Form Program Informatio Program Informatio Program Information Sheet

IMLS PROGRAM INFORMATION SHEET
PLEASE NOTE: Information contained within this form may be made publicly available.
1. Applicant Information
a. Legal Name as it appears in SAM.gov (5a from SF424S):
b. Organizational D-U-N-S® Number (5f from SF424S):
c. Expiration date of your SAM.gov registration
d. Organizational Unit Name (if different from Legal
Name):
e. Organizational Unit Address (if different from Legal Name address)
Street 1
Street 2
City

County

Please Select Your State

State

Zip+4/Postal Code

f. Organizational Unit Type (check one):
Academic Library
Aquarium

+LVWRULFDOO\%ODFN&ROOHJHRU
8QLYHUVLW\+%&8)

Research Library/Archives

History Museum

School Library or School District
applying on behalf of a School
Library or Libraries

Library Association

Science/Technology Museum

Library Consortium

Special Library

Museum Library
Museum Services Organization/
Association

Specialized Museum**

Digital Library

Native American Tribe/Alaska Native/
Native Hawaiian Organization

State Museum Agency

Four-year College

Natural History/Anthropology Museum

State Museum Library

General Museum*

Nature Center

Zoo

Graduate School of Library and
Information Science

Planetarium

Institution of higher education other than
listed above

Historic House/Site

Public Library

Other

Arboretum/Botanical Garden
Art Museum
Children’s/Youth Museum
Community College

State Library

* A museum with collections representing two or more disciplines equally (e.g., art and history)
** A museum with collections limited to one narrowly defined discipline (e.g., textiles, maritime, ethnic group)

OMB Control #: 3137-0092, Expiration date: 7/31/2018

OMB-CLR-F-0031

IMLS PROGRAM INFORMATION SHEET
2. Organizational Financial Information
a. Please complete the following table for the Organizational Unit for the three most recently completed fiscal years.
Fiscal Year

Total Revenue*

Total Expenses**

Surplus or Deficit

$0

* For nonprofit tax filers, Total Revenue can be found on Line 12 of the IRS Form 990.
** For nonprofit tax filers, Total Expenses can be found on Line 18 of the IRS Form 990.
b. If you had a budget surplus or deficit greater than 10% of your annual operating budget for two or more of the three
fiscal years listed above, please explain the circumstances of this surplus or deficit in the box below.

c. Were there any material weaknesses identified in your prior year’s audit report?
Yes
No
Not applicable
A material weakness is a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable
possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and corrected
on a timely basis.

If yes, please explain.

d. Has your organization had an A-133 audit in the past three years?
Yes

No

OMB Control #: 3137-0092, Expiration date: 7/31/2018

OMB-CLR-F-0031

IMLS PROGRAM INFORMATION SHEET
Refer to the Notice of Funding Opportunity for descriptions of these options and instructions for how to make selections.
3. Grant Program
a. Laura Bush 21st Century Librarian Program
1. Select one:
Planning
National Forum
Project
Research in Service to Practice
2. Select one:
Pre-professional
Masters-level
Doctoral-level
Early Career Development
Continuing Education
3. Select one
Lifelong Learning
Community Catalysts
National Digital Infrastructures and
Initiatives
b. National Leadership Grants for Libraries
1. Select one:
Planning
National Forum
Project
Research in Service to Practice
2. Select one:
Lifelong Learning
Community Catalysts
National Digital Infrastructures and
Initiatives
c. Native American Basic
d. Native American Library Services Enhancement
1. Select one:
Preservation and Revitalization
Educational Programming
Digital Services
e. Native Hawaiian Library Services
1. Select one:
Preservation and Revitalization
Educational Programming
Digital Services

f. Accelerating Promising Practice for Small Libraries
g. Museums for America
1. Select one:
Lifelong Learning
Community Anchors and Catalysts
Collections Stewardship and Public Access

h. Museums Empowered
1. Select one:
Digital Technology
Diversity and Inclusion
Evaluation
Organizational Management
i. Inspire! Grants for Small Museums
1. Select one:
Lifelong Learning
Community Anchors and Catalysts
Collections Stewardship and Public Access
j. National Leadership Grants for Museums
1. Select one:
Collections Care and Public Access
Data, Analysis, and Assessment
Digital Platforms and Applications
Diversity and Inclusion
Professional Development
2. Select one:
Non-research, $50,000–$1,000,000
Research, $50,000–$1,000,000

Rapid prototyping, $5,000–$50,000
k. Museum Grants for African American History and Culture
1. Select one:
$5,000–$50,000
$50,001–$250,000

l. Native American/Native Hawaiian Museum Services

4. Agency Level Goals
Select the IMLS Agency-Level Goal that best aligns with your proposed project.
Promote Lifelong Learning
Build Capacity
Increase Public Access
Please review in the NOFO the specific performance measure statement choices and the information you will be required
to collect for each in Promote Lifelong Learning and Build Capacity projects.
OMB Control #: 3137-0092, Expiration date: 7/31/2018

OMB-CLR-F-0031

IMLS PROGRAM INFORMATION SHEET
5. Funding Request
a. IMLS funds requested:

b. Cost share amount:

6. Population Served
Please select the target population(s) served by the proposed project:
General Population

Museum and/or Library Professionals

Early Childhood/Preschool (0-5 years)

Native Americans/Alaska Natives/Native Hawaiians

Middle Childhood/Primary School (6-12 years)

People with Mental or Physical Challenges/Disabilities

Adolescents/High School (13-19 years)

People Who Are Low Income/Economically Disadvantaged

Adults

Rural Populations

Aging, Elderly, Senior Citizens (65+ years)

Scholars/Researchers

Ethnic or Racial Minority Populations other than
Native Americans/Native Hawaiians

Unemployed

Families/Intergenerational

Other

Urban Populations

Immigrants/Refugees
Military Families
If other, please specify:
7. Museum Profile (Museum Applicants Only)
a. Is your institution organized on a permanent basis for essentially educational or aesthetic
purposes?
b. Is it your institution either a private not-for-profit organization that has tax-exempt status
under the Internal Revenue Code or a unit of state or local government?
c. Does your institution own or use tangible objects, either animate or inanimate?
d. Does your institution exhibit these objects to the general public at least 120 days a year
through facilities your institution owns or operates?

Yes

No

Yes

No

Yes

No

Yes

No

e. Your institution’s attendance for the 12-month period prior to the application

f. Year your institution was first open and exhibiting to the public:
g. Total number of days your institution was open to the public for the 12-month period prior to application:
h. Does your institution employ at least one professional staff member, or the full-time equivalent,
whether paid or unpaid, who is primarily engaged in the acquisition, care, or exhibition to the
public of tangible objects owned or used by your institution?

Yes

i. Number of full-time paid institution staff:
j. Number of full-time unpaid institution staff:
k. Number of part-time paid institution staff:
l. Number of part-time unpaid institution staff:
OMB Control #: 3137-0092, Expiration date: 7/31/2018

OMB-CLR-F-0031

No

IMLS PROGRAM INFORMATION SHEET
8. Project Elements (Museums for America and Inspire! Grants for Small Museums Only)
Your response to this question will help us match your application to reviewers with appropriate experience. Make your
choice under the project category that you selected in Question 3 (Grant Program).
LIFELONG LEARNING
If you are applying in the Lifelong Learning Project Category, select the primary element that is core to
your proposed project from the list below (check only one):
Interpretation
Adult Programs
Digital Media

K-12 Programs, With Schools

Early Learning

K-12 Programs, Out of School

Exhibitions

Public Programs

Family Programs
COMMUNITY ANCHORS AND CATALYSTS
If you are applying in the Community Anchors and Catalysts Project Category, select the primary element that is core to
your proposed project from the list below (check only one):
Audience Research and Evaluation

Community-Focused Planning Activities

Civic Engagement

Community Outreach/Audience Development

Community-Driven Exhbitions and Progams

Digital Media

COLLECTIONS STEWARDSHIP AND PUBLIC ACCESS
If you are applying in the Collections Stewardship and
Project
Category,
theCategory, select
element
is coreelement
to your that is
Public
Accessselect
Project
thethat
primary
core to your proposed project from the list below (check only one):

Cataloguing, Inventorying, Registration
Collections Information Management

Conservation Treatment
Curation

Collections Planning

Database Management

Conservation Environmental Improvement/Rehousing

Digital Asset Management

Conservation Survey

Digitization

Please identify the material type(s) that will be affected by your project:
Animals, living
Animals, preserved
Architecture
Books and Paper
Electronic Media
Objects

Photographic Materials
Plants, living
Plants, preserved
Sculpture
Textiles
Wooden Artifacts

Paintings

OMB Control #: 3137-0092, Expiration date: 7/31/2018

OMB-CLR-F-0031