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Proposal Summary Template $_____________________________

Request for a New Award or Modification


to an Existing Award (If modification, Program Goal:
include award number.) Total Number of Individuals Affected in the
Targeted Area:
Total
Organization’s Headquarters Organization’s Field
Number of
Contact Person: Contact Person:
Mailing Address: Mailing Address:
Telephone: Telephone:
Fax: Fax:
E-mail: Email:

Beneficiaries Targeted (Individuals):


Country/Region: Total Number of IDP Beneficiaries Targeted
Submission/Revision Date: (Individuals):
Program Title:
Program Duration (number of months):
Proposed Start Date:

Proposal includes the following categories


of restricted goods:

Restricted Goods Check box if


applicable
Agricultural
commodities
Vehicles not
manufactured in the
U.S.
Pharmaceuticals -
Human and Veterinary
Pesticides
Fertilizer
Used equipment
USG-owned excess
property

Dollar Amount Requested from OFDA

$_____________________________
Dollar Amount from Other Sources

$_____________________________
Dollar Amount of In-Kind Contributions

$_____________________________
Total Dollar Amount of Program
A separate Sector Table should be used
for EACH sector.
Sector:
Objective:
Dollar Amount
Requested:
Number of
Beneficiaries
Targeted:
Number of IDP
Beneficiaries
Targeted:*
Geographic
Area(s):
Sub-
Sector:
Indicator (A):

Indicator (B):

Sub-
Sector:
Indicator (A):

Indicator (B):

*Individuals – a subset Number of Beneficiaries


Targeted

One (1) Cross-Cutting Theme (CCT) table


should be completed per proposal. This
table should include information for all
CCTs:
Relevant
Name
Sector and Indicators
of CCT
Sub Sector
CCT (A)
CCT (B)
CCT (C)
SUGGESTED PROPOSAL OUTLINE COST AND BUDGET OUTLINE
A) Justification A) Documentation on Ineligible and
1. Problem Statement Restricted Goods, Services, and
2. Needs Assessment Summary Countries
3. Justification for Intervention 1. Ineligible Goods and Service
B) Program Description 2. Ineligible Suppliers
1. Program Level 3. Restricted Goods
a. Goal 4. Foreign Policy Restricted Countries
b. Beneficiaries B) Detailed Itemized Budget
c. Critical Assumptions C) Budget Narrative
d. Program-Level Coordination D) Branding Strategy and Marking Plan
e. Safety and Security Plan for E) SF-424
Program/Field Staff F) Completed/Signed Certifications and
f. Transition and Exit Strategy Representations
2. Sector Level G) Voluntary Survey on Faith-Based and
a. Sector Community Organizations
b. Objective H) Required Supporting Administrative
c. Dollar Amount Documentation
d. Beneficiaries 1. Organizational Structure
e. Geographic Areas 2. Accountability
f. Sector-Level Coordination 3. Cost Sharing (Matching) and In-kind
3. Sub-sector Level Contributions
a. Sub-Sectors 4. Sub-award Arrangements
b. Technical Design 5. Past Performance References
c. Beneficiary Description 6. Self-certification for Compliance with
d. Indicators USAID Policies and Procedures for
4. Cross-Cutting Themes Personnel, Procurement, Property
a. Program Integration management, and Travel (U.S. NGOs
b. Indicators only)
C) Monitoring and Evaluation 7. U.S. Government Negotiated Indirect
1. Monitoring Plans Cost Rate Agreement (NICRA)
2. Evaluation Plans 8. Program Income
9. Pipeline Analysis (Award
Modifications Only)
10. Safety and Security Plan
11. New Vendor Information Form (if the
applicant has never received USAID
awards.)