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DocuSign Envelope ID: B701CF6A-1C9A-46CB-9234-56F771D80955 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 expenses for the entire program and ALL sources of 507.503 <br /> program/ funding. 24 CFR 570.506, <br /> project for 570.507, 570.601, <br /> which funding a. ❑ Program Budget Worksheet 570.602, 570.607(b), <br /> is requested) b. ❑ Program Budget Detail 570.611 <br /> 24 CFR <br /> c. ❑ Cost Per Unit 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. [' Audit: Organizations receiving $300,000 or more OMB Circular A-133 <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. ❑ IRS Federal Tax-Exemption Letter <br /> e. ❑ Certificate of Insurance <br /> f. ❑ List of Board of Directors 24 CFR Parts 84 or 85 <br /> g. ❑ Articles of Incorporation/Bylaws 24 CFR 570.208, <br /> h. ❑ Authorization to Request Funds 570.500(c), 570.611 <br /> i. ❑ Authorized official designation <br /> j. ❑ Solid Waste Program Fee (SWPF) Verification <br /> Main Application 5/24/2016 9:22:20 AM 0:° J c 2 of 2 I <br />