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FEDERAL ASSISTANCE 2 CANT'S NUMBER <br />1. ,TYPE APPLI• ' None <br />OF 13 NOTICE OF INTENT CATION <br />SUBMISSION (OPTIONAL) IDENTI• b DATE <br />FIER ar Yale month day <br />pram. to ❑ PREAPPLICATION 91 -03 -04 <br />bag ❑ APPLICATION 19 <br />Dour <br />Blank <br />4. LEGAL APPLICANT/RECIPIENT <br />a. Applicant Name "`age County <br />b. Organization Unit County Government <br />c. Street/P.O. Box P. 0 • Box 8181 <br />d. City . Hillsborough e. County Orange <br />f. State N. C- ZIP Code. 27278 <br />e h. Contact Person (Nome Terri Tyson, R Director <br />G 6 Telephone N t (919) 968 -6060 <br />La 7• TITLE OF APPLICANT'S PROJECT (Use section IV of this form to provide a summary <br />s description of the project.) <br />Orange County -Chapel Hill Retired Senior Volunteer <br />Program. The project provides the means by which an <br />individual aged 60 or older may serve the community as <br />e a volunteer to the best of his/her ability. <br />9. AREA OF PROJECT IMPACT !Names of ,,ier awnnes .totes rest 10. ESTIMATED NO. OF <br />Orange County, North Carolina PERSONS BENEFITING <br />480 <br />12. PROPOSED FUNDING <br />a. NUMBER <br />13. CONGRESSIONAL DISTRICT OF: <br />a. FEDERAL <br />S 28,312 <br />.00 <br />a. APPLICANT <br />Fourth <br />b. PROJECT <br />Fourth <br />b. APPLICANT <br />37,775 .00 <br />c. SPATE <br />- <br />.00 <br />15. PROJECT START <br />DATE Year -1h day <br />1991. -07 -01 <br />16. PROJECT <br />DURATION <br />12 :efanths <br />d. LOCAL <br />13,177 .00 I <br />e. OTHER <br />_0_ .00 <br />3. STATE <br />a. NUMBER <br />APPLI- <br />H- Cammumty Action Atienty <br />CATION <br />I- Higher Educational Institution <br />IDENTI• <br />J- Indian Tribe <br />FIER <br />b. DATE <br />NOTE: TO BE <br />SSIGNED <br />ASSIGNED <br />BY STATE <br />19 <br />Year month day <br />5. EMPLOYER IDENTIFICATION NUMBER (EIN) <br />56- 6000327 <br />6, <br />PRO- <br />GRAM <br />[Front CFDA1 <br />a. NUMBER <br />17 12 1. 101012J <br />MULTIPLE 0 <br />8. TYPE OF APPLICANT/RECIPIENT <br />Acetate <br />G -Special Purpose District <br />H- Interstate <br />H- Cammumty Action Atienty <br />C- Sustitute <br />I- Higher Educational Institution <br />Organization <br />J- Indian Tribe <br />D- •County <br />K-- Other(5peegjt, <br />E -City <br />F-School District <br />Enter appropriate letter M <br />11. TYPE OF ASSISTANCE <br />A +Basic Grant D- Insumnee <br />B- Suppiemental Grant E-Other <br />C -lose Enter appropriate letterfs) <br />ft <br />14.'1'YFE OF APPLICATION <br />A-NaN' C- Revision E- Augmentation <br />B- Renewal D--Continuation <br />Enter appaprw, Warr <br />LHi <br />17. TYPE OF CHANGE [For 14r or last <br />A -Inc osse Dollars F -Other fSpi afyi <br />B- Decrease Dollars <br />C-- Increase Duration <br />D- Decrease Duration <br />E- Cancellation <br />f. Total $ 79 264 '001 18. DATE <br />EDERAL AGENCY 19 9Yr- (IT -t t y Enter Dupe. <br />19. FEDERAL AGENCY TO RECEIVE REQUEST nr[ate 4tlrnn[ <br />20. EXISTING FEDERAL <br />a. ORGANIZATIONAL UNIT (IF APPROPRIATE) b. ADMINISTRATIVE CONTACT (IF KNOWN) GRANT IDENT. NO. <br />Region IV 440- 4768/09 <br />t:. ADDRESS <br />101 Marietta Street, N.W. 21. REMARKS ADDED <br />Atlanta, Ga. 30303 0 Yesallo <br />e 22. To the hat ofUW k- ledgs and beii f data a. YES, THLS NOTICE OF INTENT /PREAPPLICATION /APPLICATION WAS MADE AVAILABLE <br />in this prea*ieationitswitat;on am true <br />P E TO THE E CUTIVE ORDER 12372 PROCESS FOR REVIEW ON: <br />u APPLICANT and s aacaa[rin his been dale DATE , <br />M CERTIFIES aat�t'W � �° ga"e*++;nr ba+r of she ap <br />THAT ■ shlie attt a chd ed th aare 1 ompy with <br />raeJ we <br />asasuna is <br />v awro•+d b. NO. PROGRAM IS NOT COVERED BY E.O. 12372 ❑ <br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW ❑ IL c CCE.RTIFYING TYPED NAME AND TITLE b. SIGNATURE <br />5 REPRE. Moses Carey, Chair <br />SENTATIVE ., .._.�� -- . <br />24.4,Mn ICA- Ymr atl,i-I day <br />27. ACTION TAKEN <br />I : a AWARDED <br />x I ; b. REJECTED <br />e. RETURNED FOR <br />AMENDMENT <br />j ! I I d. RETURNED FOR <br />3t E.O. 12972 SUBMISSION <br />BY APPLJCANT TO <br />v STATE <br />e. DEFERRED <br />�e f. WfrHDRAWN <br />25. FEDERAL APPLICATION IDENT. NO. <br />28. FUNDING <br />a. FEDERAL S 00 <br />b. APPLICAN7 <br />00 <br />c. STATE <br />00 <br />d. LOCAL <br />.00 <br />e. OTHER <br />00 <br />f. Total <br />= .D0 <br />26. FEDERAL GRANT IDENTIFICATION <br />Year month day 30. Year montk dot. <br />29. ACTION DATED. 19 STARTING <br />DATE 19 <br />31. CONTACT FOR ADDITIONAL 32. Year month dal. <br />INFORMATION [!vats and te4yame atonbm ENDING <br />DATE 19 <br />33. REMARKS ADDED <br />Yes 11 No <br />PAGE 1 <br />Pre &'d by OMB Cirtvinr A•102 <br />