Luzerne County ARPA Grant Application

Luzerne County

American Rescue Plan Act Grant Program (ARPA Grant) Application
This application should be completed by all internal and external organizations/departments/businesses applying for ARPA funding with the Luzerne County. Completed applications (including all required attachments) should be submitted online through this portal. Paper submissions, including those by mail, fax or email submission, will not be accepted.

Below are the relevant links, exhibits and other resources to assist in completing the questionnaire. Refer to the email sending this questionnaire for the Exhibits referenced below.

Exhibits

Exhibit A – Eligible Activities (Excerpt from Treasury’s Coronavirus State & Local Fiscal Recovery Funds: Overview of the Final Rule document. Detailed information on allowable projects under this grant). Link: Eligible Activities

Exhibit B – Expenditure Categories (EC) (Excerpt from Treasury’s Coronavirus Compliance & Reporting Guidance Version 5.0 published September 20, 2022.) Review the EC list to determine the appropriate detailed level expenditure category based on the eligible activity identified for the project. Link: Expenditure Categories

Exhibit C - Application (PDF copy of questions. Use as a resource for preparing your organization’s Project Questionnaire). Link: Application

Exhibit D - ARPA Grant Budget Template (Required attachment). Link: ARPA Grant Budget

Form W-9 - Link: Form W-9

Request for Advance/Reimbursement - Link: Request for Advance/Reimbursement

Below are links to resources, guidance, and regulations referenced in the ARPA Application.

Page Name: US Department of the Treasury’s Coronavirus State and Local Fiscal Recovery Funds Page Link: https://home.treasury.gov/policy-issues/coronavirus/assistance-for-state-local-and-tribal-governments/state-and-local-fiscal-recovery-funds

Page Name: 2 CFR 200 Uniform Guidance Subpart E – Cost Principles (This section of the Code of Federal Regulations identifies allowable and unallowable expenses with Federal grant dollars) Link: https://www.ecfr.gov/current/title-2/part-200/subpart-E

Document Name: Treasury’s Coronavirus State & Local Fiscal Recovery Funds: Overview of the Final Rule (Highly Recommended Reading: a detailed summary of the Federal program through which these funds are made available) Link: https://home.treasury.gov/system/files/136/SLFRF-Final-Rule-Overview.pdf

Document Name: Compliance and Reporting Guidance – State and Local Fiscal Recovery Funds (Highly Recommended Reading: a detailed overview of the reporting requirements for this program. The County will require aggregate data from subrecipients to compile reports to the US Department of the Treasury) Link: https://home.treasury.gov/system/files/136/SLFRF-Compliance-and-Reporting-Guidance.pdf

Document Name: Expenditure Categories & Reporting Requirements: Compliance and Reporting Guidance – State and Local Fiscal Recovery Funds Link: https://home.treasury.gov/system/files/136/SLFRF-Final-Rule-Overview.pdf

Page Name: SAM.gov – The System for Award Management (Applicants are STRONGLY encouraged to provide evidence of “Active” status in the System for Award Management. All subrecipients for the ARPA Grant are required to provide this documentation in order to execute a subrecipient grant agreement). Link: www.sam.gov
Section 1. Applicant Information

Please provide the following information for your agency/organization:
Applicant Agency/Organization/Deparment Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Point of Contact
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Federal Identification Number
Organization Information
Agency/Organization Type:*

501(c)(3) NonprofitOther NonprofitSmall BusinessCounty DepartmentLocal Municipality or other Government EntitiyOther
If "Other Nonprofit", enter legal agency/organization type. Otherwise, enter N/A.*
Project/Program Name*
Brief description of proposed project/program (150 character limit)*

0/150
Section 2. Project/Program Objectives

Please respond to the questions below:
General and Programmatic
1. Select the Eligible Use Category that best matches your project/program objective. See SLFRF Overview of the Final Rule (below) for the eligible activity criteria.

1: Public Health2: Negative Economic Impacts (if selected, you MUST also select at least one option in question 1a. )3: Public Health-Negative Economic Impact: Public Sector Capacity5: Infrastructure6: Revenue Replacement7: AdministrativeRequest County to Determine
SLFRF Overview of the Final Rule
1a. If you selected "2: Negative Economic Impacts " in question 1, select at least one of the following subcategories. Otherwise, select N/A.*

Assistance to HouseholdsAssistance to Small BusinessesAssistance to NonprofitsAid to Impacted Industries
2. Please describe, in detail, the proposed project/program and how it will support Luzerne County in its efforts to respond to and recover from the COVID-19 public health emergency. Refer to the SLFRF Overview of the Final Rule for more detailed information related to your selected eligible activity. (1000 character limit) *

0/1000
3. Review the SLFRF Overview of the Final Rule document. For the eligible use category you selected in Question 1, provide a detailed narrative describing how your proposed project/program meets the eligibility requirements of the selected category. (1000 character limit)

For example, a County Department proposing to make grants available to disproportionately impacted small business looking to cover costs related to expansion would have selected "Support the COVID-19 public health and economic response" in question 1 and "Assistance to Small Businesses" in question 1a. The following information should be included in their narrative:

a. Information that confirms that businesses supported through the proposed project will have no more than 500 employees, or if applicable, the size standard in number of employees established by the Administrator of the Small Business Administration for the industry in which the business concern or organization operates, and are a small business concern as defined in section 3 of the Small Business Act (which includes, among other requirements, that the business is independently owned and operated and is not dominant in its field of operation)

b. Criteria for determination that the Small Business is considered a Disproportionately Impacted Small Business (Small businesses operating in Qualified Census Tracts, Small businesses operated by Tribal governments or on Tribal lands, small businesses operating in the U.S. territories
Enter your response below:*

0/1000
4. Will your proposed project/program use these grant funds to support an evidence-based intervention (evidence-based refers to interventions that have been tested, proven effective and are backed by reputable research and studies – See Appendices 1 and 2 of the State and Local Fiscal Recovery Funds Compliance and Reporting Guidance - below)?*

YesNo
State and Local Fiscal Recovery Funds Compliance and Reporting Guidance
4a. Please briefly explain your response while being as specific as possible. (1000 character limit)*

0/1000
5. Please describe, in detail, how your agency/organization intends to measure the impact of its proposed project/program. (1000 character limit)*
6. What is the location (address and neighborhood) of your proposed project/program? Be as specific as possible. Preference may be given to those projects that are shown to benefit the Luzerne County residents and community partners. (150 character limit)*

0/150
7. Is this a new, existing, or modified/expanded project/program?*

NewExistingModified/Expanded
8. Will this project/program benefit any minority populations that have been impacted or disproportionately impacted by COVID19?*

YesNo
8a. Briefly explain your response while being as specific as possible. (500 character limit)*

0/500
9. Does this project/program reduce adverse climate impacts and/or promote environmental sustainability? *

YesNo
9a. Please briefly explain your response while being as specific as possible. (500 character limit)*

0/500
10. As an attachment, please provide a proposed project/program timeline from inception to completion. All ARPA grant funds distributed by the County must be obligated by December 31, 2024. The timeline must be uploaded for your application to be considered complete.*

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Budget/Funding
1. How much funding is your agency/organization requesting? *
Enter dollar amount in the form of a number value - for example 100000 for one hundred thousand dollars. Please do not enter dollar signs, commas, or punctuation as this field will only accept number values.
1. Complete and upload your proposed project/program budget. The budget must be uploaded for your application to be considered complete.*

Please upload the budget as a Microsoft Excel Spreadsheet.
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2. But for receiving this funding, would your agency/organization be able to implement this proposed project/program?*

YesNo
2a. Please briefly explain your response while being as specific as possible. (500 character limit)*

0/500
Required Documentation/Application Checklist

Use this checklist as a guide to ensure that your application is complete. Note: You are not required to check off each document for successful application submission, but you must actually submit all required documents for your application to be considered "complete".
For Internal Projects, upload the following documents with the ARPA application.

Complete and Signed ARPA Grant ApplicationDetailed budget for the proposed project/programA proposed project/program timeline (funds must be obligated by December 31, 2024)Any additional relevant documents regarding the project - Upload belowOther
Upload any other relevant documents here (optional).

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For Small Businesses, upload the following documents with the ARPA application.

Complete and Signed ARPA Grant ApplicationDetailed budget for the proposed project/programA proposed project/program timeline (funds must be obligated by December 31, 2024)Any additional relevant documents regarding the project - Upload belowCertificate of Good StandingPrevious 2 Years Federal Business Tax ReturnForm W-9Request for Advance/Reimbursement FormEvidence of Active SAM statusFor capital projects, quotes, contracts, and other relevant documentsOther
Upload any other relevant documents here (optional).

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For Non Profits, upload the following documents with the ARPA application.

Complete and Signed ARPA Grant ApplicationDetailed budget for the proposed project/programA proposed project/program timeline (funds must be obligated by December 31, 2024)Any additional relevant documents regarding the project - Upload belowCertificate of Good StandingPrevious 2 Years Form 990 Tax ReturnRequest for Advance/Reimbursement FormEvidence of Active SAM statusVerification of Non Profit StatusFor capital projects, quotes, contracts, and other relevant documents
Upload any other relevant documents here (optional).

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APPLICATION CERTIFICATION AND SIGNATURE PAGE
THE APPLICANT CERTIFIES TO THE BEST OF ITS KNOWLEDGE:
1. The information submitted to Luzerne County in this application, including required supporting documentation, is true and correct.
2. The applicant is in compliance with all applicable federal, state, and local laws, regulations, ordinances, and orders and must report any and all noncompliance with said laws that could have an adverse material impact on the business. Adverse material impact includes lawsuits, criminal or civil actions, bankruptcy proceedings, or regulatory action by a governmental entity.
3. The applicant has not received other federal, state, or local assistance for the same expenses as submitted in this application.
4. The applicant is current on all federal, state, and local (i.e., property taxes) taxes.
Authorized Official Name, Title*
Authorized Official Signature*

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

Luzerne County

Section 1. Applicant Information

Primary Point of Contact

Organization Information

Section 2. Project/Program Objectives

General and Programmatic

Budget/Funding

Required Documentation/Application Checklist

APPLICATION CERTIFICATION AND SIGNATURE PAGE