# Request for Applications Under the Office of Community Services' Fiscal Year 1994 Training and Technical Assistance Program > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A94-7140 ## Record - **Collection:** Federal Register - **Document type:** Uncategorized Document - **Published:** March 25, 1994 ## Text 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. ----------------------------------------------------------------------- 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. BILLING CODE 4184-01-P TN25MR94.000 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 TN25MR94.001 TN25MR94.002 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 ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Title------------------------------------------------------------------ Applicant organization------------------------------------------------- Date submitted--------------------------------------------------------- BILLING CODE 4184-01-P TN25MR94.003 TN25MR94.004 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------------------------------------------------------------------- BILLING CODE 4184-01-P TN25MR94.005 BILLING CODE 4184-01-C 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 --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A94-7140. Public record. Not legal advice.