Form PIS Supplemenatary PIS Supplemenatary PIS Supplemenatary Information Form

IMLS Supplementary Information Form
PLEASE NOTE: Information contained within this form may be made publicly available.

Applicant Information
The organizational unit performing the activities described in the application
is the same as the legal applicant from the SF-424 Short Organizational form.

o Yes

o No

(NOTE: Which of the shaded panels should display depends on which option is selected from the radio
button list. If the applicant checks 'yes', only display the first panel; if 'no', only the second.)

Option 1 (yes)
Select the institution type that most accurately describes the legal applicant:
Archive
V
(NOTE: This list will be bound to a list of 40 or so categories so the selected text and its corresponding
value will be included in the XML inside the form. I will provide the category values in the DAT.)

Option 2 (no)
Provide the following information for the organizational unit performing the activities described in
the application.
Organizational unit
Address line 1
Address line 2
City
State
Postal code
Country
Select the institution type that most accurately describes the organizational unit:
Archive
V
(NOTE: This list will be bound to the same list of categories as the list above so the selected text and its
corresponding value will be included in the XML inside the form. I will provide the category values in the
DAT.)

Funding Request
IMLS funds requested
Cost share/match amount*
Total costs
* Enter $0 if the budget includes no cost share or match.
(NOTE: This area will be visible for everyone. As with the NEH version of this form, line 3 is calculated, the
sum of lines 1 and 2. Yellow = required.)

Indirect Cost Rate
The budget includes indirect costs:

o Yes

o No

(NOTE: The shaded panel below should display only if the applicant selects the 'Yes' radio button.)

o The indirect cost rate has been negotiated with a federal agency. Select from list below.
List of agencies

V

(NOTE: This list will be bound to a short list of agencies so the selected text and its corresponding
value will be included in the XML inside the form. I will provide the category values in the DAT.)
Rate
Expiration date

o The indirect cost rate does not exceed the 10% de minimis rate
(NOTE: if this radio button is selected, the Rate box above fills with 10%.)
(NOTE: Please make the datatype of Rate a decimal/float rather than an integer, and allow for two
decimal places, e.g. 32.75.)

Population(s) Served
Select the target population(s) to be served by the activities described in the application. Choose all
that apply.

(NOTE: The names and IDs of these categories will be included in the DAT so the selected values will be
included in the XML inside the form.)

E
a
r
l
y

General population

Museum and/or Library professionals

Early childhood/preschool (0-5 years)

Native Americans, Native Hawaiian or
Alaskans

Middle childhood/primary school (6-12 years)
Adolescents/High school (13-19 years)
Adults
Aging, elderly, senior citizens (65+ years)
Ethnic, racial minority populations other
than Native America/Native Hawaiian
Families/Intergenerational
Immigrants/Refugees
Military families

People with mental/physical challenges or
disabilities
People who are low income or economically
disadvantaged
Rural populations
Scholars/Researchers
Unemployed
Urban populations
Other