Orange County NC Website
Browse       Search
DocuSign Envelope ID: CB0C1343-06EB-4BE7-9AF6-62EE77BD69FE t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 24 CFR 570.200(a), <br /> 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, <br /> each program/ expenses for the entire program and ALL sources of 507.503 <br /> project for funding. 24 CFR 570.506, <br /> which funding 570.507, 570.601, <br /> is requested) a. X Program Budget Worksheet 570.602, 570.607(b), <br /> b. X Program Budget Detail 570.611 <br /> 24 CFR <br /> c. X Cost Per Unit 570.502-570.504, <br /> d. X Agency Operating Budget Worksheet 570.506, <br /> 570.507, 570.610; 24 <br /> CFR Parts 84 or 85, and <br /> OMB Circulars A-87 or A- <br /> 122; <br /> Treasury Circular 1075 <br /> 5. Supplemental A. Part A: CDBG & HOME NA <br /> Sections (as B. Part B: Construction/Rehab NA <br /> applicable) <br /> 6. Attachments a. X Audit: Organizations receiving $300,000 or OMB Circular A-133 <br /> more in Federal financial assistance, and/or <br /> organizations with more than $500,000 of <br /> receipts and expenditures in a fiscal year, must <br /> secure an audit. <br /> b. X IRS Federal Form 990 <br /> c. X NC Solicitation License <br /> d. X IRS Federal Tax-Exemption Letter <br /> e. X Certificate of Insurance 24 CFR Parts 84 or 85 <br /> f. X List of Board of Directors 24 CFR 570.208, <br /> g. X Articles of Incorporation/Bylaws 570.500(c), 570.611 <br /> h. X Authorization to Request Funds <br /> i. X Authorized official designation <br /> j. X Solid Waste Program Fee (SWPF) Verification <br /> Main Application 1/21/2016 18:35:26 a1/p1 I:' c 2 of 2 <br />