Appropriations Request Form
Fiscal Year 2011
Congressman Sam Johnson
1211 Longworth House Office Building
Washington, DC20515
(202) 225-4201
Application Deadline: February 15, 2010
FY 2011 requests will not be accepted without a completed application form for each project submitted. With 435 Members of Congress making requests the appropriations process can be intensely competitive. Your completion of a request does not in any way guarantee the Congressman’s support nor its funding. In addition, please also include a Recipient Request Certification Form (per Republican conference rules), a detailed finance plan, a “white paper” and a completed Committee form. Individual subcommittee deadline requests may vary.
*Be advised that all information submitted may potentially be subject to full public disclosure.
Please fill out this form (typed) to the best of your ability. All answers must be kept under 150 words. Please return all required information to Congressman Johnson’s Office BEFORE February 15, 2010. Send to . If you are submitting more than one project, please note that each project must have its own request form and a different priority number.
Request Information:
Request Type:
Department/Agency/Service Component(if known; example: Dept. of Justice):
Division/Bureau/Account and Account Number (if known; example: FBI, Office of Justice Programs):
Project Name:
Priority(if submitting multiple requests, 1 is the highest priority number):
Intended Recipient/Grantee:(include all available contact information):
Point of Contact:(name, title, address, phone number, alternate phone number, cell phone number, and email address)
Location :( address, city, state, zip)
Project Description/Purpose:
New Project: Yes / No
Where is this authorized?
(Statutory citation, if known)
Request Amount: $
Prior Funding Awarded:(years and amounts)
Is this in the President’s budget request (if so, at what $ amount)?
Net Change to the FY10 President’s budget:
Did you make a similar request last year (if so, what was your request)?
Non-federal cost share:
Current status of project for which request is made:
Background/justification for request:
Please list all locations that would be impacted by this request (in addition, please include the percentage and dollar amount of funding that each location is expected to receive):
Number of jobs within the 3rd District that will be affected by FY2011 funding:
Have you contacted any other members of Congress, specifically, the Texas Delegation (either House or Senate) regarding this request? Please specify:
This project would most appropriately be funded under which one of the following Appropriations Bills:
_____ Agriculture
_____ Commerce, Justice, Science
_____ Defense
_____ Energy and Water
_____ Financial Services
_____ Homeland Security
_____ Interior and Environment
_____ Labor, Health and Human Services, Education
_____ Military Construction – Veterans’ Affairs
_____ State Department, Foreign Operations
_____ Transportation, Housing and Urban Development
If one of the following sections corresponds with the bill you selected, please fill out that section only. If the bill you selected does not have a corresponding section below, please disregard this section.
Agriculture:
What is the anticipated benefit and/or impact of the project?
Defense:
2011 Budget Line Item Title:
Benefit to DoD:
DoD Supporting Program Manager/Agency contact information:
Identification (as appropriate):
RDT&E (R-1 Line #)Procurement (P-1 Line #)MilCon (Project #)
Bill and/or Report Language:
Energy and Water:
Corps of Engineers District:
Interior and Environment:
Which account is funding coming from:
If it is a STAG request (water / wastewater only) then answer the following questions:
Is preliminary planning and engineering design completed? YES/ NO
What is the total cost of the project based on facilities plan on preliminary engineering report?
Does the community have a financing plan certified by an authorized local official demonstrating how it will cover the 45% matching funds? YES/ NO
Is the project on the state’s SRF priority list? YES/ NO
Labor HHS:
Project Budget Breakdown:
Mil Con/VA:
Installation:
Project Number:
(Available from the project’s form DD 1391)
Is this a request for design funding only?
Transportation:
How much of this request can be spent in FY11?
If this is a highway, transit, rail, or aviation request, did you check eligibility with the state DOT, FTA, FRA, or FAA:
If yes, did the State DOT, FTA, FRA, or FAA indicate the project is eligible under the account requested?
If this is an FHWA request, is the project considered by the state and/or regional transportation officials as critical to their needs?
If this is a highway request, is the project on the state’s transportation improvement plan?
Please include a letter of support from these officials, and if you cannot, please explain.
* Please remember to email this completed request form back to our office BEFORE February 15, 2010. Send to . If you need additional information, please do not hesitate to contact Mark Williams at (202) 225-4201.
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