[Federal Register Volume 59, Number 86 (Thursday, May 5, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-10648]


[[Page Unknown]]

[Federal Register: May 5, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of Community Services
[Program Announcement No. OCS 94-10]

 

Limited Competition; Request for Applications Under the Office of 
Community Services' FY 1994 Demonstration Partnership Program, Special 
Set-Aside for Empowerment Zone/Enterprise Community--Technical 
Assistance/Planning Grants

AGENCY: Administration for Children and Families (ACF), DHHS.

ACTION: Request for applications for technical assistance-planning 
grants from all eligible entities under the Demonstration Partnership 
Program (DPP) which also meet the eligibility criteria set forth below.

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SUMMARY: The Office of Community Services (OCS) announces that, based 
on availability of funds, it has set aside up to two million dollars 
($2,000,000) for technical assistance/planning grants not to exceed ten 
thousand dollars ($10,000) each, related to the development of 
Strategic Plans by communities seeking designation as Empowerment Zones 
or Enterprise Communities under Title XX of the Social Security Act. 
Applications will be accepted for grants pursuant to the Secretary's 
authority under section 408(a) as amended (Pub. L. 99-425), of the 
Human Services Reauthorization Act of 1986. This Program Announcement 
contains forms and instructions for submitting an application, and 
consists of six parts:
    Part A sets forth eligibility criteria for funding under this 
Program Announcement;
    Part B describes the purposes of this program, the type of project 
that will be considered for funding, and the size and duration of 
grants;
    Part C provides details on application requirements such as the 
amount of matching funds applicants are required to commit, 
prohibitions on use of funds, partnership agreements, etc.;
    Part D describes the application procedures including where and how 
to submit an application;
    Part E describes contents of application and how the project 
narrative should be ordered and presented;
    Part F details post-award information and reporting requirements.

CLOSING DATE: The closing date for submission of applications is May 
12, 1994.

FOR FURTHER INFORMATION CONTACT: Office of Community Services, Division 
of Community Demonstration Programs, Attn: Richard M. Saul, 370 
L'Enfant Promenade SW., Fifth floor, Washington, DC 20447, telephone 
(202) 401-9341.

Part A--Eligible Applicants

1. Basic Eligibility Criteria

    Grants pursuant to this announcement may be made to any 
organization which is officially designated as a community action 
agency or community action program under section 673(1) of the 
Community Services Block Grant (CSBG) Act, meets all the requirements 
under section 675(c)(3) of the CSBG Act, and which meets the additional 
criteria set out in paragraph 2. below. All eligible applicants are 
current recipients of Community Services Block Grant funds. For 
purposes of the Demonstration Partnership Program only, the term 
eligible applicant also includes an organization that serves migrant 
and seasonal farmworkers and that received Community Services Block 
Grant funds in fiscal year 1993. OCS/ACF will be the final determiner 
of an organization's status as an eligible entity under the Community 
Services Block Grant Act.

2. Additional Eligibility Criteria

    Additional Criteria: to be eligible for funding under this Program 
Announcement an applicant must also:
    a. Contain within its service area a community or communities which 
as of the closing date for application under this Program Announcement 
has filed with HUD or USDA a Notice of Intent to Participate indicating 
an intent to apply for designation as an Empowerment Zone or Enterprise 
Community; and
    b. Of the agencies meeting the criteria set out in subparagraph 
(1), above, have a CSBG funding level in FY 1994 which is one of the 
200 smallest among those submitting an otherwise acceptable application 
in response to this announcement. (OCS estimates that agencies which 
received FY 1994 CSBG grants of less than approximately $350,000 should 
be eligible, although the final figure will not be known until all 
applications are received.)

Part B--Type of Project Eligible for Funding

    OCS is interested in providing funds to eligible applicants with 
limited resources whose service areas have a high incidence of poverty. 
The purpose of this set-aside is to provide capacity-building grants 
that will enable eligible applicants to strengthen their staffs or 
obtain other resources that will enable them to participate, in 
partnership with others in their communities, in the development of 
Strategic Plans for their service areas which will be submitted to USDA 
and HUD seeking designation as Empowerment Zones or Enterprise 
Communities. OCS looks to the participation in this planning process 
made possible by these grants as a way of achieving the following 
goals: (1) That low income people will be involved in the design and 
implementation of these Strategic Plans and as beneficiaries of the 
programs they propose, (2) that the Plans will include provision for 
independent third-party evaluation that will verify such involvement 
and assess its benefits, and (3) that the Plans will provide a vehicle 
for replication of past successful Demonstration Partnership Programs.
    Funds under this set aside may be used to acquire additional staff 
and/or to contract for necessary expertise or resources in order to 
enable the applicant to develop partnership arrangements through which 
it can contribute effectively to the development of a Strategic Plan 
that will embody the goals outlined above. Reasonable and necessary 
travel costs, including those necessary to facilitate low income 
participation in the strategic planning process, may also be paid for 
with grant funds. The end result should be a comprehensive, finely-
tuned Strategic Plan that will include innovative approaches to provide 
for greater self-sufficiency of the poor.
    A maximum of $10,000 will be granted to eligible applicants which 
submit acceptable applications as described below. OCS has set aside a 
total of up to two million dollars ($2,000,000) to fund these grants, 
which will have project periods of six months. Funds not obligated by 
grantees at the end of the project period will lapse.
    It should be noted that under the terms of the authorizing 
legislation recipients of these TA/Planning grants will not be eligible 
to receive any other grants under the Demonstration Partnership Program 
in FY 1994.

Part C--Application Requirements

1. Limitation on Use of Funds

    Grant funds under this Program Announcement may only be used for 
Salaries, Travel, and Contract/Consultant Services. (Categories a, c, 
and f on SF 424A)

2. Prohibition on the Use of Funds

    The use of funds for the purchase, construction or improvement of 
real property is prohibited. This prohibition includes expenditures for 
weatherization and home repairs.

3. Eligibility

    Applicant must be an eligible entity as defined in Part A. As part 
of establishing eligibility, the application must contain a letter 
signed by the State Director of the Community Services Block Grant 
program certifying that the applicant meets the Basic Eligibility 
Criteria set out in Part A, Paragraph 1 of this Announcement, and that 
it has the capacity to operate the proposed project. The application 
must also contain, as part of the Project Narrative, a statement 
certifying that a Notice of Intent to Participate has been submitted 
from the applicant's service area to either HUD or USDA indicating an 
intent to apply for designation as an Empowerment Zone or an Enterprise 
Community. The statement must identify the entity which submitted the 
Notice and its location, and must indicate that to the best of the 
applicant's knowledge and belief the submission was based on the 
existence of eligible census tracts within the applicant's community or 
service area.

4. Matching Funds

    An applicant is required to obtain commitment of at least one 
private or public sector dollar or equivalent in-kind contribution for 
each dollar of OCS funds awarded for under this Program Announcement. 
Public sector resources that can be counted toward the minimum match 
include funds from State and local governments, and funds from certain 
block grants allocated to the States by the Federal Government, 
provided that the authorizing legislation for these grants permits such 
use. (CDBG legislation permits such use; CSBG legislation does not.) 
Funds identified by the applicant as those to be counted toward the 
minimum match requirement may be in the form of grantee-incurred costs, 
cash or third-party in-kind contributions fairly valued.

5. Partnership Agreement

    To be considered for funding applicants must include in the 
application a signed letter from the EZ/EC Applicant Entity, if already 
selected, and from the unit or units of local government which will be 
signing off on the EZ/EC Application for designation, pledging 
cooperation with the applicant as a member of the group engaged in 
development of the Strategic Plan in their community. Applicants are 
encouraged to seek similar letters from other agencies or organizations 
in their community involved in the Strategic Planning process.

6. Sub-Contracting or Delegating Projects

    An applicant will not be funded where the proposal is for a grantee 
to act as a mere conduit of funds to a third party without performing a 
substantive role itself. This prohibition does not bar subcontracting 
or subgranting for specific services or activities needed to conduct 
the project.

7. Maintenance of Effort

    The activities funded under this program announcement must be in 
addition to, and not in substitution for, activities previously carried 
on without Federal assistance. Also, funds or other resources currently 
devoted to activities designed to meet the needs of the poor within a 
community, area, or State must not be reduced in order to provide the 
required matching contributions. When legislation for a particular 
block grant permits the use of its funds as match, the applicant must 
show that it has received a real increase in its block grant allotment 
and must certify that other anti-poverty programs will not be scaled 
back to provide the match required for this project. (See Attachment B)

Part D--Submission of Applications

1. Application Submission

    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 OFM/DDG-
EZ/EC, 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, 6th Floor 
OFM/DDG, 901 D Street, SW., Washington, DC 20447. An application will 
be considered to be received on time if sent on or before the closing 
date as evidenced by a legible U.S. Postal Service postmark or a 
legibly dated receipt from a commercial carrier.

(Applicants are cautioned to request a legibly dated U. S. Postal 
Service postmark or to obtain a legibly dated receipt from a commercial 
carrier or the U. S. Postal Service. Private metered postmarks are not 
acceptable as proof of timely mailing.)

2. Late Applications

    Applications which do not meet one of these criteria are considered 
late applications. The ACF Division of Discretionary Grants will notify 
each late applicant that its application will not be considered in this 
competition.

3. Extension of Deadline

    The ACF Office of Community Services may extend the deadline for 
all applicants because of acts of God such as floods, hurricanes, etc., 
or when there is a disruption of the mails. However, if the Office of 
Community Services does not extend the deadline for all applicants, it 
may not waive or extend the deadline for any applicant.
    Applications once submitted are considered final and no additional 
materials will be accepted.
    One signed original application and two copies should be submitted.

Part E--Contents of Application, Appendices, and Intergovernmental 
Review

1. Contents of Application

    Each application submission should include a signed original and 
two additional copies of the application. Each application should 
include the following in the order presented:
    a. A completed Standard Form 424 which has been signed by an 
official of the organization applying for the grant who has authority 
to obligate the organization legally; [Note: The original SF-424 must 
bear the original signature of the authorizing representative of the 
applicant organization]
    b. Budget Information-Non-Construction Programs (SF-424A) Note that 
grant funds under this Announcement may only be used for Salaries, 
Travel, and Contract/Consultant Services (Budget Categories a, c, and 
f). Attach to the SF 424A a breakout of total project costs reflecting 
Federal (OCS funds) and matching non-Federal resources (including funds 
from other Federal programs) along with budget justification. (See 
Attachment A, SF-424 and SF-424A)
    c. Filled out, signed and dated Assurances--Non-Construction 
Programs (SF-424B);
    d. By signing and submitting this application the applicant is 
certifying that it will comply with the Federal requirements concerning 
Drug-Free Workplace and debarment regulations;
    e. Restrictions on Lobbying, Certification for Contracts, Grants, 
Loans, and Cooperative Agreements: Filled out, signed and dated form 
found at Attachment D;
    f. Disclosure of Lobbying Activities, SF-LLL: Filled out, signed 
and dated form found at Attachment D, if necessary;
    g. A project narrative of not more than two pages that will include 
the following components in the order enumerated:
    (1) A statement of the amount of applicant's FY 1994 CSBG grant 
award.
    (2) A statement certifying that a Notice of Intent to Participate 
has been submitted from the applicant's service area to either HUD or 
USDA indicating an intent to apply for designation as an Empowerment 
Zone or an Enterprise Community. The statement must identify the entity 
which submitted the Notice and its location, and must indicate that to 
the best of the applicant's knowledge and belief the submission was 
based on the existence of eligible census tracts within the applicant's 
community or service area.
    (3) A statement indicating the names of the counties and principal 
towns in the applicant's service area;
    (4) A brief Project Design indicating how applicant proposes to 
achieve the goals set out in Part B, above;
    (5) Identification of the program Partners (Selected EZ/EC 
Applicant, Unit of Local Government, other organizations involved in 
planning process, etc.)
    h. An itemized budget justification detailing proposed costs, 
explaining budget appropriateness and showing required match.

2. Appendices

    Including Maintenance of Effort Certification (See Attachment B); 
letter from the State CSBG Director certifying eligibility of applicant 
(as described in Part C, Paragraph 3, Eligibility, above; letter(s) of 
cooperation (described in Part C, Paragraph 5, Partnership Agreement, 
above); letters of match commitment or letters of intent; and signed 
certifications, etc., in attachment A (listed in sub-paragraphs (e) and 
(f) above).

3. Intergovernmental Review

    This program is covered under Executive Order 12372, 
Intergovernmental Review of Federal Programs and 45 CFR part 100, 
Intergovernmental Review of Department of Health and Human Services 
Programs and Activities. Under the Order, States may design their own 
processes for reviewing and commenting on proposed Federal assistance 
under covered programs.
    All States and Territories except Alabama, Alaska, Connecticut, 
Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana, Nebraska, Oregon, 
Oklahoma, Pennsylvania, Virginia, Washington, American Samoa and Palau 
have elected to participate in the Executive Order process and have 
established Single Points of Contact (SPOCs). Applications from 
Federally-recognized Indian Tribes are exempt from the requirements of 
Executive Order 12372.
    Applicants from these seventeen jurisdictions need take no action 
regarding Executive Order 12372. All other applicants should contact 
their SPOC as soon as possible to alert them of the prospective 
application and to receive any necessary instructions.
    Applicants must submit any required material to the SPOCs as soon 
as possible so that the program office can obtain and review SPOC 
comments as part of the award process. It is imperative that the 
applicant submit all required materials, if any, to the SPOC and 
indicate the date of this submittal (or the date of contact if no 
submittal is required) on the Standard Form 424, item 16a.
    Under 45 CFR 100.8(a)(2), a SPOC has 60 days from the application 
deadline date to comment on proposed new or competing continuation 
awards. However, for this program announcement, the SPOC comment period 
has been reduced to seven (7) days in order to ensure timely awards. 
These comments are reviewed as part of the award process. Failure to 
notify the SPOC can result in a delay in grant award.
    SPOCs are encouraged to eliminate the submission of routine 
endorsements as official recommendations. Additionally, SPOCs are 
requested to clearly differentiate between mere advisory comments and 
those official State process recommendations which they intend to 
trigger the accommodate or explain rule under 45 CFR 100.10. It is 
helpful in tracking SPOC comments if the SPOC will clearly indicate the 
applicant organization as it appears on the application SF-424.
    When comments are submitted directly to ACF, they should be 
addressed to: Department of Health and Human Services, Administration 
for Children and Families, Office of Financial Management, Division of 
Discretionary Grants, 6th Floor, 370 L'Enfant Promenade, SW., 
Washington, DC 20447. A list of the Single Points of Contact for each 
State and Territory is included at Attachment C of this announcement.

Part F--Post-Award and Reporting Requirements

    Following approval of the applications selected for funding, notice 
of project approval and authority to draw down project funds will be 
made in writing. The official award document is the Financial 
Assistance Award which provides the amount of Federal funds approved 
for use in the project, the project and budget periods for which 
support is provided, the terms and conditions of the award, and the 
total required financial grantee participation.
    Grantees are subject to the audit requirements in OMB Circulars A-
128 and A-133.
    Attachment E indicates the regulations which apply to all 
applicants/grantees under the Demonstration Partnership Program.
    Grantees will be required to submit a final progress and financial 
report within 90 days of the termination of the project.

    Dated: April 22, 1994.
Donald Sykes,
Director, Office of Community Services.
BILLING CODE 4184-01-P

TN05MY94.121


BILLING CODE 4184-01-C

Instructions for the SF 424

    This is a standard form used by applicants as a required 
facesheet for preapplications and applications submitted for Federal 
assistance. It will be used by Federal agencies to obtain applicant 
certification that States which have established a review and 
comment procedure in response to Executive Order 12372 and have 
selected the program to be included in their process, have been 
given an opportunity to review the applicant's submission.

Item and Entry

    1. Self-explanatory.
    2. Date application submitted to Federal agency (or State if 
applicable) & applicant's control number (if applicable).
    3. State use only (if applicable).
    4. If this application is to continue or revise an existing 
award, enter present Federal identifier number. If for a new 
project, leave blank.
    5. Legal name of applicant, name of primary organizational unit 
which will undertake the assistance activity, complete address of 
the applicant, and name and telephone number of the person to 
contact on matters related to this application.
    6. Enter Employer Identification Number (EIN) as assigned by the 
Internal Revenue Service.
    7. Enter the appropriate letter in the space provided.
    8. Check appropriate box and enter appropriate letter(s) in the 
space(s) provided:

--``New'' means a new assistance award.
--``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
--``Revision'' means any change in the Federal Government's 
financial obligation or contingent liability from an existing 
obligation.

    9. Name of Federal agency from which assistance is being 
requested with this application.
    10. Use the Catalog of Federal Domestic Assistance number and 
title of the program under which assistance is requested.
    11. Enter a brief descriptive title of the project. If more than 
one program is involved, you should append an explanation on a 
separate sheet. If appropriate (e.g., construction or real property 
projects), attach a map showing project location. For 
preapplications, use a separate sheet to provide a summary 
description of this project.
    12. List only the largest political entities affected (e.g., 
State, counties, cities).
    13. Self-explanatory.
    14. List the applicant's Congressional District and any 
District(s) affected by the program or project.
    15. Amount requested or to be contributed during the first fund/
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 a an attached sheet. For multiple program funding, 
use totals and show breakdown using same categories as item 15.
    16. Applicants should contact the State Single Point of Contact 
(SPOC) for Federal Executive Order 12372 to determine whether the 
application is subject to the State intergovernmental review 
process.
    17. This question applies to the applicant organization, not the 
person who signs as the authorized representative. Categories of 
debt include delinquent audit disallowances, loans and taxes.
    18. To be signed by the authorized representative of the 
applicant. A copy of the governing body's authorization for you to 
sign this application as official representative must be on file in 
the applicant's office. (Certain Federal agencies may require that 
this authorization be submitted as part of the application).

BILLING CODE 4184-01-P

TN05MY94.122


TN05MY94.123

BILLING CODE 4184-01-C

Instructions for the SF-424A

General Instructions

    This form is designed so that application can be made for funds 
from one or more grant programs. In preparing the budget, adhere to 
any existing Federal grantor agency guidelines which prescribe how 
and whether budgeted amounts should be separately shown for 
different functions or activities within the program. For some 
programs, grantor agencies may require budgets to be separately 
shown by function or activity. For other programs, grantor agencies 
may require a breakdown by function or activity. Sections A, B, C, 
and D should include budget estimates for the whole project except 
when applying for assistance which requires Federal authorization in 
annual or other funding period increments. In the latter case, 
Sections A, B, C, and D should provide the budget for the first 
budget period (usually a year) and Section E should present the need 
for Federal assistance in the subsequent budget periods. All 
applications should contain a breakdown by the object class 
categories shown in Lines a-k of Section B.

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

    For applications pertaining to a single Federal grant program 
(Federal Domestic Assistance Catalog number) and not requiring a 
functional or activity breakdown, enter on Line 1 under Column (a) 
the catalog program title and the catalog number in Column (b).
    For applications pertaining to a single program requiring budget 
amounts by multiple functions or activities, enter the name of each 
activity or function on each line in Column (a), and enter the 
catalog number in Column (b). For applications pertaining to 
multiple programs where none of the programs require a breakdown by 
function or activity, enter the catalog program title on each line 
in Column (a) and the respective catalog number on each line in 
Column (b).
    For applications pertaining to multiple programs where one or 
more programs require a breakdown by function or activity, prepare a 
separate sheet for each program requiring the breakdown. Additional 
sheets should be used when one form does not provide adequate space 
for all breakdown of data required. However, when more than one 
sheet is used, the first page should provide the summary totals by 
programs.

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

    For new applications, leave Columns (c) and (d) blank. For each 
line entry in Columns (a) and (b), enter in Columns (e), (f), and 
(g) the appropriate amounts of funds needed to support the project 
for the first funding period (usually a year).
    For continuing grant program applications, submit these forms 
before the end of each funding period as required by the grantor 
agency. Enter in Columns (c) and (d) the estimated amounts of funds 
which will remain unobligated at the end of the grant funding period 
only if the Federal grantor agency instructions provide for this. 
Otherwise, leave these columns blank. Enter in columns (e) and (f) 
the amounts of funds needed for the upcoming period. The amount(s) 
in Column (g) should be the sum of amounts in Columns (e) and (f).
    For supplemental grants and changes to existing grants, do not 
use Columns (c) and (d). Enter in Column (e) the amount of the 
increase or decrease of Federal funds and enter in Column (f) the 
amount of the increase or decrease of non-Federal funds. In Column 
(g) enter the new total budgeted amount (Federal and non-Federal) 
which includes the total previous authorized 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 from this project. Do not add or subtract this 
amount from the total project amount. Show under the program 
narrative statement the nature and source of income. The estimated 
amount of program income may be considered by the federal grantor 
agency in determining the total amount of the grant.

Section C. Non-Federal-Resources

    Lines 8-11--Enter amounts of non-Federal resources that will be 
used on the grant. If in-kind contributions are included, provide a 
brief explanation on a separate sheet.

    Column (a)--Enter the program titles identical to Column (a), 
Section A. A breakdown by function or activity is not necessary.
    Column (b)--Enter the contribution to be made by the applicant.
    Column (c)--Enter the amount of the State's cash and in-kind 
contribution if the applicant is not a State or State agency. 
Applicants which are a State or State agencies should leave this 
column blank.
    Column (d)--Enter the amount of cash and in-kind contributions 
to be made from all other sources.
    Column (e)--Enter totals of Columns (b), (c), and (d).

    Line 12--Enter the total for each of Columns (b)-(e). The amount 
in Column (e) should be equal to the amount on Line 5, Column (f), 
Section A.

Section D. Forecasted Cash Needs

    Line 13--Enter the amount of cash needed by quarter from the 
grantor agency during the first year.
    Line 14--Enter the amount of cash from all other sources needed 
by quarter during the first year.
    Line 15--Enter the totals of amounts on Lines 13 and 14.

Section E. Budget Estimates of Federal Funds Needed for Balance of the 
Project

    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 right to examine all records, 
books, papers, or documents related to the award; and will establish 
a proper accounting system in accordance with generally accepted 
accounting standards or agency directives.
    3. Will establish safeguards to prohibit employees from using 
their positions for a purpose that constitutes or presents the 
appearance of personal or organizational conflict of interest, or 
personal gain.
    4. Will initiate and complete the work within the applicable 
time frame after receipt of approval of the awarding agency.
    5. Will comply with the Intergovernmental Personnel Act of 1970 
(42 U.S.C. Secs. 4728-4763) relating to prescribed standards for 
merit systems for programs funded under one of the nineteen statutes 
or regulations specified in Appendix A of OPM's Standards for a 
Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
    6. Will comply with all Federal statutes relating to 
nondiscrimination. These include but are not limited to: (a) Title 
VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits 
discrimination on the basis of race, color or national origin; (b) 
Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 
Secs. 1681-1683, and 1685-1686), which prohibits discrimination on 
the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, 
as amended (29 U.S.C. Sec. 794), which prohibits discrimination on 
the basis of handicaps; (d) the Age Discrimination Act of 1975, as 
amended (42 U.S.C. Secs. 6101-6107), which prohibits discrimination 
on the basis of age; (e) the Drug Abuse Office and Treatment Act of 
1972 (P.L. 92-255), as amended, relating to nondiscrimination on the 
basis of drug abuse; (f) the Comprehensive Alcohol Abuse and 
Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 
(P.L. 91-616), as amended, relating to nondiscrimination on the 
basis of alcohol abuse or alcoholism; (g) Secs. 523 and 527 of the 
Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), 
as amended, relating to confidentiality of alcohol and drug abuse 
patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 
U.S.C. Sec. 3601 et seq.), as amended, relating to nondiscrimination 
in the sale, rental or financing of housing; (i) any other 
nondiscrimination provisions in the specific statute(s) under which 
application for Federal assistance is being made; and (j) the 
requirements of any other nondiscrimination statute(s) which may 
apply to the application.
    7. Will comply, or has already complied, with the requirements 
of Titles II and III of the Uniform Relocation Assistance and Real 
Property Acquisition Policies Act of 1970 (P.L. 91-646) which 
provide for fair and equitable treatment of persons displaced or 
whose property is acquired as a result of Federal or federally 
assisted programs. These requirements apply to all interests in real 
property acquired for project purposes regardless of Federal 
participation in purchases.
    8. Will comply with the provisions of the Hatch Act (5 U.S.C. 
Secs. 1501-1508 and 7324-7328) which limit the political activities 
of employees whose principal employment activities are funded in 
whole or in part with Federal funds.
    9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40 
U.S.C. Sec. 276c and 18 U.S.C. Secs. 874), and the Contract Work 
Hours and Safety Standards Act (40 U.S.C. Secs. 327--333), regarding 
labor standards for federally assisted construction subagreements.
    10. Will comply, if applicable, with flood insurance purchase 
requirements of Section 102(a) of the Flood Disaster Protection Act 
of 1973 (P.L. 93-234) which requires recipients in a special flood 
hazard area to participate in the program and to purchase flood 
insurance if the total cost of insurable construction and 
acquisition is $10,000 or more.
    11. Will comply with environmental standards which may be 
prescribed pursuant to the following: (a) institution of 
environmental quality control measures under the National 
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order 
(EO) 11514; (b) notification of violating facilities pursuant to EO 
11738; (c) protection of wetlands pursuant to EO 11990; (d) 
evaluation of flood hazards in floodplains in accordance with EO 
11988; (e) assurance of project consistency with the approved State 
management program developed under the Coastal Zone Management Act 
of 1972 (16 U.S.C. Secs. 1451 et seq.); (f) conformity of Federal 
actions to State (Clear Air) Implementation Plans under Section 
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. Sec. 7401 
et seq.); (g) protection of underground sources of drinking water 
under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered 
Species Act of 1973, as amended, (P.L. 93-205).
    12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 
U.S.C. Secs. 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. 4469a-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. Secs. 4801 et seq.) which prohibits the use of lead-
based paint in construction or rehabilitation of residence 
structures.
    17. Will cause to be performed the required financial and 
compliance audits in accordance with the Single Audit Act of 1984.
    18. Will comply with all applicable requirements of all other 
Federal laws, executive orders, regulations and policies governing 
this program.
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Signature of Authorized Certifying Official

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Applicant Organization

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Title

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Date Submitted

Attachment B--Certification Regarding Maintenance of Effort

    The undersigned certifies that:
    (1) activities funded under this program announcement are in 
addition to, and not in substitution for, activities previously carried 
on without Federal assistance.
    (2) funds or other resources currently devoted to activities 
designed to meet the needs of the poor within a community, area, or 
State have not been reduced in order to provide the required matching 
contributions.
    When legislation for a particular block grant permits the use of 
its funds as match, the applicant must show that it has received a real 
increase in its block grant allotment and must certify that other anti-
poverty programs will not be scaled back to provide the match required 
for this project.
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Organization

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Authorized Signature

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Title

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Date

Attachment C--Executive Order 12372--State Single Points of Contact

Arizona

Mrs. Janice Dunn, Attn: Arizona State Clearinghouse, 3800 N. Central 
Avenue, 14th Floor, Phoenix, Arizona 85012, Telephone (602) 280-1315

Arkansas

Tracie L. Copeland, Manager, State Clearinghouse, Office of 
Intergovernmental Services, Department of Finance and Administration, 
P.O. Box 3278, Little Rock, Arkansas 72203, Telephone (501) 682-1074

California

Glenn Stober, Grants Coordinator, Office of Planning and Research, 1400 
Tenth Street, Sacramento, California 95814, Telephone (916) 323-7480

Colorado

State Single Point of Contact, State Clearinghouse, Division of Local 
Government, 1313 Sherman Street, Room 520, Denver, Colorado 80203, 
Telephone (303) 866-2156

Delaware

Ms. Francine Booth, State Single Point of Contact, Executive 
Department, Thomas Collins Building, Dover, Delaware 19903, Telephone 
(302) 736-3326

District of Columbia

Rodney T. Hallman, State Single Point of Contact, Office of Grants 
Management and Development, 717 14th Street, NW., Suite 500, 
Washington, DC 20005, Telephone (202) 727-6551

Florida

Florida State 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 Benson, State Planning Office, State House Station #38, 
Augusta, Maine 04333, Telephone (207) 289-3261

Maryland

Ms. Mary Abrams, Chief, Maryland State Clearinghouse, Department of 
State Planning, 301 West Preston Street, Baltimore, Maryland 21201-
2365, Telephone (301) 225-4490

Massachusetts

Karen Arone, State Clearinghouse, Executive Office of Communities and 
Development, 100 Cambridge Street, Room 1803, Boston, Massachusetts 
02202, Telephone (617) 727-7001

Michigan

Richard S. Pastula, Director, Michigan Department of Commerce, Lansing, 
Michigan 48909, Telephone (517) 373-7356

Mississippi

Ms. Cathy Mallette, Clearinghouse Officer, Office of Federal Grant 
Management and Reporting, 301 West Pearl Street, Jackson, Mississippi 
39203, Telephone (601) 960-2174

Missouri

Ms. Lois Pohl, Federal Assistance Clearinghouse, Office of 
Administration, P.O. Box 809, room 430, Truman Building, Jefferson 
City, Missouri 65102, Telephone (314) 751-4834

Nevada

Department of Administration, State Clearinghouse, Capitol Complex, 
Carson City, Nevada 89710, Telephone (702) 687-4065, Attention: Ron 
Sparks, Clearinghouse Coordinator

New Hampshire

Mr. Jeffrey H. Taylor, Director, New Hampshire Office of State 
Planning, Attn: Intergovernmental Review, Process/ James E. Bieber, 
2\1/2\ Beacon Street, Concord, New Hampshire 03301, Telephone (603) 
271-2155

New Jersey

Gregory W. Adkins, Acting director, Division of Community Resources, 
N.J. Department of Community Affairs, Trenton, New Jersey 08625-0803, 
Telephone (609) 292-6613.

    Please direct correspondence and questions to: Andrew J. Jaskolka, 
State Review Process, Division of Community Resources, CN 814, room 
609, Trenton, New Jersey, 08625-0803, Telephone (609) 292-9025.

New Mexico

George Elliott, Deputy Director, State Budget Division, room 190, 
Bataan Memorial Building, Santa Fe, New Mexico 87503, Telephone (505) 
827-3640, FAX (505) 827-3006

New York

New York State Clearinghouse, Division of the Budget, State Capitol, 
Albany, New York 12224, Telephone (518) 474-1605

North Carolina

Mrs. Chrys Baggett, Director, Office of the Secretary of Admin., N.C. 
State Clearinghouse, 116 W. Jones Street, Raleigh, North Carolina 
27603-8003, Telephone (919) 733-7232

North Dakota

N.D. Single Point of Contact, Office of Intergovernmental Assistance, 
Office of Management and Budget, 600 East Boulevard Avenue, Bismarck, 
North Dakota 58505-0170, Telephone (701) 224-2094

Ohio

Larry Weaver, State Single Point of Contact, State/Federal Funds 
Coordinator, State Clearinghouse, Office of Budget and Management, 30 
east Broad Street, 34th Floor, Columbus, Ohio 43266-0411, Telephone 
(614) 466-0698

Rhode Island

Mr. Daniel W. Varin, Associate Director, Statewide Planning Program, 
Department of Administration, Division of Planning, 265 Melrose Street, 
Providence, Rhode Island 02907, Telephone (401) 277-2656

    Please direct correspondence and questions to: Review Coordinator, 
Office of Strategic Planning.

South Carolina

Omeagia Burgess, State Single Point of Contact, Grant Services, Office 
of the Governor, 1205 Pendleton Street, Room 477, Columbia, South 
Carolina 29201, Telephone (803) 734-0494

South Dakota

Ms. Susan Comer, State Clearinghouse Coordinator, Office of the 
Governor, 500 East Capitol, Pierre, South Dakota 57501, Telephone (605) 
773-3212

Tennessee

Mr. Charles Brown, State Single Point of Contact, State Planning 
Office, 500 Charlotte Avenue, 309 John Sevier Building, Nashville, 
Tennessee 37219, Telephone (615) 741-1676

Texas

Mr. Thomas Adams, Governor's Office of Budget and Planning, P.O. Box 
12428, Austin, Texas 78711, Telephone (512) 463-1778

Utah

Utah State Clearinghouse, Office of Planning and Budget, Attn: Carolyn 
Wright, Room 116 State Capitol, Salt Lake City, Utah 84114, Telephone 
(801) 538-1535

Vermont

Mr. Bernard D. Johnson, Assistant Director, Office of Policy Research & 
Coordination, Pavilion Office Building, 109 State Street, Montpelier, 
Vermont 05602, Telephone (802) 828-3326

West Virginia

Mr. Fred Cutlip, Director, Community Development Division, West 
Virginia Development Office, Building #6, Room 553, Charleston, West 
Virginia 25305, Telephone (304) 348-4010

Wisconsin

Mr. William C. Carey, Federal/State Relations, Wisconsin Department of 
Administration, 101 South Webster Street, P.O. Box 7864, Madison, 
Wisconsin 53707, Telephone (608) 266-0267

Wyoming

Sheryl Jeffries, State Single Point of Contact, Herschler Building, 4th 
Floor, East Wing, Cheyenne, Wyoming 82002, Telephone (307) 777-7574

Guam

Mr. Michael J. Reidy, Director, Bureau of Budget and Management 
Research, Office of the Governor, P.O. Box 2950, Agana, Guam 96910, 
Telephone (671) 472-2285

Northern Mariana Islands

State Single Point of Contact, Planning and Budget Office, Office of 
the Governor, Saipan, CM, Northern Mariana Islands 96950

Puerto Rico

Norma Burgos/Jose H. Caro, Chairman/Director, Puerto Rico Planning 
Board, Minillas Government Center, P.O. Box 41119, San Juan, Puerto 
Rico 00940-9985, Telephone (809) 727-4444

Virgin Islands

Jose L. George, Director, Office of Management and Budget, #41 
Norregade Emancipation Garden Station, Second Floor, Saint Thomas, 
Virgin Islands 00802

    Please direct correspondence to: Linda Clarke, Telephone (809) 774-
0750.

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BILLING CODE 4184-01-C

Certification Regarding Debarment, Suspension, and Other Responsibility 
Matters--Primary Covered Transactions

    By signing and submitting this proposal, the applicant, defined as 
the primary participant in accordance with 45 CFR part 76, certifies to 
the best of its knowledge and belief that it and its principals:
    (a) Are not presently debarred, suspended, proposed for debarment, 
declared ineligible, or voluntarily excluded from covered transactions 
by any Federal Department or agency;
    (b) Have not within a 3-year period preceding this proposal been 
convicted of or had a civil judgment rendered against them for 
commission of fraud or a criminal offense in connection with obtaining, 
attempting to obtain, or performing a public (Federal, State, or local) 
transaction or contract under a public transaction; violation of 
Federal or State antitrust statutes or commission of embezzlement, 
theft, forgery, bribery, falsification or destruction of records, 
making false statements, or receiving stolen property;
    (c) Are not presently indicted or otherwise criminally or civilly 
charged by a governmental entity (Federal, State of 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 Tire Participants)

    By signing and submitting this lower tier proposal, the prospective 
lower tier participant, as defined in 45 CFR part 76, certifies to the 
best of its knowledge and belief that it and its principals:
    (a) Are not presently debarred, suspended, proposed for debarment, 
declared ineligible, or voluntarily excluded from participation in this 
transaction by any federal department or agency.
    (b) Where the prospective lower tier participant is unable to 
certify to any of the above, such prospective participant shall attach 
an explanation to this proposal.
    The prospective lower tier participant further agrees by submitting 
this proposal that it will include this clause entitled ``Certification 
Regarding Debarment, Suspension, Ineligibility, and Voluntary 
Exclusion--Lower Tier Covered Transactions.'' without modification in 
all lower tier covered transactions and in all solicitations for lower 
tier covered transactions.

Certification Regarding Lobbying

Certification for Contracts, Grants, Loans, and Cooperative Agreements

    The undersigned certifies, to the best of his or her knowledge and 
belief, that:
    (1) No Federal appropriated funds have been paid or will be paid, 
by or on behalf of the undersigned, to any person for influencing or 
attempting to influence an officer or employee of any agency, a Member 
of Congress, an officer or employee of Congress, or an employee of a 
Member of Congress in connection with the awarding of any Federal 
contract, the making of any Federal grant, the making of any Federal 
loan, the entering into of any cooperative agreement, and the 
extension, continuation, renewal, amendment, or modification of any 
Federal contract, grant, loan, or cooperative agreement.
    (2) If any funds other than Federal appropriated funds have been 
paid or will be paid to any person for influencing or attempting to 
influence an officer or employee of any agency, a Member of Congress, 
an officer or employee of Congress, or an employee of a Member of 
Congress in connection with this Federal contract, grant, loan or 
cooperative agreement, the undersigned shall complete and submit 
Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in 
accordance with its instructions.
    (3) The undersigned shall require that the language of this 
certification be included in the award documents for all subawards at 
all tiers (including subcontracts, subgrants, and contracts under 
grants, loans, and cooperative agreements) and that all subrecipients 
shall certify and disclose accordingly.
    This certification is a material representation of fact upon which 
reliance was placed when this transaction was made or entered into. 
Submission of this certification is a prerequisite for making or 
entering into this transaction imposed by section 1352, title 31, U.S. 
Code. Any person who fails to file the required certification shall be 
subject to a civil penalty of not less than $10,000 and not more than 
$100,000 for each such failure.

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-P

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BILLING CODE 4184-01-C

Attachment E

    The following DHHS regulations apply to all applicants/grantees 
under the Demonstration Partnership Program, Special Set-Aside for 
Empowerment Zone/Enterprise Community--Technical Assistance/Planning 
Grants:
    Title 45 of the Code of Federal Regulations:

Part 16--Procedures of the Departmental Grant Appeals Board
Part 74--Administration of Grants (non-governmental)
Part 74--Administration of Grants (state and local governments and 
Indian Tribal affiliates):
    Sections 74.62(a)  Non-Federal Audits
    74.173  Hospitals
    74.174(b)  Other Nonprofit Organizations
    74.304  Final Decisions in Disputes
    74.710  Real Property, Equipment and Supplies
    74.715  General Program Income
Part 75--Informal Grant Appeal Procedures
Part 76--Debarment and Suspension from Eligibility for Financial 
Assistance
Subpart F--Drug Free Workplace Requirements
Part 80--Non-discrimination Under Programs Receiving Federal Assistance 
through the Department of Health and Human Services
Effectuation of Title VI of the Civil Rights Act of 1964
Part 81--Practice and Procedures for Hearings Under Part 80 of this 
Title
Part 83--Nondiscrimination on the basis of sex in the admission of 
individuals to training programs
Part 84--Non-discrimination on the Basis of Handicap in Programs
Part 91--Non-discrimination on the Basis of Age in Health and Human 
Services Programs or Activities
Receiving Federal Financial Assistance
Part 92--Uniform Administrative Requirements for Grants and Cooperative 
Agreements to States and Local Governments (Federal Register, March 11, 
1988)
Part 93--New Restrictions on Lobbying
Part 100--Intergovernmental Review of Department of Health and Human 
Services Programs and Activities

[FR Doc. 94-10648 Filed 5-4-94; 8:45 am]
BILLING CODE 4184-01-P