Changing the Culture of Welfare Demonstration

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

Changing the Culture of Welfare Demonstration

AGENCY: Administration for Children and Families, Department of Health

and Human Services.

ACTION: Announcement of the availability of funds and request for

applications to create and test various cultural change models for

adoption by welfare offices throughout the nation.

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SUMMARY: The Administration for Children and Families (ACF) announces

the availability of Federal funding to participate in intensive joint

planning and development activities that would reinforce the concept of

the temporary nature of welfare, and promote self-sufficiency and

employment. Funding under this announcement is authorized by section

1110 of the Social Security Act governing Social Services Research and

Demonstration activities.

DATES: The closing date for submission of applications is August 25,

1995.

ADDRESSES: Application receipt point: Department of Health and Human

Services, Administration for Children and Families, Division of

Discretionary Grants, 370 L'Enfant Promenade, S.W., 6th Floor, Mailstop

6C-462 Washington, DC 20447, William McCarron, Grants Officer.

Hand delivered applications are accepted during the normal working

hours of 8:00 a.m. to 4:30 p.m., Monday through Friday, on or prior to

the established closing date at: Administration for Children and

Families, Division of Discretionary Grants, 6th Floor, ACF Guard

Station, 901 D Street S.W., Washington DC 20447.

FOR FURTHER INFORMATION CONTACT: Yvonne C. Howard, Project Officer,

Administration for Children and Families, Office of Family Assistance,

370 L'Enfant Promenade, S.W., 5th Floor, Washington, DC 20447.

Telephone (202) 401-4619.

[[Page 32965]] SUPPLEMENTARY INFORMATION: The Administration for

Children and Families (ACF) announces that competing applications are

being accepted for Federal financial assistance to participate in

intensive joint planning and development activities that would

reinforce the concept of the temporary nature of welfare, and promote

self-sufficiency and employment. An initial financial award for 12

months, for up to 8 sites will be made under this announcement. The

Department will fund up to four (4) grantees who will be selected on a

competitive basis to receive second year continuation grants for

implementation of cultural change models. The recipients will be

expected to enter into a cooperative agreement with ACF.

This program announcement consists of four parts. Part I provides

background information about the Changing the Culture of Welfare (CCW)

demonstration. Part II describes the activities supported by this

announcement and application requirements. Part III describes the

application review process. Part IV provides information and

instructions for the development and submission of applications. The

forms to be used for submitting an application follow Part IV.

Part I--Introduction

Current welfare reform proposals emphasize work, responsibility and

the temporary nature of welfare. The focus of the Aid to Families with

Dependent Children (AFDC) program is changing from providing benefits

to preventing welfare dependency. There is growing consensus that AFDC

benefits should be transitional, time-limited assistance, requiring a

goal-oriented partnership between the welfare agency and the AFDC

client. Such a partnership should be designed to help the client

recognize the value of work and construct a plan to enter the job

market and/or training to quickly achieve economic self-sufficiency.

Welfare reform initiatives in the 1980s and 1990s exemplify States'

efforts to seek alternative methods of reducing welfare dependency.

Reform has primarily been sought through waivers of statutory

provisions, seen as barriers to achieving economic independence. In the

welfare debate, another emerging issue has been the need for a radical

culture change in the welfare system and the methods of assistance

provided to the AFDC families.

Part II--Project Design

Purpose

The purpose of the demonstration project is to provide an

opportunity for State/local IV-A agencies who: (1) want to design and

implement cultural change strategies or (2) are already implementing

cultural change strategies successfully but want to further expand

their initiatives, to focus more strongly on work, and make the system

more supportive of self-sufficiency efforts.

State and local welfare agencies are on the front line of the

needed culture change since change must begin where the client meets

the worker. In focusing on what the client needs to become self-

sufficient, workers, supervisors, and administrators must view their

jobs in a broader context. Workers must be empowered to participate in

changing the culture of the welfare office and helping clients move

from dependence to independence.

This culture change may be achieved by a variety of different

approaches, including changes in management style, staff training,

performance measurement and changes to the AFDC and JOBS rules which

are perceived to impede the transition from welfare dependency to

economic self-sufficiency.

Sites will need to create and test cultural change models and look

at the impacts, costs, and benefits of their models. They will need to

demonstrate how the model can be expanded and provide up-front delivery

of services to promote employment opportunities and portray welfare as

a transitional program.

They will need to also demonstrate how the job of the AFDC worker

has changed, or will change, from one of determining eligibility and

payment accuracy to one of financial consultant/customer service agent.

This role includes working with the client to explore options and

alternatives to public assistance, resources available in the community

to meet immediate client needs, demonstrating the financial benefits of

employment vs. receipt of welfare, and marketing (employment

opportunities to the client, and clients to potential employers) etc.

Eligible Applicants

Financial assistance under this announcement is limited to State

and local IV-A agencies. An applications from a local IV-A agency must

be approved by the State IV-A agency.

ACF is interested in providing financial support to IV-A agencies

with experience in, or a demonstrated commitment to changing the

culture of welfare. Examples of cultural change include:

1. Training management and staff, as part of a overall process

redesign geared toward employment and self-sufficiency, including

customer relations training.

2. Improving and modifying technology to support the line worker's

ability to service clients.

3. Implementing performance standards for evaluating staff with an

emphasis on job placement standards as an important criteria.

4. Establishing new criteria and incentives to reward staff

participating in and promoting cultural change activities.

5. Implementing a competency-based case management system.

6. Reclassifying personnel positions to upgrade eligibility

determination staff.

7. Co-locating administrative and client service delivery staff

working on AFDC and JOBS. Combining income maintenance and JOBS

responsibilities in one worker.

8. Implementing more intensive interventions to accommodate harder-

to-serve populations which would include individuals with learning

disabilities and/or developmental disabilities.

9. Establishing with educational institutions such as community

colleges, training institutions and local employers, short term

competency-based training programs linked to actual jobs.

Minimum Requirements for Project Design.

In order to compete successfully in response to this announcement,

the applicant should develop a plan which:

Includes an outline and discussion of current, or planned

culture change activities at the proposed demonstration sites. This

outline should include a description of the specific features/

components and services that are involved with, or impacted by culture

change activities, relevant demographics of the demonstration site, and

the level of agency commitment and community collaboration.

Describes how the applicant proposes to expand existing

culture change strategies and how these strategies will involve a

coordinated, integrated approach among, at minimum, AFDC/JOBS staff.

Demonstrates how this model will increase the

experiential/research information we now have of what AFDC clients need

to become self-sufficient.

Demonstrates how the model (or parts thereof) can be

replicated in other localities. [[Page 32966]]

Includes methods for measuring the effects of the

demonstration on AFDC/JOBS participants, e.g. increased participation,

employment/earnings; reduced welfare dependency.

Describes how a cost/benefit analysis will compare the

direct and indirect costs with the financial and non-financial benefits

of the program from the point of view of the participants; the

government (Federal, State, and local); and the taxpayer.

Includes the applicant's approach for providing assistance

and training to State and county demonstration project staff, as

needed.

Provides information about other (State, local, community)

resources the site will use to support this effort, including financial

support (if any) for the demonstration, in addition to Federal funding.

Provides for travel to Washington, DC (2 times) and one

site visit to another project for up to three people.

In recognition of the scope of the initiative, the potential

difficulty in successfully implementing and operationalizing agency

culture change, and the significance of the initiative for public

policy, ACF has determined that a close, cooperative working

relationship between the ACF and the selected States will greatly

further the public interest. Therefore, the awards made under this

announcement will be cooperative agreements between ACF and the

selected State IV-A agencies. It is anticipated that ACF will be

involved in the performance of the initiative in the following manner:

ACF, working in cooperation with the State, will review

and comment on the agency's cultural change strategies to ensure that

the project meets specified goals and objectives.

ACF will conduct site visits, teleconferences, and

meetings, as appropriate, to provide technical assistance.

ACF will facilitate information sharing and discussions

across sites.

The above-cited areas of involvement are illustrative of the

anticipated level of Federal involvement with the selected States in

the initiative. The exact activities will be detailed in the

Cooperative Agreement which will be developed with each selected State.

Project Duration

The length of the project should not exceed two years (24 months).

This announcement is soliciting applications for two-year projects.

Awards, on a competitive basis, will be for an initial one-year budget

period for the design and planning of the project. Up to eight

recipients of this initial award will compete among themselves for the

four (4) continuation awards. Four awards for project implementation,

beyond the one-year budget period but within the two-year project

period will be entertained, subject to availability of funds,

satisfactory progress of the recipient, and a determination that

continued funding would be in the best interest of the Government.

Federal Share of the Project

The maximum Federal share of the Project is not to exceed $1.8

million for the two-year project period, subject to the availability of

funds. The maximum Federal share for the first year budget period will

be $400,000 divided among up to eight recipients. The maximum Federal

share for the second year continuation grants will be $1.4 million

divided among four recipients.

Matching Requirement

Applicants must provide at least five (5) percent of the total cost

of the project. The total approved cost of the project is the sum of

the ACF share and the non-Federal share. The non-Federal share may be

met by cash or in-kind contributions, although applicants are

encouraged to meet their match requirements through cash contributions.

Therefore, a project requesting $50,000 in Federal funds must include a

match of at least $2,632 (i.e., 5 percent of the sum of the Federal and

the non-Federal cost of the project). The successful applicant's match

must be met by the completion of the project period.

The recipient will be required to provide the agreed upon non-

Federal share, even if it exceeds the required match stated above.

Therefore, applicants should ensure that any amount proposed as

matching funds is committed to the project prior to inclusion in its

budget.

Anticipated Number of Projects to be Funded

Up to eight projects will be funded under this announcement.

Part III--The Review Process

A. Review Process and Funding Decisions

Timely applications from eligible applicants will be reviewed and

scored competitively. Reviewers will use the evaluation criteria listed

below to review and score the application.

In addition ACF may refer applications to other Federal or non-

Federal funding sources when it is determined to be in the best

interest of the Federal Government or the applicant. It may also

solicit comments from ACF Regional Office staff, other Federal

agencies, interested foundations and national organizations. These

comments along with those of the reviewers will be considered by ACF in

making the funding decision.

In making a funding decision, ACF may give preference to

applications which reflect experience in working with the cultural

change strategies since such experience on the part of a recipient has

the potential to substantially improve the development of a culture

change model.

B. Evaluation Criteria

Using the evaluation criteria below, reviewers will review and

score each application. Applicants should insure that they address each

minimum requirement listed above.

Reviewers will determine the strengths and weaknesses of each

application in terms of the appropriate evaluation criteria listed

below, provide comments, and assign numerical scores. The point value

following each criterion heading indicates the maximum numerical weight

that each criterion may be given in the review process.

Review Criteria

(1) Knowledge of Changing the Culture of Welfare (25 points)

The applicant's proposal should demonstrate a good understanding of

the project design and the tasks and objectives involved in the

project. The application should provide: (a) evidence of organizational

experience in changing the culture of welfare and/or (b) evidence of

commitment to planning and implementing agency cultural change

activities. The discussion should also reflect a clear understanding of

``culture'' change and the current emphasis on work and responsibility

and transitional benefits.

(2) Approach and Project Design (30 points)

The application should include: (a) an outline of the project

design which takes into account specific features the applicant wishes

to address, the objectives, component(s) and services that will be

impacted by the culture change strategies; (b) a description of how the

applicant will involve agency staff (AFDC and JOBS) in the planning

process, which staff (front-line worker/management etc.), and the level

of staff involvement; and (c) the applicant's approach for providing

assistance and training to agency staff to enable their full

participation in the planning process. [[Page 32967]]

(3) Public--Private Partnerships (15 points)

In order to maximize the potential resources of the community to

provide options and alternatives to the public welfare system, the

applicant should provide evidence of coordination and commitments by

public, private, non-profit, community organizations and businesses to

support changing the culture of welfare.

(4) Methodology (5 points)

The application should describe proposed methodology for measuring

the effects of the planned demonstration on AFDC/JOBS participants and

the extent to which the experiential/research knowledge will be

increased.

(5) Staff Skills and Responsibilities (20 points)

It has been our experience that in order for demonstrations of this

scope to be successful, the support and commitment of the

administrators at the highest levels of the agency are necessary.

Demonstrations such as this are under tight time constraints and

require innovation and flexibility. For example, it may be necessary

from time to time to provide exceptions to normal administrative

processes or to establish expedited processes. Thus the support and

commitment of senior official to accomplish the many tasks involved is

critical. The application should discuss this issue and indicate the

level of commitment to the demonstration which is proposed. The

application should list key individuals who will work on the project

along with a short description of the nature of their contribution.

Summarize the background and experience of the project director and key

project staff.

(6) Budget Appropriateness (5 points)

The application should demonstrate that the project's costs are

reasonable in view of the anticipated results and benefits. Applicants

may refer to the budget information presented in the Standard Forms 424

and 424A.

Part IV--Instructions for the Development and Submission of

Applications

This part contains information and instructions for submitting

applications in response to this announcement. Application forms are

provided as part of this announcement along with a checklist for

assembling an application package.

A. Required Notification of the State Single Point of Contact

This program announcement 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

Program and Activities. Under the Order, States may design their own

processes for reviewing and commenting on proposed Federal assistance

under covered programs.

All States and Territories except Alabama, Alaska, Colorado,

Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana,

Nebraska, Oklahoma, Oregon, Virginia, Pennsylvania, South Dakota,

Washington, American Samoa and Palau have elected to participate in the

Executive Order process and have established Single Points of Contact

(SPOCs), listed at the end of this announcement. Applicants from these

nineteen jurisdictions need take no action regarding E.O. 12372.

Applicants for projects to be administered by Federally-recognized

Indian Tribes are also exempt from the requirements of E.O. 12372.

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

alert them of the prospective applications and receive any necessary

instructions. Applicants must submit any required material to the SPOCs

as soon as possible so that the program office can obtain and review

SPOC comments as part of the award process. It is imperative that the

applicant submit all required materials, if any, to the SPOC and

indicate the date of this submittal (or the date of contact if no

submittal is required) on the Standard Form 424, item 16a.

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

deadline to comment on proposed new or competing continuation awards.

SPOCs are encouraged to eliminate the submission of routine

endorsements as official recommendations. Additionally, SPOCs are

requested to clearly differentiate between mere advisory comments and

those official State process recommendations which may trigger the

``accommodate or explain'' rule.

When comments are submitted directly to ACF, they should be

addressed to: Department of Health and Human Services, Administration

for Children and Families, Division of Discretionary Grants, 370

L'Enfant Promenade, S.W., 6th Floor, Mailstop 6C-462, Washington, D.C.

20447.

Refer to the beginning of this announcement under the heading

ADDRESSES, for hand delivered applications.

B. Deadline for Submittal of Applications

The closing date for submittal of applications under this program

announcement is found at the beginning of this announcement under the

heading DATES. Applications shall be considered as meeting the

announced deadline if they are either:

1. Received on or before the deadline date at the receipt point

specified in this program announcement, or

2. Sent on or before the deadline date and received by ACF in time

for the independent review. Applicants are cautioned to request a

legibly dated receipt from a commercial carrier or U.S. Postal Service.

Private metered postmarks shall not be acceptable as proof of timely

mailing.

Late Applications: Applications which do not meet the criteria in 1

and 2 above are considered late applications. ACF shall notify each

late applicant that its application will not be considered in the

current competition.

Extension of Deadlines: ACF may extend the deadline for all

applicants because of acts of God, such as floods, hurricanes, etc., or

when there is widespread disruption of mails. However, if ACF does not

extend the deadline for all applicants, it will not extend the deadline

for any applicants.

C. Instructions for Preparing the Application

In order to assist applicants in completing the application, the

Standard Forms 424 and 424A, required certifications, and a list of

SPOCs have been included at the end of Part IV of this announcement.

Please reproduce single-sided copies of these forms from the reprinted

forms and type your information onto the copies.

Please prepare your application in accordance with the following

instructions:

1. SF 424 Page 1, Application Cover Sheet

Please read the following instructions before completing the

application cover sheet. An explanation of each item is included.

Complete only the items specified.

Item 1. Type of Submission--Non-Construction.

Item 2. Date Submitted and Applicant Identifier--Date application

is submitted to ACF and applicant's own internal control number, if

applicable.

Item 3. Date Received By State--State use only (if applicable).

Item 4. Date Received by Federal Agency--Leave blank.

[[Page 32968]]

Item 5. Applicant Information.

Legal Name--Enter the legal name of applicant organization. For

applications developed jointly, enter the name of the lead organization

only. There must be a single applicant for each application.

Organizational Unit--Enter the name of the primary unit within the

applicant organization which will actually carry out the project

activity. If this is the same as the applicant organization, leave the

organizational unit blank.

Address--Enter the complete address that the organization actually

uses to receive mail, since this is the address to which all

correspondence will be sent. Do not include both street address and

P.O. box number unless both must be used in mailing.

Name and telephone number of the person to be contacted on matters

involving this application (give area code)--Enter the full name and

telephone number of a person who can respond to questions about the

application. This person should be accessible at the address given.

Item 6. Employer Identification Number (EIN)--Enter the employer

identification number of the applicant organization, as assigned by the

Internal Revenue Service, including, if known, the Central Registry

System suffix.

Item 7. Type of Applicant--Self-explanatory.

Item 8. Type of Application--New.

Item 9. Name of Federal Agency--DHHS/ACF.

Item 10. Catalog of Federal Domestic Assistance Number--93.647.

Item 11. Descriptive Title of Applicant's Project--Changing the

Culture of Welfare.

Item 12. Areas Affected by Project--Leave Blank.

Item 13. Proposed Project--Enter the desired start date for the

project and projected completion date. The project period must begin no

later than September 30, 1995.

Item 14. Congressional District of Applicant/Project--Enter the

number of the Congressional district where the applicant's principal

office is located.

Items 15. Estimated Funding Levels--In completing 15a through 15f,

the dollar amounts entered should reflect the total amount requested

for the first 12-month budget period.

Item 15a. Enter the amount of Federal funds requested in accordance

with the preceding paragraph. This amount should be no greater than the

maximum amount available under this announcement for the first 12-month

budget period.

Items 15b-e. Enter the amount(s) of funds from non-Federal sources

that will be contributed to the proposed project. Items b-e are

considered cost-sharing or matching funds.

Item 15f. Enter the estimated amount of income, if any, expected to

be generated from the proposed project. Do not add or subtract this

amount from the total project amount entered under item 15g. Describe

the nature, source and anticipated use of this income in the Project

Narrative Statement.

Item 15g. Enter the sum of items 15a-15e.

Item 16a. Is Application Subject to Review By State Executive Order

12372 Process?--Check Yes if your State participates in the E.O. 12372

process. Enter the date the application was made available to the State

for review. Select the appropriate SPOC from the listing provided at

the end of Part IV. The review of the application is at the discretion

of the SPOC.

Item 16b. Is Application Subject to Review By State Executive Order

12372 Process?--Check No if the program has not been selected by State

for review.

Item 17. Is the Applicant Delinquent on any Federal Debt?--Check

the appropriate box. This question applies to the applicant

organization, not the person who signs as the authorized

representative. Categories of debt include audit disallowances, loans

and taxes.

Item 18. To the best of my knowledge and belief, all data in this

application/preapplication are true and correct. The document has been

duly authorized by the governing body of the applicant and the

applicant will comply with the attached assurances if the assistance is

awarded.--To be signed by the authorized representative of the

applicant. A copy of the governing body's authorization for signature

of this application by this individual as the official representative

must be on file in the applicant's office, and may be requested from

the applicant.

Item 18a-c. Typed Name of Authorized Representative, Title,

Telephone Number--Enter the name, title and telephone number of the

authorized representative of the applicant organization.

Item 18d. Signature of Authorized Representative--Signature of the

authorized representative named in Item 18a. At least one copy of the

application must have an original signature. Use colored ink (not

black) so that the original signature is easily identified.

Item 18e. Date Signed--Enter the date the application was signed by

the authorized representative.

2. SF 424A--Budget Information--Non-Construction Programs

This is a form used by many Federal agencies. For this application,

Sections A, B, C, and E are to be completed. Sections D and F do not

need to be completed.

Section A--Budget Summary. Line 1:

Column (a): Enter Changing the Culture of Welfare;

Column (b): Enter 93.647.

Columns (c) and (d): Leave blank.

Columns (e), (f) and (g): Enter the appropriate amounts needed to

support the project for the first budget period.

Section B--Budget Categories. This budget should include the

Federal as well as non-Federal funding for the proposed project for the

first 12-month budget period. The budget should relate to item 15g,

total funding, on the SF 424. Under column (5), enter the total

requirements for funds (Federal and non-Federal) by object class

category.

A separate budget justification should be included to explain fully

and justify items, as indicated below. The types of information to be

included in the justification are indicated under each category. The

budget justification should immediately follow the second page of the

SF 424A.

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

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

should be included on line 6h, Other.

Justification: Identify the staff, if known, specify. 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.

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

Justification: Provide a break-down of amounts and percentages that

comprise fringe benefit costs, such as health insurance, FICA,

retirement insurance, etc.

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

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

consultant's travel or local transportation, which should be included

on Line 6h, Other.

Justification: Include the name(s) of traveler(s), total number of

trips, destinations, length of stay, transportation costs and

subsistence allowances.

Equipment--Line 6d. Enter the total costs of all equipment to be

acquired by the project. For grants governed by the administrative

requirements of 45 CFR part 74, equipment means an article of

[[Page 32969]] nonexpendable tangible personal property having an

acquisition cost of $5000 or more per unit and a useful life of more

than one year. For grants governed by the administrative requirements

of 45 CFR part 92, equipment is tangible, nonexpendable 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

justified. The equipment must be required to conduct the project, and

the applicant organization or its subgrantees must not 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.

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

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

Justification: Specify general categories of supplies and their

costs.

Contractual--Line 6f. Enter the total costs of all contracts,

including procurement contracts (except those which belong on other

lines such as equipment, supplies, etc.) and contracts with secondary

recipient organizations. Also include any contracts with organizations

for the provision of technical assistance. Do not include payments to

individuals on this line.

Justification: Attach a list of contractors, indicating the names

of the organizations, the purposes of the contracts, and the estimated

dollar amounts of the awards as part of the budget justification.

Whenever the applicant/grantee intends to delegate part or all of the

program to another agency, the applicant/grantee must complete this

section (Section B, Budget Categories) for each delegate agency by

agency title, along with the supporting information. The total cost of

all such agencies will be part of the amount shown on Line 6f. Provide

backup documentation identifying the name of contractor, purpose of

contract, and major cost elements.

Construction--Line 6g. Not applicable. New construction is not

allowable.

Other--Line 6h. Enter the total of all other costs. Where

applicable, such costs may include, but are not limited to: insurance;

medical and dental costs; noncontractual fees and travel paid directly

to individual consultants; local transportation (all travel which does

not require per diem is considered local travel); space and equipment

rentals; printing and publication; computer use; training costs,

including tuition and stipends; training service costs, including wage

payments to individuals and supportive service payments; and staff

development costs. Note that costs identified as miscellaneous and

honoraria are not allowable.

Justification: Specify the costs included.

Total Direct Charges--Line 6i. Enter the total of Lines 6a through

6h.

Indirect Charges--6j. Enter the total amount of indirect charges

(costs). If no indirect costs are requested, enter none. Local and

State governments should enter the amount of indirect costs determined

in accordance with HHS requirements. When an indirect cost rate is

requested, these costs are included in the indirect cost pool and

should not be charged again as direct costs to the grant. In the case

of training grants to other than State or local governments (as defined

in title 45, Code of Federal Regulations, part 74), the Federal

reimbursement of indirect costs will be limited to the lesser of the

negotiated (or actual) indirect cost rate or 8 percent of the amount

allowed for direct costs, exclusive of any equipment charges, rental of

space, tuition and fees, post-doctoral training allowances, contractual

items, and alterations and renovations.

Justification: Enclose a copy of the indirect cost rate agreement,

if applicable.

Total--Line 6k. Enter the total amounts of lines 6i and 6j.

Program Income--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.

Justification: Describe the nature, source, and anticipated use of

program income in the Program Narrative Statement.

Section C--Non-Federal Resources. This section summarizes the

amounts of non-Federal resources that will be applied to the grant. On

lines 8-11, list estimates for each projected budget period within the

total project period (if an additional line is needed, use line 23 and

label it appropriately). Enter total amounts on line 12.

In-kind contributions are defined in title 45 of the Code of

Federal Regulations, Part 74.2., as the value of non-cash contributions

provided by non-Federal third parties. Third party in-kind

contributions may be in the form of real property, equipment, supplies

and other expendable property, and the value of goods and services

directly benefiting and specifically identifiable to the project or

program.

Justification: Describe third party in-kind contributions, if

included.

Section D--Forecasted Cash Needs. Not applicable.

Section E--Budget Estimate of Federal Funds Needed For Balance of

the Project. On lines 16-19, list estimates for Federal assistance

required for future budget periods within the total project period.

List estimated total amounts on line 20.

Section F--Other Budget Information. Not applicable.

3. Program Narrative Statement

The Program Narrative Statement should be clear, concise, and

address the specific requirements mentioned under Part II. The

narrative should also provide information concerning how the

application meets the evaluation criteria using the following headings:

(a) Knowledge of Changing the Culture of Welfare;

(b) Approach and Project Design;

(c) Public-Private Partnerships;

(d) Methodology;

(e) Staff Skills and Responsibilities;

(f) Budget Appropriateness.

The specific information to be included under each of these

headings is described in section B of Part III--Evaluation Criteria.

The narrative should be typed double-spaced. All pages of the

narrative (including charts, references, footnotes, tables, maps,

exhibits, etc.) must be sequentially numbered, beginning with

Organizational Experience. The length of the application, including the

application forms and all attachments, should not exceed 125 pages.

4. Assurances/Certifications

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

Construction Programs, and the Certification Regarding Lobbying. Both

must be signed and returned with the application. In addition,

applicants must certify their compliance with: (1) Drug-Free Workplace

Requirements; and (2) Debarment and Other Responsibilities. These

certifications are self-explanatory. Copies of these assurances and

certifications are reprinted at the end of this announcement and should

be reproduced, as necessary. A duly authorized representative of the

applicant organization must certify that the applicant is in compliance

with these assurances and certifications. A signature on the SF 424

indicates compliance with Drug-Free Workplace and Debarment notices and

Public Law 103-227, Part C--Environmental Tobacco Smoke, also known as

the Pro-Children Act of 1994. [[Page 32970]]

D. Checklist for a Complete Application

The checklist below is for your use to ensure that your application

package has been properly prepared.

--One original application, signed and dated, plus two copies.

--Complete application length should not exceed 125 pages.

--A complete application consists of the following items in this order:

Application for Federal Assistance (SF 424);

A completed SPOC certification with the date of SPOC

contact entered in line 16, page 1 of the SF 424 if applicable;

Budget Information--Non-construction programs (SF 424A);

Budget Justification for SF 424A Section B--Budget

Categories;

Letter from the Internal Revenue Service to prove

nonprofit status, if necessary;

Copy of the applicant's approved indirect cost rate

agreement, if appropriate;

Program Narrative Statement (See Part III, Section C);

Assurances--Non-construction programs (SF 424B); and

Certification Regarding Lobbying.

E. Submitting the Application

Each application package must include an original and two copies of

the complete application. Each copy should be stapled securely. All

pages of the narrative (including charts, tables, maps, exhibits, etc.)

must be sequentially numbered. In order to facilitate handling, please

do not use covers, binders, or tabs.

Applicant should include a self-addressed, stamped acknowledgment

card. All applicants will be notified automatically about the receipt

of their application.

Catalog of Federal Domestic Assistance 93.647.

Dated: May 22, 1995.

Lavinia Limon,

Director, Office of Family Assistance.

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BILLING CODE 4184-01-C

[[Page 32972]] 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) and applicant's control number (if applicable).

3. State use only (if applicable).

4. If this application is to continue or revise an existing

award, enter present Federal identifier number. If for a new

project, leave blank.

5. Legal name of applicant, name of primary organizational unit

which will undertake the assistance activity, complete address of

the applicant, and name and telephone number of the person to

contact on matters related to this application.

6. Enter Employer Identification Number (EIN) as assigned by the

Internal Revenue Service.

7. Enter the appropriate letter in the space provided.

8. Check appropriate box and enter appropriate letter(s) in the

space(s) provided:

--``New'' means a new assistance award.

--``Continuation'' means an extension for an additional funding/

budget period for a project with a projected completion date.

--``Revision'' means any change in the Federal Government's

financial obligation or contingent liability from an existing

obligation.

9. Name of Federal agency from which assistance is being

requested with this application.

10. Use the Catalog of Federal Domestic Assistance number and

title of the program under which assistance is requested.

11. Enter a brief descriptive title of the project. If more than

one program is involved, you should append an explanation on a

separate sheet. If appropriate (e.g., construction or real property

projects), attach a map showing project location. For

preapplications, use a separate sheet to provide a summary

description of this project.

12. List only the largest political entities affected (e.g.,

State, counties, cities).

13. Self-explanatory.

14. List the applicant's Congressional District and any

District(s) affected by the program or project.

15. Amount requested or to be contributed during the first

funding/budget period by each contributor. Value of in-kind

contributions should be included on appropriate lines as applicable.

If the action will result in a dollar change to an existing award,

indicate only the amount of the change. For decreases, enclose the

amounts in parentheses. If both basic and supplemental amounts are

included, show breakdown on an attached sheet. For multiple program

funding, use totals and show breakdown using same categories as item

15.

16. Applicants should contact the State Single Point of Contact

(SPOC) for Federal Executive Order 12372 to determine whether the

application is subject to the State intergovernmental review

process.

17. This question applies to the applicant organization, not the

person who signs as the authorized representative. Categories of

debt include 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

[[Page 32975]] Instructions for the SF-424A

General Instructions

This form is designed so that application can be made for funds

from one or more grant programs. In preparing the budget, adhere to

any existing Federal grantor agency guidelines which prescribe how

and whether budgeted amounts should be separately shown for

different functions or activities within the program. For some

programs, grantor agencies may require budgets to be separately

shown by function or activity. For other programs, grantor agencies

may require a breakdown by function or activity. Sections A, B, C,

and D should include budget estimates for the whole project except

when applying for assistance which requires Federal authorization in

annual or other funding period increments. In the latter case,

Sections A, B, C, and D should provide the budget for the first

budget period (usually a year) and Section E should present the need

for Federal assistance in the subsequent budget periods. All

applications should contain a breakdown by the object class

categories shown in Lines a-k of Section B.

Section A. Budget Summary Lines 1-4, Columns (a) and (b)

For applications pertaining to a single Federal grant program

(Federal Domestic Assistance Catalog number) and not requiring a

functional or activity breakdown, enter on Line 1 under Column (a)

the catalog program title and the catalog number in Column (b).

For applications pertaining to a single program requiring budget

amounts by multiple functions or activities, enter the name of each

activity or function on each line in Column (a), and enter the

catalog number in Column (b). For applications pertaining to

multiple programs where none of the programs require a breakdown by

function or activity, enter the catalog program title on each line

in Column (a) and the respective catalog number on each line in

Column (b).

For applications pertaining to multiple programs where one or

more programs require a breakdown by function or activity, prepare a

separate sheet for each program requiring the breakdown. Additional

sheets should be used when one form does not provide adequate space

for all breakdown of data required. However, when more than one

sheet is used, the first page should provide the summary totals by

programs.

Lines 1-4, Columns (c) through (g)

For new applications, leave Columns (c) and (d) blank. For each

line entry in Columns (a) and (b), enter in Columns (e), (f), and

(g) the appropriate amounts of funds needed to support the project

for the first funding period (usually a year).

For continuing grant program applications, submit these forms

before the end of each funding period as required by the grantor

agency. Enter in Columns (c) and (d) the estimated amounts of funds

which will remain unobligated at the end of the grant funding period

only if the Federal grantor agency instructions provide for this.

Otherwise, leave these columns blank. Enter in columns (e) and (f)

the amounts of funds needed for the upcoming period. The amount(s)

in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not

use Columns (c) and (d). Enter in Column (e) the amount of the

increase or decrease of Federal funds and enter in Column (f) the

amount of the increase or decrease of non-Federal funds. In Column

(g) enter the new total budgeted amount (Federal and non-Federal)

which includes the total previous authorized budgeted amounts plus

or minus, as appropriate, the amounts shown in Columns (e) and (f).

The amounts(s) in Column (g) should not equal the sum of amounts in

Columns (e) and (f).

Line 5--Show the totals for all columns used.

Section B. Budget Categories

In the column headings (1) through (4), enter the titles of the

same programs, functions, and activities shown on Lines 1-4, Column

(a), Section A. When additional sheets are prepared for Section A,

provide similar column headings on each sheet. For each program,

function or activity, fill in the total requirements for funds (both

Federal and non-Federal) by object class categories.

Lines 6a-i--Show the totals of Lines 6a to 6h in each column.

Line 6j--Show the amount of indirect cost.

Line 6k--Enter the total of amounts on Lines 6i and 6j. For all

applications for new grants and continuation grants the total amount

in column (5), Line 6k, should be the same as the total amount shown

in Section A, Column (g), Line 5. For supplemental grants and

changes to grants, the total amount of the increase or decrease as

shown in Columns (1)-(4), Line 6k should be the same as the sum of

the amounts in Section A, Columns (e) and (f) on Line 5.

Line 7--Enter the estimated amount of income, if any, expected

to be generated from this project. Do not add or subtract this

amount from the total project amount. Show under the program

narrative statement the nature and source of income. The estimated

amount of program income may be considered by the federal grantor

agency in determining the total amount of the grant.

Section C. Non-Federal-Resources

Lines 8-11--Enter amounts of non-Federal resources that will be

used on the grant. If in-kind contributions are included provide a

brief explanation on a separate sheet.

Column (a)--Enter the program titles identical to Column (a),

Section A. A breakdown by function or activity is not necessary.

Column (b)--Enter the contribution to be made by the applicant.

Column (c)--Enter the amount of the State's cash and in-kind

contribution if the applicant is not a State or State agency.

Applicants which are a State or State agencies should leave this

column blank.

Column (d)--Enter the amount of cash and in kind contributions

to be made from all other sources.

Column (e)--Enter 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.

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 [[Page 32976]] accordance with

generally accepted accounting standards or agency directive.

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 C.F.R. 900, Subpart F).

6. Will comply with all Federal statutes relating to

nondiscrimination. These include but are not limited to: (a) Title

VI of the Civil Rights Act of 1964 (P.L. 88-352 which prohibits

discrimination on the basis of race, color or national origin: (b)

Title IX of the Education Amendments of 1972, as amended (2) 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) 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 non-discrimination 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 1973 (P.L. 93-234) which requires recipients in a special flood

hazard area to participate in the program and to purchase flood

insurance if the total cost of insurable construction and

acquisition if $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 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. 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 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

----------------------------------------------------------------------

Applicant Organization

----------------------------------------------------------------------

Title

----------------------------------------------------------------------

Date Submitted

Executive Order 12373--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

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, N.W., Suite 500,

Washington, D.C. 20005, Telephone (202) 727-6551

Florida

Florida State Clearinghouse, Intergovernmental Affairs Policy Unit,

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

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

8441

Georgia

Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse,

254 Washington Street, S.W., Atlanta, Georgia 30334, Telephone (404)

656-3855

Illinois

Steve Klokkenga, State 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 [[Page 32977]]

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

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.

BILLING CODE 4184-01-P

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[[Page 32979]]

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BILLING CODE 4184-01-C

[[Page 32980]] 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.

Certification Regarding Lobbying

Certification for Contracts, Grants, Loans, and Cooperative

Agreements

The undersigned certifies, to the best of his or her knowledge

and belief, that:

(1) No Federal appropriated funds have been paid or will be

paid, by or on behalf of the undersigned, to any person for

influencing or attempting to influence an officer or employee of any

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

an employee of a Member of Congress in connection with the awarding

of any Federal contract, the making of any Federal grant, the making

of any Federal loan, the entering into of any cooperative agreement,

and the extension, continuation, renewal, amendment, or modification

of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been

paid or will be paid to any person for influencing or attempting to

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

Congress, an officer or employee of Congress, or an employee of a

Member of Congress in connection with this Federal contract, grant,

loan or cooperative agreement, the undersigned shall complete and

submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in

accordance with its instructions.

(3) The undersigned shall require that the language of this

certification be included in the award documents for all subawards

at all tiers (including subcontracts, subgrants, and contracts under

grants, loans, and cooperative agreements) and that all

subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon

which reliance was placed when this transaction was made or entered

into. Submission of this certification is a prerequisite for making

or entering into this transaction imposed by section 1352, title 31,

U.S. Code. Any person who fails to file the required certification

shall be subject to a civil penalty of not less than $10,000 and not

more than $100,000 for each such failure.

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.

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Signature

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Title

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Organization

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Date

BILLING CODE 4184-01-P

[[Page 32981]]

[GRAPHIC][TIFF OMITTED]TN26JN95.004

BILLING CODE 4184-01-C

[[Page 32982]] Certification Regarding Environmental Tobacco Smoke

Public Law 103-227, Part C--Environmental Tobacco Smoke, also

known as the Pro-Children Act of 1994 (Act), requires that smoking

not be permitted in any portion of any indoor routinely owned or

leased or contracted for by an entity and used routinely or

regularly for provision of health, day care, education, or library

services to children under the age of 18, if the services are funded

by Federal programs either directly or through State or local

governments, by Federal grant, contract, loan, or loan guarantee.

The law does not apply to children's services provided in private

residences, facilities funded solely by Medicare or Medicaid funds,

and portions of facilities used for inpatient drug or alcohol

treatment. Failure to comply with the provisions of the law may

result in the imposition of a civil monetary penalty of up to $1000

per day and/or the imposition of an administrative compliance order

on the responsible entity.

By signing and submitting this application the applicant/grantee

certifies that it will comply with the requirements of the Act. The

applicant/grantee further agrees that it will require the language

of this certification be included in any subawards which contain

provisions for the children's services and that all subgrantees

shall certify accordingly.

[FR Doc. 95-15585 Filed 6-23-95; 8:45 am]

BILLING CODE 4184-01-P