[Federal Register Volume 60, Number 13 (Friday, January 20, 1995)]
[Notices]
[Pages 4304-4324]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-1364]
[[Page 4303]]
_______________________________________________________________________
Part III
Department of Health and Human Services
_______________________________________________________________________
Office of Community Services
_______________________________________________________________________
Request for Applications Under the Office of Community Services' Fiscal
Year 1995 Community Food and Nutrition Program; Notice
Federal Register / Vol. 60, No. 13 / Friday, January 20, 1995 /
Notices
[[Page 4304]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of Community Services
[Program Announcement No. OCS 95-02]
Request for Applications Under the Office of Community Services'
Fiscal Year 1995 Community Food and Nutrition Program
AGENCY: Office of Community Services, Administration for Children and
Families, Department of Health and Human Services.
ACTION: Request for applications under the Office of Community
Services' Community Food and Nutrition Program.
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SUMMARY: The Office of Community Services (OCS) announces that
competing applications will be accepted for new grants pursuant to the
Secretary's discretionary authority under Section 681A of the Community
Services Block Grant Act of 1981 as amended. This Program Announcement
contains forms and instructions for submitting an application. Grants
made under this Program Announcement are subject to the availability of
funds for support of these activities.
CLOSING DATE: The closing date for submission of applications is March
21, 1995.
FOR FURTHER INFORMATION CONTACT: Joseph Carroll, Program Manager,
Office of Community Services, Division of Community Demonstration
Programs, Attention: CFN Programs, 370 L'Enfant Promenade S.W.,
Washington, D.C. 20447, (202) 401-9233.
This Announcement is accessible on the OCS Electronic Bulletin
Board for downloading through your computer modem by calling 1-800-627-
8886. For assistance in accessing the Bulletin Board, A Guide to
Accessing and Downloading is available from Ms. Minnie Landry at (202)
401-5309.
Table of Contents
Part A--Preamble
1. Legislative Authority
2. Definitions of Terms
3. Purpose of Community Food and Nutrition Program
(a) Project Requirements
Part B--Application Requirements
1. Eligible applicants
2. Availability of Funds and Grant Amounts
3. Project Periods and Budget Periods
4. Administrative Costs/Indirect Costs
5. Program Beneficiaries
6. Number of Projects in Application
7. Multiple Submittal
8. Sub-Contracting or Delegating Projects
Part C--Program Priority Area
1. General Projects
2. Set-Asides
3. Nationwide Programs
Part D--Review Criteria
Criteria for Review and Evaluation of Application Submitted Under
this Program Announcement
Part E--Instructions for Completing Application Package
1. SF-424--``Application for Federal Assistance''
2. SF-424A ``Budget Information--Non-Construction''
3. SF-424B ``Assurances--Non-Construction''
4. Project Narrative
Part F--Application Procedures
l. Availability of Forms
2. Application Submission
3. Intergovernmental Review
4. Application Consideration
5. Criteria for Screening Applications
a. Initial Screening
b. Pre-Rating Review
c. Evaluation Criteria
Part G--Contents of Application Package and Receipt Process
Part H--Post Award Information and Reporting Requirements
Part A--Preamble
1. Legislative Authority
The Community Services Block Grant Act as amended authorizes the
Secretary of Health and Human Services to make funds available under
several programs to support program activities which will result in
direct benefits targeted to low-income people. This Program
Announcement covers the grant authority found at Section 681A,
Community Food and Nutrition, which authorizes the Secretary to make
funds available for grants to be awarded on a competitive basis to
eligible entities for local and statewide programs (1) to coordinate
existing private and public food assistance resources, whenever such
coordination is determined to be inadequate, to better serve low-income
communities; (2) to assist low-income communities to identify potential
sponsors of child nutrition programs and to initiate new programs in
underserved or unserved areas; and (3) to develop innovative approaches
at the State and local levels to meet the nutrition needs of low-income
people.
The Act also requires that 20 percent of appropriated funds in
excess of $6 million be awarded on a competitive basis to eligible
agencies for nationwide programs, including programs benefitting Native
Americans and Migrant Farmworkers.
2. Definitions of Terms
For purposes of this Program Announcement the following definitions
apply:
--Displaced worker: An individual who is in the labor market but has
been unemployed for six months or longer.
--Indian tribe: A tribe, band, or other organized group of Native
American Indians recognized in the State or States in which it resides
or considered by the Secretary of the Interior to be an Indian tribe or
an Indian organization for any purpose.
--Innovative project: One that departs from or significantly modifies
past program practices and tests a new approach.
--Migrant Farmworker: An individual who works in agricultural
employment of a seasonal or other temporary nature who is required to
be absent from his/her place of permanent residence in order to secure
such employment.
--Seasonal farmworker: Any individual employed in agricultural work of
a seasonal or other temporary nature who is able to remain at his/her
place of permanent residence while employed.
--Underserved area (as it pertains to child nutrition programs): A
locality in which less than one-half of the low-income children
eligible for assistance participate in any child nutrition program.
--Budget Period: The term ``budget period'' refers to the interval of
time into which a grant period of assistance (project period) is
divided for budgetary and funding purposes.
--Eligible Entity: States and other public and private non-profit
agencies/organizations including Community Action Agencies and agencies
which administer nationwide programs. (see Part B.1.)
--Project Period: The term ``project period'' refers to the total time
for which a project is approved for support, including any approved
extensions.
--Self-Sufficiency: A condition where an individual or family does not
need and is not eligible for public assistance.
3. Purpose of Community Food and Nutrition Program
The Department of Health and Human Services is committed to
improving the overall health and nutritional well-being of individuals
through improved preventive health care and promotion of personal
responsibility. The Department encourages the approach to health
promotion and nutritional responsibility [[Page 4305]] with personal
messages aimed at families and communities, in various settings and
environments in which individuals and groups can most effectively be
reached.
The Department is specifically interested in improving the health
and nutrition status of low-income persons through improved access to
healthy nutritious foods or by other means. HHS encourages community
efforts to improve the coordination and integration of health and
social services for all low-income families, and to identify
opportunities for collaborating with other programs and services for
this population. Such collaboration can increase a community's capacity
to leverage resources and promote an integrated approach to health and
nutrition through existing programs and services.
a. Project Requirements
Projects funded under this program should:
(1) Be designed and intended to provide nutrition benefits,
including those which incorporate the benefits of disease prevention,
to a targeted low-income group of people;
(2) Provide outreach and public education to inform eligible low-
income individuals and families of other nutritional services available
to them under the various Federally assisted programs;
(3) Carry out targeted communications/social marketing to improve
dietary behavior and increase program participation among eligible low-
income populations. Populations to be targeted can include displaced
workers, elderly people, children, and the working poor.
(4) Consult with and/or inform local offices that administer other
food programs such as W.I.C. and Food Stamps, where applicable, to
ensure effective coordination which can jointly target services to
increase their effectiveness. Such consultation may include involving
these offices in the planning of grant applications.
(5) Focus on one or more legislatively mandated program activities:
(a) Coordination of existing private and public food assistance
resources, whenever such coordination is determined to be inadequate,
to better serve low-income populations; (b) assistance to low-income
communities in identifying potential sponsors of child nutrition
programs and initiating new programs in unserved or underserved areas;
and (c) development of innovative approaches at the state or local
levels to meet the nutrition needs of low-income people. OCS views this
program as a capacity building program, rather than as a service
delivery program.
Part B--Application Requirements
1. Eligible Applicants
Eligible applicants are States and public and private non-profit
agencies/organizations with a demonstrated ability to successfully
develop and implement programs and activities similar to those
enumerated above. OCS encourages Historically Black Colleges and
Universities and Minority Institutions to submit applications. In
addition, applicants for the set-aside must be either: (1) Indian
tribes, (2) private non-profit groups whose governing board is
comprised of a majority of Indians and whose primary purpose is serving
Indian populations, or (3) groups whose sole purpose is serving migrant
and seasonal farmworker populations.
Any non-profit organization submitting an application must submit
proof of its non-profit status in its application at the time of
submission. The non-profit agency can accomplish this by providing a
copy of the applicant's listing in the Internal Revenue Services's
(IRS) most recent list of tax-exempt organizations described in Section
501(c)(3) of the IRS tax code or by providing a copy of the currently
valid IRS tax exemption certificate and by providing a copy of the
applicant's Articles of Incorporation bearing the seal of the State in
which the corporation or association is domiciled.
2. Availability of Funds and Grant Amounts
a. FY 95 Funding
The funds available for grant awards under the CFN Program in FY 95
are:
General Projects........................................ $2,970,400
Set-Asides.............................................. 500,000
Nationwide Programs..................................... 535,200
b. Grant Amounts
No individual grant application will be considered for an amount
which is in excess of $50,000 for applications submitted under General
Projects and Set-Asides. No eligible organization may receive more than
$300,000 in the aggregate for a nationwide program.
c. Mobilization of Resources
OCS would like to mobilize as many resources as possible to enhance
projects funded under this program. OCS supports and encourages
applications submitted by applicants whose programs will leverage other
resources, either cash or third-party in-kind.
3. Project Periods and Budget Periods
For most projects OCS will grant funds for one year. However, in
rare instances, depending on the characteristics of any individual
project and on the justification presented by the applicant in its
application, a grant may be made for a period of up to 17 months.
4. Administrative Costs/Indirect Costs
There is no administrative cost limitation for projects funded
under this program. Indirect costs consistent with approved Indirect
Cost Rate Agreements are allowable. Applicants should enclose a copy of
the current approved rate agreement. However, it should be understood
that indirect costs are part of, and not in addition to, the amount of
funds awarded in the subject grant.
5. Program Beneficiaries
Projects proposed for funding under this Announcement must result
in direct benefits targeted toward low-income people as defined in the
most recent Annual Update of Poverty Income Guidelines published by
DHHS. Attachment A to this Announcement is an excerpt from the most
recently published guidelines. Annual revisions of these guidelines are
normally published in the Federal Register in February or early March
of each year and are applicable to projects being implemented at the
time of publication. Grantees will be required to apply the most recent
guidelines throughout the project period. The Federal Register may be
obtained from public libraries, Congressional offices, or by writing
the Superintendent of Documents, U.S. Government Printing Office,
Washington, D.C. 20402. They also will be accessible on the OCS
Electronic Bulletin Board. (See ``For Further Information Contact''
section at the beginning of this document.) No other government agency
or privately defined poverty guidelines are applicable to the
determination of low-income eligibility for this OCS program.
6. Number of Projects in Application
An application may contain only one project and this project must
address the basic criteria found in Part C. Applications which are not
in compliance with these requirements will be ineligible for funding.
7. Multiple Submittal
There is no limit to the number of applications that can be
submitted as long as each application contains a proposal for a
different project. [[Page 4306]] However, no applicant can receive more
than one grant.
8. Sub-Contracting or Delegating Projects
OCS will not fund any project where the role of the eligible
applicant is primarily to serve as a conduit for funds to other
organizations.
Part C--Program Priority Areas
1. General Projects--FN
The application should include a description of the target area and
population to be served as well as a discussion of the nature and
extent of the problem to be solved. The application must contain a
detailed and specific work program that is both sound and feasible.
Projects funded under this Announcement must produce permanent and
measurable results that fulfill the purposes of this program as
described above. The OCS grant funds, in combination with private and/
or other public resources, must be targeted to low-income individuals
and communities.
Applicants will certify in their submission that projects will only
serve the low-income population as stipulated in the DHHS Poverty
Income Guidelines (Attachment A). Failure to comply with the income
guidelines may result in the application being ineligible for
consideration for funding.
If an applicant is proposing a project which will affect a property
listed in or eligible for inclusion in the National Register of
Historic Places, it must identify this property in the narrative and
explain how it has complied with the provisions of Section 106 of the
National Historic Preservation Act of 1966 as amended. If there is any
question as to whether the property is listed in or eligible for
inclusion in the National Register of Historic Places, applicant should
consult with the State Historic Preservation Officer. The applicant
should contact OCS early in the development of its application for
instructions regarding compliance with the Act and data required to be
submitted to the Department of Health and Human Services.
In the case of projects proposed for funding which mobilize or
improve the coordination of existing public and private food assistance
resources, the guidelines governing those resources apply. However, in
the case of projects providing direct assistance to beneficiaries
through grants funded under this program, beneficiaries must fall
within the official DHHS Poverty Income Guidelines as set forth in
Attachment A.
Applications which propose the use of grant funds for the
development of any printed or visual materials must contain convincing
evidence that these materials are not available from other sources. OCS
will not provide funding for such items if justification is not
sufficient. Approval of any films or visual presentations proposed by
applicants approved for funding will be made part of the grant award.
In cases where material outlays for equipment (audio and visual) are
requested, specific evidence must be presented that there is a definite
programmatic connection between the equipment (audio and visual) usage
and the outreach requirements described in Part A.3.a of this
Announcement.
OCS is also interested in projects that address the needs of
homeless families and welcomes project proposals which seek to develop
innovative approaches to promote health, and nutritional awareness
among low-income populations.
2. Set-Asides--SA
In recognition of the special needs of Indians and Migrant and
Seasonal Farmworkers, a set-aside will be established to afford
priority consideration to proposals submitted by agencies serving these
populations. Proposed Projects must meet the requirements of Part C.1.
Applications which are not funded within this set-aside will also be
considered competitively within the larger pool of eligible applicants.
See Part D, Criteria II and III, for additional guidance on developing
a work program.
3. Nationwide Programs--NA
Projects funded must be nationwide in scope and must meet the
requirements of Part C.1 (General Projects). No eligible organization
may receive more than $300,000 in the aggregate for a nationwide
program.
Part D--Review Criteria
Applications which pass the initial screening and pre-rating review
(See Part F, Section 5) will be assessed and scored by reviewers. Each
reviewer will give a numerical score for each application reviewed.
These numerical scores will be supported by explanatory statements on a
formal rating form describing major strengths and weaknesses under each
applicable criterion published in the Announcement.
The in-depth evaluation and review process will use the following
criteria coupled with the specific requirements as described in Part F.
When writing their Project Narrative applicants should respond to
the review criteria using the same sequential order.
(Note: The following review criteria reiterate the information
requirements contained in Part B of this Announcement. These
requirements are approved under OMB Control Number 0970-0062.)
Criteria for Review and Evaluation of Applications Submitted Under
This Program Announcement
Criterion I: Analysis of Needs/Priorities (Maximum: 10 Points)
(a) Target area and population to be served are adequately
described (0-4 points).
In addressing the above criterion, the applicant should include the
following:
The applicant should include a description of the target area and
population to be served including specific details on any minority
population(s) to be served.
(b) Nature and extent of problem(s) and/or need(s) to be addressed
are adequately described and documented (0-6 points).
In addressing the above criterion, the applicant should include the
following:
Applicant should discuss the nature and extent of the problem(s)
and/or need(s), including specific information on minority
population(s).
Criterion II: Adequacy of Work Program (Maximum: 25 Points)
(a) Realistic quarterly time targets are set forth by which the
various work tasks will be completed (0-10 points).
(b) Activities are adequately described and appear reasonably
likely to achieve results which will have a desired impact on the
identified problems and/or needs (0-15 points).
In addressing the above criterion, the applicant should include the
following:
The applicant should address the basic criteria and legislatively-
mandated activities found in Part A.3.a and should include:
(a) Project priorities and rationale for selecting them which
relate to the specific nutritional problem(s) and/or need(s) of the
target population which were identified under Criterion I;
(b) Goals and objectives which speak to the(se) problem(s) and/or
need(s); and
(c) Project activities which if successfully carried out can be
reasonably expected to result in the achievement of these goals and
objectives.
Criterion III: Significant and Beneficial Impact (Maximum 30 Points)
(a) Applicant proposes to significantly improve or increase
nutrition services to low-income people and such
[[Page 4307]] improvements or increases are quantified. (0-15 points).
(b) Project incorporates promotional health and social services
activities for low-income people, along with nutritional services (0-5
points).
(c) Project will significantly leverage or mobilize other community
resources and such resources are detailed and quantified (0-5 points).
(d) Proposal addresses (a) problem(s) which can be resolved by one-
time OCS funding or demonstrates that non-Federal funding is available
to continue the project without Federal support (0-5 points).
In addressing the above criterion, the applicant must include:
quantitative data for items (a), (b), and (c), and discuss how the
beneficial impact relates to the relevant legislatively-mandated
program activities identified in Part A.3.a. and the Problems and/or
Needs described under Criterion I.
Criterion IV: Coordination/Services Integration (Maximum 15 Points)
(a) Proposal shows evidence of coordinated community-based planning
in its development, including strategies in the Work Program to carry
on activities in collaboration with other locally funded Federal
programs (such as HHS health and social services and USDA Food and
Consumer Service programs) in ways that will eliminate duplication and
will, for example, 1) unite funding streams at the local level to
increase program outreach and effectiveness, 2) facilitate access to
other needed social services by coordinating and simplifying intake and
eligibility certification processes for clients, or 3) bring project
participants into direct interaction with holistic family development
resources in the community where needed. (0-10 points)
(b) Community Empowerment Consideration--Special consideration will
be given to applicants who are located in areas which are characterized
by poverty and other indicators of socio-economic distress such as a
poverty rate of at least 20%, designation as an Empowerment Zone or
Enterprise Community, high levels of unemployment, and high levels of
incidences of violence, gang activity, crime, or drug use. Applicants
should document that they were involved in the preparation and planned
implementation of a comprehensive community-based strategic plan to
achieve both economic and human development in an integrated manner.
(0-5 points)
If the applicant is receiving funds from the State for community
food and nutrition activities, the applicant should address how the
funds are being utilized, and how they will be coordinated with the
proposed project to maximize the effectiveness of both. If State funds
are being used in the project for which OCS funds are being requested,
their usage should be specifically described.
Criterion V: Organization Experience in Program Area and Staff
Responsibilities (Maximum 15 Points)
(a) Organizational experiences in program area (0-5 points).
Documentation provided indicates that projects previously undertaken
have been relevant and effective and have provided permanent benefits
to the low-income population. Organizations which propose providing
training and technical assistance have detailed competence in the
specific program priority area and as a deliverer with expertise in the
fields of training and technical assistance. If applicable, information
provided by these applicants also addresses related achievements and
competence of each cooperating or sponsoring organization.
(b) Management History (0-5 points).
Applicants must demonstrate their ability to implement sound and
effective management practices and if they have been recipients of
other Federal or other governmental grants, they must also document
that they have consistently complied with financial and program
progress reporting and audit requirements. Such documentation may be in
the form of references to any available audit or progress reports and
should be accompanied by a statement by a Certified or Licensed Public
Accountant as to the sufficiency of the applicant's financial
management system to protect adequately any Federal funds awarded under
the application submitted.
(c) Staffing skills, Resources and Responsibilities (0-5 points).
The application adequately describes the experience and skills of
the proposed project director showing that the individual is not only
well qualified, but that his/her professional capabilities are relevant
to the successful implementation of the project. If the key staff
person has not yet been identified, the application contains a
comprehensive position description which indicates that the
responsibilities to be assigned to the project director are relevant to
the successful implementation of the project. The application must
indicate that the applicant has adequate facilities and resources (i.e.
space and equipment) to successfully carry out the work plan.
In addressing the above criterion, the applicant should include the
following:
The applicant must clearly show that sufficient time of the Project
Director and other senior staff will be budgeted to assure timely
implementation and oversight of the project and that the assigned
responsibilities of the staff are appropriate to the tasks identified
for the project.
Criterion VI: Adequacy of Budget (Maximum: 5 Points)
(a) Budget is adequate and administrative costs are appropriate in
relation to the services proposed (0-5 points).
Part E--Instructions for Completing Application Package
(Approved by the OMB under Control Number 0970-0062)
The standard forms attached to this Announcement shall be used when
submitting applications for all funds under this Announcement.
It is recommended that you reproduce single-sided copies of the SF-
424, SF-424A and SF-424B, and type your application on the copies.
Please prepare your application in accordance with instructions
provided on the forms as well as with the OCS specific instructions set
forth below:
1. SF-424--Application for Federal Assistance
Top of Page. Please enter the single priority area designation
under which the application is being submitted. An application should
be submitted under only one priority area.
Item 1. For the purposes of this announcement, all projects are
considered Applications; there are no Pre-Applications.
Item 2. Date Submitted and Applicant Identifier--Date application
is submitted to ACF and applicant's own internal control number, if
applicable.
Item 3. Date Received by State--N/A
Item 4. Date Received by Federal Agency--Leave blank.
Items 5 and 6. The legal name of the applicant must match that
listed as corresponding to the Employer Identification Number. Where
the applicant is a previous Department of Health and Human Services
grantee, enter the Central Registry System Employee Identification
Number (CRS/EIN) and the Payment Identifying Number, if one has been
assigned, in the Block entitled Federal Identifier located at the top
right hand corner of the form.
Item 7. If the applicant is a non-profit corporation, enter N in
the box and specify non-profit corporation in the space marked Other.
Proof of non-profit [[Page 4308]] status, such as IRS certification,
Articles of Incorporation, or By-laws, must be included as an appendix
to the project narrative.
Item 8. Type of Application--Please check ``new'' application.
Item 9. Enter DHHS-ACF/OCS.
Item 10. The Catalog of Federal Domestic Assistance number for the
OCS program covered under this announcement is 93.571. The title is
Community Services Block Grant Discretionary Awards--Community Food and
Nutrition Program.
Item 11. In addition to a brief descriptive title of the project,
indicate the priority area for which funds are being requested. Use the
following letter designations:
FN--General Projects
SA--Projects where Migrant and Seasonal Farmworker organizations and
Indian Tribes or Indian organizations are applying specifically for
set-aside funds described in Part B
NP--Grants to organizations with nationwide programs
Item 12. Areas Affected by Project--List only the largest unit or
units affected, such as State, county or city.
Item 13. Proposed Project--The ending date should be calculated
based on a 12-month project period.
Item 14. Congressional District of Applicant/Project--Enter the
number of the Congressional District where the applicant's principal
office is located and the number of the Congressional district(s) where
the project will be located.
Item 15a. For purposes of this Announcement, this amount should
reflect the amount requested for the entire project period.
Item 15b-e. These items should reflect both cash and third-party
in-kind contributions for the total project period.
Item 15f. N/A
Item 15g. Enter the sum of Items 15a-15e.
2. SF-424A--``Budget Information-Non-Construction Programs''
See Instructions accompanying this page as well as the instructions
set forth below:
In completing these sections, the Federal Funds budget entries will
relate to the requested OCS Community Food and Nutrition Program funds
only, and Non-Federal will include mobilized funds from all other
sources--applicants, State, and other. Federal funds other than those
requested from the Community Food and Nutrition Program should be
included in Non-Federal entries.
Sections A and D of SF-424A must contain entries for both Federal
(OCS) and non-Federal (mobilized funds).
Section A--Budget Summary
Line 1-4
Col. (a):
Line 1--Enter OCS Community Food and Nutrition Program; Col. (b):
Line 1--Enter 93.571.
Col. (c) and (d): Not Applicable
Col. (e)-(g):
For each line 1-4, enter in columns (e), (f) and (g) the
appropriate amounts needed to support the project for the entire
project period.
Line 5--Enter the figures from Line 1 for all columns completed,
(e), (f), and (g).
Section B--Budget Categories
This section should contain entries for OCS funds only. For all
projects, the first budget period of 12 months will be entered in
Column #1.
Allocability of costs is governed by applicable cost principles set
forth in 45 CFR Parts 74 and 92.
Budget estimates for administrative costs must be supported by
adequate detail for the grants officer to perform a cost analysis and
review. Adequately detailed calculations for each budget object class
are those which reflect estimation methods, quantities, unit costs,
salaries, and other similar quantitative detail sufficient for the
calculation to be duplicated. For any additional object class
categories included under the object class other identify the
additional object class(es) and provide supporting calculations.
Supporting narratives and justifications are required for each
budget category, with emphasis on unique/special initiatives; large
dollar amounts; local, regional, or other travel; new positions; major
equipment purchases; and training programs.
A detailed itemized budget with a separate budget justification for
each major item should be included as indicated below:
Line 6a--Personnel: Enter the total costs of salaries and wages.
Justification
Identify the project director. Specify by title or name the
percentage of time allocated to the project, the individual annual
salaries and the cost to the project (both Federal and non-Federal) of
the organization's staff who will be working on the project.
Line 6b--Fringe Benefits: Enter the total costs of fringe benefits
unless treated as part of an approved indirect cost rate which is
entered on line 6j.
Justification
Enter the total costs of fringe benefits, unless treated as part of
an approved indirect cost rate.
Line 6c--Travel: Enter total cost of all travel by employees of the
project. Do not enter costs for consultant's travel.
Justification
Include the name(s) of traveler(s), total number of trips,
destinations, length of stay, mileage rate, transportation costs and
subsistence allowances.
Line 6d--Equipment: Enter the total costs of all non-expendable
personal property to be acquired by the project. ``Non-expendable
personal property'', means tangible personal property having a useful
life of more than one year and an acquisition cost of $5,000 or more
per unit.
Justification
Equipment to be purchased with Federal funds must be required to
conduct the project, and the applicant organization or its subgrantees
must not already have the equipment or a reasonable facsimile available
to the project.
Line 6e--Supplies: Enter the total costs of all tangible personal
property (surplus) other than that included on line 6d.
Line 6f--Contractual. Enter the total costs of all contracts,
including (1) procurement contracts (except those which belong on other
lines such as equipment, supplies, etc.) and (2) contracts with
secondary recipient organizations including delegate agencies and
specific project(s) or businesses to be financed by the applicant.
Justification
Attach a list of contractors, indicating the names of the
organizations, the purposes of the contracts, the estimated dollar
amounts, and selection process of the awards as part of the budget
justification. Also provide back-up documentation identifying the name
of contractor, purpose of contract, and major cost elements.
Note: Whenever the applicant/grantee intends to delegate part of
the program to another agency, the applicant/grantee must submit
Sections A and B of this Form SF-424A, completed for each delegate
agency by agency title, along with the required supporting
information referenced in the applicable instructions.
The total costs of all such agencies will be part of the amount
shown on Line 6f. Provide draft Request for Proposal in accordance with
45 CFR Part 74, Appendix H. Free and open [[Page 4309]] competition is
encouraged for any procurement activities planned using ACF grant
funds, and is required for any procurement that exceeds $25,000.
Line 6g--Construction: Not applicable.
Line 6h--Other: Enter the total of all other costs. Such costs,
where applicable, may include, but are not limited to, insurance, food,
medical and dental costs (noncontractual), fees and travel paid
directly to individual consultants, local transportation (all travel
which does not require per diem is considered local travel), space and
equipment rentals, printing and publication, computer use training
costs including tuition and stipends, training service costs including
wage payments to individuals and supportive service payments, and staff
development costs.
Line 6j--Indirect Charges: Enter the total amount of indirect
costs. This line should be used only when the applicant currently has
an indirect cost rate approved by the Department of Health and Human
Services or other Federal agencies.
If the applicant organization is in the process of initially
developing or renegotiating a rate, it should immediately upon
notification that an award will be made, develop a tentative indirect
cost rate proposal based on its most recently completed fiscal year in
accordance with the principles set forth in the pertinent DHHS Guide
for Establishing Indirect Cost Rates, and submit it to the appropriate
DHHS Regional Office. It should be noted that when an indirect cost
rate is requested, those costs included in the indirect cost pool
cannot be also budgeted or charged as direct costs to the grant.
Indirect costs consistent with approved Indirect Cost Rate Agreements
are allowable.
Line 6k--Totals. Enter the total amounts of Lines 6i and 6j.
Line 7--Program Income: Enter the estimated amount of income, if
any, expected to be generated from this project. Separately show
expected program income generated from OCS support and income generated
from other mobilized funds. Do not add or subtract this amount from the
budget total. Show the nature and source of income in the program
narrative statement.
Justification
Describe the nature, source and anticipated use of program income
in the Program Narrative Statement.
Section C--Non-Federal Resources
This section is to record the amounts of Non-Federal resources that
will be used to support the project. Non-Federal resources mean other
than OCS funds for which the applicant has received a commitment.
Provide a brief explanation, on a separate sheet, showing the type of
contribution, broken out by Object Class Category, (See Section B.6)
and whether it is cash or third-party in-kind. The firm commitment of
these required funds must be documented and submitted with the
application in order to be given credit in the criterion.
Except in unusual situations, this documentation must be in the
form of letters of commitment or letters of intent from the
organization(s)/individuals from which funds will be received.
Line 8--Grant Program
Col. (a): Enter the project title.
Col. (b): Enter the amount of cash or donations to be made by the
applicant.
Col. (c): Enter the State contribution.
Col. (d): Enter the amount of cash and third party in-kind
contributions to be made from all other sources.
Col. (e): Enter the total of columns (b), (c), and (d).
Lines 9, 10, and 11 should be left blank.
Line 12--Carry the total of each column of Line 8, (b) through (e).
The amount in Column (e) should be equal to the amount on Section A,
Line 5, Column (f).
Justification
Describe third party in-kind contributions, if included.
Section D--Forecasted Cash Needs
Line 13--Federal: Enter the amount of Federal (OCS) cash needed for
this grant, by quarter, during the 12 month budget period.
Line 14--Non-Federal: Enter the amount of cash from all other
sources needed by quarter during the first year.
Line 15--Totals: Enter the total of Lines 13 and 14.
Section F--Other Budget Information
Line 21--Direct Charges: Include narrative justification required
under Section B for each object class category for the total project
period.
Line 22--Indirect Charges: Enter the type of HHS or other Federal
agency approved indirect cost rate (provisional, predetermined, final
or fixed) that will be in effect during the funding period, the
estimated amount of the base to which the rate is applied and the total
indirect expense. Also, enter the date the rate was approved, where
applicable. Attach a copy of the approved rate agreement.
Line 23--Provide any other explanations and continuation sheets
required or deemed necessary to justify or explain the budget
information.
3. SF-424B ``Assurances Non-Construction''
All applicants must sign and return the ``Assurances'' with the
application.
4. Project Narrative
Each narrative should include the following major Sections:
a. Analysis of Need
b. Project Design (Work Programs)
c. Organizational Experience in Program Areas
d. Management History
e. Staffing and Resources
f. Staff Responsibilities
The project narrative must address the specific purposes mentioned
in Part A of this Program Announcement. The narrative should provide
information on how the application meets the evaluation criteria in
part D of this Program Announcement.
Part F--Application Procedures
1. Availability of Forms
Applications for awards under this OCS program must be submitted on
Standard Forms (SF) 424, 424A, and 424B. Part E and attachment B to
this Program Announcement contain all the instructions and forms
required for submittal of applications. The forms may be reproduced for
use in submitting applications. Copies of the Federal Register
containing this Announcement are available at most local libraries and
Congressional District Offices for reproduction. They are also
available for downloading from OCS' Electronic Bulletin Board. If
copies are not available at these sources they may be obtained by
writing or telephoning the office listed in the section entitled ``For
Further Information'' at the beginning of this Announcement.
2. Application Submission
a. Deadlines. Applications shall be considered as meeting the
deadline if they are either:
(1) Received on or before the deadline date at the Department of
Health and Human Services, Administration for Children and Families,
Division of Discretionary Grants, 370 L'Enfant Promenade, SW., 6th
Floor, Washington, DC 20447, or
(2) Sent on or before the deadline date and received by ACF in time
for the independent review. Applicants are cautioned to request a
legibly dated U.S. Postal Service postmark or to obtain a legibly dated
receipt from a commercial carrier or U.S. Postal Service. Private
Metered postmarks shall not be acceptable as proof of timely mailing.
[[Page 4310]]
b. Applications submitted by other means. Applications which are
not submitted in accordance with the above criteria shall be considered
as meeting the deadline only if they are physically received before the
close of business on or before the deadline date. Hand delivered
applications are accepted during the normal working hours of 8:00 a.m.
to 4:30 p.m., Monday through Friday, on or prior to the established
closing date at: at the Administration for Children and Families,
Division of Discretionary Grants, 6th Floor, ACF Guard Station, 901 D
Street, SW., Washington, DC 20447.
c. Late Applications. Applications which do not meet one of these
criteria are considered late applications. The ACF Division of
Discretionary Grants will notify each late applicant that its
application will not be considered in this competition.
d. Extension of Deadline. The ACF Office of Community Services may
extend the deadline for all applicants because of acts of God such as
floods, hurricanes, etc. or when there is a disruption of the mails.
However, if the granting agency does not extend the deadline for all
applicants, it may not waive or extend the deadline for any applicant.
Applications once submitted are considered final and no additional
materials will be accepted .
One signed original application and four copies are required.
Note: Applicants should note that the U.S. Postal Service does
not uniformly provide a dated post mark. Before relying on this
method, applicants should check with their local post office. In
some instances packages presented for mailing after a pre-determined
time are postmarked with the next day's date. In other cases,
postmarks are not routinely placed on packages. Applicants are
cautioned to verify that there is a date on the package, and that it
list the correct date of mailing, before accepting a receipt.
Private metered postmarks are not acceptable as proof of timely
mailing.
Applications which have a postmark later than the closing date, or
which are hand-delivered after the closing date, will be returned to
the sender without consideration in the competition.
3. Intergovernmental Review
This program is covered under Executive Order 12372,
Intergovernmental Review of Federal Programs, and 45 CFR Part 100,
Intergovernmental Review of Department of Health and Human Services
Programs and Activities. Under the Order, States may design their own
processes for reviewing and commenting on proposed Federal assistance
under covered programs.
All States and Territories except Alabama, Alaska, Colorado,
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana,
Nebraska, Oklahoma, Oregon, Pennsylvania, South Dakota, Virginia,
Washington, American Samoa and Palau have elected to participate in the
Executive Order process and have established Single Points of Contact
(SPOCs). Applicants from these nineteen jurisdictions need take no
action regarding E.O. 12372. Applicants for projects to be administered
by Federally-recognized Indian Tribes are also exempt from the
requirements of E.O. 12372. Applicants must submit any required
material to the SPOCs as soon as possible so that the program office
can obtain and review SPOC comments as part of the award process. It is
imperative that the applicant submit all required materials, if any, to
the SPOC and indicate the date of this submittal (or the date of
contact if no submittal is required) on the Standard Form 424, item
16a.
Under 45 CFR 100.8(a)(2), a SPOC has 60 days from the application
deadline date to comment on proposed new or competing continuation
awards.
SPOCs are encouraged to eliminate the submission of routine
endorsements as official recommendations.
Additionally, SPOCs are requested to clearly differentiate between
mere advisory comments and those official State process recommendations
which may trigger the ``accommodate or explain'' rule.
When comments are submitted directly to ACF, they should be
addressed to: Department of Health and Human Services, Administration
for Children and Families, Division of Discretionary Grants, 6th Floor,
370 L'Enfant Promenade, SW Washington, DC 20447.
A list of the Single Points of Contact for each State and Territory
is included as Attachment E of this Announcement.
4. Application Consideration
Applications which meet the screening requirements in Section 5
below will be reviewed competitively. Such applications will be
referred to reviewers for a numerical score and explanatory comments
based solely on responsiveness to program guidelines and evaluation
criteria published in this Announcement. Applications will be reviewed
by persons outside of the OCS unit which would be directly responsible
for programmatic management of the grant. The results of these reviews
will assist the Director and OCS program staff in considering competing
applications. Reviewers' scores will weigh heavily in funding decisions
but will not be the only factors considered. Applications will
generally be considered in order of the average scores assigned by
reviewers. However, highly ranked applications are not guaranteed
funding since the Director may also consider other factors deemed
relevant including, but not limited to, the timely and proper
completion of projects funded with OCS funds granted in the last five
(5) years: comments of reviewers and government officials; staff
evaluation and input; geographic distribution; previous program
performance of applicants; compliance with grant terms under previous
DHHS grants; audit reports; investigative reports; and applicant's
progress in resolving any final audit disallowances on OCS or other
Federal agency grants. OCS reserves the right to discuss applications
with other Federal or non-Federal funding sources to ascertain the
applicant's performance record.
5. Criteria for Screening Applications
a. Initial Screening
All applications that meet the published deadline for submission
will be screened to determine completeness and conformity to the
requirements of this Announcement. Only those applications meeting the
following requirements will be reviewed and evaluated competitively.
Others will be returned to the applicants with a notation that they
were unacceptable.
(1) The application must contain a completed and signed Standard
Form SF-424.
(2) The SF-424 must be signed by an official of the organization
applying for the grant who has authority to obligate the organization
legally.
b. Pre-rating Review
Applications which pass the initial screening will be forwarded to
reviewers for analytical comment and scoring based on the criteria
detailed in the Section below and the specific requirements contained
in Part A of this Announcement. Prior to the programmatic review, these
reviewers and/or OCS staff will verify that the applications comply
with this program announcement in the following areas:
(1) Eligibility: Applicant meets the eligibility requirements found
in Part B.
(2) Number of Projects: The application contains only one project.
(3) Target Populations: The application clearly targets the
specific outcomes and benefits of the project to low-income
participants and beneficiaries as defined in the DHHS
[[Page 4311]] Poverty Income Guidelines (Attachment A).
(4) Grant Amount: The amount of funds requested does not exceed
$50,000 (except for nationwide programs).
(5) Program Focus: The application addresses the purposes described
in Part A of this Announcement.
c. Evaluation Criteria
Applications which pass the initial screening and pre-rating review
will be assessed and scored by reviewers. Each reviewer will give a
numerical score for each application reviewed. These numerical scores
will be supported by explanatory statements on a formal rating form
describing major strengths and major weaknesses under each applicable
criterion published in this Announcement.
Part G--Contents of Application and Receipt Process
(Approved by the OMB under Control Number 0970-0062)
1. Contents of Application
Each application submission must include:
A signed original and four additional copies of the application.
Each copy of the application must contain in the order listed each
of the following:
a. Table of Contents with page numbers noted for each major section
and subsection of the proposal and each section of the appendices. Each
page in the application, including those in all appendices, must be
numbered consecutively.
b. ``A Project Abstract'' (a succinct description of the project in
200 words or less.)
c. Standard Form 424. Application for Federal Assistance. The SF-
424 should be completed in accordance with instructions provided with
the form, as well as OCS specific instructions set forth in Part E of
this Announcement. The SF-424 must contain an original signature of the
certifying representative of the applicant organization.
Applicants must also be aware that the applicant's legal name as
required in SF-424 (Item 5) must match that listed as corresponding to
the Employer Identification Number (Item 6).
d. Standard Form 424A, Budget Information. Pages 1 and 2 should be
completed.
e. Standard Form 424B, Assurances--Non-Construction Programs.
Applicants requesting financial assistance for a non-construction
project must file the Standard Form 424B, Assurances: ``Non-
Construction Programs.'' Applicants must sign and return the Standard
Form 424B with their applications.
f. Restriction on Lobbying Activities--Applicants must provide a
certification concerning Lobbying. Prior to receiving an award in
excess of $100,000, applicants shall furnish an executed copy of the
lobbying certification. Applicants must sign and return the
certification with their applications.
g. Disclosure of Lobbying Activities--SF-ILL: Fill out, sign and
date form found at Attachment F, (required only if lobbying has
actually taken place or is expected to take place in trying to obtain
the grant for which the applicant is applying.)
h. Project Narrative--(See Part E, Section 3.)
i. Applicants must make the appropriate certification of their
compliance with the Drug-Free Workplace Act of 1988. By signing and
submitting the applications, applicants are providing the certification
and need not mail back the certification with the applications.
j. Applicants must make the appropriate certification that they are
not presently debarred, suspended or otherwise ineligible for award. By
signing and submitting the applications, applicants are providing the
certification and need not mail back the certification with the
applications.
The total number of pages for the narrative portion of the
application package must not exceed 30 pages in their entirety.
Applications must be uniform in composition since OCS may find it
necessary to duplicate them for review purposes. Therefore,
applications must be submitted on 8\1/2\ x 11 inch paper only. They
must not include colored, oversized or folded materials, organizational
brochures, or other promotional materials, slides, films, clips, etc.,
in the proposal. Such materials will be discarded if included.
Applications should be two-holed punched at the top center and
fastened separately with a compressor slide paper fastener, such as an
ACCO clip, or a binder clip.
While applications must be comprehensive, OCS encourages
conciseness and brevity in the presentation of materials and cautions
the applicant to avoid unnecessary duplication of information.
2. Acknowledgement of Receipt
An acknowledgement postcard will be mailed to all applicants with
an identification number which will be noted on the acknowledgement.
This number must be referred to in all subsequent communications with
OCS concerning the application. If an acknowledgment is not received
within three weeks after the deadline date, applicants must notify ACF
by telephone (202) 401-9365. Applicant should also submit a mailing
label for the acknowledgement card.
Part H--Post Award Information and Reporting Requirements
Following approval of the applications selected for funding, notice
of project approval and authority to draw down project funds will be
made in writing. The official award document is the Financial
Assistance Award which provides the amount of Federal funds approved
for use in the project, the budget period for which support is
provided, and the terms and conditions of the award.
In addition to the General Conditions and Special Conditions (where
the latter are warranted) which will be applicable to grants, grantees
will be subject to the provisions of 45 CFR Parts 74 (non-governmental)
and 92 (governmental) along with OMB Circular 122 and 87.
Grantees will be required to submit semi-annual progress and
financial reports (SF-269) as well as a final progress and financial
report.
Grantees are subject to the audit requirements in 45 CFR Parts 74
and 92.
Section 319 of Public Law 101-121, signed into law on October 23,
1989, imposes new prohibitions and requirements for disclosure and
certification related to lobbying when applicant has engaged in
lobbying activities or is expected to lobby in trying to obtain the
grant. It provides limited exemptions for Indian tribes and tribal
organizations. Current and prospective recipients (and their subtier
contractors and/or grantees) are prohibited from using appropriated
funds for lobbying Congress or any Federal agency in connection with
the award of a contract, grant, cooperative agreement or loan. In
addition, for each award action in excess of $100,000 (or $150,000 for
loans) the law requires recipients and their subtier contractors and/or
subgrantees (1) to certify that they have neither used nor will use any
appropriated funds for payment to lobbyists, (2) to submit a
declaration setting forth whether payments to lobbyists have been or
will be made out of non-appropriated funds and, if so, the name,
address, payment details, and purpose of any agreements with such
lobbyists whom recipients or their subtier contractors or subgrantees
will pay with the nonappropriated funds and (3) to file quarterly up-
dates about the use of lobbyists if any event occurs that materially
affects the accuracy of the information submitted by way of
[[Page 4312]] declaration and certification. The law establishes civil
penalties for noncompliance and is effective with respect to contracts,
grants, cooperative agreements and loans entered into or made on or
after December 23, 1989. See Attachment H for certification and
disclosure forms to be submitted with the applications for this
program.
Attachment G indicates the regulations which apply to all
applicants/grantees under the Discretionary Grants Program.
Dated: January 13, 1995.
Donald Sykes,
Director, Office of Community Services.
Attachment A.--1994 Poverty Income Guidelines for All States Except
Alaska and Hawaii and the District of Columbia
------------------------------------------------------------------------
Poverty
Size of family unit guideline
------------------------------------------------------------------------
1............................................................ $7,360
2............................................................ 9,840
3............................................................ 12,320
4............................................................ 14,800
5............................................................ 17,280
6............................................................ 19,760
7............................................................ 22,240
8............................................................ 24,720
------------------------------------------------------------------------
For family units with more than 8 members, add $2,480 for each
additional member.
Poverty Income Guidelines for Alaska
------------------------------------------------------------------------
Poverty
Size of family unit Guideline
------------------------------------------------------------------------
1............................................................ $9,200
2............................................................ 12,300
3............................................................ 15,400
4............................................................ 18,500
5............................................................ 21,600
6............................................................ 24,700
7............................................................ 27,800
8............................................................ 30,900
------------------------------------------------------------------------
For family units with more than 8 members, add $3,100 for each
additional member.
Poverty Income Guidelines for Hawaii
------------------------------------------------------------------------
Poverty
Size of family unit guideline
------------------------------------------------------------------------
1............................................................ $8,470
2............................................................ 11,320
3............................................................ 14,170
4............................................................ 17,020
5............................................................ 19,870
6............................................................ 22,720
7............................................................ 25,570
8............................................................ 28,420
------------------------------------------------------------------------
For family units with more than 8 members, add $2,850 for each
additional member. (The same increment applies to smaller family sizes
also, as can be seen in the figures above.)
BILLING CODE 4184-01-P
[[Page 4313]]
[GRAPHIC][TIFF OMITTED]TN20JA95.000
BILLING CODE 4184-01-C
[[Page 4314]]
Instructions for the SF 424
This is a standard form used by applicants as a required
facesheet for preapplications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant
certification that States which have established a review and
comment procedure in response to Executive Order 12372 and have
selected the program to be included in their process, have been
given an opportunity to review the applicant's submission.
Item and Entry
1. Self-explanatory.
2. Date application submitted to Federal agency (or State if
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing
award, enter present Federal identifier number. If for a new
project, leave blank.
5. Legal name of applicant, name of primary organizational unit
which will undertake the assistance activity, complete address of
the applicant, and name and telephone number of the person to
contact on matters related to this application.
6. Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's
financial obligation or contingent liability from an existing
obligation.
9. Name of Federal agency from which assistance is being
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than
one program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For
preapplication, use a separate sheet to provide a summary
description of this project.
12. List only the largest political entities affected (e.g.,
State, counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any
District(s) affected by the program or project.
15. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable.
If the action will result in a dollar change to an existing award,
indicate only the amount of the change. For decreases, enclose the
amounts in parentheses. If both basic and supplemental amounts are
included, show breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same categories as item
15.
16. Applicants should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine whether the
application is subject to the State intergovernmental review
process.
17. This question applies to the applicant organization, not the
person who signs as the authorized representative. Categories of
debt include delinquent audit disallowances, loans and taxes.
18. To be signed by the authorized representative of the
applicant. A copy of the governing body's authorization for you to
sign this application as official representative must be on file in
the applicant's office. (Certain Federal agencies may require that
this authorization be submitted as part of the application.)
BILLING CODE 4184-01-P
[[Page 4315]]
[GRAPHIC][TIFF OMITTED]TN20JA95.001
[[Page 4316]]
[GRAPHIC][TIFF OMITTED]TN20JA95.002
BILLING CODE 4184-01-C [[Page 4317]]
Instructions for the SF-424A
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing the budget, adhere to
any existing Federal grantor agency guidelines which prescribe how
and whether budgeted amounts should be separately shown for
different functions or activities within the program. For some
programs, grantor agencies may require budgets to be separately
shown by function or activity. For other programs, grantor agencies
may require a breakdown by function or activity. Sections A, B, C,
and D should include budget estimates for the whole project except
when applying for assistance which requires Federal authorization in
annual or other funding period increments. In the latter case,
Sections A, B, C, and D should provide the budget for the first
budget period (usually a year) and Section E should present the need
for Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class
categories shown in Lines a-k of Section B.
Section A. Budget Summary
Lines 1-4, Columns (a) and (b)
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring a
functional or activity breakdown, enter on Line 1 under Column (a)
the catalog program title and the catalog number in Column (b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of each
activity or function on each line in Column (a), and enter the
catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a breakdown by
function or activity, enter the catalog program title on each line
in Column (a) and the respective catalog number on each line in
Column (b).
For applications pertaining to multiple programs where one or
more programs require a breakdown by function or activity, prepare a
separate sheet for each program requiring the breakdown. Additional
sheets should be used when one form does not provide adequate space
for all breakdown of data required. However, when more than one
sheet is used, the first page should provide the summary totals by
programs.
Lines 1-4, Columns (c) Through (g.)
For new applications, leave Columns (c) and (d) blank. For each
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the project
for the first funding period (usually a year).
For continuing grant program applications, submit these forms
before the end of each funding period as required by the grantor
agency. Enter in Columns (c) and (d) the estimated amounts of funds
which will remain unobligated at the end of the grant funding period
only if the Federal grantor agency instructions provide for this.
Otherwise, leave these columns blank. Enter in columns (e) and (f)
the amounts of funds needed for the upcoming period. The amount(s)
in Column (g) should be the sum of amounts in Columns (e) and (f).
For supplemental grants and changes to existing grants, do not
use Columns (c) and (d). Enter in Column (e) the amount of the
increase or decrease of Federal funds and enter in Column (f) the
amount of the increase or decrease of non-Federal funds. In Column
(g) enter the new total budgeted amount (Federal and non-Federal)
which includes the total previous authorized budgeted amounts plus
or minus, as appropriate, the amounts shown in Columns (e) and (f).
The amount(s) in Column (g) should not equal the sum of amounts in
Columns (e) and (f).
Line 5--Show the totals for all columns used.
Section B. Budget Categories
In the column headings (1) through (4), enter the titles of the
same programs, functions, and activities shown on Lines 1-4, Column
(a), Section A. When additional sheets are prepared for Section A,
provide similar column headings on each sheet. For each program,
function or activity, fill in the total requirements for funds (both
Federal and non-Federal) by object class categories.
Lines 6a-i--Show the totals of Lines 6a to 6h in each column.
Line 6j--Show the amount of indirect cost.
Line 6k--Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount
in column (5), Line 6k, should be the same as the total amount shown
in Section A, Column (g), Line 5. For supplemental grants and
changes to grants, the total amount of the increase or decrease as
shown in Columns (1)-(4), Line 6k should be the same as the sum of
the amounts in Section A, Columns (e) and (f) on Line 5.
Line 7--Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
amount from the total project amount. Show under the program
narrative statement the nature and source of income. The estimated
amount of program income may be considered by the federal grantor
agency in determining the total amount of the grant.
Section C. Non-Federal-Resources
Lines 8-11--Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a)--Enter the program titles identical to Column (a),
Section A. A breakdown by function or activity is not necessary.
Column (b)--Enter the contribution to be made by the applicant.
Column (c)--Enter the amount of the State's cash and in-kind
contribution if the applicant is not a State or State agency.
Applicants which are a State or State agencies should leave this
column blank.
Column (d)--Enter the amount of cash and in-kind contributions
to be made from all other sources.
Column (e)--Enter total of Columns (b), (c), and (d).
Line 12--Enter the total for each Columns (b)-(e). The amount in
Column (e) should be equal to the amount on Line 5, Column (f),
Section A.
Section D. Forecasted Cash Needs
Line 13--Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14--Enter the amount of cash from all other sources needed
by quarter during the first year.
Line 15--Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed for Balance of
the Project
Lines 16-19--Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or activity
is not necessary. For new applications and continuation grant
applications, enter in the proper columns amounts of Federal funds
which will be needed to complete the program or project over the
succeeding funding periods (usually in years). This section need not
be completed for revisions (amendments, changes, or supplements) to
funds for the current year of existing grants.
If more than four lines are needed to list the program titles,
submit additional schedules as necessary.
Line 20--Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21--Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal
grantor agency.
Line 22--Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the
funding period, the estimated amount of the base to which the rate
is applied, and the total indirect expense.
Line 23--Provide any other explanations or comments deemed
necessary.
Assurances--Non-Construction Programs
Note: Certain of these assurances may not be applicable to your
project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may
require applicants to certify to additional assurances. If such is
the case, you will be notified.
As the duly authorized representative of the applicant I certify
that the applicant:
1. Has the legal authority to apply for Federal assistance, and
the institutional, managerial and financial capability (including
funds sufficient to pay the non-Federal share of project costs) to
ensure proper planning, management and completion of the project
described in this application.
2. Will give the awarding agency, the Comptroller General of the
United States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records,
books, papers or documents related to the award; and will
[[Page 4318]] establish a proper accounting system in accordance
with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using
their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or
personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970
(42 U.S.C. Secs. 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of the nineteen statutes
or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to: (a) Title
VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b)
Title IX of the Education Amendments of 1972, as amended (20 U.S.C.
Secs. 1681-1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973,
as amended (29 U.S.C. Sec. 794), which prohibits discrimination on
the basis of handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. Secs. 6101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and Treatment Act of
1972 (P.L. 92-255), as amended, relating to nondiscrimination on the
basis of drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation Act of 1970
(P.L. 91-616), as amended, relating to nondiscrimination on the
basis of alcohol abuse or alcoholism; (g) Secs. 523 and 527 of the
Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3),
as amended, relating to confidentiality of alcohol and drug abuse
patient records; (h) Title VIII of the Civil Rights Act of 1968 (42
U.S.C. Sec. 3601 et seq.), as amended, relating to nondiscrimination
in the sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s) under which
application for Federal assistance is being made; and (j) the
requirements of any other nondiscrimination statute(s) which may
apply to the application.
7. Will comply, or has already complied, with the requirements
of Titles II and III of the Uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91-646) which
provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or federally
assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of federal
participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C.
Secs. 1501-1508 and 7324-7328) which limit the political activities
of employees whose principal employment activities are funded in
whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40
U.S.C. Sec. 276c and 18 U.S.C. Secs. 874), and the Contract Work
Hours and Safety Standards Act (40 U.S.C. Secs. 327-333), regarding
labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and
acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order
(EO) 11514; (b) notification of violating facilities pursuant to EO
11738; (c) protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance with EO
11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. Secs. 1451 et seq.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans under Section
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. Sec. 7401
et seq.); (g) protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered
Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16
U.S.C. Secs. 1271 et seq.) related to protecting components or
potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with
Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and protection of
historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966
(P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the
care, handling, and treatment of warm blooded animals held for
research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention
Act (42 U.S.C. Secs. 4801 et seq.) which prohibits the use of lead
based paint in construction or rehabilitation of residence
structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies governing
this program.
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Signature of authorized certifying official
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Title
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Applicant organization
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Date Submitted
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Attachment D
Certification Regarding Debarment, Suspension, and Other
Responsibility Matters--Primary Covered Transactions
By signing and submitting this proposal, the applicant, defined
as the primary participant in accordance with 45 CFR Part 76,
certifies to the best of its knowledge and believe that it and its
principals:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from covered
transactions by any Federal Department or agency;
(b) have not within a 3-year period preceding this proposal been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (Federal,
State, or local) transaction or contract under a public transaction;
violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property;
(c) are not presently indicted or otherwise criminally or
civilly charged by a governmental entity (Federal, State, or local)
with commission of any of the offenses enumerated in paragraph
(1)(b) of this certification; and
(d) have not within a 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or
local) terminated for cause or default.
The inability of a person to provide the certification required
above will not necessarily result in denial of participation in this
covered transaction. If necessary, the prospective participant shall
submit an explanation of why it cannot provide the certification.
The certification or explanation will be considered in connection
with the Department of Health and Human Services (HHS) determination
whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an
explanation shall disqualify such person from participation in this
transaction.
The prospective primary participant agrees that by submitting
this proposal, it will include the clause entitled ``Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion--Lower Tier Covered Transaction.'' provided below with
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion--Lower Tier Covered Transactions
(To Be Supplied to Lower Tier Participants)
By signing and submitting this lower tier proposal, the
prospective lower tier participant, as defined in 45 CFR Part 76,
certifies to the best of its knowledge and belief that it and its
principals:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any federal department or
agency.
(b) where the prospective lower tier participant is unable to
certify to any of the above, such prospective participant shall
attach an explanation to this proposal.
The prospective lower tier participant further agrees by
submitting this proposal that it will include this clause entitled
``certification Regarding Debarment, Suspension, Ineligibility, and
Voluntary Exclusion--Lower Tier Covered Transactions.'' without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
Attachment E
Executive Order 12372--State Single Points of Contact
Arizona
Mrs. Janice Dunn, Attn: Arizona State Clearinghouse, 3800 N. Central
Avenue, 14th Floor, Phoenix, Arizona 85012, Telephone (602) 280-1315
Arkansas
Ms. Tracie L. Copeland, Manager, State Clearinghouse, Office of
Intergovernmental Service, Department of Finance and Administration,
P.O. Box 3278, Little Rock, Arkansas 72203, Telephone (501) 682-1074
California
Mr. Glenn Stober, Grants Coordinator, Office of Planning and
Research, 1400 Tenth Street, Sacramento, California 95814, Telephone
(916) 323-7480
Delaware
Ms. Francine Booth, State Single Point of Contact, Executive
Department, Thomas Collins Building, Dover, Delaware 19903,
Telephone (302) 736-3326
District of Columbia
Mr. Rodney T. Hallman, State Single Point of Contact, Office of
Grants Mgmt and Development, 717 14th Street N.W., Suite 500,
Washington, D.C. 20005, Telephone (202) 727-6551
Florida
Florida State Clearinghouse, Intergovernmental Affairs Policy Unit,
Executive Office of the Governor, Office of Planning and Budgeting,
The Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-
8114
Georgia
Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse,
254 Washington Street, S.W., Room 534A, Atlanta, Georgia 30334,
Telephone (404) 656-3855
Illinois
Mr. Steve Klokkenga, State Single Point of Contact, Office of the
Governor, 107 Stratton Building, Springfield, Illinois 62706,
Telephone (217) 782-1671
Indiana
Ms. Jean S. Blackwell, Budget Director, State Budget Agency, 212
State House, Indianapolis, Indiana 46204, Telephone (317) 232-5610
Iowa
Mr. Steven R. McCann, Division of Community Progress, Iowa
Department of Economic Development, 200 East Grand Avenue, Des
Moines, Iowa 50309, Telephone (515) 281-3725
Kentucky
Mr. Ronald W. Cook, Office of the Governor, Department of Local
Government, 1024 Capitol Center Drive, Frankfort, Kentucky 40601,
Telephone (502) 564-2382
Maine
Ms. Joyce Benson, State Planning Office, State House Station #38,
Augusta, Maine 04333, Telephone (207) 289-3261
Maryland
Ms. Mary Abrams, Chief, Maryland State Clearinghouse, Department of
State Planning, 301 West Preston Street, Baltimore, Maryland 21201-
2365, Telephone (301) 225-4490
Massachusetts
Ms. Karen Arone, State Clearinghouse, Executive Office of
Communities and Development, 100 Cambridge Street, Room 1803,
Boston, Massachusetts 02202, Telephone (617) 727-7001
Michigan
Mr. Richard S. Pastula, Director, Michigan Department of Commerce,
Lansing, Michigan 48909, Telephone (517) 373-7356
Mississippi
Ms. Cathy Mallette, Clearinghouse Officer, Office of Federal Grant
Management and Reporting, 301 West Pearl Street, Jackson,
Mississippi 39203, Telephone (601) 949-2174
Missouri
Ms. Lois Pohl, Federal Assistance Clearinghouse, Office of
Administration, P.O. Box 809, Room 430, Truman Building, Jefferson
City, Missouri 65102, Telephone (314) 751-4834
Nevada
Department of Administration, State Clearinghouse, Capitol Complex,
Carson City, Nevada 89710, Telephone (702) 687-4065, Attn: Mr. Ron
Sparks, Clearinghouse Coordinator
New Hampshire
Mr. Jeffrey H. Taylor, Director, New Hampshire Office of State
Planning, Attn: Intergovernmental Review Process/James E. Bieber,
2\1/2\ Beacon Street, Concord, New Hampshire 03301, Telephone (603)
271-2155
New Jersey
Mr. Gregory W. Adkins, Acting Director, Division of Community
Resources, New Jersey Department of Community Affairs, Trenton, New
Jersey 08625-0803, Telephone (609) 292-6613
Please direct correspondence and questions to:
Andrew J. Jaskolka, State Review Process, Division of Community
Resources, CN 814, Room 609, Trenton, New Jersey 08625-0803,
Telephone (609) 292-9025 [[Page 4322]]
New Mexico
Mr. George Elliott, Deputy Director, State Budget Division, Room
190, Bataan Memorial Building, Santa Fe, New Mexico 87503, Telephone
(505) 827-3640, Fax (505) 827-3006
New York
New York State Clearinghouse, Division of the Budget, State Capitol,
Albany, New York 12224, Telephone (518) 474-1605
North Carolina
Mrs. Chrys Baggett, Director, Office of the Secretary of Admin.,
N.C. State Clearinghouse, 116 W. Jones Street, Raleigh, North
Carolina 27603-8003, Telephone (919) 733-7232
North Dakota
North Dakota Single Point of Contact, Office of Intergovernmental
Assistance, Office of Management and Budget, 600 East Boulevard
Avenue, Bismarck, North Dakota 58505-0170, Telephone (701) 224-2094
Ohio
Mr. Larry Weaver, State Single Point of Contact, State/Federal Funds
Coordinator, State Clearinghouse, Office of Budget and Management,
30 East Broad Street, 34th Floor, Columbus, Ohio 43266-0411,
Telephone (614) 466-0698
Rhode Island
Mr. Daniel W. Varin, Associate Director, Statewide Planning Program,
Department of Administration, Division of Planning, 265 Melrose
Street, Providence, Rhode Island 02907, Telephone (401) 277-2656
Please direct correspondence and questions to:
Review Coordinator, Office of Strategic Planning
South Carolina
Omeagie Burgees, State Single Point of Contact, Grant Services,
Office of the Governor, 1205 Pendleton Street, Room 477, Columbia,
South Carolina 29201, Telephone (803) 734-0494
Tennessee
Mr. Charles Brown, State Single Point of Contact, State Planning
Office, 500 Charlotte Avenue, 309 John Sevier Building, Nashville,
Tennessee 37219, Telephone (615) 741-1676
Texas
Mr. Thomas Adams, Governor's Office of Budget and Planning, P.O. Box
12428, Austin, Texas 78711, Telephone (512) 463-1778
Utah
Utah State Clearinghouse, Office of Planning and Budget, ATTN: Ms.
Carolyn Wright, Room 116 State Capitol, Salt Lake City, Utah 84114,
Telephone (801) 538-1535
Vermont
Mr. Bernard D. Johnson, Assistant Director, Office of Policy
Research & Coordination, Pavilion Office Building, 109 State Street,
109 State Street, Montpelier, Vermont 05602, Telephone (802) 828-
3326
West Virginia
Mr. Fred Cutlip, Director, Community Development Division, West
Virginia Development Office, Building #6, Room 553, Charleston, West
Virginia 25305, Telephone (304) 348-4010
Wisconsin
Mr. William C. Carey, Federal/State Relations Office, Wisconsin
Department of Administration, 101 South Webster Street, P.O. Box
7864, Milwaukee, Wisconsin 53707, Telephone (608) 266-0267
Wyoming
Ms. Sheryl Jeffries, State Single Point of Contact, Herachler
Building, 4th Floor, East Wing, Cheyenne, Wyoming 82002, Telephone
(307) 777-7574
Guam
Mr. Michael J. Reidy, Director, Bureau of Budget and Management
Research, Office of the Governor, P.O. Box 2950, Agana, Guam 96910,
Telephone (671) 472-2285
Northern Mariana Islands
State Single Point of Contact, Planning and Budget Office, Office of
the Governor, Saipan, CM, Northern Mariana Islands 96950
Puerto Rico
Norma Burgos/Jose E. Caro, Chairman/Director, Puerto Rico Planning
Board, Minillas Government Center, P.O. Box 41119, San Juan, Puerto
Rico 00940-9985, Telephone (809) 727-4444
Virgin Islands
Jose L. George, Director, Office of Management and Budget, No. 41
Norregade Emancipation Garden Station, Second Floor, Saint Thomas,
Virgin Islands 00802
Please direct correspondence to:
Ms. Linda Clarke, Telephone (809) 774-0750
Attachment F--Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative
Agreements
The undersigned certifies, to the best of his or her knowledge
and belief, that:
(1) No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification
of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant,
loan or cooperative agreement, the undersigned shall complete and
submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in
accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
State for Loan Guarantee and Loan Insurance
The undersigned states, to the best of his or her knowledge and
belief, that:
If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this
commitment providing for the United States to insure or guarantee a
loan, the undersigned shall complete and submit Standard Form-LLL
``Disclosure Form to Report Lobbying,'' in accordance with its
instructions.
Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required statement shall
be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
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Signature
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Title
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Organization
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Date
BILLING CODE 4184-01-P
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BILLING CODE 4184-01-C [[Page 4324]]
Attachment G--DHHS Regulations Applying to All Applicants/Grantees
Under the Community Food and Nutrition Program
Title 45 of the Code of Federal Regulations:
Part 16--Department of Grant Appeals Process
Part 74--Administration of Grants (non-governmental)
Part 74--Administration of Grants (state and local governments and
Indian Tribal affiliates):
Sections
74.62(a) Non--Federal Audits
74.173 Hospitals
74.174(b) Other Nonprofit Organizations
74.304 Final Decisions in Disputes
74.710 Real Property, Equipment and Supplies
74.715 General Program Income
Part 75--Informal Grant Appeal Procedures
Part 76--Debarment and Suspension from Eligibility for Financial
Assistance Subpart F--Drug Free Workplace Requirements
Part 80--Non-Discrimination Under Programs Receiving Federal
Assistance through the Department of Health and Human Services
Effectuation of Title VI of the Civil Rights Act of 1964
Part 81--Practice and Procedures for Hearings Under Part 80 of this
Title
Part 83--Non-discrimination on the basis of sex in the admission of
individuals to training programs
Part 84--Non-discrimination on the Basis of Handicap in Programs
Part 91--Non-discrimination on the Basis of Age in Health and Human
Services Programs or Activities Receiving Federal Financial
Assistance
Part 92--Uniform Administrative Requirements for Grants and
Cooperative Agreements to States and Local Governments (Federal
Register, March 11, 1988)
Part 93--New Restrictions on Lobbying
Part 100--Intergovernmental Review of Department of Health and Human
Services Programs and Activities
Attachment H
[Optional Checklist (for use of applicant only) to verify contents of application]
----------------------------------------------------------------------------------------------------------------
Check
----------------------------------------------------------------------------------------------------------------
A. Application contains:
1. Table of Contents.......................................................................... [ ]
2. A Project Abstract (no more than 200 words)................................................ [ ]
3. Completed SF 424, Application for Federal Assistance....................................... [ ]
4. Completed SF 424A, Budget Information--Non-construction Programs........................... [ ]
5. Signed SF 424B, Assurances--Non-Construction Programs...................................... [ ]
6. A project narrative with the following components:
a. Analysis of need....................................................................... [ ]
b. Project design......................................................................... [ ]
c. Organizational experience in program................................................... [ ]
d. Management history..................................................................... [ ]
e. Staffing and resources (resume or job description)..................................... [ ]
f. Staff responsibilities................................................................. [ ]
7. Relevant portions of the organization's by-laws and articles of incorporation confirming
eligibility.................................................................................. [ ]
8. A signed copy of Certification Regarding the Anti-Lobbying Provision....................... [ ]
9. A completed Disclosures of Lobbying Activities form, if appropriate........................ [ ]
10. A self-addressed mailing label which can be affixed to a postcard to acknowledge receipt
of application............................................................................... [ ]
B. Application does not exceed a total of 30 pages................................................ [ ]
C. Application includes one original and four copies, printed on white 8\1/2\ by 11 inch paper.... [ ]
D. Applicant is aware that the signing and submitting the application for funds under the CFN
Program, it is certifying that it has read and understood the Federal Guidelines concerning a
drug-free workplace and the debarment regulations set forth in attachments E and F respectively.. [ ]
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[FR Doc. 95-1364 Filed 1-19-95; 8:45 am]
BILLING CODE 4184-01-P