Grantmaker A_Offline Application Option_Noncompetitive Awards_June 2024

O MB Control Number=2035.NEW, Expiration Date =mm/dd/yyyy

The use of this provided template is optional. EPA will not penalize or withhold a benefit from the respondent for providing the requested information in another format.

Thriving Communities XXXXXX Environmental Protection Agency Noncompetitive Grant

Grantmaker A

To complete application:

• Create account by going to < application website > directly or through Grantmaker A’s website link

• Sign-up for an account on < application website >

• Enter email address for individual filling out application

• For assistance with < application website > use red question mark help icon on top right of their website or contact: < contact email for application website >

• For assistance with application contact: < contact email for Grantmaker A >

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. OMB Control Number: 2035-NEW. Responses to this collection of information are voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 2 to 6 hours. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to Director, Information Engagement Division; U.S. Environmental Protection Agency (2821T); 1200 Pennsylvania Ave., NW; Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

I. Organization Information

1. Organization Name

   1. If Fiscally Sponsored please list your Fiscal Sponsor and the name of your project – Official applicant must be the Fiscal Sponsor

2. Eligibility Status

1. 501c3

2. 501c3 Fiscally Sponsored Project – Official applicant must be the Fiscal Sponsor

3. Institutions of higher education

4. Local governments

5. Native American Organizations

6. Tribal governments (both federally recognized and state-recognized) and Intertribal Consortia

7. (Ineligible) None of the above – Individuals, For Profit Businesses, State Governments

3. Brief Description of Applicant Organization

 i.     Provide a brief description (100 words or less) of the applicant organization, including its mission and key ongoing projects and activities in which it is involved.

4. Mailing Address

   1. Country, Address, Address Line 2 (optional), City, State, Province or Region, Zip or Postal Code

5. Site Address (if different from address above)

1. Country, Address, Address Line 2 (optional), City, State, Province or Region, Zip or Postal Code

4. Organization Phone number

5. Organization Website

6. Employer Identification Number

7. Do you operate as a 501(c)(3) or fall under the eligible subgrantee entities list?

8. Organizational Annual Budget (for current year or next year depending on timing of the grant release date)

9. Provide Income Statement for most recently completed fiscal year

10. Year organization founded

11.  How many full-time equivalent employees (FTE) does your organization employ?

 

 

II. Contact Information

14. Primary Contact Name

i.     individual will be responsible for ongoing reporting and administration of this grant

1. Primary Contact Title

2. Primary Contact Phone Number

3. Primary Contact Email

15. Authorized Person Contact Name

i.     individual with signatory authority

1. Authorized Contact Phone Number

2. Authorized Contact Email

16. Other Contact Information

III. Environmental Justice Issue(s) to Be Addressed

 

17. What are the local environmental/public health issue(s) that your project seeks to assess (Phase I) or address (Phase II and III)?

1. Air quality & asthma

2. Fence line air quality monitoring

3. Monitoring of effluent discharges from industrial facilities

4. Water quality & sampling

5. Small cleanup projects

6. Improving food access to reduce vehicle miles traveled

7. Stormwater issues and green infrastructure

8. Lead and asbestos contamination

9. Pesticides and other toxic substances

10. Healthy homes that are energy/water use efficient and not subject to indoor air

11. pollution

12. Illegal dumping activities, such as education, outreach, and small-scale clean-ups

13. Emergency preparedness and disaster resiliency

14. Environmental job training for occupations that reduce greenhouse gasses and

15. other air pollutants

16. Environmental justice training for youth

17. Other

17a. Other (please describe)

IV. Project Plan, Goals, Outputs, and Outcomes

(Projects must benefit people in disadvantaged communities as defined by the IRA map)

 

17. Short Project description, goals, and community need for project