Request for Applications Under the Office of Community Services' Fiscal Year 1994 Training and Technical Assistance Program

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Community Services

[Program Announcement No. OCS 94-04]

Request for Applications Under the Office of Community Services'

Fiscal Year 1994 Training and Technical Assistance Program

AGENCY: Office of Community Services, ACF, DHHS.

ACTION: Request for applications under the Office of Community

Services' Training and Technical Assistance 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 681(a)(3) of the

Community Services Block Grant Act of 1981 (Title VI of Public Law 97-

35, the Omnibus Budget Reconciliation Act of 1981, 42 U.S.C.

9910(a)(3)). This Program Announcement consists of seven parts. Part A

covers information on the legislative authority and defines terms used

in the Program Announcement. Part B describes the types of activities

that will be considered for funding. Part C provides details on who is

eligible to apply and application prerequisites. Part D provides

information on application procedures including the availability of

forms, where to submit an application, criteria for initial screening

of applications, and project evaluation criteria. Part E provides

guidance on the content of an application package and the application

itself. Part F provides instructions for completing an application.

Part G details post-award requirements.

CLOSING DATE: The closing date for submission of applications is May

24, 1994.

FOR FURTHER INFORMATION CONTACT: Mae Brooks, Division of Block Grants,

Office of Community Services, Administration for Children and Families,

370 L'Enfant Promenade SW., Washington, DC 20447. You may also call

(202) 401-9343.

Part A--Preamble

1. Legislative Authority

Section 681(a)(3) of the Community Services Block Grant (CSBG) Act

authorizes the Secretary of Health and Human Services to make funds

available to States and public and private nonprofit organizations to

provide for training and technical assistance to aid States in carrying

out their responsibilities under the CSBG Act.

2. Definitions of Terms

For purposes of this Program Announcement the following definitions

apply:

``Training'' is an educational activity or event which is designed

to impart knowledge, understanding, or increase the development of

skills. Such training activities may be in the form of assembled events

such as workshops, seminars, or programs of self-instructional

activities.

``Technical assistance'' is a problem-solving event generally

utilizing the services of an expert. Such services may be provided on-

site, by telephone, or other communications. These services address

specific problems and are intended to assist with the immediate

resolution of a given problem or set of problems.

``State'' means all of the States and the District of Columbia.

Except where specifically noted, for purposes of this Program

Announcement it also means ``Territory.''

``Territory'' refers to the Commonwealth of Puerto Rico, the

American Virgin Islands, Guam, American Samoa, the Commonwealth of the

Northern Mariana Islands, and the Republic of Palau.

``Local service providers'' are the approximately 1,000 local

public or private nonprofit agencies that receive Community Services

Block Grant funds from States to provide services to, or undertake

activities on behalf of, low-income people.

``Nationwide'' refers to the scope of the technical assistance

training on data collection projects to be undertaken with grant funds.

Proposed projects must provide for the implementation of technical

assistance, training or data collection for a significant number of

States, and the local service providers who administer CSBG funds.

Part B--Purpose

Section 681(a)(3) of the CSBG Act authorizes the Secretary of the

Department of Health and Human Services to make grants to States and

public agencies and private nonprofit organizations, or to enter into

contracts or jointly financed cooperative arrangements with States and

public agencies and private nonprofit organizations, to provide for

training and technical assistance to aid States in carrying out their

responsibilities for conducting and administering the CSBG Program.

OCS is soliciting applications which implement these legislative

mandates on a national basis and in a comprehensive manner. OCS

believes that training and technical assistance needs are best

identified at the State and local levels, not at the Federal level.

Therefore, funds will be provided in the form of grants. Proposed

projects under this Program Announcement must focus on one of the

following program priorities:

Priority 1--Training and Technical Assistance: The development and

implementation of a comprehensive, nationwide training and/or technical

assistance program to assist State staff and/or staff of local service

providers which receive funding under the CSBG Act, to acquire the

skills and knowledge needed to administer and implement programs

designed to ameliorate the causes of poverty in the communities.

Programs must include the provision of training and/or technical

assistance to State staff and/or staff of local service providers

nationwide, i.e., in each of the Federal Regions, in the most cost

effective manner possible. Collaboration with State CSBG coordinators

and local service providers will be required in identifying the

training and technical assistance needs of staff of local service

providers.

Priority 2--Data Collection: The design of a survey instrument, and

the collection, analysis, and dissemination of information on FY 1993

CSBG Programs on a nationwide basis through a process that relies on

voluntary State cooperation. The information must be comprehensive

enough and disseminated in such formats as to enable States and local

service providers to improve their planning, management, and delivery

of services and to assure that the general public has a clear

understanding of those programs and their outcomes.

Submissions 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 the development of films or visual

presentations proposed by applicants approved for funding will made

part of the grant ward.

See Part F, Section 4, for special instructions on developing a

work program.

Part C--Application Prerequisites

1. Eligible Applicants

Eligible applicants for Priority 1 are States, public agencies and

private non-profit organizations that can demonstrate familiarity and

expertise nationwide with the training and/or technical assistance

needs of community action agencies or State CSBG administering

agencies; and, for Priority 2, States, public agencies and private non-

profit organizations that can demonstrate their familiarity with the

CSBG Program and their ability to collect data from States on a

voluntary basis. In order to be considered for funding, proof of non-

profit status must be submitted with the application. Any of the

following is acceptable evidence: (1) Copy of the applicant

organization's listing in the Internal Revenue Service's (IRS) most

recent list of tax-exempt organizations described in section 501(c)(3)

of the IRS Code; or (2) a copy of the current valid IRS tax exemption

certificate.

2. Available Funds

The amount of funds available for grant awards under this

announcement in FY 94 is $271,439; $171,439 are available for training

and technical assistance activities and $100,000 for data collection

activities. It is anticipated that two grants will be made for T&TA

activities and one grant will be made for data collection activities.

3. Grant Duration

OCS will grant funds for a maximum of 12-month project and budget

periods. The application must clearly demonstrate that the project work

plan will achieve measurable results and can be successfully completed

within the stated time period.

4. Project Beneficiaries

Projects proposed for funding under the training and technical

assistance priority area must result in direct benefits to staffs of

State or local service providers in carrying out their responsibilities

under the Community Services Block Grant Act.

5. Sub-Contracting or Delegating Projects

OCS will not fund any project where the role of the applicant is

primarily to serve as a conduit for funds to organizations other than

the applicant. This prohibition does not bar the making of subgrants or

subcontracting for specific services or activities needed to conduct

the project. However, the applicant must have a substantive role in the

implementation of the project for which funding is requested.

Part D--Application Procedures

1. Availability of Forms

Attachments A, B and C contain all of the standard forms necessary

for the application for awards under these OCS programs. These forms

may be photocopied for use in developing the application.

Copies of the Federal Register containing this announcement are

available at most local libraries and Congressional District Offices

for reproduction. If copies are not available at these sources, they

may be obtained by writing or telephoning the office listed under the

section entitled FOR FURTHER INFORMATION at the beginning of this

announcement.

For purposes of this announcement, all applicants will use SF-424,

SF-424A, and SF-424B. Instructions for completing the SF 424, SF-424A,

and SF-424B are found in Attachments A, B, and C and Part F.

Part F contains instructions for the project narrative. The project

narrative will be submitted on plain bond paper along with the SF-424

and related forms.

Attachment I provides a checklist to aid applicants in preparing a

complete application package for OCS.

2. Application Submission

Refer to the section entitled ``Closing Date'' at the beginning of

this Program Announcement for the last day on which applications should

be submitted. Applications may be mailed to: Administration for

Children and Families, Division of Discretionary Grants, 6th Floor OFM/

DDG, OCS-94-04, 370 L'Enfant Promenade SW., Washington, DC 20447.

Hand-delivered applications are accepted during normal working

hours of 8 a.m. to 4:30 p.m., Monday through Friday, except legal

holidays, on or prior to the established closing date at:

Administration for Children and Families, Division of Discretionary

Grants, OCS-94-04, Sixth Floor, 901 D Street SW., Washington, DC 20447.

An application shall be considered as meeting the announced

deadline if it is either:

1. Received on or before the deadline date at a place specified in

the Program Announcement, or

2. Sent on or before the deadline date and received by the granting

agency in time for them to be considered during the competitive review

and evaluation process. (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 the U.S. Postal Service. Private metered

postmarks are not acceptable as proof of timely mailing.)

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.

The ACF 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 ACF 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 two copies should be submitted.

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, Connecticut,

Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana, Nebraska,

Oklahoma, Oregon, Pennsylvania, 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 seventeen 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.

Otherwise, applicants should contact their SPOCs as soon as possible to

alert them of the prospective applications and receive any necessary

instructions, 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 424A, item 16a.

Under 45 CFR 100.8(a)(2), a SPOC has 60 days from the application

deadline date to comment on proposed new awards. These comments are

reviewed as a part of the award process. Failure to notify the SPOC can

result in a delay in grant award.

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 they intend to

trigger the ``accommodate or explain'' rule under 45 CFR 100.10.

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, OCS-94-04,

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 Appendix G of this announcement.

4. Application Consideration

Applications which meet the screening requirements in Sections 5a

and 5b 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 OCS in considering

competing applications. Reviewers' scores will weigh heavily in funding

decisions but will not be the only factors considered. Applications

will be ranked and generally considered in order of the average scores

assigned by reviewers. However, highly ranked applications are not

guaranteed funding since the other factors deemed relevant may be

considered including, but not limited to, the timely and proper

completion of projects funded with OCS funds granted in the past 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 applicants will receive an

acknowledgement with an assigned identification number. This number,

along with any other identifying codes, must be referenced in all

subsequent communications concerning the application. If an

acknowledgement is not received within three weeks after the deadline

date, please notify ACF by telephone at (202) 401-9230. 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 Standard Form 424 ``Application

for Federal Assistance'' (SF-424), a budget (SF-424A), and signed

``Assurances'' (SF-424B) completed according to instructions published

in Part F and Attachments A, B, and C of this program announcement.

(2) A project narrative must also accompany the standard forms.

(3) The SF-424 and the SF-424B 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 and/or OCS staff to verify, prior to the

programmatic review, that the applications comply with this Program

Announcement in the following areas:

(1) Eligibility: Applicant meets the eligibility requirements found

in Part C. Applicant also must be aware that the applicant's legal name

as required on the SF 424 (Item 5) must match that listed as

corresponding to the Employer Identification Number (Item 6).

(2) Duration of Project: The application contains a project that

can be successfully implemented in 12 months.

(3) Target Populations: The application clearly targets the

specific outcomes and benefits of the project to State staff recipients

of CSBG funds and/or local providers of CSBG-funded services and

activities.

(4) Program Focus: The application must address development and

implementation of a nationwide, comprehensive training and/or technical

assistance or data collection activities as described in Part B of this

announcement.

An application may be disqualified from the competition and

returned to the applicant if it does not conform to one or more of the

above requirements.

c. Evaluation criteria. Applications which pass the 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. The in-depth

evaluation and review process will use the following criteria coupled

with the specific requirements contained in Part B. (Note: The

following review criteria reiterate collection of information

requirements contained in Part F 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

(1) Criterion I: Need for Assistance (Maximum: 20 points)

(a) The application documents that the project addresses a vital

nationwide need related to the purposes of this Program Announcement

(Part B) and provides statistics and other data and information in

support of its contention (0-10 points).

(b) Provides current supporting documentation or other testimonies

from State CSBG Directors and local service providers or State and

Regional organizations of local service providers (0-10 points).

(2) Criterion II: Work Program (Maximum: 30 points).

(a) Goals are appropriately related to needs and are specific and

measurable (0-10 points).

(b) Activities are comprehensive and nationwide in scope, and

adequately described and appropriately related to goals (0-10 points).

(c) Time frames and chronology of key activities are realistic (0-2

points).

(d) The plan for conducting an assessment that will determine the

degree to which the stated goals and objectives of the project are

achieved is adequate and workable and, where appropriate, the plan for

disseminating the information resulting from the project to CSBG

grantees, local service providers, and other interested parties is

workable and assures that all relevant parties are included in the

dissemination (0-8 points).

(3) Criterion III: Significant and Beneficial Impact (Maximum 25

points)

(a) Applicant adequately describes how the project will assure

long-term program and management improvements for States and/or local

providers of CSBG services and activities (0-15 points).

(b) For T&TA applications: The project will impact on a significant

number of State staff or local service providers (0-10 points).

(c) For data collection applications: The applicant has the ability

to collect data from a significant number of States (0-10 points).

(4) Criterion IV: Ability of Applicant to Perform (Maximum: 20

points)

(a) The application demonstrates that the applicant has experience

relevant to the activities that it proposes to undertake (0-10 points).

(b) The applicant's proposed project director and primary staff are

well qualified and their professional experiences are relevant to the

successful implementation of the proposed project (0-10 points).

(5) Criterion V: Adequacy of Budget (Maximum: 5 points).

(a) The resources requested are reasonable and adequate to

accomplish the project (0-3 points).

(b) Total costs are reasonable and consistent with anticipated

results (0-2 points).

Part E--Contents of Application and Receipt Process

1. Contents of Application

Each application should include one original and two additional

copies of the following:

a. A completed Standard Form 424 which has been signed by an

official of the organization applying for the grant who has authority

to obligate the organization legally. The applicant must be aware that

in signing and submitting the application for this award, it is

certifying that it will comply with the Federal requirements concerning

the drug-free workplace and debarment regulations set forth in

Attachments D and E.

b. ``Budget Information-Non-Construction Programs'' (SF-424A).

c. A filled out, signed and dated ``Assurances--Non-Construction

Programs'' (SF-424B), Attachment C.

d. Restrictions on Lobbying--Certification for Contracts, Grants,

Loans, and Cooperative Agreements: fill out, sign and date form found

at Attachment F.

e. Disclosure of Lobbying Activities, SF-LLL: fill out, sign and

date form found at Attachment F, as appropriate.

f. A Project Narrative consisting of the following elements

preceded by a consecutively numbered Table of Contents that will

describe the project in the following order:

(i) Need for Assistance

(ii) Work Program

(iii) Significant and Beneficial Impact

(iv) Management History

(v) Staffing and Resources

(vi) Appendices including proof of non-profit status, such as IRS

determination of non-profit status; By-Laws; Articles of Incorporation;

Certification Regarding Lobbying; resumes, etc. The original must bear

the signature of the authorizing official representing the applicant

organization. The total number of pages for the entire application

package should not exceed 30 pages, including appendices. Pages should

be numbered sequentially throughout. If appendices include photocopied

materials, they must be legible. Applications should be two-hole

punched at the top center and fastened separately with a compressor

slide paper fastener or a binder clip. The submission of bound

applications or applications enclosed in a binder is specifically

discouraged.

Applications must be uniform in composition since OCS may find it

necessary to duplicate them for review purposes. Therefore,

applications must be submitted on white 8\1/2\ x 11 inch paper only.

They must not include colored, oversized or folded materials. Do not

include organizational brochures or other promotional materials,

slides, films, clips, etc. in the proposal. They will be discarded if

included.

Part F--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 the applicant reproduce the SF-424

(Attachment A), SF-424A (Attachment B), SF-424B (Attachment C) and that

the application be typed on the copies. If an item on the SF-424 cannot

be answered or does not appear to be related or relevant to the

assistance requested, the applicant should write ``NA'' for ``Not

Applicable.''

The application should be prepared in accordance with the standard

instructions in Attachments A and B corresponding to the forms, as well

as the specific instructions set forth below:

1. SF-424 ``Application for Federal Assistance'' Item

1. For the purposes of this announcement, all projects are

considered ``Applications''; there are no ``Pre-Applications.''

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.

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 status such as IRS determination,

Articles of Incorporation, or by-laws, must be included as an appendix

to the project narrative.

8. For the purposes of this announcement, all applications are

``New''.

9. Enter ``DHHS-ACF/OCS''.

10. The Catalog of Federal Domestic Assistance number for the OCS

program covered under this announcement is ``93.032''.

11. In addition to a brief descriptive title of the project, the

following letter designations must be used: ``TA''--for training and

technical assistance projects; ``TD''--for data collection activities.

The title is ``Community Services Block Grant Discretionary

Awards--Training and Technical Assistance Program.''

15a. For purposes of this Announcement, this amount should reflect

the amount requested for the entire project period. 15b-e. These items

should reflect both cash and third party in-kind contributions for the

total project period.

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 Training and Technical Assistance

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 Training and Technical Assistance

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 Training and Technical Assistance Program'';

Col. (b):

Line 1 Enter ``93.032''.

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. Allowability of costs is governed by applicable cost

principles set forth in 45 CFR Parts 74 and 92.

A separate itemized budget justification should be included to

explain fully and justify major items, as indicated below. The budget

justification should immediately follow the Table of Contents.

Column 5: Enter total requirements for Federal funds by the Object

Class Categories of this section.

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. Equipment means

tangible non-expendable 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. The justification also must contain plans for future

use or disposal of the equipment after the project ends.

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

property (surplus) other than that included on line 6d.

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. With the exception of States and

local governments, applicants should enclose a copy of the current

approved rate agreement if it was negotiated with a Federal agency

other than the Department of Health and Human Services. For an

educational institution the indirect costs on training grants will be

allowed at the lesser of the institution's actual indirect costs or 8

percent of the total direct costs.

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.

The total amount shown in Section B, Column (5), Line 6k, should be

the same as the amount shown in Section A, Line 5, Column (e).

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. Column 5: Carry totals from Column 1 to Column 5

for all line items.

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.

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--

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--Enter the amount of Federal (OCS) cash needed for this

grant, by quarter, during the first 12 month budget period.

Line 14--Enter the amount of cash from all other sources needed by

quarter during the first year.

Line 15--Enter the total of Lines 13 and 14.

Section F--Other Budget Information

Line 21--Include narrative justification required under Section B

for each object class category for the total project period.

Line 22--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 if it was negotiated with a Federal

agency other than the Department of Health and Human Services.

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'' found at

Attachment C with their application.

4. Project Narrative

Each narrative section of the application must address one or more

of the focus areas described in Part B and follow the format outlined

below.

a. Need for Assistance

b. Work Program

c. Significant and Beneficial Impact

d. Ability of the Applicants to Perform

e. Staffing and Resources

a. Need for assistance. The application should identify the problem

areas in which State organizations receiving CSBG funds and/or local

service providers which receive CSBG funds as subgrantees from States

are seeking assistance and how those needs were identified. Applicants

also should provide current supporting documentation or other

testimonies from State CSBG Directors and local service providers or

State and Regional organizations of local service providers, as

appropriate, regarding need for the proposed project.

b. Work program. The application must contain a detailed and

specific work program that is both sound and feasible. Applicants must

address how the proposed project will carry out the legislative mandate

and the program activities found in Part B. This section of the

narrative must include the goals of the project related to the needs,

the activities that they propose to carry out to address those goals,

the methods by which they will carry out those activities, and the plan

for disseminating products resulting from the project, where

appropriate. Project activities must be described in a quantitative

manner, e.g. number of training days, number of workshops, number of

persons to be trained, number of local services providers to be

impacted, materials to be developed, etc. The applicant must define the

comprehensive nature of the proposed project and the methods which will

be used to ensure that it is a nationwide project.

For data collection projects, applicants should, at a minimum,

describe the methodology to be used to identify the kind of data to be

collected, how the data will be collected, how the applicant will

assure that the appropriate data will be collected, a plan for data

analysis, the methods by which the data will be disseminated and the

audiences, and a plan for conducting an assessment of the usefulness of

data collected.

The application must (1) set forth realistic quarterly time targets

by which the various work tasks will be completed; (2) include a plan

for conducting an assessment of its activities as they relate to the

goals and objectives; and (3) include a description of how the

applicant will involve other appropriate organizations in the planning

or implementation of the project in order to avoid duplication of

effort and to leverage additional resources.

c. Significant and beneficial impact. Each applicant must indicate

how the project will have a significant and beneficial impact. At a

minimum the applicant must provide (1) A description of how the project

will result in long-term improvements for the State organization

receiving CSBG funds and/or local providers who receive CSBG as a

subgrantee of the State and (2) the types and amounts of public and/or

private resources it will mobilize and how those resources will

directly benefit the project. An applicant proposing a project with a

training and technical assistance focus also must indicate the number

of local service providers and/or staff it will impact. An applicant

proposing a project with a data collection focus also must provide a

description of the mechanism the applicant will use to collect data,

how it can assure collections from a significant number of states, and

how many states will be willing to submit data to the applicant.

d. Ability of applicants to perform. Organizations must detail

their competence in the specific program area. Documentation must be

provided which addresses (1) accomplishments relevant to the proposed

project, and (2) experience relevant to the CSBG program.

Organizations which propose providing training and technical

assistance must detail their competence in the specific program

priority area and as a deliverer with expertise in the fields of

training and technical assistance on a nationwide basis. If applicable,

information provided by these applicants must also address related

achievements and competence of each cooperating or sponsoring

organization.

e. Staffing and resources. The application must fully describe

(e.g. a resume) the experience and skills of the proposed project

director and primary staff showing that the individuals are not only

well qualified but that their professional capabilities are relevant to

the successful implementation of the proposed project.

Part G--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 Notice of Grant

Award which provides the amount of Federal funds approved for use in

the project, the project and budget periods for which support is

provided, the terms and conditions of the award, and the total project

period for which support is contemplated.

In addition to the standard terms and conditions which will be

applicable to grants, grantee will be subject to the provisions of 45

CFR parts 74 (non-governmental) and 92 (governmental) and OMB Circulars

A-128 and A-133.

Grantees will be required to submit quarterly 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

(non-governmental) and 92 (governmental) and OMB Circulars A-128 and A-

133.

Section 1352 of Public Law 101-121, signed into law on October 23,

1989, imposes prohibitions and requirements for disclosure and

certification related to lobbying on recipients of Federal contracts,

grants, cooperative agreements, and loans. It provides exemptions for

Indian tribes and tribal organizations. Current and prospective

recipients (and their subtier contractors and/or grantees) are

prohibited from using Federal funds, other than profits from a Federal

contract, 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 disclose the name,

address, payment details, and purpose of any agreements with lobbyists

whom recipients or their subtier contractors or subgrantee will pay

with profits or nonappropriated funds on or after December 22, 1989,

and (3) to file quarterly up-dates about the use of lobbyists if

material changes occur in their use. The law establishes civil

penalties for noncompliance. See Attachment F for certification and

disclosure forms to be submitted with the applications for this

program.

Attachment H indicates the regulations which apply to all

applicants/grantees under this program.

Dated: March 17, 1994.

Donald Sykes,

Director, Office of Community Services.

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BILLING CODE 4184-01-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 his 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 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

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BILLING CODE 4184-01-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 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 budget 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 inkind 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 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

Line 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.

Attachment C--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. 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 CFR 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.

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. 794), which prohibits discrimination on the basis

of handicaps; (d) the Age Discrimination Act of 1975, as amended (42

U.S.C. 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.

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.

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. 276a to 276a-7), the Copeland Act (40 U.S.C.

276c and 18 U.S.C. 874), and the Contract Work Hours and Safety

Standards Act (40 U.S.C. 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 (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. 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. 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.

Signature of authorized certifying official

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Title------------------------------------------------------------------

Applicant organization-------------------------------------------------

Date submitted---------------------------------------------------------

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BILLING CODE 4184-01-C

Attachment E--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 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.

Attachment F--Certification Regarding Anti-Lobbying Provisions

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.

Statement for Loan Guarantees 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.

alt. cost--------------------------------------------------------------

Signature

alt. cost--------------------------------------------------------------

Title

alt. cost--------------------------------------------------------------

Organization

alt. cost--------------------------------------------------------------

Date-------------------------------------------------------------------

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Attachment G--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

Tracie L. Copeland, Manager, State Clearinghouse, Office of

Intergovernmental Services, Department of Finance and Administration,

P.O. Box 3278, Little Rock, Arkansas 72203, Telephone (501) 682-1074

California

Glenn Stober, Grants Coordinator, Office of Planning and Research, 1400

Tenth Street, Sacramento, California 95814, Telephone (916) 323-7480

Colorado

State Single Point of Contact, State Clearinghouse, Division of Local

Government, 1313 Sherman Street, Room 520, Denver, Colorado 80203,

Telephone (303) 866-2156

Delaware

Ms. Francine Booth, State Single Point of Contact, Executive

Department, Thomas Collins Building, Dover, Delaware 19903, Telephone

(302) 736-3326

District of Columbia

Rodney T. Hallman, State Single Point of Contact, Office of Grants

Management and Development, 717 14th Street, NW., Suite 500,

Washington, DC 20005, Telephone (202) 727-6551

Florida

Florida State Clearing House, Intergovernmental Affairs Policy Unit,

Executive Office of the Governor, Office of Planning and Budgeting, The

Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-8441

Georgia

Mr. Charles H. Badger, Administrator, Georgia State Clearing House, 254

Washington Street, SW., Atlanta, Georgia 30334, Telephone (404) 656-

3855

Illinois

Steve Klokkenga, Single Point of Contact, Office of the Governor, 107

Stratton Building, Springfield, Illinois 62706, Telephone (217) 782-

1671

Indiana

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

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

Karen Arone, State Clearinghouse, Executive Office of Communities and

Development, 100 Cambridge Street, Room 1803, Boston, Massachusetts

02202, Telephone (617) 727-7001

Michigan

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) 960-2174

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, Attention: 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

Gregory W. Adkins, Acting Director, Division of Community Resources,

N.J. 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

New Mexico

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

N.D. 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

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

Omeagia Burgess, State Single Point of Contact, Grant Services, Office

of the Governor, 1205 Pendleton Street, Room 477, Columbia, South

Carolina 29201, Telephone (803) 734-0494

South Dakota

Ms. Susan Comer, State Clearinghouse Coordinator, Office of the

Governor, 500 East Capitol, Pierre, South Dakota 57501, Telephone (605)

773-3212

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: 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, 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, Wisconsin Department of

Administration, 101 South Webster Street, P.O. Box 7864, Madison,

Wisconsin 53707, Telephone (608) 266-0267

Wyoming

Sheryl Jeffries, State Single Point of Contact, Herschler 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 H. 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, #41

Norregade Emancipation Garden Station, Second Floor, Saint Thomas,

Virgin Islands 00802, Please direct correspondence to: Linda Clarke,

Telephone (809) 774-0750

Attachment H

Checklist for Use in Submitting OCS Grant Applications (Optional)

The application should contain:

1. A completed, signed SF-424, ``Application for Federal

Assistance''. The letter code for the priority areas (TA) or (TD)

should be in the lower right-hand corner of the page;

2. A completed ``Budget Information-Non-Construction'' (SF-424A);

3. A signed ``Assurances-Non-Construction'' (SF-424A);

4. A Project Narrative beginning with a Table of Contents that

describes the project in the following order:

(a) Need for Assistance

(b) Work Program

(c) Significant and Beneficial Impact

(d) Ability of Applicant to Perform

(e) Staffing and Resources

5. Appendices including proof of non-profit status, Single Points

of Contact comments (where applicable), resumes;

6. A signed copy of ``Certification Regarding Anti-Lobbying

Activities'';

7. A completed ``Disclosures of Lobbying Activities'', if

appropriate; and

8. A self-addressed mailing label which can be affixed to a

postcard to acknowledge receipt of application.

The application should not exceed a total of 30 pages. It should

include one original and four identical copies, printed on white 8\1/2\

by 11 inch paper, two holes punched at the top center and fastened

separately with a compressor slide paper fastener or a binder clip.

The applicant must be aware that in signing and submitting the

application for this award, it is certifying that it will comply with

the Federal requirements concerning the drug-free workplace and

debarment regulations set forth in Attachments D and E.

Attachment I

The following DHHS regulations apply to all applicants/grantees

under the Training and Technical Assistance Program:

Title 45 of the Code of Federal Regulations:

Part 16--Procedures of the Departmental Grant Appeals Board

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

Sections 74.173 Hospitals

Sections 74.174(b) Other Nonprofit Organizations

Sections 74.304 Final Decisions in Disputes

Sections 74.710 Real Property, Equipment and Supplies

Sections 74.715 General Program Income

Part 75--Informal Grant Appeal Procedures

Part 76--Debarment and Suspension form 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 84--Non-discrimination on the Basis of Handicap in Programs

Part 86--Nondiscrimination on the basis of sex in the admission of

individuals to training 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

[FR Doc. 94-7140 Filed 3-24-94; 8:45 am]

BILLING CODE 4184-01-P