Application Checklist (also available in Word)

1. Tribal name and Tribal Lead Agency name.

2. Contact person's name, address, phone number, fax number, and e-mail address.

3. Description of current child care facilities, including the number of each type of facility (e.g., homes, centers) and a brief description of each center (size, type of structure, condition, and number of children served)

4. Explanation of why current facilities are not adequate, and why the lack of facilities will inhibit future program operations. Must include estimates of children who: (1) currently receive CCDF services; (2) are currently eligible and in need but are not being served due to inadequate facilities; (3) are projected to receive CCDF services over the next five years (in the absence of this proposed construction/ renovation); and (4) are projected to be eligible and in need, but will not be served (without proposed construction/renovation) due to inadequate facilities, over the next five years.

5. A statement that adequate facilities are not otherwise available through lease, donation, purchase by non-CCDF funds, or other means.

6.(a) The following written assurance: "The use of CCDF funds for construction or renovation will not result in a decrease in the level of child care services provided by the Tribal Lead Agency, as compared to the level of services provided in the preceding fiscal year"; and (b) Additionally, a description of how the current fiscal year's level of child care services compares to the preceding year's level of services. The Tribal Lead Agency may define "level of services" in terms of the number of children served and/or the amount of funds spent on child care. Regardless of which definition it chooses, the Tribal Lead Agency should include in its description information about both the number of children served and the amount of funds spent on child care.

7.(a) A description (or map) of the facility's site, and an explanation of the appropriateness of the location in relation to the Tribal Lead Agency's service area; and (b) Include a statement of the effect of the facility's location on the transportation of children to the program, on the Tribal Lead Agency's ability to collaborate with other child care, Head Start, social services and health providers, and on all other program activities and services.

8.(a) The plans and specifications for the proposed construction or renovation, including architectural designs; and (b) Describe the facility as it will be after construction or renovation is complete, including information on the size and type of structure, the number and a description of the rooms, the lot on which the building is located (including the space available for a playground and for parking), and the number of children the facility will serve. For major renovation requests, describe and identify the current condition of the facility as well as the proposed renovations

9. A proposed schedule for the construction or renovation, and occupancy, of the facility.

10. The intended uses of the facility, including information demonstrating that the facility will be used principally to provide direct services to children. If the facility is to be used for other purposes in addition to the operation of the child care program, the Tribal Lead Agency must state what portion of the facility is to be used for such other purposes.

11. The terms of any proposed or existing loan(s) related to the construction or renovation and the repayment plans (detailing balloon payments or other unconventional terms, if any), and information on all other sources of funding of the construction or renovation, including any restrictions or conditions imposed by other funding sources. The mortgage or security agreement must have provisions regarding foreclosure and default; see Program Instruction.

12. An estimate of the total cost of the proposed construction or renovation, including estimated one-time costs (e.g., planning costs; labor, materials and services; initial equipment) and ongoing costs (e.g., insurance premiums, maintenance costs, and property taxes

13. A statement of the amount of construction or renovation costs that will be paid with CCDF funds listed separately by the Federal fiscal year in which the CCDF funds become (or became) available. Indicate whether the funds should be transferred from Tribal Mandatory or Discretionary funds.

14. A statement of whether or not there is a Head Start program in the Tribal Lead Agency's service area. If there is a Head Start program in the service area, the applicant must describe: any child care/Head Start collaboration efforts; the extent to which Head Start will use the child care facility; and the extent to which Head Start funds will pay for construction and renovation costs, if applicable. The applicant must demonstrate collaboration if there is a Head Start program in the service area.

15. A statement of who owns the land on which the facility is/will be located. If the Tribal Lead Agency proposes to construct or renovate a facility located on land that it does not own, the application must describe the easement, right of way or land rental it will obtain or has obtained to allow it sufficient access to the facility.

16. FOR MAJOR RENOVATION REQUESTS ONLY: A statement indicating whether the Tribal Lead Agency owns the facility to be renovated. If the Tribal Lead Agency does not own the facility, the application must include information about the owner and a copy of the lease for the facility. If the Tribal Lead Agency does not own the facility, the Tribal Lead Agency must have a long-term lease; see Program Instruction.

17. Written assurances that the facility will be constructed or renovated to comply with: (1) applicable licensing and code requirements; (2) access requirements of the Americans with Disabilities Act (P.L. 101-336)); (3) section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794); and, (4) if applicable, the Flood Disaster Protection Act of 1973 (P.L. 93-234).

18.(a) An assessment of the impact of construction or renovation on the human environment, addressing in particular any significant change in land use (including substantial increases in traffic due to transportation services) pursuant to the National Environmental Policy Act of 1969 (42 U.S.C. §4332(2)(C)); (b) A report showing results of tests for environmental hazards present in the facility, ground water, and soil (or justification why testing is not necessary); and (c) Information necessary to comply with the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470f).

19. An assurance that the Tribal Lead Agency will comply with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (42 U.S.C. §4601 et seq.), and information about costs that may be incurred due to compliance.

20. FOR MODULAR UNIT REQUESTS ONLY: A statement describing procedures for purchasing the modular unit. This must include a copy of the unit's specifications and an assurance that the Tribal Lead Agency will comply with procurement procedures in 45 CFR Part 92.36, including an assurance that transactions will be conducted in a manner to provide, to the maximum extent practical, open and free competition.