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Fill and Sign the Healthfirst Eft and Era Authorization Form

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DCNR- Bureau of Recreation and Conservation Community Conservation Partnerships Program (C2P2) eGrants Application Step-By-Step Instructions Read all of these instructions before entering your application into the Environmental eGrants system. If you have any problems with the eGrant application please contact Grants Customer Service Center at 1-800-326-7734. 1. Go to the DCNR homepage (www.dcnr.state.pa.us), go to the left navigation bar and click on “Apply for Grants”. 2. Click on “Online Grant Applications”. 3. Click on “Log in/Register” and Register as a New User if not already registered; or if already registered enter your User Name and Password. 4. Click on “Find a Grant” on the left navigation bar. 5. Scroll down to appropriate DCNR C2P2 Grant Program Title and click on Apply for this Grant. Project Type: [Required] Select appropriate Project Type [Required] Use the legal name of the entity applying for the grant. Must be the same as the name used to register for a SAP Number. (Example: use Mansfield Borough instead of Borough of Mansfield) APPLICANT PROFILE GeneralApplicant Legal Name: Fed Employer ID Number: [Required] Self-explanatory SAP Vendor Number: Call the Central Vendor Management Unit at 717-346-2676 (Harrisburg area) or 877-435-7363 (toll free) if you are not sure if you have a SAP Number or do not know what it is. If you do not have one, you must register as a Non-Procurement Vendor at https://www.vendorregistration.state.pa.us/cvmu/paper/GranteeRegistrati on.aspx and a SAP number will be issued. [Required] We advise you to acquire a SAP Number one month prior to applying for a grant. Organizational DUNS: [Required] The Federal government requires Pennsylvania to provide the DUNS number for grantees. For information on how to get a DUNS number, visit http://www.dnb.com/US/duns_update/. The Dun & Bradstreet toll free customer service number is 800-234-3867. If you identify your organization as a prospective federal grant applicant when you call you should get your number quickly, but note it may take up to 2 weeks (or longer). Department/Bureau Name: [Not Required] Department or Bureau of Applicant that is applying for the grant, if applicable. Division/Office Name: 12/21/2010 [Not Required] Division or Office of the above Department or Bureau, if applicable. C2P2 Grants Cycle 2011-2012 1 Applicant Address- [Required] Address MUST match the address associated with your SAP number. Applicant Type- [Required] Select all Applicant Types that apply to your organization. Non-Profit Information- [Not-Required] If your organization is an incorporated 501(c)(3) non-profit, you must fill out this section; in addition you must be registered with the PA Bureau of Charitable Organizations. You may use the following weblink http://www.dos.state.pa.us/char/site/default.asp to register or to check if already registered. Project Coordinator- [Required] This should be the primary contact for the application and project. PROJECT INFORMATION GeneralIs this a statewide project? [Not Required] Will your project impact a statewide audience? Project Title: [Required] Please give your project a descriptive title of fewer than 10 words. Please use this title for all correspondence and when referencing this project. (Example: M&M Park- Phase I) Project Start and End Date: [Required] Projects must be completed within 3 years of the contract start date. Commonwealth Adviser- [Not Required] Please list the name of your Bureau of Recreation and Conservation Regional Adviser with whom you discussed your project. Brief Project Description- [Required] Limited to 500 characters. Provide a brief description of the project, to include type, size and location of the project, as applicable. Please refer to the samples on the Bureau’s C2P2 website for your specific project type. Location Name: [Required] Please use the descriptive project title as supplied earlier. (Example: M&M Park- Phase I) One title per project site. Address Line 1 Address Line 2: [Required] This is the address where the project is located, not the applicant address. Street Address 1 can be a U.S. Postal Address or a general site location if a postal address is not available. Complete for each project site. Is the Property Leased? [Required] Identify for each project site. The applicant must control the property that will be developed, rehabilitated, or for which a Master Site Development Plan will be created. Note: Check yes if you own the site but control has been leased to another party. In addition, you must check yes if you are leasing the property from another party. Property Owner: [Required] Name of property owner for each project site. County(ies): [Required] Select one or more county(ies) as appropriate for each project site. Municipality(ies): [Required] Select one or more municipality(ies) as appropriate for each project site. PA House District(s): [Required] Select applicable PA House District(s) as appropriate for each project site. PROJECT LOCATION 12/21/2010 C2P2 Grants Cycle 2011-2012 2 PA Senate District(s): U.S. Congressional District(s): Mapping Information- [Required] Select applicable PA Senate District(s) as appropriate for each project site. [Not Required] Select applicable U.S. Congressional District Number(s) as appropriate for each project site. [Required] Enter Latitude and Longitude for each project site. [Required] Enter Acreage (if applicable). [Required] Applicable primarily to trail projects, greenways or watershed studies. Length in Miles; noting logical beginning and ending points [Not Required] Parcel Number (if applicable and available) Current Attachments- Add more attachments: [Not Required] Shapefiles that clearly show the project area, street names and intersections with sufficient detail to locate the project site. [Not Required] PROJECT BUDGET Total Grant Amount Requested: [Required] The amount you are requesting. Name of Match Source; Cash/Non-Cash; and Pending or Secured: [Required] Credit for match will not be given unless all of the matching funds have been listed and confirmed. If a single match source provides both Pending (P) and Secured (S) funding, in either the cash or non-cash categories, each must be listed on separate lines. You are reminded to use the “Update Totals” to ensure that your values add properly. ATTACHMENTS Download the available forms/worksheets to your computer. Complete and save them on your computer. Note: In the download and upload forms sections, the listing of forms will not appear in the same order as they appear in these instructions. Form order will vary by project type. Download Forms- Agricultural Land Preservation Policy Form: Once Downloaded Insert Web Application ID, Applicant Legal Name, and Project Title at the top of each form. [Required] Certification must be checked by the appropriate person authorized to represent the applicant. DCNR will restrict funding for activities that will result in the irreversible conversion of “prime agricultural land” to other uses, unless no other feasible alternative exists. By the submission of a Grant Application, applicants certify that the proposed project activities are not in violation of E.O. 2003-2. This questionnaire titled “How Does the State’s Agricultural Land Preservation Policy Apply to Your Project?” has been provided to aid the applicant in the determination of applicability of the E.O. to the project. 12/21/2010 C2P2 Grants Cycle 2011-2012 3 Budget Cash Worksheets: [Required] Budget Non-Cash Worksheets: [Conditional] Use the appropriate worksheet as provided for your project type. Please note that land acquisition projects are cash only while all others permit the use of non-cash values. These values are to be included on your Summary Cost Estimate Form. Use the appropriate worksheet(s) as applicable. These include the following: Worksheet #2 In-House Services Worksheet #3 Equipment Use Worksheet #4 Volunteer Services Worksheet #5 Donations- Professional Services, Materials, Equipment and/or Land Please note that land acquisition projects are cash only while all others permit the use of non-cash values. These values are to be included on your Summary Cost Estimate Form. Certification Page: [Required] Certification must be checked by the appropriate person authorized to represent the applicant. County/Municipal Notification Letters: [Required] [UPLOAD ONLY] The County Planning Agency must be notified of the proposed project to assure that all Land Acquisitions and/or Development projects are in accordance with the short and long-term recreation and conservation objectives and plans for the area. Detailed Budget Form: [Required] Please use the form provided for your project type (Development, Land Acquisition, Planning, and Technical Assistance) and give sufficient detailed budget information. Please refer to the Eligible and Ineligible Grant Project Activities/Costs Policy at http://www.dcnr.state.pa.us/brc/grants/grantpolicies/index.htm Draft Sales Agreement: [Optional] [UPLOAD ONLY] For Land Acquisition projects and Development-Land Donation, only. If available please provide. Grant Agreement Signature Page: [Required] Download the form, sign it in blue ink, and mail it to the Grants Customer Service Center. Grant Agreement Signature Page Inst.: [Optional] Detailed instructions for the Grant Agreement Signature Page. Do not upload. Letters of Commitment: [Conditional] [UPLOAD ONLY] Letters of Commitment from ALL project partners pledging Non-Cash and/or Cash support MUST be uploaded. PNDI Receipt: [Conditional] [UPLOAD ONLY] Please go the PNHP Website and select the PNDI Project Planning and Review link in the left navigation area. For additional information, see FAQ for PNDI on the Community Conservation Partnership Program webpage. PNDI Receipt required for all projects except the following Planning projects: Comprehensive Recreation, Park and Open Space Plan, Feasibility Study for rehab projects, County Greenway and Open Space Network Plan, Municipal Greenway and Open Space Network Plan, or Rivers Conservation Plan. In addition, PNDI may not be applicable to all Partnerships Projects. 12/21/2010 C2P2 Grants Cycle 2011-2012 4 Primary Appraisal: [Required] [UPLOAD ONLY] You are reminded to review the Land Acquisition section to confirm eligibility requirements for the proposed project. Required for Land Acquisition and for Development-Land Donation, projects only. Ten (10) megabytes (MB) per attachment. (More than one attachment may be necessary to upload the entire file.) Failure to submit an appraisal or provide one in the proper format will delay or prevent an application from being selected for funding. The Appraisal must be prepared by state certified General Real Estate Appraiser. Project Budget Cost Estimate Inst.: [Optional] Detailed instructions for the Project Budget Cost Estimate Form. These instructions can be viewed and downloaded. Do not upload. Project Narrative/ Selection Criteria: [Required] Complete the Project Narrative/Selection Criteria Form, focusing on the following items. 1. Project Benefits 2. Keystone, Green and Sustainable Project Principles 3. Project Schedule/Timeline 4. Project Partners 5. DCNR’s Action Plan Instructions can be viewed and downloaded from this section of the application. Please note: Your responses are limited to (3) pages. Proj. Narrative/ Selection Criteria Inst.: [Optional] Detailed instructions for the Project Narrative/Selection Criteria Form. Do not upload. Property Survey or Tax Map: [Required] [UPLOAD ONLY] For Development projects, only. Identify the parcels to be acquired and/or eased. Public Value and Use Form: [Required] For Land Acquisition projects and Development-Land Donation, only. Download the form, sign it, scan back into the computer, and upload into eGrants. Please keep the original signed form for your records. Your responses are limited to (2) pages. Resolution: [Required] For multi-municipal projects, attach resolutions from each participating municipality. Download the form, sign it, scan back into the computer, and upload into eGrants. Please keep the original signed form for your records. Resolution Page Instructions: [Optional] Detailed instructions for the Resolution Page Form. Do not upload. Site Development 12/21/2010 C2P2 Grants Cycle 2011-2012 5 Drawing: [Conditional] [UPLOAD or MAIL IN] Applicable to Development projects only. If you have a digital copy we prefer you upload the document. Otherwise you may mail it in along with the Grant Agreement Signature Page. Site Development Drawing Checklist: [Conditional] Applicable to Development projects only. Use this checklist as your guide to completing the Site Development Drawing which must be uploaded as part of this application. Site Photos: [Optional] [UPLOAD ONLY] As applicable. Summary Cost Estimate Form: [Required] Information in the Detailed Budget Form in addition to the worksheets should be used to support the information provided in the Summary Cost Estimate Form. Survey or Tax Map/ Public Access Map: [Required] [UPLOAD ONLY] For Land Acquisition and Development- Land Donation projects, only. Identify the parcels to be acquired and/or eased. Trail Supplement Information Form: [Conditional] If you designate your project as a trail project – Development, Land Acquisition, Planning or Equipment Purchase, you will be required to complete this form. Download the form, sign the first page, scan back into the computer, and upload into eGrants. Please keep the original signed form for your records. Upload Attachments- Locate the forms/worksheets you completed and saved on your PC, then click on Upload this file. Upload your files one at a time. Insert Web Application ID, Applicant Legal Name, and Project Title at the top of each form. Agricultural Land Preservation Policy Form: [Required] Budget Cash Worksheets: [Required] Budget Non-Cash Worksheets: [Conditional] Certification Page: [Required] County/Municipal Notification Letters: [Required] Detailed Budget Form: [Required] Draft Sales Agreement: [Optional] Grant Agreement Signature Page: [Required] Letters of Commitment: [Conditional] PNDI Receipt: [Conditional] 12/21/2010 To be mailed in separately. C2P2 Grants Cycle 2011-2012 6 Primary Appraisal: [Conditional] Project Narrative/ Selection Criteria: [Required] Property Survey or Tax Map: [Required] Public Value and Use Form: [Required] Resolution: [Required] Site Development Drawing: [Conditional] Site Photos: [Optional] Summary Cost Estimate Form: [Required] Survey or Tax Map/ Public Access Map: [Required] Trail Supplement Information Form: [Conditional] CERTIFICATION CERTIFICATION - Authorized Organizational Representative (AOR) Enter contact information for person authorized to sign this application. Submit Application: Ensure all information is complete and accurate. The Certification box must be checked. Click the Submit this Application button. Certification Confirmation page: You will receive this page once you successfully submit the application. If your application is not complete you will have to resolve any issues before you can submit the application. Note: make sure you have enough time to make changes and submit your application before the application closing time; or you will be locked out of the system and be unable to submit. Mail a copy of the Confirmation Cover Sheet with any documents you are mailing in to the Grants Customer Service Center. If you have any problems with the eGrant application please contact the Grants Customer Service Center at 1-800-326-7734. Grants Customer Service Center Address PA Department of Conservation and Natural Resources Attn: Grants Customer Service Center th 400 Market Street, 6 Floor Harrisburg, PA 17105-8767 12/21/2010 C2P2 Grants Cycle 2011-2012 7

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