2014-2015 Application for Funding
CITY OF MILFORD
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
Program Year 40
The application deadline is Friday, April 4, 2014 by 5:00 PM. The application is available in electronic
format upon request. Applications received by fax or email will not be considered. Any modification to the
application or form(s) will deem the application incomplete.
1.
Applicant Information
Organization ______________________________________________________________
Applicant Name/Title ________________________________________________________
Address ___________________________________________________________________
Phone _____________________
Fax ________________________
Email _______________________________
Name of Officer/Board Chairman _________________________ Phone: ______________
Federal Tax ID (EIN)________________________ DUNS Number ___________________
SAM.gov Registration: Cage Code:
2.
Expiration date: ___________
Proposal & Eligibility
Name of Proposed Project or Activity? ____________________________________________
Amount of CDBG Funds Requested ? _____________________________________________
Project/activity address or location? ______________________________________________
Describe specifically the proposed project/activity (not the general organization) for which funds
are being requested. ____________________________________________________________
______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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Who does the Applicant expect the proposed project/activity to benefit?
_____________________________________________________________________________
_____________________________________________________________________________
Approximate number of people the Applicant expects the project/activity to assist?_______
What procedure will the Applicant use to certify a person(s) income eligibility to participate
in the CDBG funded activity?
______________________________________________________________________________
______________________________________________________________________________
What procedure will the Applicant use to document the number of people assisted?
_____________________________________________________________________________
_____________________________________________________________________________
3.
Community Need & Objective
Describe the community need for this project/activity. ______________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________
How does the project/activity address the community need? _________________________
____________________________________________________________________________
____________________________________________________________________________
Which National Objective does the proposal address? (Check One)
Benefit to Low- Moderate Income Persons (Specify subcategory, if applicable)
Area Benefit -Street improvements, water & sewer lines, neighborhood facilities, façade
improvements in commercial districts.
Limited Clientele - Abused children, battered spouse, elderly persons (defined by HUD as
62 years of age and above), homeless persons, severely disabled adults, illiterate adults, migrant
farm workers, persons with AIDS.
Housing - Permanent housing: Property acquisition; rehabilitation, conversion of
nonresidential structures; and assistance to household to purchase home.
Jobs - Involving employment.
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Preventing or eliminating slums or blight - Activities might include clearance of derelict
properties, converting a lot to a park or playground, façade improvements, removal of toxic
materials.
Meet other needs of a particular urgency - Needs that pose a serious and immediate threat to
health or welfare and other financial resources are not available. Immediate needs arising from a
catastrophe such as a flood or hurricane.
Which Community Development Objective does the project address? (Check One) Additional
information may be requested to determine the eligibility of the proposed activity.
Housing Assistance
Homelessness Assistance
Community Development
4.
Management & Accounting Compliance
Total anticipated project/activity budget? _________________________
Will the CDBG request cover the entire project/activity budget?
Yes
No
If the CDBG allocation is less than the requested amount does the applicant have the resources
available to fund the balance of activity/project budget?
Yes
No
Please record all matching project funding sources on the attached Activity Budget
form.
If no, please explain when the resources will be available? _____________________________
Anticipated project start and completion date? _____________
to _____________
Please advise how the Applicant plans to manage and complete the project/activity as anticipated.
____________________________________________________________________________________
_______________________________________________
Will the Applicant hire outside management to oversee the project or activity? Yes
No
If yes, please provide the name and contact information of the project manager _____________
____________________________________________________________________________
Has the Applicant expended $750,000 or more in federal funds during the most recently
completed fiscal year? Yes
No
If yes, please provide a copy of the most recent single federal
audit report.
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5.
Outcomes Measurement
There are five performance components to the outcomes measurement model. Please explain
how the proposed project/activity relates to each component. Please refer to the application
instructions for guidance with outcomes measurement.
Goal: ______________________________________________________________________
____________________________________________________________________________
Inputs: _____________________________________________________________________
____________________________________________________________________________
Activities: ___________________________________________________________________
____________________________________________________________________________
Outputs: ____________________________________________________________________
____________________________________________________________________________
Outcomes: __________________________________________________________________
____________________________________________________________________________
6.
Application Attachments
Please submit the following documents with the application.
 CDBG Activity Budget form (required)
 Organization’s current fiscal year operating budget.
 Most recent Annual Report and/or Financial Statement.
 Most recent Single Federal Audit
 Copy of IRS 501(c)(3) Tax Exemption Letter.
 Organization information on program and/or service(s).
 Organization’s Mission Statement and By-laws.
 List of current Board of Directors.
Return Completed Applications To:
City of Milford
Department of Community Development
70 West River Street, 2nd floor
Milford, CT 06460
Signature of Applicant __________________________________ Date _______________________
Printed Name __________________________________________
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