[Federal Register Volume 59, Number 90 (Wednesday, May 11, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11383]


[[Page Unknown]]

[Federal Register: May 11, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)

Administration on Aging

 

White House Conference on Aging; Program Announcement No. WHCoA 
94-2; Availability of Funds and Request for Applications for Mini-
conferences

AGENCY: White House Conference on Aging, AoA, HHS.

ACTION: Announcement of availability of funds and request for 
applications to conduct mini-conferences in preparation for the 1995 
White House Conference on Aging.

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SUMMARY: the White House Conference on Aging (WHCoA) announces that it 
will hold a competition for the funding of mini-conferences in 
preparation for the 1995 White House Conference on Aging. Funding for 
WHCoA grants is authorized by the Older Americans Act, Public Law 102-
375 and Public Law 103-171.
    This program announcement consists of two parts. Part I provides 
background information and describes the program under which the WHCoA 
is inviting applications to be considered for funding. Part II 
describes, in detail, the application process and provides guidance on 
how to prepare and submit an application.
    All of the forms necessary to submit an application are included 
following Part II. They complete the application kit that an applicant 
needs for preparing and for submitting an application under this 
announcement.
    Grants will be made under this announcement subject to the 
availability of funds for the support of the program described herein.

DATES: The deadline date for the submission of applications is June 6, 
1994.

ADDRESSES: Application receipt point: Department of Health and Human 
Services; Administration on Aging, Office of Administration and 
Management, 330 Independence Avenue, SW., room 4644, Washington, DC 
20201, Attn: WHCoA-94-2.

FOR FURTHER INFORMATION CONTACT:
For programmatic information, contact Judy Satine, Department of Health 
and Human Services, White House Conference on Aging, 501 School Street, 
SW., 8th Floor, Washington, DC 20024, telephone (202) 245-7826. For 
grant technical information, contact Margaret Tolson, AoA, see address 
above, telephone (202) 401-0838.

SUPPLEMENTARY INFORMATION:

Part I. Background Information and Program Description

A. Statutory Authority

    The statutory authority for awards made under this Announcement is 
contained in the Older Americans Act as amended, Public Law 102-375 and 
Public Law 103-171.

B. Eligible Applicants

    In general, any eligible public or nonprofit private organization, 
agency or institution is eligible to apply under this program 
announcement. Any applicant that is not now a DHHS grantee should 
include, with its application, Internal Revenue Service or other 
legally recognized documentation of its nonprofit status. A nonprofit 
applicant cannot be funded without proof of its status.

C. Program Description

    President Clinton announced in February that he has formally called 
for a White House Conference on Aging to be convened in May 1995.
    Previous White House Conferences in 1961, 1971 and 1981 adopted 
recommendations that resulted in local, state and Federal initiatives 
which improved the security and well being of older Americans. The 1995 
Conference will produce recommendations that will meet the needs of 
Older Americans in the twenty-first century.
    A White House Conference on Aging in intended to produce policy 
recommendations to guide national aging policy over the next decade. In 
Public Law 102-375, the Older Americans Act amendments of 1992, 
Congress specifically identified six primary purposes for the 
Conference. They are:
    (1) To increase public awareness of the interdependence of 
generations and the essential contributions of older individuals to 
society for the well-being of all generations;
    (2) To identify the problems facing older individuals and the 
commonalities of the problems with problems of younger generations;
    (3) To examine the well-being of older individuals including the 
impact the wellness of older individuals has on our aging society;
    (4) To develop such specific and comprehensive recommendations for 
executive and legislative action as may be appropriate for maintaining 
and improving the well-being of the aging;
    (5) To develop recommendations for the coordination of Federal 
policy with State and local needs and the implementation of such 
recommendations; and
    (6) To review the status and multigenerational value of 
recommendations adopted at previous White House Conferences on Aging.
    Of major significance to the 1995 White House Conference on Aging 
in direct participation by individuals and organizations in the pre-
conference stages. As part of this grass roots effort, the WHCoA has 
adopted a four pronged approach that includes local forums, mini-
conferences as well as State and Regional conferences. The purpose of 
these events is to identify those issues of mutual concern to the aging 
population and to develop recommendations that warrant specific 
attention by the White House Conference of Aging. An integral part of 
this strategy is the conduct of mini-conferences which are topic or 
constituency specific. The recommendations from these conferences will 
play an integral role in the development of the agenda for the 1995 
Conference.
    In order for a mini-conference to be considered for funding, the 
proposed event must:
    (1) Be a policy oriented event. The focus of the event must be 
either:
    (a) On one of the following specific Federal policy issues:

Interdependence of generations;
Older persons as community resources;
Employment and continued productivity opportunities for middle-aged and 
older persons including training;
Home and community based long-term care services including caregivers 
assistance and health promotion;
Housing and coordinated services;
Income security with particular emphasis on alleviating poverty;
National retirement policy including pre-retirement;
Crime;
Nutrition;
Disability and aging services;
Mental health and substance abuse;
Future of aging services to be reflected in the Older Americans Act;
Combatting false stereotypes;
Minority aging;
Biomedical and other appropriate research; and
Related topics to promote the independence, well-being and security of 
older persons.

or
    (b) On one of the following specific constituencies:
Older Women;
One of the following groups of minority elderly:
    Native American
    African American
    Asian/Pacific Islanders
    Hispanic
Elderly persons with disabilities.

    (2) Should have substantial and significant input and participation 
by older persons. It should involve older persons and organizations 
representing older persons in the development and implementation of the 
event. Efforts should be made to seek out an appropriately diverse 
representation of interested parties.
    (3) Provide at a maximum five recommendations that can be utilized 
by the WHCoA. These recommendations must be:
    (a) Well articulated;
    (b) Based on demonstrated information, knowledge and consensus 
reached at event;
    (c) Have a reasonable prospect of being attainable within the 
current political, economic, and fiscal environment;
    (d) Received within 30 days after the mini-conference.
    The report should devote no more than 3 pages double spaced per 
recommendation for up to 5 recommendations (total maximum of 15 double 
spaced pages).
    (4) Provide an implementation plan to demonstrate:
    (a) How they will plan, design, and carry out the mini-conference 
including proposed date and location, proposed participants (audience 
discussants and speakers) and cooperating organizations;
    (b) How they will seek additional sources of support;
    (c) What they will do as an advocacy group to ensure that their 
recommendations, if adopted by the WHCoA, are implemented into public 
policy.
    (5) Be held by March 31, 1995.
    (6) Be held in a location accessible to persons with disabilities.
    (7) Not be a profit-making or fund-raising event although it is 
permissible to charge a fee to recover the costs of the event.
    Project Costs: It is expected that 12-15 projects at $6,000 each 
will be funded by the WHCoA. Applicants are expected to obtain 
additional funding from other sources and are encouraged to include 
with their applications letters of commitment from other funding 
sources.

Part II. Information and Guidelines for the Application Process and 
Review

    Part II of this Announcement contains general information for 
potential applicants and basic guidelines for submitting applications 
in response to this announcement. Application forms are provided along 
with detailed instructions for developing and assembling the 
application package for submittal to the White House Conference on 
Aging. Specific eligibility guidelines were provided in the program 
description above.

A. General Information


1. Review Process and Considerations for Funding
    The following steps are involved in the review process.
    a. Notification: All applicants will automatically be notified of 
the receipt of their application and informed of the identification 
number assigned to it.
    b. Expert Review: Applications that conform to the requirements of 
this program announcement will be reviewed and scored competitively 
against the evaluation criteria specified in section D, below. This 
independent review of applications is performed by panels consisting of 
qualified persons. The scores and judgments of these expert reviewers 
are a major factor in making award decisions.
    c. Decision-Making Process: After the panel review session, 
applicants may be contacted by WHCoA staff to furnish additional 
information. Applicants who are contacted should not assume that 
funding is guaranteed. An award is official only upon receipt of the 
Financial Assistance Award (Form DGCM 3-785).
    d. Timeframe: Applicants should be aware that the time interval 
between the deadline for submission of applications and the award of a 
grant may be several weeks in duration. This length of time is required 
to review and process grant applications.
2. Notification Under Executive Order 12372
    This is not a covered program under Executive Order 12372.

B. Deadline for Submission of Applications

    The closing date for submission of applications is June 6, 1994. 
Applications must be either sent or hand-delivered to the address 
specified in Section C, below. Hand-delivered applications are accepted 
during the normal working hours of 9 a.m. to 5:30 p.m., Eastern Time, 
Monday through Friday. An application will meet the deadline if it is 
either:
    1. Received at the mailing address on or before the applicable 
deadline date; or
    2. Sent before midnight of the applicable deadline date as 
evidenced by either: (1) A U.S. Postal Service receipt or postmark or 
(2) a receipt from a commercial carrier. The application must also be 
received in time to be considered under the competitive independent 
review mandated by Chapter 1-62 of the DHHS Grants Administration 
Manual. Applicants are strongly advised to obtain proof that the 
application was sent by the applicable deadline date. If there is a 
question as to when an application was sent, applicants will be asked 
to provide proof that they have met the applicable deadline date. 
Private metered postmarks are not acceptable as proof of a timely 
submittal.
    Applications which do not meet the above deadlines are considered 
late applications and will not be considered for funding.

C. Application Screening Requirements

    All applications will be screened to determine completeness and 
conformity to the requirements of this announcement. These screening 
requirements are intended to assure a level playing field for all 
applicants. Applications which fail to meet one or more of the criteria 
described below will not be reviewed and will receive no further 
consideration for funding. Complete, conforming applications will be 
reviewed and scored competitively.
    In order for an application to be reviewed, it must meet the 
following screening requirements:
    1. The application must not exceed 10 pages, double-spaced, 
exclusive of certain required forms and assurances which are listed 
below. Applications whose typescript is single-spaced or space-and-a-
half will be considered only if it is determined the applicant has not 
thereby gained a competitive advantage. The following documents are 
excluded from the 10 page limitation: (1) Standard Forms (SF) 424, 424A 
(including up to a four page budget justification) and 424B; (2) the 
certification forms regarding lobbying; debarment, suspension, and 
other responsibility matters; and drug-free workplace requirements; and 
(3) proof of non-profit status.
    2. Applications submitted under this announcement must be either 
postmarked by midnight, June 6, 1994, or hand-delivered by 5:30 p.m., 
Eastern Time, on June 6, 1994 to the address provided below: Department 
of Health and Human Services, Administration on Aging, Office of 
Administration and Management, 330 Independence Avenue, SW., room 4644, 
Washington, DC 20201, Attn: AoA-94-2.
    3. Applicants must meet the specific eligibility requirements set 
forth above in the program description.
Under No Circumstances Will Applications That Do Not Meet These 
Screening Requirements Be Assigned To Reviewers

D. Evaluation Criteria

    Applications which pass the screening will be evaluated by an 
independent review panel of at least three individuals. These reviewers 
will be primarily experts from within the Federal government. Based on 
the specific programmatic considerations set forth in the announcement, 
the reviewers will comment on and score the applications, focusing 
their comments and scoring decisions on the criteria below.
    1. Purpose and Need for Assistance: 20 points
    a. Does the proposed project clearly and adequately respond to the 
stated requirements for a mini-conference?
    b. Does the proposed project address one of the listed topics/
constituency groups in a relevant and thorough manner?
    2. Approach/Method--Implementation and Activities: 30 points
    a. Does the application clearly express and organize an 
implementation plan which systematically includes specific objectives 
and tasks which will result in an effective mini-conference?
    b. Does the implementation plan include timelines for 
accomplishment of tasks and objectives? Is the sequence and timing of 
events logical and realistic?
    c. Do the proposed presenters have demonstrated qualifications 
which are appropriate for their roles?
    3. Anticipated Outcomes: 30 points
    a. Does the proposal include a plan for advocacy which is likely to 
increase public awareness of the recommendations from the mini-
conference? Is this advocacy plan adequate for communicating 
recommendations to all appropriate audiences? Does it provide a 
realistic plan to achieve implementation of the recommendations should 
they be adopted by the 1995 White Conference on Aging?
    4. Level of Effort: 20 points
    a. Are the qualifications of the key organizers of the mini-
conference appropriate for their roles?
    b. Does the organization have a track record which demonstrates its 
capability and knowledge to conduct the mini-conference?

E. The Components of an Application

    To expedite the processing of applications, we request that you 
arrange the components of your application, the original and two 
copies, in the following order:
     SF 424, Application for Federal Assistance; SF 424A, 
Budget, accompanied by your budget justification; SF 424B (Assurances); 
and the certification forms regarding lobbying; debarment, suspension, 
and other responsibility matters; and drug-free workplace requirements.

    Note: The original copy of the application must have an original 
signature in item 18d on the SF 424.

     Proof of nonprofit status, as necessary:
     Project summary description;
     Program narrative.
    The original and each copy should be stapled securely (front and 
back if necessary) in the upper left corner. Pages should be numbered 
sequentially. In order to facilitate the handling and reproduction of 
the application for purposes of the review, please do not use covers, 
binders or tabs.

F. Communications With WHCoA

    Do not include a self-addressed, stamped acknowledgment card. All 
applicants will be notified by mail of the receipt of their application 
and informed of the identification number assigned to it. This number 
should be referred to in all subsequent communication with WHCoA 
concerning the application.
    After an identification number is assigned and the applicant has 
been notified of the number, applications are filed numerically by 
identification number for quick retrieval. It will not be possible for 
WHCoA staff to provide a timely response to inquiries about a specific 
application unless the identification number is given.
    Applicants are advised that, prior to reaching a decision, the 
WHCoA will not release information relative to an application other 
than that it has been received and that it is being reviewed. 
Unnecessary inquiries delay the process. Once a decision is reached, 
the applicant will be notified as soon as possible of the acceptance or 
rejection of the application.

G. Completing the Application

    To assist applicants in completing Forms SF 424 and SF 424A 
correctly, samples of completed forms have been provided as part of 
this announcement. These samples are to be used as a guide only. Be 
sure to submit your application on the blank copies. Please prepare 
your application consistent with the following guidance:
    1. SF 424, Cover Page: Complete only the items specified in the 
following instructions:
    Item 1. Enter an ``X'' in the block marked Application--Non-
construction.
    Item 2. Fill in the date you submitted the application. Leave the 
applicant identifier box blank.
    Item 3. Not applicable.
    Item 4. Leave blank.
    Item 5. Provide the legal name of applicant; the name of the 
primary organizational unit which will undertake the assistance 
activity; the applicant address; and the name and telephone number of 
the person to contact on matters related to this application.
    Item 6. Enter the employer identification number (EIN) of the 
applicant organization as assigned by the Internal Revenue Service. 
Please include the suffix to the EIN, if known.
    Item 7. Enter the appropriate letter in the box provided.
    Item 8. Place an ``X'' in the box marked New.
    Item 9. Enter the White House Conference on Aging.
    Item 10. Leave blank.
    Item 11. The title should describe concisely the nature of the 
project. Try not to exceed 10 to 12 words and 120 characters including 
spaces and punctuation.
    Item 12. Not applicable.
    Item 13. Enter the desired start date for the project and the 
desired end date for the project. The project must be completed by 
March 31, 1995.
    Item 14. List the applicant's Congressional District and the 
District(s), if any, directly affected by the proposed project.
    Item 15. Enter the funding request to the WHCoA under Item 15a, 
Federal. Enter the applicant's share of the project costs under 15b, 
Applicant. If there are third party contributions, enter those under 
Item 15e, Other. Enter the sum of these amounts under Item 15g, Total.
    Item 16. Enter ``No'' under Item b.
    Item 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.
    Item 18. To be signed by an authorized representative of the 
applicant organization. A document attesting to that sign-off authority 
must be on file in the applicant's office.
2. SF 424A--Budget Information
    This form (SF424A) is designed to apply for funding under more than 
one grant program; thus, for purposes of this WHCoA program, most of 
the budget item columns/blocks are superfluous and should be regarded 
as not applicable. The applicant should consider and respond to only 
the budget items for which guidance is provided below. Section A--
Budget Summary and Section B--Budget Categories should include both 
Federal and non-Federal funding for the proposed project.

Section A--Budget Summary

    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 columns (e) and (f) 
in column (g).

Section B--Budget Categories

    Use only the last column under Section B, namely the column headed 
Total (5), to enter the total requirements for funds (combining both 
the Federal and non-Federal shares) by object class category.
    A brief budget justification should be appended to this Section 
which shows the breakdown of budget cost items by Federal and non-
Federal shares and justifies each of the major items, personnel, 
travel, other, etc.
    Line 6a--Personnel: Enter total costs of salaries and wages of 
applicant/grantee staff. Do not include the costs of consultants, which 
should be included under 6h--Other.
    Line 6b--Fringe Benefits: Enter the total costs of fringe benefits.
    Line 6c--Travel: 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.
    Line 6d--Equipment: Enter the total cost of all equipment to be 
acquired by the project. The threshold for equipment is $500 or more 
per unit.
    Line 6e--Supplies: Enter the total costs of all tangible expendable 
personal property (supplies) other than those included on line 6d.
    Line 6f--Contractual: Enter of total costs of all contracts, if 
applicable. Do not include payments to individuals on this line.
    Line 6g--Construction: Not applicable.
    Line 6h--Other: Enter the total of all other costs. Such costs, 
where applicable, 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 cost, 
including tuition and stipends, training service costs including wage 
payments to individuals and supportive service payments; and staff 
development costs.
    Line 6i--Total Direct Charges: Show the totals of Lines 6a through 
6h.
    Line 6j--Indirect Charges: Not applicable.
    Line 6k--Total: Enter the total amounts from Line 6i.

Section C--Non-Federal Resources

    Line 12--Totals: As applicable, enter amounts of non-Federal 
resources that will be used in carrying out the proposed project. If 
third-party in-kind contributions are included, provide a brief 
explanation in the budget justification section.

Section D--Forecasted Cash Needs:

    Not applicable.

Section E--Budget Estimate of Federal Funds Needed for Balance of the

Project
    Line 20--Totals: Not applicable.

Section F--Other Budget Information

    Line 21--Direct Charges: Not applicable
    Line 22--Indirect Charges: Not applicable
    Line 23--Remarks: Provide any other explanations or comments deemed 
necessary.
3. SF 424B--Assurances
    Applicants are required to file an SF 424B, Assurances--Non-
Construction Programs. Please note that a duly authorized 
representative of the applicant organization must certify that the 
applicant is in compliance with these assurances.
    With the possible exception of an Assurance of Protection of Human 
Subjects, no other assurances are required. For research projects in 
which human subjects may be at risk, an Assurance of Protection of 
Human Subjects may be needed. If there is a question regarding the 
applicability of this assurance, contact the Office for Protection from 
Research Risks of the National Institutes of Health at (301) 496-7041.
4. Certification Forms
    Certifications are required of the applicant regarding: (1) 
Lobbying; (b) debarment, suspension, and other responsibility matters; 
and (3) drug-free workplace requirements. Please note that a duly 
authorized representative of the applicant organization must attest to 
the applicant's compliance with these certifications.
5. Project Summary Description
    On a separate page, provide a project summary description headed by 
the name of the applicant organization as shown in SF 424, item 5. 
Please limit the summary description to a maximum of 1,200 characters, 
including words, spaces and punctuation.
    The description should be specific and succinct. It should outline 
the objectives of the mini-conference, the approaches to be used and 
the outcomes expected.
6. Program Narrative
    The Program Narrative is the critical part of the application. It 
should be clear, concise, and, of course, responsive to the program 
under which the application is being submitted. In describing your 
proposed project, make certain that you respond fully to the evaluation 
criteria set forth in Section D above. The format of the narrative 
should, in fact, parallel the criteria.
    Please have the narrative typed on one side of 8\1/2\'' x 11'' 
plain white paper with 1'' margins on both sides. All pages of the 
narrative (including charts, tables, maps, exhibits, etc.) should be 
sequentially numbered, beginning with ``Purpose and Need for 
Assistance'' as page number one. (Applicants should not submit 
reproductions of larger size paper, reduced to meet the size 
requirement).
    The narrative should also identify the author(s) of the proposal, 
their relationship with the applicant, and the role they will play, if 
any, should the project be funded.
    This narrative guidance is in accordance with that provided in OMB 
Circular A-102. The checklist reporting form (Section H, below) is 
consistent with that approved under OMB control number 0937-0189.

H. Points to Remember

    1. There is a 10 double-spaced page limitation for the substantive 
parts of the application. Before submitting your application, please 
check that you have adhered to this requirement which is spelled out in 
Section C.
    2. You are required to send an original and two copies of an 
application.
    3. The summary description (1,200 characters or less) should 
accurately reflect the nature and scope of the proposed project.
    4. In following the required format for preparing the program 
narrative, make certain that you have responded fully to the four (4) 
evaluative criteria which will be used by reviewers to evaluate and 
score all applications.
    5. Before submitting the application, have someone other than the 
author(s): (1) apply the screening requirements to make sure you are in 
compliance; and (2) carry out a trial run review based upon the 
evaluative criteria. Take the opportunity to consider the results of 
the trial run and then make whatever changes you deem appropriate.
    6. Applications must be mailed by midnight, or hand-delivered by 
5:30 p.m., Eastern Time, on June 6, 1994 to the address below. 
Department of Health and Human Services, Administration on Aging, 
Office of Administration and Management, 330 Independence Avenue SW., 
Room 4644, Washington, D.C. 20201, Attn: WHCoA-94-2,
Fernando M. Torres-Gil,
Assistant Secretary for Aging.
BILLING CODE 4130-02-M

TN11MY94.000


BILLING CODE 4130-02-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 funding/
budget period by each contributor. Value of in-kind contributions 
should be included on appropriate lines as applicable. If the action 
will result in a dollar change to an existing award, indicate only the 
amount of the change. For decreases, enclose the amounts in 
parentheses. If both basic and supplemental amounts are included, show 
breakdown on an attached sheet. For multiple program funding, use 
totals and show breakdown using same categories as item 15.
16. Applicants should contact the State Single Point of Contact (SPOC) 
for Federal Executive Order 12372 to determine whether the application 
is subject to the State intergovernmental review process.
17. This question applies to the applicant organization, not the person 
who signs as the authorized representative. Categories of debt include 
deliquent 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 4130-02-M

TN11MY94.001


TN11MY94.002


BILLING CODE 4130-02-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 muiltiple 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 total 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 Column (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 amoun ts 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 supplemental) 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. 91-19) 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. 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. 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. 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.

----------------------------------------------------------------------
Signature of Authorized Certifying Official

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Applicant Organization

----------------------------------------------------------------------
 Title

----------------------------------------------------------------------
Date Submitted

Program Narrative Statement

A. New Applications

    1. Objectives and need for assistance. Pinpoint any relevant 
physical, economic, social, financial, institutional, or other problems 
requiring a solution. Demonstrate the need for the assistance and state 
the principal and subordinate objectives of the project. Supporting 
documentation or other testimonies from concerned interests other than 
the applicant may be used. Any relevant data based on planning studies 
should be included or footnoted.
    2. Results or Benefits Expected. Identify results and benefits to 
be derived. The anticipated contribution to policy, practice, theory 
and/or research should be indicated.
    3. Approach. Outline a plan of action pertaining to the scope and 
detail how the proposed work will be accomplished for each project. 
Cite factors which might accelerate or decelerate the work and your 
reasons for taking this approach as opposed to others. Describe any 
unusual features of the project, such as design or technological 
innovations, reductions in cost or time, or extraordinary social and 
community involvements. Provide for each assistance program 
quantitative projections of the accomplishments to be achieved, if 
possible. When accomplishments cannot be quantified, list the 
activities in chronological order to show the schedule of 
accomplishments and their target dates. Identify the kinds of data to 
be collected and maintained, and discuss the criteria to be used to 
evaluate the results and success of the project. Explain the 
methodology that will be used to determine if the needs identified and 
discussed are being met and if the results and benefits identified are 
being achieved. List each organization, cooperator, consultant, or 
other key individuals who will work on the project along with a short 
description of the nature of their effort or contribution.
    4. Geographic Location. Give a precise location of the project and 
area to be served by the proposed project. Maps or other graphic aids 
may be attached.
    5. If applicable, provide the following information: for research 
and demonstration assistance requests, present a biographical sketch of 
the program director with the following information: Name, address, 
telephone number, background, and other qualifying experience for the 
project. Also, list the name, training and background for other key 
personnel engaged in the project. Describe the relationship between 
this project and other work planned, anticipated, or underway under 
Federal assistance.

B. Supplemental Applications

    Explain the reason for all requests for supplemental assistance and 
justify the need for additional funding. Discuss accomplishments to 
date and list in chronological order a schedule of accomplishments, 
progress or milestones anticipated with the new funding request. If 
there have been significant changes in the project objectives, 
location, approach or time delays, explain and justify. For other 
requests for changes, or amendments, explain the reason for the 
changes(s). If the total budget has been exceeded or if the individual 
budget items have changed more than the prescribed limits, explain and 
justify the change and its effect on the project.

C. Continuation Applications

    Continuation applications need only provide information explaining 
significant changes to the original Program Narrative Statement and a 
description of accomplishments from the prior budget period.

BILLING CODE 4130-02-M

TN11MY94.003


TN11MY94.004


TN11MY94.005


BILLING CODE 4130-02-C
U.S. Department of Health and Human Services--Certification Regarding 
Drug-Free Workplace Requirements--Grantees Other Than Individuals
    By signing and/or submitting this application or grant agreement, 
the grantee is providing the certification set out below.
    This certification is required by regulations implementing the 
Drug-Free Workplace Act of 1988, 45 CFR Part 76, Subpart F. The 
regulations, published in the May 25, 1990 Federal Register, require 
certification by grantees that they will maintain a drug-free 
workplace. The certification set out below is a material representation 
of fact upon which reliance will be placed when the Department of 
Health and Human Services (HHS) determines to award the grant. If it is 
later determined that the grantee knowingly rendered a false 
certification, or otherwise violates the requirements of the Drug-Free 
Workplace Act, HHS, in addition to any other remedies available to the 
Federal Government, may taken action authorized under the Drug-Free 
Workplace Act. False certification or violation of the certification 
shall be grounds for suspension of payments, suspension or termination 
of grants, or governmentwide suspension or debarment.
    Workplaces under grants, for grantees other than individuals, need 
not be identified on the certification. If known, they may be 
identified in the grant application. If the grantee does not identify 
the workplaces at the time of application, or upon award, if there is 
no application, the grantee must keep the identity of the workplace(s) 
on file in its office and make the information available for Federal 
inspection. Failure to identify all known workplaces constitutes a 
violation of the grantee's drug-free workplace requirements.
    Workplace identifications must include the actual address of 
buildings (or parts of buildings) or other sites where work under the 
grant takes place. Categorical descriptions may be used (e.g., all 
vehicles of a mass transit authority or State highway department while 
in operation, State employees in each local unemployment office, 
performers in concert halls or radio studios.)
    If the workplace identified to HHS changes during the performance 
of the grant, the grantee shall inform the agency of the change(s), if 
it previously identified the workplaces in question (see above).
    Definitions of terms in the Nonprocurement Suspension and Debarment 
common rule and Drug-Free Workplace common rule apply to this 
certification. Grantees' attention is called, in particular, to the 
following definitions from these rules:
    ``Controlled substance'' means a controlled substance in Schedules 
I through V of the Controlled Substances Act (21 U.S.C. 812) and as 
further defined by regulation (21 CFR 1308.11 through 1308.15).
    ``Conviction'' means a finding of guilt (including a plea of nolo 
contendere) or imposition of sentence, or both, by any judicial body 
charged with the responsibility to determine violations of the Federal 
or State criminal drug statutes;
    ``Criminal drug statute'' means a Federal or non-Federal criminal 
statute involving the manufacture, distribution, dispensing, use, or 
possession of any controlled substance;
    ``Employee'' means the employee of a grantee directly engaged in 
the performance of work under a grant, including: (i) All ``direct 
charge'' employees; (ii) all ``indirect charge'' employees unless their 
impact or involvement is insignificant to the performance of the grant; 
and, (iii) temporary personnel and consultants who are directly engaged 
in the performance of work under the grant and who are on the grantee's 
payroll. This definition does not include workers not on the payroll of 
the grantee (e.g., volunteers, even if used to meet a matching 
requirement; consultants or independent contractors not on the 
grantee's payroll; or employees of subrecipients or subcontractors in 
covered workplaces).
    The grantee certifies that it will or will continue to provide a 
drug-free workplace by:
    (a) Publishing a statement notifying employees that the unlawful 
manufacture, distribution, dispensing, possession or use of a 
controlled substance is prohibited in the grantee's workplace and 
specifying the actions that will be taken against employees for 
violation of such prohibition;
    (b) Establishing an ongoing drug-free awareness program to inform 
employees about:
    (1) The dangers of drug abuse in the workplace; (2) the grantee's 
policy of maintaining a drug-free workplace; (3) Any available drug 
counseling, rehabilitation, and employee assistance programs; and, (4) 
The penalties that may be imposed upon employees for drug abuse 
violations occurring in the workplace;
    (c) Making it a requirement that each employee to be engaged in the 
performance of the grant be given a copy of the statement required by 
paragraph (a);
    (d) Notifying the employee in the statement required by paragraph 
(a) that, as a condition of employment under the grant, the employee 
will:
    (1) Abide by the terms of the statement; and, (2) Notify the 
employer in writing of his or her conviction for a violation of a 
criminal drug statute occurring in the workplace no later than five 
calendar days after such conviction;
    (e) Notifying the agency in writing, within ten calendar days after 
receiving notice under subparagraph (d)(2) from an employee or 
otherwise receiving actual notice of such conviction. Employers of 
convicted employees must provide notice, including position title, to 
every grant officer or other designee on whose grant activity the 
convicted employee was working, unless the Federal agency has 
designated a central point for the receipt of such notices. Notice 
shall include the identification number(s) of each affected grant;
    (f) Taking one of the following actions, within 30 calendar days of 
receiving notice under subparagraph (d)(2), with respect to any 
employee who is so convicted:
    (1) Taking appropriate personnel action against such an employee, 
up to and including termination, consistent with the requirements of 
the Rehabilitation Act of 1973, as amended; or, (2) Requiring such 
employee to participate satisfactorily in a drug abuse assistance or 
rehabilitation program approved for such purposes by a Federal, State, 
or local health, law enforcement, or other appropriate agency;
    (g) Making a good faith effort to continue to maintain a drug-free 
workplace through implementation of paragraphs (a), (b), (c), (d), (e), 
and (f).

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, or local) with 
commission of any of the offenses enumerated in paragraph (1)(b) of 
this certification; and
    (d) have not within a 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or local) 
terminated for cause or default.
    The inability of a person to provide the certification required 
above will not necessarily result in denial of participation in this 
covered transaction. If necessary, the prospective participant shall 
submit an explanation of why it cannot provide the certification. The 
certification or explanation will be considered in connection with the 
Department of Health and Human Services (HHS) determination whether to 
enter into this transaction. However, failure of the prospective 
primary participant to furnish a certification or an explanation shall 
disqualify such person from participation in this transaction.
    The prospective primary participant agrees that by submitting this 
proposal, it will include the clause entitled ``Certification Regarding 
Debarment, Suspension, Ineligibility, and Voluntary Exclusion--Lower 
Tier Covered Transaction'' provided below without modification in all 
lower tier covered transactions and in all solicitations for lower tier 
covered transactions.

Certification Regarding Debarment, Suspension, Ineligibility and 
Voluntary Exclusion--Lower Tier Covered Transactions

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

Certification Regarding Lobbying

Certification for Contracts, Grants, Loans, and Cooperative Agreements

    The undersigned certifies, to the best of his or her knowledge and 
belief, that:
    (1) No Federal Appropriated Funds have been paid or will be paid, 
by or on behalf of the undersigned, to any person for influencing or 
attempting to influence an officer or employee or any agency, a Member 
of Congress, an officer or employee 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 or any agency, a Member of Congress, 
an officer or employee of Congress, or an 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.
----------------------------------------------------------------------
Organization
----------------------------------------------------------------------
Authorized Signature    Title    Date

    Note: If Disclosure Forms are required, please contact: Margaret 
A. Tolson, Director; Grants Management Division; 330 Independence 
Avenue, S.W., Room 4256-COHEN; Washington, D.C. 20201-0001.
[FR Doc. 94-11383 Filed 5-10-94; 8:45 am]
BILLING CODE 4130-02-M