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Application for Federal Assistance SF -424 16. Congressional Districts Of: ' a. Applicant FL -8 ' b. Program/Project FL -8 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attachment View Attachment 17. Proposed Project: ' a. Start Date: 07/01/2022 "b. End Date: 06/30/2024 18. Estimated Funding ($): ' a. Federal 317, 220.00 ' b. Applicant 0.001 * c. State 0.001 ' d. Local 0.00 * e. Other 0.00 ' f. Program Income 0.00 'g. TOTAL 317,220.00 ' 19. Is Application Subject to Review By State Under Executive Order 12372 Process? D a. This application was made available to the State under the Executive Order 12372 Process for review on �. 0 b. Program is subject to E.O. 12372 but has not been selected by the State for review. ® c. Program is not covered by E.O.12372. * 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) ❑ Yes ® No If "Yes", provide explanation and attach Add Attachment Delete Attachment I E View Attachment 21. *By signing this application, I certify (1) to the statements contained in the list of certifications"" and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances'"' and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) ® *' I AGREE The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: * First Name: Phillip Middle Name: * Last Name: Matson Suffix: * Title: Community Development Director *Telephone Number: 772-226-1253 Fax Number: *Email: pmatson@ircgov.com 'Signature of Authorized Representative: ' Date Signed: 10/04/2021 24