OFFICE OF CONGRESSMAN BRIAN HIGGINS
FISCAL YEAR 2010 APPROPRIATION REQUEST FORM

Please provide responses to each information request immediately below the question in bold.  
Note that if this is a transportation, water infrastructure or defense project, there are additional 
sections at the end of this form that must be completed.  This completed form is due by 5pm on 
February 20, 2009, via Microsoft Word email attachment to andy.tantillo@mail.house.gov.  
Please call 202-225-3306 if you have any questions or need additional information.  Thank you.

General Information:  
Name of Organization: 

Name of Project: 

Amount of Funding Requested:  

If making more than 1 request: This request is our    1st    2nd    3rd    priority.   

Project Description: (1 to 2 sentences on specifically how the money will be spent)

What is the purpose of this project?  Why would it be a good use of federal taxpayer 
dollars?  

What is the status of the project?  How much work, if any, has been completed to 
date?  What is the schedule for completion of the project?

Have you contacted any other Representatives or Senators to make this request this 
year?  If yes, who? 

Do any other House Members represent your organization?  If yes, who? 


Funding Details:
In which Appropriations bill do you seek funding? (If known)

In which Federal Program or Account do you seek funding? 

Is the Institution a qualified grant recipient under the above federal program?  

Total project cost: (including all funding sources and all years) 

What other funding sources are contributing to this project (e.g. state, local, 
private)?  What amount has each of these funding sources contributed?

If required by the federal program you have selected, is the requisite local match 
available?       


If the funding is received in January 2010, how much can be spent by September 30, 
2010?

If this project has previously received federal funding, please list the amount it has 
received in previous appropriations cycles, and which Member of Congress (House 
Member and/or Senator) secured this funding.  Please also list any competitive 
grants, formula funding, or other federal support the project has received:
FY 2009: (was it in the House or Senate-passed bill?)
FY 2008:
FY 2007: (was it in the House or Senate-passed bill?)
FY 2006:
FY 2005:
  

Contact Information:
Mailing Address of Organization making the request: 

Please include the name, title, phone number, and e-mail address for each of the 
following people:

Highest Level Person at the Organization: (Who may the Congressman contact?)

Project Contact at the Organization: (Who may our staff work with?)

Government Affairs Representative for the Organization: (If any)


Abstract:
Below, please provide an abstract of no more than one page to describe your proposed 
project.  Explain how the project meets a specific federal responsibility or the criteria of 
the federal program under which you are seeking funding.  



 








Please note that an extended application follows in this document for transportation, 
water infrastructure, and defense projects.  


If this is a transportation project, please also provide the following:

Project Name: Brief description of the project and location (city, county, state, etc.). 
NOTE: This description may be used in the House report and must be as accurate as 
possible for the agency to allocate the money to the correct project for the proper use. 
Example: Main Road widening and resurfacing, City, State.

Detailed project description, including any previous funding (such as in an 
appropriations act or SAFETEA-LU) or authorizations in statute (such as 
designation as a high priority corridor in title 23, United States Code):

State/Local Share of project cost: NOTE: Most projects require a State and/or local 
match of at least 20% of the project's total cost. Example: A $1,000,000 project with a 
20% match would be $800,000 Federal and $200,000 State/Local funding.

How much of the request can be spent by September 30, 2010?

Please check eligibility with NYSDOT.  Did NYSDOT indicate the project is eligible 
under the account requested?  

Is the project on the State's Transportation Improvement Plan?  

Is the project considered by the State and/or regional transportation officials as 
critical to their needs?  Please attach a letter of support from these officials.

Describe the type of federal environmental assessment which you anticipate will be 
required for this project (Do you anticipate a simple EA or a full EIS?  Do you anticipate a 
FONSI, a Negative Declaration, or a finding of impacts) and how far along you are in that 
process (specifically, if an EA or EIS is required, when do you anticipate its completion, 
and if a Record of Decision is required, when is it anticipated, and from which agency)?


If this is a water infrastructure project, please also provide the following:

Name of Project: 

Grantee Name: (Legal entity which will receive the grant. Please be specific)

City:						State:

Purpose: (Specify drinking water, wastewater, storm water, and/or water quality protection)

Is preliminary planning and engineering design completed?

Total estimated cost of the project based on facilities plan or preliminary 
engineering report:

Amount requested: (Cannot be greater than 55% of the total project amount)

Amount received from past appropriations: (Specify dollar amount per year and 
source of funds, such as the Drinking Water State Revolving Fund, Clean Water State 
Revolving Fund, STAG Grants, Department of Agriculture Rural Development Program)

Does the community have a financing plan certified by an authorized local official 
demonstrating how it will cover the 45% matching funds?

Is the project on the state's State Revolving Fund priority list?  If yes, provide rank:

Important, please read:  
There is a 45% cost share requirement for any portion of a project funded through a 
STAG grant. For example, a $1 million project would involve a maximum of $550,000 
from the Federal government and the remaining $450,000 is the responsibility of the 
entity receiving the grant and would be required prior to project initiation.

What permitting requirements, if any, do you anticipate from the New York State 
Department of Environmental Conservation and the U.S. Army Corps of 
Engineers?  Are you aware of any issues that could preclude this project from 
securing such a permit?  When do you anticipate requisite permits to be 
issued/when were they issued?


If this is a defense request please provide the PE or budget line number, agency account, 
and analyst on the committee.  Defense requests will also be required to fill out additional 
paperwork.	

If this is a military construction request, please attach DoD Form 1391.

Congressman Higgins FY 2010 Appropriations Form	Page 1 of 5