Family Violence Prevention and Services Program

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families and the Public Health Service

[Program Announcement No. OCS 95-12]

Family Violence Prevention and Services Program

AGENCY: Office of Community Services, Administration for Children and

Families; Centers for Disease Control and Prevention, Public Health

Service; and the Substance Abuse and Mental Health Services

Administration, Public Health Service; in the Department of Health and

Human Services (HHS).

ACTION: Notice of the availability of financial assistance and request

for applications to establish a National Domestic Violence Hotline.

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SUMMARY: The Office of Community Services, Administration for Children

and Families, in cooperation with the Centers for Disease Control and

Prevention and Substance Abuse and Mental Health Services

Administration, announces the availability of funds in fiscal year 1995

for the award of one cooperative agreement on a competitive basis to

operate a national, toll-free telephone hotline to provide information

and assistance to victims of domestic violence. This announcement

contains all of the application materials needed to apply for this

cooperative agreement.

The purpose of the national domestic violence hotline is to provide

information and referral services, counseling, and assistance to

victims of domestic violence, their children and other family members,

and others affected by such violence and to enable them to find safety

and protection in crisis situations. The successful applicant will be

required to provide telephonic assistance on a 24 hour-per-day, seven

day-a-week basis throughout the continental United States, and in

Alaska, Hawaii, the Commonwealth of Puerto Rico, and the Virgin

Islands.

DATES: The closing date for submission of applications is June 5, 1995.

ADDRESSES: Applications may be mailed to the Department of Health and

Human Services, Administration for Children and Families/Division of

Discretionary Grants, 370 L'Enfant Promenade, SW., 6th Floor, (OCS 95-

12) Washington, DC. 20447.

Hand delivered applications are accepted during the normal working

hours of 8 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, 901 D Street, SW., 6th Floor (OCS 95-12), OFM/DDG, Washington,

DC 20447.

FOR FURTHER INFORMATION CONTACT: William D. Riley, Administration for

Children and Families, Office of Community Services, Division of State

Assistance, 370 L'Enfant Promenade, S.W., Washington, DC. 20447.

Telephone (202) 401-5529.

SUPPLEMENTARY INFORMATION: This program announcement consists of four

parts. Part I provides information on the legislative authority

applicable to this announcement and background information on the

proposed national domestic violence hotline. Part II describes the

minimum requirements for the design of the hotline that the applicant

must address in its application. Part III describes the evaluation

criteria. Part IV provides information and instructions for the

development and submission of an application.

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

Please copy and use these forms in submitting an application under this

announcement. No additional application materials are available or

needed to submit an application.

Applicants should note that the cooperative agreement to be awarded

under this program announcement is subject to the availability of

funds.

Part I: General Information

A. Legislative Authority

Title III of the Child Abuse Amendments of 1984, (Pub. L. 98-457,

42 U.S.C. 10401, et seq.) is entitled the Family Violence Prevention

and Services Act (the Act). The Act was first implemented in FY 1986,

was reauthorized and amended in 1992 by Pub. L. 102-295, and was

reauthorized and amended for fiscal years 1996 through 2000 by Pub. L.

103-322, the Violent Crime Control and Law Enforcement Act of 1994

(Crime Bill), signed into law on September 13, 1994.

One part of the Crime Bill, the Violence Against Women Act, added

section 316 to the Family Violence Prevention and Services Act to

authorize a grant award for up to five years to provide for the

operation of a national, toll-free telephone hotline to provide

information and assistance to victims of domestic violence.

B. Conceptual Framework and Scope of Services

The prevalence of family violence is widespread and its effective

prevention and treatment requires coordination and collaboration among

a broad range of legal, justice system, health, and social service

providers, and advocates at the Federal, State and local levels.

To serve the wide range of expected calls effectively, the hotline

must have expertise about domestic violence and services to victims of

domestic violence. The staff also must understand the importance of

using appropriate linkages with State and local resources to serve

callers to the hotline. The benefits of a highly visible national

hotline to victims and others will be directly related to the

productive working relationships and coordinated provision of services

between and among the hotline and State and local hotlines and other

services and resources.

Calls to the hotline may range from the urgent and life-threatening

to calls for general reference information. The target population to be

served by the hotline is specified in the statute as ``victims of

domestic violence.'' The hotline should be prepared to respond to the

broad range of violence that [[Page 12221]] occurs in the context of

family and intimate relationships, domestic violence, spouse abuse,

partner abuse, battering of women, sexual assault, date rape, and

acquaintance rape. The hotline also will serve those less directly

affected by such abuse, e.g., relatives, children of victims and other

family members, friends, neighbors, perpetrators and batterers, other

concerned individuals, and the general public.

In terms of the scope of the services provided by the hotline, the

statute requires the provision of ``information and assistance'' and

``counseling and referral services.'' Therefore, the applicants'

proposed design and plan for operating the hotline and responding to

callers is important. However, the hotline is not expected to provide

extended or long-term counseling or therapy services. The fuller

discussion of a problem and consideration of options is done most

appropriately at the local level, given the variation in laws and

services available among the States and localities.

Finally, because domestic violence often contributes to isolation,

helplessness, loss of self-esteem, and dependence, a self-help and

empowerment model of services is needed. Such a model:

Protects and assures safety for all victims and other

family members;

Builds on the strengths and resources of individuals and

families;

Offers options and support for independent decision-making

based on specific individual and family needs and circumstances; and

Assists individuals and families to obtain protection and

needed services that are respectful of cultural and community

characteristics.

Finally, we recognize that there is an inter-relationship between

alcohol, drug abuse, and mental health (ADM) problems and domestic

violence. Alcohol abuse has been demonstrated to contribute to violent

behavior. Moreover, the abuse of alcohol coupled with other drugs is

even more likely to be associated with severe battering incidents than

is alcohol by itself. Victims of and or witnesses to domestic violence

also may experience psychological consequences or turn to substance to

ameliorate their pain. In addition to physical trauma resulting from

acts of physical abuse, battered women suffer from a number of mental

health consequences, including higher levels of depression, drug and

alcohol abuse, suicide attempts, and low self-esteem. Many of the

mental health consequences of spousal violence result from chronic

intimidation and fear, which are often as significant as the actual,

acts of physical aggression. Witnessing spousal violence contributes to

the cycle of violence outside the home. There is an increased

likelihood of child abuse in homes where there has already been spouse

abuse.

C. Eligible Applicants

Any private nonprofit agency, organization, institution, Tribal

organization, or combination thereof, is eligible to apply for these

funds. Any nonprofit organization submitting an application must submit

proof of its nonprofit status in its application at the time of

submission. The non-profit agency can accomplish this by providing a

copy of the applicant's listing in the Internal Revenue Service's (IRS)

most recent list of tax-exempt organizations described in Section

501(c)(3) of the IRS Code or by providing a copy of the currently valid

IRS tax exemption certificate, or by providing a copy of the articles

of incorporation bearing the seal of the State in which the corporation

or association is domiciled.

D. Availability of Funds

As authorized by section 316 of the Act, the Office of Community

Services will award one cooperative agreement in FY 1995 of a maximum

of $1 million for the implementation of the toll-free rational domestic

violence hotline. The source of these funds will be the Crime Bill

Trust Fund.

Non-competitive continuation grant awards for each of years two

through five (FYs 1996-1999) will be a maximum of $850,000, subject to

the availability of funds. This total represents $400,000 from the

Crime Bill Trust Fund for the operation of the hotline and $450,000 to

be used to carry out additional statutory and programmatic activities

on behalf of the Centers for Disease Control and Prevention (CDC), the

Substance Abuse and Mental Health Services Administration (SAMHSA), and

the Office of Community Services (OCS).

Because the national hotline is viewed as a viable mechanism to

achieve a number of specific aims, in each of years two through five

CDC plans to provide $250,000 under section 393 of the Public Health

Services Act to provide additional support for State and local domestic

violence hotlines in response to the demand generated by the national

public awareness campaign; SAMHSA plans to provide $100,000 under

appropriate FY 1996 statutory authorities to enhance the hotline

database to include ADM resources, support the training of hotline

staff to assure that they are knowledgeable about ADM involvement in

incidents of domestic violence and can make appropriate referrals to

ADM services, and, to the extent possible, collect such information

from callers; and OCS plans to provide $100,000 under section 305 of

the Family Violence Prevention and Services Act to support additional

compilation and reporting of information based on calls to the hotline.

These supplemental activities are described in greater detail as

grantee requirements in Part II of this announcement.

Section 316 of the Act also states that funds appropriated and

awarded from the Crime Trust Fund will remain available until expended,

i.e., the $1 million in FY 1995 and $400,000 in FYs 1996-1999. This

provides additional flexibility to the grantee in the timing and use of

these funds. The funds for additional purposes in FYs 1996-1999

($450,000 in each of years two through five) must be expended by the

end of the fiscal year following receipt of the funds.

E. Duration of Project

The Office of Community Services, in cooperation with CDC and

SAMHSA, will award one grant, as a cooperative agreement, for up to

five years (60-month project period). The initial grant award, to be

made on a competitive basis, will cover a 12-month budget period.

Application for continuation funding beyond the initial 12-month budget

period, but within the 60-month project period, will be considered in

subsequent years on a non-competitive basis, subject to the approval of

the Secretary, the availability of funds, the satisfactory performance

of the grantee, and the determination that the continued funding and

support of the project would be in the best interest of the government.

F. Cooperative Agreement

The Office of Community Services intends to support the national

toll-free hotline through a cooperative agreement. A cooperative

agreement is Federal financial aid in which substantial Federal

involvement is anticipated. The responsibilities of the Administration

for Children and Families and of the successful applicant will be

identified and incorporated into the cooperative agreement during pre-

award negotiations. It is anticipated that ACF responsibilities will

not change the project requirements found in Part II of this

announcement.

The grantee will outline a plan of interaction with OCS for

implementation under a cooperative [[Page 12222]] agreement including,

as appropriate, activities involving Federal staff. The plan under the

cooperative agreement will describe the general and specific

responsibilities of the grantee and the grantor as well as foreseeable

joint responsibilities. A schedule of tasks will be developed and

agreed upon in addition to any special conditions relating to the

implementation of the hotline.

G. Grantee Share of the Project

The grantee must provide at least 25 percent of the total approved

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

of the Federal 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 $1,000,000 in Federal funds for the

first year budget period must include a match of at least $333,333 (25

percent of total project cost). If approved for funding, the grantee

will be held accountable for commitments of non-Federal resources, and

failure to provide the required amounts will result in a disallowance

of unmatched Federal funds.

Part II: Project Requirements

Requirements for Project Implementation

The following requirements must be met by the grantee and addressed

in the application:

1. All funds received by the grantee pursuant to Section 316 of the

Act must be used to establish and operate a national toll-free,

telephone hotline to provide information and assistance to victims of

domestic violence.

2. In establishing the hotline, the private, nonprofit entity

shall--

Contract with a carrier for the use of a toll-free

telephone line;

Employ, train, and supervise personnel to answer incoming

calls and provide counseling and referral services on a 24-hour-a-day

basis;

Assemble and maintain a current database of information

relating to services for victims of domestic violence to which callers

may be referred throughout the United States, including information on

the availability of shelters that serve battered women and their

children; and

Publicize the hotline to potential users throughout the

united States.

3. To be approved by the Secretary, the application must include a

complete description of the applicant's plan for the operation of a

national domestic violence hotline, including description of--

The training program for hotline personnel;

The hiring criteria for hotline personnel;

The methods for the creation, maintenance, and updating of

a resource database;

A plan for publicizing the availability of the hotline;

A plan for providing service to non-English speaking

callers, including hotline personnel who speak Spanish; and

A plan for facilitating access to the hotline by persons

with hearing impairments.

4. The applicant must demonstrate that it has:

Nationally recognized expertise in the area of domestic

violence and a record of high quality service to victims of domestic

violence, including a demonstration of support from advocacy groups,

such as domestic violence State coalitions or recognized national

domestic violence groups; and

A commitment to diversity, and to the provision of

services to ethnic, racial, and non-English speaking minorities, in

addition to older individuals and individuals with disabilities.

5. The applicant must demonstrate knowledge of the field, including

the range of services and the resources available for domestic violence

victims, their children and family members, perpetrators and batterers,

and other concerned individuals, including services and resources

relating to substance and mental health problems; State and Indian

tribal domestic violence laws, including the availability of legal

protection; and the barriers affecting access to such services,

resources and protection.

6. The applicant must demonstrate experience in providing high-

quality crisis intervention, information and referral, and counseling

services and support to battered women, their children, other domestic

violence victims, their family and friends, batterers, and the general

public.

7. The applicant must demonstrate an understanding of the

relationship of alcohol, drug abuse, and mental health (ADM) problems

to incidents of domestic violence and the ability to make appropriate

referrals to callers.

8. The applicant must demonstrate an understanding of the need for

a national hotline for domestic violence victims, including a

description of the function and limitation of the current network of

national and State crisis hotlines, information lines, and State

victims referral services.

9. The applicant must provide a plan and demonstrated ability to

build, maintain, and keep current a comprehensive database of resource

information, including the full range of services available in local

communities, the types of legal protection and services available in

different States and localities, and the capability to access

information.

10. The applicant must provide a detailed description of:

The telecommunications and computer technology that will

be employed to establish and support the hotline, including all

management functions, referral functions, resource database management

functions, monitoring functions, and overall project administration and

quality control, including periodic reporting to HHS;

The design and operation of the telephone system that will

be used to provide the service; its capacity and its limitations,

including information such as the capacity to facilitate the number of

incoming calls, call conferencing, automatic call referral to local

providers, and service integration with computers.

The methods that will be used to ensure that the national

hotline is a confidential crisis intervention and the specific

provisions that will be in place to safeguard the confidentiality of

callers and ensure the proper handling of confidential or sensitive

information;

The personnel recruitment, hiring, and training program

(i.e., a description of an initial and ongoing training plan for staff

and volunteers should be included in this section) that will ensure the

delivery of quality crisis intervention, information and referral,

assistance, and counseling services to diverse populations;

The specific emergency response and crisis protocol to be

used, the ability to conference call (or ``patch'') a caller to a local

domestic violence, legal services, or mental health or substance abuse

program when appropriate, and the plans for minimizing such problems as

crank/obscene calls and busy signals; and

The methods the applicant will use to provide for the

development, maintenance, and updating of a comprehensive resource

database (distributed to the maximum extent appropriate); the technical

capacity to link with other State and local databases in order to

maintain an extensive and current resource locator or listing; the

ability to facilitate communication among service providers to assist

the [[Page 12223]] provision of services; and how the information on

best practices gathered through the inventory being conducted by CDC

will be used to assist victims. 11. The applicant must demonstrate an

understanding of the technological requirements of such a project and

include a detailed timeline to provide the following services

nationally:

24-hour/365 days per year access;

Direct access to English and Spanish-speaking personnel at

all times and provision for services to other non-English speaking

callers and the hearing impaired;

Personnel (paid staff and volunteers) trained in crisis

intervention, information and referral, and counseling skills;

Comprehensive database of current information;

The ability to connect callers directly to local programs

or services when appropriate;

Emergency response protocol for callers in immediate

danger; and

Appropriate confidentiality safeguards; and data

collection and data management capability sufficient to support program

administration, reporting, monitoring, and an ongoing quality

assessment of the hotline service.

12. The applicant must provide a plan to coordinate, work with, and

provide hotline services and data resource and referrals that make

maximum use of existing domestic violence programs and resources,

including, but not limited to, local and State-wide domestic violence

hotlines, State Domestic Violence Coalitions, shelter programs,

emergency services, legal services programs, national domestic violence

resource centers, other existing national hotlines, and other national

organizations; resources related to child abuse and youth endangerment,

ADM problems, and perpetrators and batterers programs, the national

domestic violence media campaign coordinated by the Family Violence

Prevention Fund, and the various activities of the Centers for Disease

Control under its campaign to prevent violence against women. The

applicant must provide support to State and local domestic violence

hotlines in response to the demand generated by the national public

awareness campaign.

13. The applicant must provide a description of the quality

assurance system it will use to assess regularly the quality of the

services being provided by the hotline and the extent to which the

goals and objectives of the service are being met. The quality

assurance system also must include actions to address identified

problems.

14. The applicant must provide a comprehensive plan to publicize

the hotline to a wide national audience, including efforts to ensure

promotion through the national media and through targeted outreach to

racially and ethnically diverse communities, older individuals, and

individuals with disabilities.

15. The applicant must demonstrate the ability to staff,

financially support, and programmatically administer a national project

of this scope.

16. The author(s) of the application must be clearly identified

together with a description of his or her current relationship to the

applicant organization and any future project role he or she may have

if the project is funded.

17. The applicant must provide an assurance that any information

collected as a part of this grant will become the property of the

Federal Government.

18. The applicant must provide an assurance that it will work with

the Federal Project Officer to identify the information that will be

compiled based on incoming calls including compilation of information

on both maternal and child victims of domestic violence and individual

and situational factors characterizing violent and abusive behavior.

19. The applicant must provide an assurance that it will comply

with the grant administration requirements in 45 CFR part 74.

Part III: Evaluation Criteria

The five criteria that follow will be used to review and evaluate

how each application has addressed the requirements stated in Part II

and should be used in developing the program narrative. The point

values following each criterion heading indicate the maximum numerical

weight that each section will be given in the review process.

1. Need for the Project (10 Points)

Provide a detailed discussion of the need for a national domestic

violence hotline of the scope being proposed. Provide a detailed

analysis of the available data related to the problem being addressed

(both domestic violence in general and the specific lack of a national

domestic violence hotline); the strengths and limitations of other

national and local crisis intervention and victim services hotline/

referral services available, and the ``state-of-the-art'' relative to

the problem being addressed by the proposal.

2. Goals and Objectives (10 Points)

Clearly state the project goals and objectives. Objectives should

be stated in concrete, measurable terms which clearly identify the

population(s) to be served, the type, quality, and level of service to

be provided, the timeline for the establishment and delivery of

services, and other project benchmarks. The anticipated demand for

hotline services during the initial start-up period and a projection of

the demand on an ongoing basis should be discussed, with supporting

documentation. Describe the precise location of the project.

3. Approach (30 Points)

Provide a sound workable plan of action (approach) which details:

how the proposed work will be accomplished; how each task relates to

the project's goals and activities; identifies the key staff member

responsible for the specific tasks; provides a chart indicating the

timetable for completing each task, the phasing in of the tasks over

time, the lead staff person, and the time committed to the task; cites

factors which might accelerate or decelerate the work; justifies the

approach selected over other approaches; makes maximum use of existing

facilities and resources and off-the-shelf technology; describes and

supports any unusual features of the project, such as design or

technological innovations, reductions in cost or time, or extraordinary

social or community involvement; and provides projections of the

accomplishments to be achieved and identifies the activities for which

Federal technical assistance, advice, or guidance as the project is

implemented is anticipated and would be acceptable.

4. Results and Benefits Expected (20 Points)

Identify, in specific terms, the results and benefits to be derived

from the project and relate each result and benefit to a specific

objective. Indicate the aggregate number of calls expected to be

received and individuals to be assisted on an annual basis, e.g., the

expected volume of calls in such service areas as crisis counseling,

immediate referrals to shelters, or the number of referrals made in

response to non-English speaking callers. Indicate the anticipated

impact on and the subsequent benefit of the national hotline to victims

of domestic violence and on the existing network of State and local

shelters and services. Identify the kinds of data to be collected,

maintained, and updated, and discuss [[Page 12224]] the criteria to be

used to assure the quality of the services provided.

5. Level of Effort (30 Points)

Expertise, Commitment, and Support. The extent to which the

applicant has nationally recognized expertise in the area of domestic

violence and a record of high quality service to victims of domestic

violence, including a demonstration of support from advocacy groups,

such as State Domestic Violence Coalitions or recognized national

domestic violence groups; the extent of the applicant's commitment to

diversity, and to the provision of service to ethnic, racial, and non-

English speaking minorities, older individuals, and individuals with

disabilities.

Staff Background and Organizational Experience. The adequacy of the

staffing pattern for the proposed project, how the individual

responsibilities are linked to project tasks, and the contributions to

be made by key staff. Each collaborating or cooperative organization,

individual consultant, or other key individuals who will work on the

project should be listed along with a description of the nature of

their effort or contribution.

Competence of Staff. The background and experience of the project

director and key project staff and the history and accomplishments of

the organization; the qualifications of the project team including any

experience with similar projects; the variety of skills, relevant

educational background, and the ability to effectively manage the

project and to coordinate activities with other agencies. One or two

pertinent paragraphs on each key member are preferred to vitae/resumes.

However, vitae/resumes may be included.

Adequacy of Resources. The adequacy of the available resources and

organizational experience with regard to the tasks of the proposed

project. List the financial, physical, and other resources already

committed by other public and private agencies and institutions, if

any. Explain how these organizations will participate in the day to day

operations of the project. Letters from these agencies and

organizations identifying and discussing the specifics of their

commitment and participation must be included in the application.

Budget. Relate the proposed budget to the level of effort required

to obtain the project objectives. Demonstrate that the project's costs

are reasonable in view of the anticipated results.

Collaborative Efforts. The additional anticipated private sector

resources that may be available to support or enhance the overall

program. Discuss in detail and provide documentation for any proposed

collaborative or coordinated efforts with other public and private

agencies or organizations. Identify these agencies or organizations and

explain how their participation will enhance the project. Letters from

these agencies and organizations must be included discussing their

interest and/or commitment in supporting this project, the stage of the

planning and decision-making, and the expected level of resource

commitment.

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 publication along with a checklist for

assembling an application package. Please copy and use these forms in

submitting an application.

Potential applicants should read this section carefully in

conjunction with the information describing the proposed project under

which the application is to be submitted. The project design

requirements are found in Part II.

A. Required Notification of the State Single Point of Contact

This program is covered under Executive Order 12372, (E.O.)

``Intergovernmental Review of Federal Programs,'' and 45 CFR Part 100,

``Intergovernmental Review of Department of Health and Human Services

Program and Activities.'' Under the E.O., States may design their own

processes for reviewing and commenting on proposed Federal assistance

under covered programs.

All States and territories, except Alabama, Alaska, Colorado,

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

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

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

the E.O. process and have established Single Points of Contact (SPOCs).

Applicants from these nineteen jurisdictions need take no action

regarding 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 OCS 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 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 differentiate clearly 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, (OCS-95-

12) 370 L'Enfant Promenade, SW., 6th Floor, Washington, DC 20447.

A list of the Single Points of Contact for each State and Territory

is included at the end of this announcement.

B. Deadline for Submittal of Applications

The closing date for submittal of applications under this program

announcement is found at the beginning of this program announcement

under DATES. Applications shall be considered as meeting the announced

deadline if they are either:

1. Received on or before the deadline date at the Department of

Health and Human Services, Administration for Children and Families,

Division of Discretionary Grants, (OCS-95-12) 370 L'Enfant Promenade,

SW., 6th Floor, Washington, DC 20447, or

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

to be considered during the competitive review process.

Applications must be postmarked no later than the date to be found

at the beginning of the Program Announcement under DATES. When mailing

application packages, applicants are strongly advised to obtain a

legibly dated receipt from a commercial carrier (such as UPS, Federal

Express, etc.) or from the U.S. Postal Service as proof of mailing by

the deadline date. Private metered postmarks are not acceptable as

proof of timely mailing.

Late applications. Applications which do not meet the criteria

under ``Deadlines'' are considered late applications. The ACF shall

notify each late applicant that its application will not be considered

in the current competition.

Extension of deadlines. The ACF reserves the right to extend the

deadline [[Page 12225]] for all applicants due to acts of God, such as

floods, hurricanes or earthquakes; if there is widespread disruption of

the mail; or if ACF determines a deadline extension to be in the best

interest of the Government. However, ACF will not waive or extend the

deadline for any applicant unless the deadline is waived or extended

for all applicants.

C. Instructions for Preparing the Application and Completing

Application Forms

The SF 424, SF 424A, Page 2, and the required certifications have

been reprinted for your convenience in preparing the application. You

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

forms in the announcement, typing your information onto the copies.

Please do not use forms directly from the Federal Register

announcement, as they are printed on both sides of the page.

In order to assist applicants in correctly completing the SF 424

and SF 424A, instructions for these forms are included below.

Where specific information is not required under this program, NA

(not applicable) has been preprinted on the form.

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.

Top of Page! Enter designation ``HTL.''

Item 1! ``Type of Submission''--Preprinted on the form.

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.

Item 5: ``Applicant Information'' ``Legal Name''--Enter the legal

name of applicant organization.

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

the applicant organization which will actually carry out the project

activity. Do not use the name of an individual as the applicant. 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, including the area code, of the person

to be contacted on matters involving this application ``--Enter the

full name (including academic degree, if applicable) and telephone

number of a person who can respond to questions about the application.

This person should be accessible at the address given here and will

receive all correspondence regarding the application.

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''--Preprinted on the form.

Item 9: ``Name of Federal Agency''--Preprinted on the form.

Item 10: ``Catalog of Federal Domestic Assistance Number and

Title''--Enter the Catalog of Federal Domestic Assistance (CFDA) number

assigned to the program under which assistance is requested and its

title. The CFDA number for this program is 93.671.

Item 11: ``Descriptive Title of Applicant's Project''--Enter the

project title. The title is generally short and is descriptive of the

project.

Item 12: ``Areas Affected by Project''--Enter the governmental unit

where significant and meaningful impact could be observed. List only

the largest unit or units affected, such as State, county, or city. If

an entire unit is affected, list it rather than subunits.

Item 13: ``Proposed Project''--Enter the desired start date for the

project and projected completion date.

Item 14: ``Congressional District of Applicant/Project''--Enter the

number of the Congressional district where the applicant's principal

office is located and the number of the Congressional district(s) where

the project will be located. If statewide, a multi-State effort, or

nationwide, enter ``00.''

Items 15: ``Estimated Funding Levels''--

In completing 15a through 15f, the dollar amounts entered should

reflect, for a 17 month or less project period, the total amount

requested. If the proposed project period exceeds 17 months, enter only

those dollar amounts needed for the first 12 month budget period of the

proposed five year project 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 specified in the project description.

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.'' The value of third party

in-kind contributions should be included on appropriate lines as

applicable. For more information regarding funding and ``matching''

requirements, see Part I, Grantee Share of the Project.

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. If not applicable, enter N/A.

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

Item 16a: ``Is Application Subject to Review By State Executive

Order 12372 Process? Yes.''--Enter the date the applicant contacted the

SPOC regarding this application. 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. The SPOC will verify the date noted

on the application. If there is a discrepancy in dates, the SPOC may

request that the Federal agency delay any proposed funding until

September 30, 1995.

Item 16b: ``Is Application Subject to Review By State Executive

Order 12372 Process? No.''--Check the appropriate box if the

application is not covered by E.O. 12372 or if the program has not been

selected by the 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 [[Page 12226]] 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, E and F are to be completed. Section D does not need

to be completed.

Sections A and B should include the Federal as well as the non-

Federal funding for the proposed project covering (1) The total project

period of 17 months or less; or (2) the first 12 month budget period,

if the proposed project period exceeds 17 months.

Section A--Budget Summary. This section includes a summary of the

budget. On line 5, enter total Federal costs in column (e) and total

non-Federal costs, including third party in-kind contributions, but not

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

(g).

Section B--Budget Categories. This budget, which includes the

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

(1) The total project period of 17 months or less or (2) the first 12

month budget period if the proposed project period exceeds 17 months.

It 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 major items, as indicated below. The types of information

to be included in the justification are indicated under each category.

For multiple year projects, it is desirable to provide this information

for each year of the project. 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 project director, if known. 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,

unless treated as part of an approved indirect cost rate.

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

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

retirement insurance, etc.

Travel--Line 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 State and local governments, including

Federally recognized Indian Tribes, ``equipment'' is 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. For all other

applicants, the threshold for equipment is $5,000 or more per unit. The

higher threshold for State and local governments became effective

October 1, 1988, through the implementation of 45 CFR Part 92,

``Uniform Administrative Requirements for Grants and Cooperative

Agreements to State and Local Governments.''

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.'' Generally,

this line should be used when the applicant (except local governments)

has a current indirect cost rate agreement approved by the Department

of Health and Human Services or another Federal agency.

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.

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

Applicants subject to the limitation on the Federal reimbursement of

indirect costs for training grants should specify this. [[Page 12227]]

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.

Enter this information on line 12 entitled ``Totals.'' ``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 expandable 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. This section should only be completed if the total project

period exceeds 17 months.

Totals--Line 20: For projects that will have more than one budget

period, enter the estimated required Federal funds for the second

budget period (months 13 through 24) under column ``(b) First.'' If a

third budget period will be necessary, enter the Federal funds needed

for months 25 through 36 under ``(c) Second.'' Columns (d) and (e) are

not applicable in most instances, since ACF funding is almost always

limited to a three-year maximum project period. They should remain

blank.

Section F--Other Budget Information.

Direct Charges--Line 21: Not applicable.

Indirect Charges--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.

Remarks--Line 23. If the total project period exceeds 17 months,

you must enter your proposed non-Federal share of the project budget

for each of the remaining years of the project.

3. Project Summary Description

Clearly mark this separate page with the applicant name as shown in

item 5 of the SF 424, and the title of the project as shown in item 11

of the SF 424. The summary description should not exceed 300 words.

These 300 words become part of the computer database on each project.

Care should be taken to produce a summary description which

accurately and concisely reflects the proposal. It should describe the

objectives of the project, the approaches to be used and the outcomes

expected. The description should also include a list of major products

that will result from the proposed project, such as software packages,

materials, management procedures, data collection instruments, training

packages, or videos (please note that audiovisuals should be closed

captioned). The project summary description, together with the

information on the SF 424, will constitute the project ``abstract.'' It

is the major source of information about the proposed project and is

usually the first part of the application that the reviewers read in

evaluating the application.

4. Program Narrative Statement

The Program Narrative Statement is a very important part of an

application. It should be clear, concise, and address the specific

requirements mentioned under the project description in Part II. The

narrative should also provide information concerning how the

application meets the evaluation criteria using the following headings:

(a) Need for the Project

(b) Goals and Objectives

(c) Approach

(d) Results and Benefits Expected

(e) Level of Effort

The specific information to be included under each of these headings is

described in Part III, Evaluation Criteria.

The narrative should be typed double-spaced on a single-side of an

8\1/2\'' x 11'' plain white paper, with 1'' margins on all sides. All

pages of the narrative (including charts, references/footnotes, tables,

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

``Need for the Project'' as page number one. Applicants should not

submit reproductions of larger size paper, reduced to meet the size

requirement. There is no page limit on the length of the narrative.

The length of the remainder of the application, including the

application forms and all attachments, should not exceed 60 pages. A

page is a single side of an 8\1/2\'' x 11'' sheet of paper. Applicants

are requested not to send pamphlets, brochures or other printed

material along with their application as these pose photocopy

difficulties. These materials, if submitted, will not be included in

the review process if they exceed the 60-page limit. Each page of the

application will be counted to determine the total length.

5. Organizational Capability Statement

The Organizational Capability Statement should consist of a brief

(two to three pages) background description of how the applicant

organization (or the unit within the organization that will have

responsibility for the project) is organized, the types and quantity of

services it provides, and/or the research and management capabilities

it possesses. This description should cover capabilities not included

in the Program Narrative Statement. It may include descriptions of any

current or previous relevant experience, or describe the competence of

the project team and its demonstrated ability to produce a final

product that is readily comprehensible and usable. An organization

chart showing the relationship of the project to the current

organization should be included.

6. 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; and (3)

Certification Regarding Environmental Tobacco Smoke. These

certifications are self-explanatory. Copies of these assurances/

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/certifications. A signature on the SF 424

indicates compliance with the Drug Free Workplace Requirements, the

Debarment and Other Responsibilities, and the Environmental Tobacco

Smoke certifications.

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, signed and dated application, plus two copies.

Applications for different priority areas are packaged separately;

______Application is from an organization which is eligible under the

eligibility requirements defined [[Page 12228]] in the priority area

description (screening requirement);

______Application length, excluding the narrative, does not exceed 60

pages, unless otherwise specified in the project description.

______A complete application consists of the following items in this

order:

______Application for Federal Assistance (SF 424, REV 4-88);

______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, REV

4-88);

______Budget justification for Section B--Budget Categories;

______Table of Contents;

______Letter from the Internal Revenue Service to prove non-profit

status, if necessary;

______Copy of the applicant's approved indirect cost rate

agreement, if appropriate;

______Project summary description and listing of key words;

______Program Narrative Statement (See Part III);

______Organizational capability statement, including an

organization chart;

______Any appendices/attachments;

______Assurances--Non-Construction Programs (Standard Form 424B,

REV 4-88); and

______Certification Regarding Lobbying.

E. The Application Package

Each application package must include an original and two copies of

the complete application. Each copy should be stapled securely (front

and back if necessary) in the upper left-hand corner. All pages of the

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

sequentially numbered, beginning with page one. In order to facilitate

handling, please do not use covers, binders or tabs. Do not include

extraneous materials as attachments, such as agency promotion

brochures, slides, tapes, film clips, minutes of meetings, survey

instruments or articles of incorporation.

Applicant should include a self-addressed, stamped acknowledgment

card. All applicants will be notified automatically about the receipt

of their application. If acknowledgment of receipt of your application

is not received within eight weeks after the deadline date, please

notify ACF by telephone at (202) 401-5529.

(Catalog of Federal Domestic Assistance Number 93.671, Family

Violence Prevention and Services.)

Dated: March 1, 1995.

Donald Sykes,

Director, Office of Community Services.

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BILLING CODE 4184-01-C

[[Page 12230]]

Instructions for the SF 424

This is a standard form used by applicants as a required

facesheet for preapplications and applications submitted for Federal

assistance. It will be used by Federal agencies to obtain applicant

certification that States which have established a review and

comment procedure in response to Executive Order 12372 and have

selected the program to be included in their process, have been

given an opportunity to review the applicant's submission.

Item and Entry

1. Self-explanatory.

2. Date application submitted to Federal agency (or State if

applicable) & applicant's control number (if applicable).

3. State use only (if applicable).

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

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

project, leave blank.

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

which will undertake the assistance activity, complete address of

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

contact on matters related to this application.

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

Internal Revenue Service.

7. Enter the appropriate letter in the space provided.

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

space(s) provided:

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

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

budget period for a project with a projected completion date.

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

financial obligation or contingent liability from an existing

obligation.

9. Name a 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 he 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.)

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BILLING CODE 4184-01-C

[[Page 12233]]

Instructions for the SF-424A

General Instructions

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

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

any existing Federal grantor agency guidelines which prescribe how

and whether budgeted amounts should be separately shown for

different functions or activities within the program. For some

programs, grantor agencies may require budgets to be separately

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

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

and D should include budget estimates for the whole project except

when applying for assistance which requires Federal authorization in

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

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

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

for Federal assistance in the subsequent budget periods. All

applications should contain a breakdown by the object class

categories shown in Lines a-k of Section B.

Section A. Budget Summary

Lines 1-4, Columns (a) and (b)

For applications pertaining to a single Federal grant program

(Federal Domestic Assistance Catalog number) and not requiring a

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

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

For applications pertaining to a single program requiring budget

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

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

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

multiple programs where none of the programs require a breakdown by

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

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

Column (b).

For applications pertaining to multiple programs where one or

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

separate sheet for each program requiring the breakdown. Additional

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

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

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

programs.

Lines 1-4, Columns (c) Through (g.)

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

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

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

for the first funding period (usually a year).

For continuing grant program applications, submit these forms

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

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

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

only if the Federal grantor agency instructions provide for this.

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

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

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

For supplemental grants and changes to existing grants, do not

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

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

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

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

which includes the total previous authorized budgeted amounts plus

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

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

Columns (e) and (f).

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

Section B. Budget Categories

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

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

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

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

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

Federal and non-Federal) by object class categories.

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

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

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

applications for new grants and continuation grants the total amount

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

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

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

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

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

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

to be generated form 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

Lines 16-19--Enter in Column (a) the same grant program titles

shown in column (a), Section A. A breakdown by function or activity

is not necessary. For new applications and continuation grant

applications, enter in the proper columns amounts of Federal funds

which will be needed to complete the program or project over the

succeeding funding periods (usually in years). This section need not

be completed for revisions (amendments, changes, or supplements) to

funds for the current year of existing grants.

If more than four lines are needed to list the program titles,

submit additional schedules as necessary.

Line 20--Enter the total for each of the Columns (b)-(e). When

additional schedules are prepared for this Section, annotate

accordingly and show the overall totals on this line.

Section F. Other Budget Information

Line 21--Use this space to explain amounts for individual direct

object-class cost categories that may appear to be out of the

ordinary or to explain the details as required by the Federal

grantor agency.

Line 22--Enter the type of indirect rate (provisional,

predetermined, final or fixed) that will be in effect during the

funding period, the estimated amount of the base to which the rate

is applied, and the total indirect expense.

Line 23--Provide any other explanations or comments deemed

necessary.

Assurances--Non-Construction Programs

Note: Certain of these assurances may not be applicable to your

project or program. If you have questions, please contact the

awarding agency. Further, certain Federal awarding agencies may

require applicants to certify to additional assurances. If such is

the case, you will be notified.

As the duly authorized representative of the applicant I certify

that the applicant:

1. Has the legal authority to apply for Federal assistance, and

the institutional, managerial and financial capability (including

funds sufficient to pay the non-Federal share of project costs) to

ensure proper planning, management and completion of the project

described in this application.

2. Will give the awarding agency, the Comptroller General of the

United States, and if appropriate, the State, through any authorized

representative, access to and the [[Page 12234]] right to examine

all records, books, papers, or documents related to the award; and

will establish a proper accounting system in accordance with

generally accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from using

their positions for a purpose that constitutes or presents the

appearance of personal or organizational conflict of interest, or

personal gain.

4. Will initiate and complete the work within the applicable

time frame after receipt of approval of the awarding agency.

5. Will comply with the Intergovernmental Personnel Act of 1970

(42 U.S.C. Secs. 4728-4763) relating to prescribed standards for

merit systems for programs funded under one of the nineteen statutes

or regulations specified in Appendix A of OPM's Standards for a

Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all Federal statutes relating to

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

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

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

Title IX of the Education Amendments of 1972, as amended (20 U.S.C.

Secs. 1681-1683, and 1685-1686), which prohibits discrimination on

the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973,

as amended (29 U.S.C. Sec. 794), which prohibits discrimination on

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

amended (42 U.S.C. Secs. 6101-6107), which prohibits discrimination

on the basis of age; (e) the Drug Abuse Office and Treatment Act of

1972 (P.L. 92-255), as amended, relating to nondiscrimination on the

basis of drug abuse; (f) the Comprehensive Alcohol Abuse and

Alcoholism Prevention, Treatment and Rehabilitation Act of 1970

(P.L. 91-616), as amended, relating to nondiscrimination on the

basis of alcohol abuse or alcoholism; (g) Secs. 523 and 527 of the

Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3),

as amended, relating to confidentiality of alcohol and drug abuse

patient records; (h) Title VIII of the Civil Rights Act of 1968 (42

U.S.C. Sec. 3601 et seq.), as amended, relating to nondiscrimination

in the sale, rental or financing of housing; (i) any other

nondiscrimination provisions in the specific statute(s) under which

application for Federal assistance is being made; and (j) the

requirements of any other nondiscrimination statute(s) which may

apply to the application.

7. Will comply, or has already complied, with the requirements

of Titles II and III of the Uniform Relocation Assistance and Real

Property Acquisition Policies Act of 1970 (P.L. 91-646) which

provide for fair and equitable treatment of persons displaced or

whose property is acquired as a result of Federal or federally

assisted programs. These requirements apply to all interests in real

property acquired for project purposes regardless of Federal

participation in purchases.

8. Will comply with the provisions of the Hatch Act (5 U.S.C.

Secs. 1501-1508 and 7324-7328) which limit the political activities

of employees whose principal employment activities are funded in

whole or in part with Federal funds.

9. Will comply, as applicable, with the provisions of the Davis-

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

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

Hours and Safety Standards Act (40 U.S.C. Secs. 327-333), regarding

labor standards for federally assisted construction subagreements.

10. Will comply, if applicable, with flood insurance purchase

requirements of Section 102(a) of the Flood Disaster Protection Act

of 1973 (P.L. 93-234) which requires recipients in a special flood

hazard area to participate in the program and to purchase flood

insurance if the total cost of insurable construction and

acquisition is $10,000 or more.

11. Will comply with environmental standards which may be

prescribed pursuant to the following: (a) institution of

environmental quality control measures under the National

Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order

(EO) 11514; (b) notification of violating facilities pursuant to EO

11738; (c) protection of wetlands pursuant to EO 11990; (d)

evaluation of flood hazards in floodplains in accordance with EO

11988; (e) assurance of project consistency with the approved State

management program developed under the Coastal Zone Management Act

of 1972 (16 U.S.C. Sec. 1451 et seq.); (f) conformity of Federal

actions to State (Clear Air) Implementation Plans under Section

176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. Sec. 7401

et seq.); (g) protection of underground sources of drinking water

under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-

523); and (h) protection of endangered species under the Endangered

Species Act of 1973, as amended, (P.L. 93-205).

12. Will comply with the Wild and Scenic Rivers Act of 1968 (16

U.S.C. Sec. 1271 et seq.) related to protecting components or

potential components of the national wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with

Section 106 of the National Historic Preservation Act of 1966, as

amended (16 U.S.C. 470), EO 11593 (identification and protection of

historic properties), and the Archaeological and Historic

Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).

14. Will comply with P.L. 93-348 regarding the protection of

human subjects involved in research, development, and related

activities supported by this award of assistance.

15. Will comply with the Laboratory Animal Welfare Act of 1966

(P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the

care, handling, and treatment of warm blooded animals held for

research, teaching, or other activities supported by this award of

assistance.

16. Will comply with the Lead-Based Paint Poisoning Prevention

Act (42 U.S.C. Sec. 4801 et seq.) which prohibits the use of lead

based paint in construction or rehabilitation of residence

structures.

17. Will cause to be performed the required financial and

compliance audits in accordance with the Single Audit Act of 1984.

18. Will comply with all applicable requirements of all other

Federal laws, executive orders, regulations and policies governing

this program.

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Signature of authorized certifying official

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Title

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Applicant organization

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Date submitted

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[[Page 12236]]

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BILLING CODE 4184-01-C

[[Page 12237]]

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 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 D--Certification Regarding Lobbying

Certification for Contracts, Grants, Loans, and Cooperative

Agreements

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

and belief, that:

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

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

influencing or attempting to influence an officer or employee of any

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

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

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

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

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

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

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

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

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

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

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

loan or cooperative agreement, the undersigned shall complete and

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

accordance with its instructions.

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

certification be included in the award documents for all subawards

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

grants, loans, and cooperative agreements) and that all

subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon

which reliance was placed when this transaction was made or entered

into. Submission of this certification is a prerequisite for making

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

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

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

more than $100,000 for each such failure.

State for Loan Guarantee and Loan Insurance

The undersigned states, to the best of his or her knowledge and

belief, that:

If any funds have been paid or will be paid to any person for

influencing or attempting to influence an officer or employee of any

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

an employee of a Member of Congress in connection with this

commitment providing for the United States to insure or guarantee a

loan, the undersigned shall complete and submit Standard Form-LLL

``Disclosure Form to Report Lobbying,'' in accordance with its

instructions.

Submission of this statement is a prerequisite for making or

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

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

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

than $100,000 for each such failure.

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Signature

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Title

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Organization

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Date

BILLING CODE 4184-01-M

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BILLING CODE 4184-01-C

[[Page 12239]]

Attachment E

Executive Order 12372--State Single Points of Contact

Arizona

Mrs. Janice Dunn, Attn: Arizona State Clearinghouse, 3800 N. Central

Avenue, 14th Floor, Phoenix, Arizona 85012, Telephone (602) 280-1315

Arkansas

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 (303) 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 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, SW., 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

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 Bension, 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 and 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

[[Page 12240]]

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 F

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 facility owned or

leased or contracted for by an entity and used routinely or

regularly for the 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 children's services and that all subgrantees shall

certify accordingly.

[FR Doc. 95-5409 Filed 3-3-95; 8:45 am]

BILLING CODE 4184-01-P