Pottawatomie County ARPA Water/Sewer/Broadband Infrastructure Request Form

This form is to help identify needs in Pottawatomie County for water, sewer, and broadband infrastructure, particularly those arising from the pandemic and possible solutions to address those needs for ARPA Coronavirus State and Local Fiscal Recovery funds apportioned to Pottawatomie County.

The American Rescue Plan Act (ARPA) of 2021 provides relief funds to state, local, and Tribal governments to enable them to continue to support the public health response and lay the foundation for a strong and equitable economic recovery. Pottawatomie County recognizes that certain needs in water, sewer, and broadband infrastructure were highlighted in responding to the public health emergency. Pottawatomie County is requesting feedback from the community on the needs facing these areas of service due to the pandemic. Responses must be submitted by April 15, 2022.

These funds are limited, one-time use monies and must comply with guidance from the U.S. Treasury. Not all requests will be eligible and not all requests will be funded. Any requests for which funds are awarded will only be paid upon completion of the project(s).

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* 1. Contact Information Required

Name

Requesting Entity

Address

City/Town

Email Address

Phone Number

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* 2. Requesting Entity Type

501(c)(3)

Governmental Entity

Other (please specify)

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* 3. Requesting Entity's Purpose or Mission

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* 4. Briefly describe the reason funds are being requested.

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* 5. How does this request address that harm and how would the funds support a strong and equitable recovery from the COVID-19 pandemic?

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* 6. Please provide any data to support this request and describe outcomes that will be monitored and measured from the use of these funds.

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* 7. Amount Requested and Proposed Budget (Whole Numbers Only)

Requested Amount

Proposed Total Project Budget

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* 8. Relevant Expenditure Category as found in Appendix 1 of the Compliance and Reporting Guidance found at: https://home.treasury.gov/system/files/136/SLFRF-Compliance-and-Reporting-Guidance.pdf

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* 9. Provide a description of the amount of all federal loans, grants, or aid provided for COVID-19-related purchases including from the Coronavirus Aid, Relief and Economic Security (CARES) Act, Public Law 116-136, or other similarly purposed federal act for which the applicant has received.

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* 10. If required by the County Commissioners to provide matching funds for any potential award, does the entity have funds to match the requested amount?

Yes, the amount of the request in full is available for matching

No, but 75-99% of the request is available for matching

No, but 50-75% of the request is available for matching

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* 11. Upload your organizational document(s). If your entity is a 501(c)(3), upload your IRS Determination Letter. Please compile all relevant documents into one file for the upload.

PDF, DOC, DOCX file types only.

Choose File

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* 12. Upload your last 2 fiscal years of financial information [or Form 990 if your entity is a 501(c)(3)].

PDF, DOC, DOCX file types only.

Choose File

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* 13. Supporting Documentation: upload any supporting documentation for answers to 1-8 above.

PDF, DOC, DOCX file types only.

Choose File

Thank you for completing this form. To finish this request after all questions are answered, please use the "DONE" button below. We will be in contact with a determination or a request for additional information.