Okaloosa County BOCC — January 19, 2016 — SF424 Chairman signature needed

1-800-518-4726 WORKSPACE FORM SUPPORT@GRANTS.GOV This Workspace form is one of the forms you need to complete prior to submitting your Application Package. This form can be completed in its entirety offline using Adobe Reader. You can save your form by clicking the "Save" button and see any errors by clicking the “Check For Errors” button. In-progress and completed forms can be uploaded at any time to Grants.gov using the Workspace feature. When you open a form, required fields are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a field, you will receive an error message. Additional instructions and FAQs about the Application Package can be found in the Grants.gov Applicants tab. OPPORTUNITY & PACKAGE DETAILS: Opportunity Number: OVW-2016-9003 Opportunity Title: OVW FY 2016 Justice for Families Program Opportunity Package ID: PKG00219779 CFDA Number: 16.021 CFDA Description: Justice Systems Response to Families Competition ID: OVW-2016-9003 Competition Title: OVW-2016-9003 Opening Date: 11/24/2015 Closing Date: 01/21/2016 Agency: Office on Violence Against Women Contact Information: Carrie Mitchell E-mail: OVW.JFF@usdoj.gov Phone: 202-307-6026 APPLICANT & WORKSPACE DETAILS: Workspace ID: WS00002018 Application Filing Name: Okaloosa County Board of County Commissioners DUNS: 6132776490000 Organization: OKALOOSA, COUNTY OF Form Name: Application for Federal Assistance (SF-424) Form Version: 2.1 Requirement: Mandatory Upload Count: 0 Download Date: 01/06/2016 Form State: Error(s) FORM ACTIONS:  OMB Number: 4040-0004 Expiration Date: 8/31/2016 Application for Federal Assistance SF-424 * 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s): Preapplication New Application Continuation * Other (Specify): Changed/Corrected Application Revision * 3. Date Received: 4. Applicant Identifier: Completed by Grants.gov upon submission. 5a. Federal Entity Identifier: 5b. Federal Award Identifier: State Use Only: 6. Date Received by State: 7. State Application Identifier: 8. APPLICANT INFORMATION: * a. Legal Name: Okaloosa County Board of County Commissioners * b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS: 59-6000765 6132776490000 d. Address: * Street1: c/o Contract and Grants Street2: 101 E James Lee Blvd, Room 104 * City: Crestview County/Parish: Okaloosa * State: FL: Florida Province: * Country: USA: UNITED STATES * Zip / Postal Code: 32536-3501 e