Response

Congressionally Directed Spending Request Form

The following form, along with any supplemental information, must be completed and submitted by Friday, March 10th at 5p.m. – late requests will not be considered. Please fill out this form in its entirety. If submitted to the Committee on your behalf, portions of this form will be made public.

Please reach out to appropriations@capito.senate.gov if you have any questions.

Requesting Entity

* Legal Name of Government Entity or Non-Profit Organization

* First Name of Contact in WV

* Last Name of Contact in WV

* Address of Contact in WV

Address

* City

* State

* Zip

* Email

* Phone

* County

Non-Profit EIN

Representation by an Outside Organization
(if applicable)

First Name

Last Name

Company

Address

City

State

Zip

Phone

Project Information

* Title of Project

* Select Subcommittee

Agriculture, Rural Development, Food and Drug Administration and Related Agencies

Have you confirmed eligibility through the WV Rural Development State Office?

Commerce, Justice Science, and Related Agencies

Energy and Water Development

Energy Projects

Financial Services and General Government

Interior, Environment, and Related Agencies

Is the project on the state's most recently finalized Clean Water or Drinking Water State Revolving Fund Intended Use Plan?

Is the project eligible under SRF guidelines?

What is the project purpose?

How will the project help the recipient meet applicable water standards

Is this project primarily to support existing water needs or to support future growth?

Is this request seeking funding for planning and design, construction, or both?

Is the Project Recipient

Is the amount requested scalable to a lower amount and if so, what is the minimum amount?

Please list any funding received from federal appropriations, including the fiscal year and source of funding

Does the community have a financing plan certified by an authorized local official demonstrating how it will cover the matching funds of 20% or more? What is the anticipated non-federal sources of funding for this project?

Is the project on the state's most recently finalized Clean Water or Drinking Water State Revolving Fund Intended Use Plan?

Is the project eligible under SRF guidelines?

What is the project addressing?

How will the project help the recipient meet applicable water standards?

Is this project primarily to support existing water needs or to support future growth?

Is this request seeking funding for planning and design, construction, or both?

Is the Project Recipient:

Is the amount requested scalable to a lower amount and if so, what is the minimum amount

Please list any funding received from federal appropriations, including the fiscal year and source of funding

Is the location on the National Register of Historic Places or a National Historic Landmark?

Has the project received a Save America's Treasures grant in the past?

Does the recipient have in place, or a plan to provide, the one-to-one match with non-federal funding source?

Labor, Health and Human Services, Education, and Related Agencies

Department of Health and Human Services-Health Resources and Services Administration-Program Management

Department of Health and Human Services-Substance Abuse and Mental Health Services Administration-Health Surveillance and Program Support

Department of Health and Human Services-Administration for Children and Families- Children and Families Services Programs

Military Construction, Veterans Affairs, and Related Agencies

Transportation, Housing and Urban Development, and Related Agencies

Homeland Security

* Project Location

* Project Purpose

* Project Description (250 words or less)

* Current Status of Project (250 words or less)

Funding Information

* FY24 Funding Request

* Total Project Cost

* Project Budget

* Are you submitting this request to another member?

If so, which member?

* Have you requested a CDS for this project before?

If so, how much was awarded?

* Does the project meet the criteria listed in the CDS guidance?

Attach relevant documents here

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