U.S. Department of Education
Washington, D.C. 20202-5335
APPLICATION FOR GRANTS
UNDER THE
Impact Aid Section 8002, FY 2017 Application Package
CFDA # 84.041A
Impact Aid # 430807 -- Version # 1
OMB No. 1810-0036, Expiration Date: 08/31/2016
Closing Date: 02/01/2016 11:59:00 PM
Impact Aid # 430807 -- Version # 1
Table of Contents
Sl#
Title
1.
Impact Aid, Sec. 8002 Cover Page ---------------------------------------------------------------------------------------------------------------------
3
2.
Impact Aid, Sec. 8002 Assurances ---------------------------------------------------------------------------------------------------------------------
4
3.
Impact Aid, Sec. 8002 Table 1. Eligible Federal Property in the Local Educational Agency ----------------------------------------
5
4.
Impact Aid, Sec. 8002 Table 2. Federal Revenue From Eligible Federal Property -----------------------------------------------------
6
5.
Impact Aid, Sec. 8002 Table 3. Assessed Value of Taxable Real Property in the LEA -----------------------------------------------
7
6.
Impact Aid, Sec. 8002 Verification Documentation -----------------------------------------------------------------------------------------------
8
7.
Verification_Document_2017_Impact_Aid_App_Section_7002_Swain_Cnty_Schools.pdf -----------------------------------------
9
8.
Impact Aid, Sec. 8002 Table 4. Tax Levy Information --------------------------------------------------------------------------------------------
10
Page 2
Page#
Final Filing Date: 02/01/2016
Applicants must submit complete
applications on or before this filing
deadline to receive full payments. See
the instructions for further information.
Form Approved:
- OMB number 1810-0036
- Expiration date: 02/29/2012
U.S. Department of Education
Impact Aid Program
Washington, DC. 20202-6244
APPLICATION FOR IMPACT AID - SECTION 8002 (Version No. 1 )
Submit an original and 1 copy to the Impact Aid Program.
Send 1 copy to the State Educational Agency (SEA) using the attached transmittal form.
ORIGINAL APPLICATION:[x]
AMENDMENT: [ ]
DUNS NUMBER
079069696
IMPACT AID NUMBER
43-NC-2017-0807
PR/AWARD NUMBER
APPLICANT NAME :
Swain County Board of Education
CONTACT PERSON NAME:
Robert S Pattillo
STREET/P.O.BOX:
PO Box 2340
TITLE:
Superintendent
CITY:
Bryson City
PHONE:
(828)488-3129
COUNTY :
Swain
FAX:
(828)488-8510
STATE:
NC
E-MAIL:
[email protected]
ZIP:
28713 ????? Zip+4:
[ ] Check if the number of acres of any eligible 8002 property have changed since the last filing for impact aid funding. *
[ ] Check if the applicant's boundaries have changed since the last filing for impact aid funding. *
* If you check either of these boxes, the Impact Aid Program will contact you to request additional information.
I certify that I have read the statements contained in this application and that these statements and all of the data included in this application are, to the best of my knowledge and belief, true,
complete and correct. I certify that I am authorized to make the representations and commitments in this application, for and on behalf of the applicant, and otherwise to act as the applicant's
authorized representative in submitting this application for funding under section 8002 of the Impact Aid Program (Title VIII of the Elementary and Secondary Education Act). I declare that the
applicant will mail a complete copy of this application to the SEA at the same time that it mails this application to the U.S. Department of Education.
NAME AND TITLE OF AUTHORIZED REPRESENTATIVE (Please type or print.)
SIGNATURE
Page 3
DATE
IMPACT AID PROGRAM ASSURANCES AND CERTIFICATIONS (Version No. 1 )
Applicant Name: Swain County Board of Education
Impact Aid Number: 43-NC-2017-0807
School Year: 2015 - 2016
The applicant hereby declares that it has filed the following assurances and certifications covering the Impact Aid Program with the U.S. Department of Education, and, as
of the date of the signature below, reaffirms and incorporates by reference those assurances and certifications in this Impact Aid application.* The applicant certifies that no
circumstances affecting the validity of the following assurances have changed since their previous filing:
i. As applicable, the assurances in OMB Standard Form 424B (Assurances for Non-Construction Programs), relating to legal authority to apply for assistance; access to
records; conflict of interest; merit systems; nondiscrimination; Hatch Act provisions; labor standards; flood insurance; environmental standards; wild and scenic river systems;
historic preservation; protection of human subjects; animal welfare; lead-based paint; Single Audit Act; and general agreement to comply with all Federal laws, executive
orders and regulations;
ii. The certification regarding lobbying in ED Form 80-0013; and
iii. With respect to the Certification Regarding Lobbying, the LEA recertifies that no Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of Congress, or an employee of a Member of Congress, in connection with the making or renewal of Federal grants under this
program; that the LEA will complete and submit Standard Form LLL "Disclosure Form to Report Lobbying," when required (34 CFR Part 82, Appendix B); and that the LEA
will require the full certification, as set forth in 34 CFR Part 82, Appendix A, in the award documents for all subawards at all tiers.
The LEA further assures that:
i. It is a local educational agency that was created and authorized to operate schools, has administrative control and direction of free public education in the school districts,
and that it may legally accept and disburse Federal funds to aid in financing its expenditures;
ii. It will comply with all applicable statutes, regulations, and requirements concerning this grant, including requirements of the Impact Aid law (Title VIII of the ESEA), the
program regulations (34 CFR Part 222), and program administrative requirements;
iii. It is hereby advised that, under section 8011 of the Impact Aid law, it is entitled to request an administrative hearing on, and/or review or reconsideration of, any action of
the Department under the Impact Aid law that adversely affects or aggrieves the applicant; any such requests are governed by the regulations in 34 CFR Part 222, Subpart
J. Any request for a hearing, review or reconsideration under 34 CFR Part 222, Subpart J, must be made in writing and submitted within 60 calendar days from the date of
the applicant's notice (receipt) of the adverse action to: Director, Impact Aid Program, United States Department of Education, 400 Maryland Ave., SW, Washington, D.C.
20202-6244.
*If the applicant is applying for Impact Aid assistance for the first time, the applicant also must file with the Impact Aid Program by the filing deadline the following assurances and
certification that it can obtain from the IAP: OMB Standard Form 424B (Assurances for Non-Construction Programs) and ED Form 80-0013 (certification regarding lobbying).
Robert S Pattillo
Superintendent
Name and Title of Authorized Certifying Representative
______________________________________________________ ___________________
Signature
Date
Page 4
OMB No. 1810-0036 Exp. 02/29/2012
Table 1. Tax Assessor's Valuation of Section 8002-Eligible Federal Property (Version No. 1 )
Applicant Name: Swain County Board of Education
Impact Aid Number: 43-NC-2017-0807
School Year: 2015 - 2016
Instructions: List all Section 8002-eligible Federal property in the LEA. When the eligible federal property is located in more than one jurisdiction, enter the total number of acres in each jurisdiction. In
column 1, enter the name of the Section 8002-eligible Federal property. In column 2, enter the name of the corresponding taxing jurisdiction. In column 3, enter the number of acres associated with and
approved as eligible federal acres for the purposes of the Impact Aid Program.
(Col. 1)
Name of Section 8002-Eligible Federal Property
(Generally, real property to which the Federal
Government acquired ownership on or after 1939)
(Col. 2)
Taxing Jurisdiction
(Col. 3)
Number of Section 8002-Eligible Acres
NEW25590
US Forest Service
Bryson City NC
County: Swain
22229
NEW25591
National Park Service
Bryson City NC
County: Swain
217451
NEW26205
Tennessee Valley Authority
Bryson City NC
County: Swain
7337
Total number of section 8002-Eligible Federal Acres
(If federal Impact Aid Program Section 8002-eligible acres total has changed from last year's submission, provide an explanation and attach/upload official documentation for the change.)
Explanation for the Change
Page 5
247017
OMB number: 1810-0036 Expiration date: 02/29/2012
Table 2. Revenue from Eligible Federal Property (Version No. 1 )
Applicant Name: Swain County Board of Education
Impact Aid Number: 43-NC-2017-0807
School Year: 2015 - 2016
Instructions: List all revenue from Federal and non-Federal sources during the second preceding fiscal year ( 2014 - 2015 ) from activities associated with section 8002-eligible Federal property. If revenue
is from Federal programs, provide the name of each Federal program and the name of the Federal agency responsible for administering that program. If only a portion of the Federal property generating
the revenue is eligible under section 8002, prorate the revenue to reflect the share attributable to the section 8002-elgible property. For example, if the LEA has 10,000 acres of U.S. Forest Service property
that generated $20,000 in timber revenues, but only 2,000 acres are eligible under section 8002, the LEA should report one-fifth (20 percent) of the total, or $4,000, as revenue associated with section 8002eligible Federal property. Do not report Impact Aid revenue or receipts from other U.S. Department of Education programs on this table.
(Col. 1)
Source of Revenue (If Federal, also List Federal Agency and Program)
(Col. 2)
Funds Received During Fiscal Year
2014 - 2015
$
USFS Timber Receipts
Total $
Page 6
36797.22
36797.22
OMB number: 1810-0036 Expiration date: 02/29/2012
Table 3. Total Acreage and Taxable Value in the Local Educational Agency (Version No. 1 )
Applicant Name: Swain County Board of Education
Impact Aid Number: 43-NC-2017-0807
School Year: 2015 - 2016
Instructions: Enter the total acreage located in the local educational agency (LEA) and the total taxable value for the purpose of levying property tax for school purposes for current expenditures of real
property located within the boundaries of the LEA. In column 1, enter the name of the taxing jurisdiction. This information must match the jurisdictions listed on Table 1. In column 2, enter the total acres
located in the LEA boundaries or taxing jurisdiction (including the Section 8002-eligible acres and other non-taxable acres). In Column 3, enter the total taxable value, for the purposes of levying property tax
for school purposes for current expenditures, of the acres listed in column 2, for the prior fiscal year (e.g., use fiscal year 2012-2013 for the FY 2014 application or the specific taxable value as of January
2013). If the LEA is located in more than one taxing jurisdiction (e.g., two counties) or contains more than one taxing jurisdiction (e.g., two townships) , enter the information for each jurisdiction separately.
This page may be copied if more space is needed.
(Col. 1)
Name of Taxing Jurisdiction
(e.g., township name, city name, county name, etc.)
(Col. 2)
Total Acres located in LEA boundaries
(or taxing jurisdiction)
370130
County: Swain
(Col. 3)
Total Taxable Value of
Real Property in the LEA
$
671123720
$
$
$
$
Total
370130.00
Page 7
$
671123720.00
Impact Aid Sec. 8002 Additional Documents (Version No. 1 )
Applicant Name: Swain County Board of Education
Attachment
Title :
File :
Impact Aid Number: 43-NC-2017-0807
Additional Documents
Verification_Document_2017_Impact_Aid_App_Section_7002_Swain_Cnty_Schools.pdf
Page 8
School Year: 2015 - 2016
Page 9
OMB number: 1810-0036 Expiration date: 02/29/2012
Table 4. Tax Levy Information (Version No. 1 )
Applicant Name: Swain County Board of Education
Impact Aid Number: 43-NC-2017-0807
School Year: 2015 - 2016
Instructions: Enter the local real property tax levy, in mills or dollars, that was used to raise funds for current operating expenditures for the local educational agency (LEA) for the prior fiscal year 2015 2016. Enter a single tax rate for school operations expenditures for all types of real property in the jurisdiction. When funds for current operating expenditures for the LEA are raised by more than one taxing
jurisdiction, enter the tax rate information for each additional jurisdiction on a separate line.
(Col. 1)
Name of Taxing Jurisdiction
(e.g., school district name, township name,
city name, county name, etc)
(Col. 2)
Tax Rate for Current Operating Expenditures for Fiscal Year 2015 - 2016
(e.g., 2.5 mills per $1.00 or $2.50 per $1000)
County: Swain
$ 0.36 per $ 100
Page 10
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