White House Conference on Aging; Program Announcement No. WHCoA 94-2; Availability of Funds and Request for Applications for Mini- conferences

DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)

Administration on Aging

White House Conference on Aging; Program Announcement No. WHCoA

94-2; Availability of Funds and Request for Applications for Mini-

conferences

AGENCY: White House Conference on Aging, AoA, HHS.

ACTION: Announcement of availability of funds and request for

applications to conduct mini-conferences in preparation for the 1995

White House Conference on Aging.

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SUMMARY: the White House Conference on Aging (WHCoA) announces that it

will hold a competition for the funding of mini-conferences in

preparation for the 1995 White House Conference on Aging. Funding for

WHCoA grants is authorized by the Older Americans Act, Public Law 102-

375 and Public Law 103-171.

This program announcement consists of two parts. Part I provides

background information and describes the program under which the WHCoA

is inviting applications to be considered for funding. Part II

describes, in detail, the application process and provides guidance on

how to prepare and submit an application.

All of the forms necessary to submit an application are included

following Part II. They complete the application kit that an applicant

needs for preparing and for submitting an application under this

announcement.

Grants will be made under this announcement subject to the

availability of funds for the support of the program described herein.

DATES: The deadline date for the submission of applications is June 6,

1994.

ADDRESSES: Application receipt point: Department of Health and Human

Services; Administration on Aging, Office of Administration and

Management, 330 Independence Avenue, SW., room 4644, Washington, DC

20201, Attn: WHCoA-94-2.

FOR FURTHER INFORMATION CONTACT:

For programmatic information, contact Judy Satine, Department of Health

and Human Services, White House Conference on Aging, 501 School Street,

SW., 8th Floor, Washington, DC 20024, telephone (202) 245-7826. For

grant technical information, contact Margaret Tolson, AoA, see address

above, telephone (202) 401-0838.

SUPPLEMENTARY INFORMATION:

Part I. Background Information and Program Description

A. Statutory Authority

The statutory authority for awards made under this Announcement is

contained in the Older Americans Act as amended, Public Law 102-375 and

Public Law 103-171.

B. Eligible Applicants

In general, any eligible public or nonprofit private organization,

agency or institution is eligible to apply under this program

announcement. Any applicant that is not now a DHHS grantee should

include, with its application, Internal Revenue Service or other

legally recognized documentation of its nonprofit status. A nonprofit

applicant cannot be funded without proof of its status.

C. Program Description

President Clinton announced in February that he has formally called

for a White House Conference on Aging to be convened in May 1995.

Previous White House Conferences in 1961, 1971 and 1981 adopted

recommendations that resulted in local, state and Federal initiatives

which improved the security and well being of older Americans. The 1995

Conference will produce recommendations that will meet the needs of

Older Americans in the twenty-first century.

A White House Conference on Aging in intended to produce policy

recommendations to guide national aging policy over the next decade. In

Public Law 102-375, the Older Americans Act amendments of 1992,

Congress specifically identified six primary purposes for the

Conference. They are:

(1) To increase public awareness of the interdependence of

generations and the essential contributions of older individuals to

society for the well-being of all generations;

(2) To identify the problems facing older individuals and the

commonalities of the problems with problems of younger generations;

(3) To examine the well-being of older individuals including the

impact the wellness of older individuals has on our aging society;

(4) To develop such specific and comprehensive recommendations for

executive and legislative action as may be appropriate for maintaining

and improving the well-being of the aging;

(5) To develop recommendations for the coordination of Federal

policy with State and local needs and the implementation of such

recommendations; and

(6) To review the status and multigenerational value of

recommendations adopted at previous White House Conferences on Aging.

Of major significance to the 1995 White House Conference on Aging

in direct participation by individuals and organizations in the pre-

conference stages. As part of this grass roots effort, the WHCoA has

adopted a four pronged approach that includes local forums, mini-

conferences as well as State and Regional conferences. The purpose of

these events is to identify those issues of mutual concern to the aging

population and to develop recommendations that warrant specific

attention by the White House Conference of Aging. An integral part of

this strategy is the conduct of mini-conferences which are topic or

constituency specific. The recommendations from these conferences will

play an integral role in the development of the agenda for the 1995

Conference.

In order for a mini-conference to be considered for funding, the

proposed event must:

(1) Be a policy oriented event. The focus of the event must be

either:

(a) On one of the following specific Federal policy issues:

Interdependence of generations;

Older persons as community resources;

Employment and continued productivity opportunities for middle-aged and

older persons including training;

Home and community based long-term care services including caregivers

assistance and health promotion;

Housing and coordinated services;

Income security with particular emphasis on alleviating poverty;

National retirement policy including pre-retirement;

Crime;

Nutrition;

Disability and aging services;

Mental health and substance abuse;

Future of aging services to be reflected in the Older Americans Act;

Combatting false stereotypes;

Minority aging;

Biomedical and other appropriate research; and

Related topics to promote the independence, well-being and security of

older persons.

or

(b) On one of the following specific constituencies:

Older Women;

One of the following groups of minority elderly:

Native American

African American

Asian/Pacific Islanders

Hispanic

Elderly persons with disabilities.

(2) Should have substantial and significant input and participation

by older persons. It should involve older persons and organizations

representing older persons in the development and implementation of the

event. Efforts should be made to seek out an appropriately diverse

representation of interested parties.

(3) Provide at a maximum five recommendations that can be utilized

by the WHCoA. These recommendations must be:

(a) Well articulated;

(b) Based on demonstrated information, knowledge and consensus

reached at event;

(c) Have a reasonable prospect of being attainable within the

current political, economic, and fiscal environment;

(d) Received within 30 days after the mini-conference.

The report should devote no more than 3 pages double spaced per

recommendation for up to 5 recommendations (total maximum of 15 double

spaced pages).

(4) Provide an implementation plan to demonstrate:

(a) How they will plan, design, and carry out the mini-conference

including proposed date and location, proposed participants (audience

discussants and speakers) and cooperating organizations;

(b) How they will seek additional sources of support;

(c) What they will do as an advocacy group to ensure that their

recommendations, if adopted by the WHCoA, are implemented into public

policy.

(5) Be held by March 31, 1995.

(6) Be held in a location accessible to persons with disabilities.

(7) Not be a profit-making or fund-raising event although it is

permissible to charge a fee to recover the costs of the event.

Project Costs: It is expected that 12-15 projects at $6,000 each

will be funded by the WHCoA. Applicants are expected to obtain

additional funding from other sources and are encouraged to include

with their applications letters of commitment from other funding

sources.

Part II. Information and Guidelines for the Application Process and

Review

Part II of this Announcement contains general information for

potential applicants and basic guidelines for submitting applications

in response to this announcement. Application forms are provided along

with detailed instructions for developing and assembling the

application package for submittal to the White House Conference on

Aging. Specific eligibility guidelines were provided in the program

description above.

A. General Information

1. Review Process and Considerations for Funding

The following steps are involved in the review process.

a. Notification: All applicants will automatically be notified of

the receipt of their application and informed of the identification

number assigned to it.

b. Expert Review: Applications that conform to the requirements of

this program announcement will be reviewed and scored competitively

against the evaluation criteria specified in section D, below. This

independent review of applications is performed by panels consisting of

qualified persons. The scores and judgments of these expert reviewers

are a major factor in making award decisions.

c. Decision-Making Process: After the panel review session,

applicants may be contacted by WHCoA staff to furnish additional

information. Applicants who are contacted should not assume that

funding is guaranteed. An award is official only upon receipt of the

Financial Assistance Award (Form DGCM 3-785).

d. Timeframe: Applicants should be aware that the time interval

between the deadline for submission of applications and the award of a

grant may be several weeks in duration. This length of time is required

to review and process grant applications.

2. Notification Under Executive Order 12372

This is not a covered program under Executive Order 12372.

B. Deadline for Submission of Applications

The closing date for submission of applications is June 6, 1994.

Applications must be either sent or hand-delivered to the address

specified in Section C, below. Hand-delivered applications are accepted

during the normal working hours of 9 a.m. to 5:30 p.m., Eastern Time,

Monday through Friday. An application will meet the deadline if it is

either:

1. Received at the mailing address on or before the applicable

deadline date; or

2. Sent before midnight of the applicable deadline date as

evidenced by either: (1) A U.S. Postal Service receipt or postmark or

(2) a receipt from a commercial carrier. The application must also be

received in time to be considered under the competitive independent

review mandated by Chapter 1-62 of the DHHS Grants Administration

Manual. Applicants are strongly advised to obtain proof that the

application was sent by the applicable deadline date. If there is a

question as to when an application was sent, applicants will be asked

to provide proof that they have met the applicable deadline date.

Private metered postmarks are not acceptable as proof of a timely

submittal.

Applications which do not meet the above deadlines are considered

late applications and will not be considered for funding.

C. Application Screening Requirements

All applications will be screened to determine completeness and

conformity to the requirements of this announcement. These screening

requirements are intended to assure a level playing field for all

applicants. Applications which fail to meet one or more of the criteria

described below will not be reviewed and will receive no further

consideration for funding. Complete, conforming applications will be

reviewed and scored competitively.

In order for an application to be reviewed, it must meet the

following screening requirements:

1. The application must not exceed 10 pages, double-spaced,

exclusive of certain required forms and assurances which are listed

below. Applications whose typescript is single-spaced or space-and-a-

half will be considered only if it is determined the applicant has not

thereby gained a competitive advantage. The following documents are

excluded from the 10 page limitation: (1) Standard Forms (SF) 424, 424A

(including up to a four page budget justification) and 424B; (2) the

certification forms regarding lobbying; debarment, suspension, and

other responsibility matters; and drug-free workplace requirements; and

(3) proof of non-profit status.

2. Applications submitted under this announcement must be either

postmarked by midnight, June 6, 1994, or hand-delivered by 5:30 p.m.,

Eastern Time, on June 6, 1994 to the address provided below: Department

of Health and Human Services, Administration on Aging, Office of

Administration and Management, 330 Independence Avenue, SW., room 4644,

Washington, DC 20201, Attn: AoA-94-2.

3. Applicants must meet the specific eligibility requirements set

forth above in the program description.

Under No Circumstances Will Applications That Do Not Meet These

Screening Requirements Be Assigned To Reviewers

D. Evaluation Criteria

Applications which pass the screening will be evaluated by an

independent review panel of at least three individuals. These reviewers

will be primarily experts from within the Federal government. Based on

the specific programmatic considerations set forth in the announcement,

the reviewers will comment on and score the applications, focusing

their comments and scoring decisions on the criteria below.

1. Purpose and Need for Assistance: 20 points

a. Does the proposed project clearly and adequately respond to the

stated requirements for a mini-conference?

b. Does the proposed project address one of the listed topics/

constituency groups in a relevant and thorough manner?

2. Approach/Method--Implementation and Activities: 30 points

a. Does the application clearly express and organize an

implementation plan which systematically includes specific objectives

and tasks which will result in an effective mini-conference?

b. Does the implementation plan include timelines for

accomplishment of tasks and objectives? Is the sequence and timing of

events logical and realistic?

c. Do the proposed presenters have demonstrated qualifications

which are appropriate for their roles?

3. Anticipated Outcomes: 30 points

a. Does the proposal include a plan for advocacy which is likely to

increase public awareness of the recommendations from the mini-

conference? Is this advocacy plan adequate for communicating

recommendations to all appropriate audiences? Does it provide a

realistic plan to achieve implementation of the recommendations should

they be adopted by the 1995 White Conference on Aging?

4. Level of Effort: 20 points

a. Are the qualifications of the key organizers of the mini-

conference appropriate for their roles?

b. Does the organization have a track record which demonstrates its

capability and knowledge to conduct the mini-conference?

E. The Components of an Application

To expedite the processing of applications, we request that you

arrange the components of your application, the original and two

copies, in the following order:

SF 424, Application for Federal Assistance; SF 424A,

Budget, accompanied by your budget justification; SF 424B (Assurances);

and the certification forms regarding lobbying; debarment, suspension,

and other responsibility matters; and drug-free workplace requirements.

Note: The original copy of the application must have an original

signature in item 18d on the SF 424.

Proof of nonprofit status, as necessary:

Project summary description;

Program narrative.

The original and each copy should be stapled securely (front and

back if necessary) in the upper left corner. Pages should be numbered

sequentially. In order to facilitate the handling and reproduction of

the application for purposes of the review, please do not use covers,

binders or tabs.

F. Communications With WHCoA

Do not include a self-addressed, stamped acknowledgment card. All

applicants will be notified by mail of the receipt of their application

and informed of the identification number assigned to it. This number

should be referred to in all subsequent communication with WHCoA

concerning the application.

After an identification number is assigned and the applicant has

been notified of the number, applications are filed numerically by

identification number for quick retrieval. It will not be possible for

WHCoA staff to provide a timely response to inquiries about a specific

application unless the identification number is given.

Applicants are advised that, prior to reaching a decision, the

WHCoA will not release information relative to an application other

than that it has been received and that it is being reviewed.

Unnecessary inquiries delay the process. Once a decision is reached,

the applicant will be notified as soon as possible of the acceptance or

rejection of the application.

G. Completing the Application

To assist applicants in completing Forms SF 424 and SF 424A

correctly, samples of completed forms have been provided as part of

this announcement. These samples are to be used as a guide only. Be

sure to submit your application on the blank copies. Please prepare

your application consistent with the following guidance:

1. SF 424, Cover Page: Complete only the items specified in the

following instructions:

Item 1. Enter an ``X'' in the block marked Application--Non-

construction.

Item 2. Fill in the date you submitted the application. Leave the

applicant identifier box blank.

Item 3. Not applicable.

Item 4. Leave blank.

Item 5. Provide the legal name of applicant; the name of the

primary organizational unit which will undertake the assistance

activity; the applicant address; and the name and telephone number of

the person to contact on matters related to this application.

Item 6. Enter the employer identification number (EIN) of the

applicant organization as assigned by the Internal Revenue Service.

Please include the suffix to the EIN, if known.

Item 7. Enter the appropriate letter in the box provided.

Item 8. Place an ``X'' in the box marked New.

Item 9. Enter the White House Conference on Aging.

Item 10. Leave blank.

Item 11. The title should describe concisely the nature of the

project. Try not to exceed 10 to 12 words and 120 characters including

spaces and punctuation.

Item 12. Not applicable.

Item 13. Enter the desired start date for the project and the

desired end date for the project. The project must be completed by

March 31, 1995.

Item 14. List the applicant's Congressional District and the

District(s), if any, directly affected by the proposed project.

Item 15. Enter the funding request to the WHCoA under Item 15a,

Federal. Enter the applicant's share of the project costs under 15b,

Applicant. If there are third party contributions, enter those under

Item 15e, Other. Enter the sum of these amounts under Item 15g, Total.

Item 16. Enter ``No'' under Item b.

Item 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.

Item 18. To be signed by an authorized representative of the

applicant organization. A document attesting to that sign-off authority

must be on file in the applicant's office.

2. SF 424A--Budget Information

This form (SF424A) is designed to apply for funding under more than

one grant program; thus, for purposes of this WHCoA program, most of

the budget item columns/blocks are superfluous and should be regarded

as not applicable. The applicant should consider and respond to only

the budget items for which guidance is provided below. Section A--

Budget Summary and Section B--Budget Categories should include both

Federal and non-Federal funding for the proposed project.

Section A--Budget Summary

On line 5, enter total Federal Costs in column (e) and total Non-

Federal Costs (including third party in-kind contributions but not

program income) in column (f). Enter the total of columns (e) and (f)

in column (g).

Section B--Budget Categories

Use only the last column under Section B, namely the column headed

Total (5), to enter the total requirements for funds (combining both

the Federal and non-Federal shares) by object class category.

A brief budget justification should be appended to this Section

which shows the breakdown of budget cost items by Federal and non-

Federal shares and justifies each of the major items, personnel,

travel, other, etc.

Line 6a--Personnel: Enter total costs of salaries and wages of

applicant/grantee staff. Do not include the costs of consultants, which

should be included under 6h--Other.

Line 6b--Fringe Benefits: Enter the total costs of fringe benefits.

Line 6c--Travel: Enter total costs of out-of-town travel (travel

requiring per diem) for staff of the project. Do not enter costs for

consultant's travel or local transportation.

Line 6d--Equipment: Enter the total cost of all equipment to be

acquired by the project. The threshold for equipment is $500 or more

per unit.

Line 6e--Supplies: Enter the total costs of all tangible expendable

personal property (supplies) other than those included on line 6d.

Line 6f--Contractual: Enter of total costs of all contracts, if

applicable. Do not include payments to individuals on this line.

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,

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 cost,

including tuition and stipends, training service costs including wage

payments to individuals and supportive service payments; and staff

development costs.

Line 6i--Total Direct Charges: Show the totals of Lines 6a through

6h.

Line 6j--Indirect Charges: Not applicable.

Line 6k--Total: Enter the total amounts from Line 6i.

Section C--Non-Federal Resources

Line 12--Totals: As applicable, enter amounts of non-Federal

resources that will be used in carrying out the proposed project. If

third-party in-kind contributions are included, provide a brief

explanation in the budget justification section.

Section D--Forecasted Cash Needs:

Not applicable.

Section E--Budget Estimate of Federal Funds Needed for Balance of the

Project

Line 20--Totals: Not applicable.

Section F--Other Budget Information

Line 21--Direct Charges: Not applicable

Line 22--Indirect Charges: Not applicable

Line 23--Remarks: Provide any other explanations or comments deemed

necessary.

3. SF 424B--Assurances

Applicants are required to file an SF 424B, Assurances--Non-

Construction Programs. Please note that a duly authorized

representative of the applicant organization must certify that the

applicant is in compliance with these assurances.

With the possible exception of an Assurance of Protection of Human

Subjects, no other assurances are required. For research projects in

which human subjects may be at risk, an Assurance of Protection of

Human Subjects may be needed. If there is a question regarding the

applicability of this assurance, contact the Office for Protection from

Research Risks of the National Institutes of Health at (301) 496-7041.

4. Certification Forms

Certifications are required of the applicant regarding: (1)

Lobbying; (b) debarment, suspension, and other responsibility matters;

and (3) drug-free workplace requirements. Please note that a duly

authorized representative of the applicant organization must attest to

the applicant's compliance with these certifications.

5. Project Summary Description

On a separate page, provide a project summary description headed by

the name of the applicant organization as shown in SF 424, item 5.

Please limit the summary description to a maximum of 1,200 characters,

including words, spaces and punctuation.

The description should be specific and succinct. It should outline

the objectives of the mini-conference, the approaches to be used and

the outcomes expected.

6. Program Narrative

The Program Narrative is the critical part of the application. It

should be clear, concise, and, of course, responsive to the program

under which the application is being submitted. In describing your

proposed project, make certain that you respond fully to the evaluation

criteria set forth in Section D above. The format of the narrative

should, in fact, parallel the criteria.

Please have the narrative typed on one side of 8\1/2\'' x 11''

plain white paper with 1'' margins on both sides. All pages of the

narrative (including charts, tables, maps, exhibits, etc.) should be

sequentially numbered, beginning with ``Purpose and Need for

Assistance'' as page number one. (Applicants should not submit

reproductions of larger size paper, reduced to meet the size

requirement).

The narrative should also identify the author(s) of the proposal,

their relationship with the applicant, and the role they will play, if

any, should the project be funded.

This narrative guidance is in accordance with that provided in OMB

Circular A-102. The checklist reporting form (Section H, below) is

consistent with that approved under OMB control number 0937-0189.

H. Points to Remember

1. There is a 10 double-spaced page limitation for the substantive

parts of the application. Before submitting your application, please

check that you have adhered to this requirement which is spelled out in

Section C.

2. You are required to send an original and two copies of an

application.

3. The summary description (1,200 characters or less) should

accurately reflect the nature and scope of the proposed project.

4. In following the required format for preparing the program

narrative, make certain that you have responded fully to the four (4)

evaluative criteria which will be used by reviewers to evaluate and

score all applications.

5. Before submitting the application, have someone other than the

author(s): (1) apply the screening requirements to make sure you are in

compliance; and (2) carry out a trial run review based upon the

evaluative criteria. Take the opportunity to consider the results of

the trial run and then make whatever changes you deem appropriate.

6. Applications must be mailed by midnight, or hand-delivered by

5:30 p.m., Eastern Time, on June 6, 1994 to the address below.

Department of Health and Human Services, Administration on Aging,

Office of Administration and Management, 330 Independence Avenue SW.,

Room 4644, Washington, D.C. 20201, Attn: WHCoA-94-2,

Fernando M. Torres-Gil,

Assistant Secretary for Aging.

BILLING CODE 4130-02-M

TN11MY94.000

BILLING CODE 4130-02-C

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 preapplications, 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

deliquent 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 4130-02-M

TN11MY94.001

TN11MY94.002

BILLING CODE 4130-02-C

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 muiltiple 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 total 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 totals of Columns (b), (c), and (d).

Line 12--Enter the total for each of Column (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 amoun ts 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 supplemental) 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 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. 91-19) 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. Sec. Sec. 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. Sec. Sec. 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. Sec. Sec. 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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Applicant Organization

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Title

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Date Submitted

Program Narrative Statement

A. New Applications

1. Objectives and need for assistance. Pinpoint any relevant

physical, economic, social, financial, institutional, or other problems

requiring a solution. Demonstrate the need for the assistance and state

the principal and subordinate objectives of the project. Supporting

documentation or other testimonies from concerned interests other than

the applicant may be used. Any relevant data based on planning studies

should be included or footnoted.

2. Results or Benefits Expected. Identify results and benefits to

be derived. The anticipated contribution to policy, practice, theory

and/or research should be indicated.

3. Approach. Outline a plan of action pertaining to the scope and

detail how the proposed work will be accomplished for each project.

Cite factors which might accelerate or decelerate the work and your

reasons for taking this approach as opposed to others. Describe any

unusual features of the project, such as design or technological

innovations, reductions in cost or time, or extraordinary social and

community involvements. Provide for each assistance program

quantitative projections of the accomplishments to be achieved, if

possible. When accomplishments cannot be quantified, list the

activities in chronological order to show the schedule of

accomplishments and their target dates. Identify the kinds of data to

be collected and maintained, and discuss the criteria to be used to

evaluate the results and success of the project. Explain the

methodology that will be used to determine if the needs identified and

discussed are being met and if the results and benefits identified are

being achieved. List each organization, cooperator, consultant, or

other key individuals who will work on the project along with a short

description of the nature of their effort or contribution.

4. Geographic Location. Give a precise location of the project and

area to be served by the proposed project. Maps or other graphic aids

may be attached.

5. If applicable, provide the following information: for research

and demonstration assistance requests, present a biographical sketch of

the program director with the following information: Name, address,

telephone number, background, and other qualifying experience for the

project. Also, list the name, training and background for other key

personnel engaged in the project. Describe the relationship between

this project and other work planned, anticipated, or underway under

Federal assistance.

B. Supplemental Applications

Explain the reason for all requests for supplemental assistance and

justify the need for additional funding. Discuss accomplishments to

date and list in chronological order a schedule of accomplishments,

progress or milestones anticipated with the new funding request. If

there have been significant changes in the project objectives,

location, approach or time delays, explain and justify. For other

requests for changes, or amendments, explain the reason for the

changes(s). If the total budget has been exceeded or if the individual

budget items have changed more than the prescribed limits, explain and

justify the change and its effect on the project.

C. Continuation Applications

Continuation applications need only provide information explaining

significant changes to the original Program Narrative Statement and a

description of accomplishments from the prior budget period.

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U.S. Department of Health and Human Services--Certification Regarding

Drug-Free Workplace Requirements--Grantees Other Than Individuals

By signing and/or submitting this application or grant agreement,

the grantee is providing the certification set out below.

This certification is required by regulations implementing the

Drug-Free Workplace Act of 1988, 45 CFR Part 76, Subpart F. The

regulations, published in the May 25, 1990 Federal Register, require

certification by grantees that they will maintain a drug-free

workplace. The certification set out below is a material representation

of fact upon which reliance will be placed when the Department of

Health and Human Services (HHS) determines to award the grant. If it is

later determined that the grantee knowingly rendered a false

certification, or otherwise violates the requirements of the Drug-Free

Workplace Act, HHS, in addition to any other remedies available to the

Federal Government, may taken action authorized under the Drug-Free

Workplace Act. False certification or violation of the certification

shall be grounds for suspension of payments, suspension or termination

of grants, or governmentwide suspension or debarment.

Workplaces under grants, for grantees other than individuals, need

not be identified on the certification. If known, they may be

identified in the grant application. If the grantee does not identify

the workplaces at the time of application, or upon award, if there is

no application, the grantee must keep the identity of the workplace(s)

on file in its office and make the information available for Federal

inspection. Failure to identify all known workplaces constitutes a

violation of the grantee's drug-free workplace requirements.

Workplace identifications must include the actual address of

buildings (or parts of buildings) or other sites where work under the

grant takes place. Categorical descriptions may be used (e.g., all

vehicles of a mass transit authority or State highway department while

in operation, State employees in each local unemployment office,

performers in concert halls or radio studios.)

If the workplace identified to HHS changes during the performance

of the grant, the grantee shall inform the agency of the change(s), if

it previously identified the workplaces in question (see above).

Definitions of terms in the Nonprocurement Suspension and Debarment

common rule and Drug-Free Workplace common rule apply to this

certification. Grantees' attention is called, in particular, to the

following definitions from these rules:

``Controlled substance'' means a controlled substance in Schedules

I through V of the Controlled Substances Act (21 U.S.C. 812) and as

further defined by regulation (21 CFR 1308.11 through 1308.15).

``Conviction'' means a finding of guilt (including a plea of nolo

contendere) or imposition of sentence, or both, by any judicial body

charged with the responsibility to determine violations of the Federal

or State criminal drug statutes;

``Criminal drug statute'' means a Federal or non-Federal criminal

statute involving the manufacture, distribution, dispensing, use, or

possession of any controlled substance;

``Employee'' means the employee of a grantee directly engaged in

the performance of work under a grant, including: (i) All ``direct

charge'' employees; (ii) all ``indirect charge'' employees unless their

impact or involvement is insignificant to the performance of the grant;

and, (iii) temporary personnel and consultants who are directly engaged

in the performance of work under the grant and who are on the grantee's

payroll. This definition does not include workers not on the payroll of

the grantee (e.g., volunteers, even if used to meet a matching

requirement; consultants or independent contractors not on the

grantee's payroll; or employees of subrecipients or subcontractors in

covered workplaces).

The grantee certifies that it will or will continue to provide a

drug-free workplace by:

(a) Publishing a statement notifying employees that the unlawful

manufacture, distribution, dispensing, possession or use of a

controlled substance is prohibited in the grantee's workplace and

specifying the actions that will be taken against employees for

violation of such prohibition;

(b) Establishing an ongoing drug-free awareness program to inform

employees about:

(1) The dangers of drug abuse in the workplace; (2) the grantee's

policy of maintaining a drug-free workplace; (3) Any available drug

counseling, rehabilitation, and employee assistance programs; and, (4)

The penalties that may be imposed upon employees for drug abuse

violations occurring in the workplace;

(c) Making it a requirement that each employee to be engaged in the

performance of the grant be given a copy of the statement required by

paragraph (a);

(d) Notifying the employee in the statement required by paragraph

(a) that, as a condition of employment under the grant, the employee

will:

(1) Abide by the terms of the statement; and, (2) Notify the

employer in writing of his or her conviction for a violation of a

criminal drug statute occurring in the workplace no later than five

calendar days after such conviction;

(e) Notifying the agency in writing, within ten calendar days after

receiving notice under subparagraph (d)(2) from an employee or

otherwise receiving actual notice of such conviction. Employers of

convicted employees must provide notice, including position title, to

every grant officer or other designee on whose grant activity the

convicted employee was working, unless the Federal agency has

designated a central point for the receipt of such notices. Notice

shall include the identification number(s) of each affected grant;

(f) Taking one of the following actions, within 30 calendar days of

receiving notice under subparagraph (d)(2), with respect to any

employee who is so convicted:

(1) Taking appropriate personnel action against such an employee,

up to and including termination, consistent with the requirements of

the Rehabilitation Act of 1973, as amended; or, (2) Requiring such

employee to participate satisfactorily in a drug abuse assistance or

rehabilitation program approved for such purposes by a Federal, State,

or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free

workplace through implementation of paragraphs (a), (b), (c), (d), (e),

and (f).

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 belief 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 without 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.

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 or any agency, a Member

of Congress, an officer or employee 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 or any agency, a Member of Congress,

an officer or employee of Congress, or an 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.

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Organization

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Authorized Signature Title Date

Note: If Disclosure Forms are required, please contact: Margaret

A. Tolson, Director; Grants Management Division; 330 Independence

Avenue, S.W., Room 4256-COHEN; Washington, D.C. 20201-0001.

[FR Doc. 94-11383 Filed 5-10-94; 8:45 am]

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