Fiscal Year 2011Federal Appropriations Request
Representative Rick Larsen (WA-02)
Please Fill out One Questionnaire for each request
You must fill out this questionnaire in order for Representative Larsen to consider the submittal of your request. Attach separate sheets or materials as needed. Please include a letter to Congressman Larsen, detailing the need for your request, as well as any additional letters of support from agencies or organizations you are working with. As the House Appropriations Committee may haveadditional requirements for all appropriation requests, further documentation may be needed at a later date. Be advised that in order to comply with new House of Representatives rules for public transparency, we are also asking that you include a justification for your request that could be added to Congressman Larsen’s website at a later date. We reserve the right to make modifications to the justification if appropriate.
PROJECT QUESTIONNAIRE
1. Provide the exact name and location of your organization, along with the name, title, address, phone number, and e-mail of the lead contact at the organization.
2. Provide name and contact information for DC representation (if any).
3. Provide the project title (name) and a brief description of the activity or project for which funding is requested. (Please limit description to 2 or 3 paragraphs maximum. If you feel that further explanation is necessary, please attach additional documentation.).
4. This project is priority ___ of ___ total requests for your organization.
5. Which Appropriations bill would this project be considered for?
A. Agency/Bureau (i.e. FBI; Corps of Engineers; USFS; ARS; etc.):
B. Requested Account (i.e. Buildings and Facilities; Aviation Safety; Capital Improvements, etc.):
- What is the total project cost?
A. What is the amount you are requesting from the Subcommittee for FY 2011?
- Please note that the Subcommittee, in general, provides only one year of funding at a time. If your request involves more than one year, please indicate the one-year amount.
B. Include a break down of the requested funding: (For example, salary $40,000; computers $3,000 etc.)
7. A. Are other secured funding sources contributing to this project or activity?
B. What amount does each of these funding sources contribute?
- Please list the amount of money this project has received over the past four Federal appropriations cycles (if any):
- Please provide a succinct explanation of why the requested funding is a valuable use of taxpayer dollars. Please be advised that your justification may be posted on Representative Larsen’s website in accordance with House Rules for public transparency and shared with the media.
- When completed, please email this form to and include in the subject line of the email what appropriations bill you are requesting from.