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DocuSign Envelope ID:FO3CBAC2-B7E2-4CDB-AFA6-CB52A071BA00 t A- continued <br /> Provider's Outside Agency Application <br /> MAN APPLICATION <br /> 24 CFR 570.200(a), <br /> 4. Financial (for Program Budget Worksheet and Detail should reflect 570,201-570, 208, <br /> each expenses for the entire program and ALL sources of 507 503 <br /> progra I funding. 24 CFR 570506, <br /> project for 570 507, 570 601, <br /> which funding a. H Pro ra udget Worksheet 570 602, 570 607(b), <br /> is requested) b. Di Pr gram B dget Detail 570 611 <br /> 24 CFR <br /> c. Ell Cost Per Unit <br /> 570.502-570.504, <br /> d. 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 <br /> Sections (as B. Part B: Construction/Rehab <br /> applicable) <br /> 6. Attachments a. H Audit: Organizations receiving $300,000 or more ' OMB Cuculdr AV133 <br /> in Federal financial assistance, and/or organizations <br /> with more than $500,000 of receipts and <br /> expenditures in a fiscal year, must secure an audit. <br /> b. IRS Federal Form 990 <br /> c. NC Solicitation License <br /> d. H IRS Federal Tax-Exemption Letter <br /> e. E Certificate of Insurance <br /> f. I List of Board of Directors 24 CFR Parts 84 or 85 <br /> g. Articles of Incorporation/Bylaws <br /> 24 CFR 570,208 <br /> h. D Authorization to Request Funds 570,500(c), 570.611 <br /> _J Authorized fficial dtsignation <br /> Solid Waste Program Fee (SWPF) Verification <br /> Main Application 1/25/2016 1:26:31 PM I , ? <br />