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Application Materials

Application for Federal Assistance Standard Form 424 (PDF)
(4 pp., 808 KB, about PDF) Click icon for EPA disclaimer.
   
Budget Information Standard Form 424A (PDF)
(2 pp., 1.55 MB, about PDF) Click icon for EPA disclaimer.
   
Assurances – Non-Construction Programs Standard Form 424B (PDF)
(2 pp., 82 KB, about PDF) Click icon for EPA disclaimer.
   
Pre-award Compliance Review Report EPA Form 4700-4 (PDF)
(1 p., 46 KB, about PDF)

 

Intergovernmental Review

If an applicant is selected to submit a full proposal under the Healthy Communities Grant Program, and is located in one of the following States, the applicant must submit 1 copy of their complete application to their State contact at the same time of submission to EPA. For more information on the process a particular State requires to be followed, an applicant should contact the office or official designated in his or her State. States that are not listed on this page have chosen not to participate in the intergovernmental review process.

MAINE
Joyce Benson (joyce.benson@state.me.us)
State Planning Office
184 State Street
38 State House Station
Augusta, Maine 04333
Telephone: (207) 287-3261
(direct) (207) 287-1461
Fax: (207) 287-6489

NEW HAMPSHIRE
Jack Ruderman
Acting Director, New Hampshire Office of Energy and Planning
Attn: Intergovernmental Review Process (irp@nh.gov)

James P. Taylor
57 Regional Drive
Concord, New Hampshire 03301-8519
Telephone: (603) 271-2155
Fax: (603) 271-2615

RHODE ISLAND
Joyce Karger (jkarger@doa.state.ri.us)
Department of Administration
One Capitol Hill
Providence, Rhode Island 02908-5870
Telephone: (401) 222-6181
Fax: (401) 222-2083

Serving Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, & Tribal Nations


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