sub-grant program, other)

Does the Recipient represent and commit that the Capital Projects will provide services or activities that directly enable work, education, and health monitoring for at least five years from the completion of the Project? [Yes/No]

Will CPF grant funds for this program be used to cover costs incurred after March 15, 2021, but prior to execution of the Grant Agreement? [Yes/No]

• If yes, you must provide the information requested under the Pre-Award Cost Annex

Program Narrative

Program Summary

Provide a description of the program (approximately 2 – 3 pages), including the program objectives, target capital assets, and the program’s history, if applicable. This should also describe the Recipient’s approach for carrying out the program, including the program’s project eligibility and selection criteria, as well as its application process, as appropriate.

Describe the program timeline and list program milestones to be achieved each year.

List the Program Website, guidance documents, or rules, if applicable. Provide links or attachments if available.

Eligibility

How will the program directly enable work, as defined in the Guidance?

How will the program directly enable education, as defined in the Guidance?

How will the program directly enable health monitoring, as defined in the Guidance?

Explain why the communities identified to be served by the Multi-Purpose Community Facilities Projects have a critical need for those projects. Refer to the guidance for more information on what should be included in this response.

What quantitative and qualitative data informed this Program Plan?

How has, or how will the Recipient identify communities with critical needs? In the response, describe any community engagement and public participation that has informed the identification of critical need for this Program, including efforts to solicit input from and/or partner with communities. How was equity considered in the design of this program and how will equity be considered in the selection of projects and the distribution of funds?

Program Administration

Describe the Recipient’s approach for ensuring compliance with award requirements, including subrecipient monitoring. The narrative should also discuss the Recipient’s institutional, managerial, and financial capability necessary to ensure proper planning, management, and completion of any such Project.

How will you incorporate participation of and engagement with the communities with critical needs in order to shape Program implementation and operations?

Program Budget

Specify the amounts of funds that the Recipient proposes to allocate to each of the following elements. The budget should include line items and sub-totals for which information is available and appropriate for the types of activities anticipated for the program. These estimates may be approximations but more detailed and accurate information will be required in reporting.

Eligible costs must adhere to eligible uses as outlined in CPF guidance and are determined in accordance with the cost principles identified in 2 C.F.R. Part 200, including Subpart E of such regulations for states and non-profit organizations. Federal funds committed to an award may only be used to cover allowable costs incurred during the period of performance and for allowable closeout costs incurred during the grant closeout process. Detailed descriptions of each eligible cost element can be found in the Guidance.

PROGRAM BUDGET
Program Administrative Costs
	2021	2022	2023	2024	2025	2026
2a. Administering the CPF funds (by the Recipient)
2b. Technical assistance to potential subrecipients
2c. Complying with grant administration and audit requirements
2d. Community Engagement
2e.
2f.
2g.
2. Total Program Administrative Costs (not to exceed amounts listed in source of funding)
Project Costs
3a. Recipient Project Costs
3b. Subgrant Project Costs
3a.vi.
3a.vii.
3a.viii.
3a.ix
3 Total Project Costs

PRE-AWARD COST ANNEX

This annex is only required if you answered “Yes” to question 5 of the Program Questionnaire. Complete the table below for program costs incurred after March 15, 2021 but prior to execution of the grant agreement (“Pre-Award Costs”)

Does the applicant provide reasonable assurance that the intended source of funds for the Pre-Award Costs was the CPF Grant? (Yes/No)

Submit an attachment describing each project that includes Pre-Award project costs. Also describe the current source of funding for the project and how the CPF funding was contemplated to be used in coordination with current sources of funding.

PRE-AWARD COSTS	Amount ($s)
3a. Recipient Project Costs (Total)
3a.ii. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments.
3a.iii. Personnel Costs
3a.iv. Repair, rehabilitation, construction, and improvement, of facilities
3a.v. Acquisition of real property, leases, and related
3a.vi Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3a.vii. Ancillary costs necessary to operationalize and put assets to full use
3a.viii. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.
3b. Subgrant Project Costs (Total)
3b.i. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments. (Do not include costs from #1 above)
3b.ii Personnel Costs
3b.iii. Repair, rehabilitation, construction, and improvement, of facilities
3b.iv. Acquisition of real property, leases, and related
3b.v Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3b.vi. Ancillary costs necessary to operationalize and put assets to full use
3b.vi. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.

Use Code 2

Use Code 2 Questionnaire

Program Identifier: [Based on the Allocation table?]

Program Title: [Based on the Allocation table?]

How will the Recipient implement the Program? (picklist = direct implementation, competitive sub-grant program, formula sub-grant program, other)

Will CPF grant funds for this program be used to cover costs incurred after March 15, 2021, but prior to execution of the Grant Agreement? [Yes/No]

• If yes, you must provide the information requested under the Pre-Award Cost Annex

Program Narrative

Program Summary

Provide a description of the program (approximately 2 – 3 pages), including the program objectives, target capital assets, and the program’s history, if applicable. This should also describe the Recipient’s approach for carrying out the program, including the program’s project eligibility and selection criteria, as well as its application process, as appropriate.

Describe the program timeline and list program milestones to be achieved each year.

List the Program Website, guidance documents, or rules, if applicable. Provide links or attachments if available.

Eligibility

How will the program directly enable work, as defined in the Guidance?

How will the program directly enable education, as defined in the Guidance?

How will the program directly enable health monitoring, as defined in the Guidance?

Describe how the Program is designed to address a critical need that results from or was made apparent or exacerbated by the COVID-19 public health emergency.

Explain why the communities identified to be served by these Projects have a critical need for those projects. Refer to the guidance for more information on what should be included in this response.

What quantitative and qualitative data informed this Program Plan?

How has, or how will the Recipient identify communities with critical needs? In the response, describe any community engagement and public participation that has informed the identification of critical need for this Program, including efforts to solicit input from and/or partner with communities. How was equity considered in the design of this program and how will equity be considered in the selection of projects and the distribution of funds?

Program Administration

Describe the Recipient’s approach for ensuring compliance with award requirements, including subrecipient monitoring. The narrative should also discuss the Recipient’s institutional, managerial, and financial capability necessary to ensure proper planning, management, and completion of any such Project.

Propose a performance measurement framework for demonstrating the Program’s performance in achieving objectives stated in the program description. For example, the framework may include the data, metrics, and goals as they relate to inputs, activities, outputs, and outcomes.

How will you incorporate participation of and engagement with the communities with critical needs in order to shape Program implementation and operations?

Program Budget

Specify the amounts of funds that the Recipient proposes to allocate to each of the following elements. The budget should include line items and sub-totals for which information is available and appropriate for the types of activities anticipated for the program. These estimates may be approximations but more detailed and accurate information will be required in reporting.

Eligible costs must adhere to eligible uses as outlined in CPF guidance, and are determined in accordance with the cost principles identified in 2 C.F.R. Part 200, including Subpart E of such regulations for states and non-profit organizations. Federal funds committed to an award may only be used to cover allowable costs incurred during the period of performance and for allowable closeout costs incurred during the grant closeout process. Detailed descriptions of each eligible cost element can be found in the Guidance.

PROGRAM BUDGET
Program Administrative Costs
	2021	2022	2023	2024	2025	2026
2a. Administering the CPF funds (by the Recipient)
2b. Technical assistance to potential subrecipients
2c. Complying with grant administration and audit requirements
2d. Community Engagement
2e.
2f.
2g.
2. Total Program Administrative Costs (not to exceed amounts listed in source of funding)
Project Costs
3a. Recipient Project Costs
3b. Subgrant Project Costs
3a.vi.
3a.vii.
3a.viii.
3a.ix
3 Total Project Costs

PRE-AWARD COST ANNEX

This annex is only required if you answered “Yes” to question 5 of the Program Questionnaire. Complete the table below for program costs incurred after March 15, 2021 but prior to execution of the grant agreement (“Pre-Award Costs”)

Does the applicant provide reasonable assurance that the intended source of funds for the Pre-Award Costs was the CPF Grant? (Yes/No)

Submit an attachment describing each project that includes Pre-Award project costs. Also describe the current source of funding for the project and how the CPF funding was contemplated to be used in coordination with current sources of funding.

PRE-AWARD COSTS	Amount ($s)
3a. Recipient Project Costs (Total)
3a.ii. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments.
3a.iii. Personnel Costs
3a.iv. Repair, rehabilitation, construction, and improvement, of facilities
3a.v. Acquisition of real property, leases, and related
3a.vi Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3a.vii. Ancillary costs necessary to operationalize and put assets to full use
3a.viii. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.
3b. Subgrant Project Costs (Total)
3b.i. Pre-project development, including data-gathering, feasibility studies, community engagement and public feedback processes, equity assessments and planning, and needs assessments. (Do not include costs from #1 above)
3b.ii Personnel Costs
3b.iii. Repair, rehabilitation, construction, and improvement, of facilities
3b.iv. Acquisition of real property, leases, and related
3b.v Permitting, planning, architectural design, engineering design, and work related to environmental, historical, and cultural reviews.
3b.vi. Ancillary costs necessary to operationalize and put assets to full use
3b.vi. Collecting and measuring performance data and activities needed to establish and maintain a performance management and evaluation regime related to projects funded by CPF.

Certification

I, the undersigned, as an Authorized Representative of the Recipient, certify that all of the information provided in this Grant Plan is true, complete, and correct after reasonable inquiry of people, systems, and other information available to the Recipient.

WARNING: Anyone who knowingly submits a false claim or makes a false statement may be subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil penalties (18 U.S.C. §§ 287, 1001; 31 U.S.C. §§ 3729, 3802). Treasury may refer any allegations of fraud, waste, or abuse in connection with CPF to the Treasury Inspector General.

OMB Control Number: 1505-0274

OMB Expiration Date: 03/31/2022

PAPERWORK REDUCTION ACT NOTICE

The information collected will be used for the U.S. Government to process requests for support. The estimated burden associated with this collection of information is sixty hours per response. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Office of Privacy, Transparency and Records, Department of the Treasury, 1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send the form to this address. An agency may not conduct or sponsor, and a person is not required to respond to,a collection of information unless it displays a valid control number assigned by OMB.