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Ected Application * If Revision, select appropriate letter(s): New Revision * 3. Date Received: * Other (Specify): 4. Applicant Identifier: Completed by Grants.gov upon submission. 5a. Federal Entity Identifier: * 5b. Federal Award Identifier: State Use Only: 6. Date Received by State: 7. State Application Identifier: 8. APPLICANT INFORMATION: * a. Legal Name: * b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS: d. Address: * Street1: Street2: * City: C.

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