[Federal Register Volume 60, Number 13 (Friday, January 20, 1995)]
[Notices]
[Pages 4304-4324]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-1364]




[[Page 4303]]

_______________________________________________________________________

Part III





Department of Health and Human Services





_______________________________________________________________________



Office of Community Services



_______________________________________________________________________



Request for Applications Under the Office of Community Services' Fiscal 
Year 1995 Community Food and Nutrition Program; Notice

  Federal Register / Vol. 60, No. 13 / Friday, January 20, 1995 / 
Notices   
[[Page 4304]] 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Community Services
[Program Announcement No. OCS 95-02]


Request for Applications Under the Office of Community Services' 
Fiscal Year 1995 Community Food and Nutrition Program

AGENCY: Office of Community Services, Administration for Children and 
Families, Department of Health and Human Services.

ACTION: Request for applications under the Office of Community 
Services' Community Food and Nutrition Program.

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

SUMMARY: The Office of Community Services (OCS) announces that 
competing applications will be accepted for new grants pursuant to the 
Secretary's discretionary authority under Section 681A of the Community 
Services Block Grant Act of 1981 as amended. This Program Announcement 
contains forms and instructions for submitting an application. Grants 
made under this Program Announcement are subject to the availability of 
funds for support of these activities.

CLOSING DATE: The closing date for submission of applications is March 
21, 1995.

FOR FURTHER INFORMATION CONTACT: Joseph Carroll, Program Manager, 
Office of Community Services, Division of Community Demonstration 
Programs, Attention: CFN Programs, 370 L'Enfant Promenade S.W., 
Washington, D.C. 20447, (202) 401-9233.
    This Announcement is accessible on the OCS Electronic Bulletin 
Board for downloading through your computer modem by calling 1-800-627-
8886. For assistance in accessing the Bulletin Board, A Guide to 
Accessing and Downloading is available from Ms. Minnie Landry at (202) 
401-5309.

Table of Contents

Part A--Preamble

1. Legislative Authority
2. Definitions of Terms
3. Purpose of Community Food and Nutrition Program
    (a) Project Requirements

Part B--Application Requirements

1. Eligible applicants
2. Availability of Funds and Grant Amounts
3. Project Periods and Budget Periods
4. Administrative Costs/Indirect Costs
5. Program Beneficiaries
6. Number of Projects in Application
7. Multiple Submittal
8. Sub-Contracting or Delegating Projects

Part C--Program Priority Area

1. General Projects
2. Set-Asides
3. Nationwide Programs

Part D--Review Criteria

Criteria for Review and Evaluation of Application Submitted Under 
this Program Announcement

Part E--Instructions for Completing Application Package

1. SF-424--``Application for Federal Assistance''
2. SF-424A ``Budget Information--Non-Construction''
3. SF-424B ``Assurances--Non-Construction''
4. Project Narrative

Part F--Application Procedures

l. Availability of Forms
2. Application Submission
3. Intergovernmental Review
4. Application Consideration
5. Criteria for Screening Applications
    a. Initial Screening
    b. Pre-Rating Review
    c. Evaluation Criteria

Part G--Contents of Application Package and Receipt Process

Part H--Post Award Information and Reporting Requirements

Part A--Preamble

1. Legislative Authority

    The Community Services Block Grant Act as amended authorizes the 
Secretary of Health and Human Services to make funds available under 
several programs to support program activities which will result in 
direct benefits targeted to low-income people. This Program 
Announcement covers the grant authority found at Section 681A, 
Community Food and Nutrition, which authorizes the Secretary to make 
funds available for grants to be awarded on a competitive basis to 
eligible entities for local and statewide programs (1) to coordinate 
existing private and public food assistance resources, whenever such 
coordination is determined to be inadequate, to better serve low-income 
communities; (2) to assist low-income communities to identify potential 
sponsors of child nutrition programs and to initiate new programs in 
underserved or unserved areas; and (3) to develop innovative approaches 
at the State and local levels to meet the nutrition needs of low-income 
people.
    The Act also requires that 20 percent of appropriated funds in 
excess of $6 million be awarded on a competitive basis to eligible 
agencies for nationwide programs, including programs benefitting Native 
Americans and Migrant Farmworkers.

2. Definitions of Terms

    For purposes of this Program Announcement the following definitions 
apply:

--Displaced worker: An individual who is in the labor market but has 
been unemployed for six months or longer.
--Indian tribe: A tribe, band, or other organized group of Native 
American Indians recognized in the State or States in which it resides 
or considered by the Secretary of the Interior to be an Indian tribe or 
an Indian organization for any purpose.
--Innovative project: One that departs from or significantly modifies 
past program practices and tests a new approach.
--Migrant Farmworker: An individual who works in agricultural 
employment of a seasonal or other temporary nature who is required to 
be absent from his/her place of permanent residence in order to secure 
such employment.
--Seasonal farmworker: Any individual employed in agricultural work of 
a seasonal or other temporary nature who is able to remain at his/her 
place of permanent residence while employed.
--Underserved area (as it pertains to child nutrition programs): A 
locality in which less than one-half of the low-income children 
eligible for assistance participate in any child nutrition program.
--Budget Period: The term ``budget period'' refers to the interval of 
time into which a grant period of assistance (project period) is 
divided for budgetary and funding purposes.
--Eligible Entity: States and other public and private non-profit 
agencies/organizations including Community Action Agencies and agencies 
which administer nationwide programs. (see Part B.1.)
--Project Period: The term ``project period'' refers to the total time 
for which a project is approved for support, including any approved 
extensions.
--Self-Sufficiency: A condition where an individual or family does not 
need and is not eligible for public assistance.

3. Purpose of Community Food and Nutrition Program

    The Department of Health and Human Services is committed to 
improving the overall health and nutritional well-being of individuals 
through improved preventive health care and promotion of personal 
responsibility. The Department encourages the approach to health 
promotion and nutritional responsibility [[Page 4305]] with personal 
messages aimed at families and communities, in various settings and 
environments in which individuals and groups can most effectively be 
reached.
    The Department is specifically interested in improving the health 
and nutrition status of low-income persons through improved access to 
healthy nutritious foods or by other means. HHS encourages community 
efforts to improve the coordination and integration of health and 
social services for all low-income families, and to identify 
opportunities for collaborating with other programs and services for 
this population. Such collaboration can increase a community's capacity 
to leverage resources and promote an integrated approach to health and 
nutrition through existing programs and services.
a. Project Requirements
    Projects funded under this program should:
    (1) Be designed and intended to provide nutrition benefits, 
including those which incorporate the benefits of disease prevention, 
to a targeted low-income group of people;
    (2) Provide outreach and public education to inform eligible low-
income individuals and families of other nutritional services available 
to them under the various Federally assisted programs;
    (3) Carry out targeted communications/social marketing to improve 
dietary behavior and increase program participation among eligible low-
income populations. Populations to be targeted can include displaced 
workers, elderly people, children, and the working poor.
    (4) Consult with and/or inform local offices that administer other 
food programs such as W.I.C. and Food Stamps, where applicable, to 
ensure effective coordination which can jointly target services to 
increase their effectiveness. Such consultation may include involving 
these offices in the planning of grant applications.
    (5) Focus on one or more legislatively mandated program activities: 
(a) Coordination of existing private and public food assistance 
resources, whenever such coordination is determined to be inadequate, 
to better serve low-income populations; (b) assistance to low-income 
communities in identifying potential sponsors of child nutrition 
programs and initiating new programs in unserved or underserved areas; 
and (c) development of innovative approaches at the state or local 
levels to meet the nutrition needs of low-income people. OCS views this 
program as a capacity building program, rather than as a service 
delivery program.

Part B--Application Requirements

1. Eligible Applicants

    Eligible applicants are States and public and private non-profit 
agencies/organizations with a demonstrated ability to successfully 
develop and implement programs and activities similar to those 
enumerated above. OCS encourages Historically Black Colleges and 
Universities and Minority Institutions to submit applications. In 
addition, applicants for the set-aside must be either: (1) Indian 
tribes, (2) private non-profit groups whose governing board is 
comprised of a majority of Indians and whose primary purpose is serving 
Indian populations, or (3) groups whose sole purpose is serving migrant 
and seasonal farmworker populations.
    Any non-profit organization submitting an application must submit 
proof of its non-profit status in its application at the time of 
submission. The non-profit agency can accomplish this by providing a 
copy of the applicant's listing in the Internal Revenue Services's 
(IRS) most recent list of tax-exempt organizations described in Section 
501(c)(3) of the IRS tax code or by providing a copy of the currently 
valid IRS tax exemption certificate and by providing a copy of the 
applicant's Articles of Incorporation bearing the seal of the State in 
which the corporation or association is domiciled.

2. Availability of Funds and Grant Amounts

a. FY 95 Funding
    The funds available for grant awards under the CFN Program in FY 95 
are:


General Projects........................................      $2,970,400
Set-Asides..............................................         500,000
Nationwide Programs.....................................         535,200
                                                                        

b. Grant Amounts
    No individual grant application will be considered for an amount 
which is in excess of $50,000 for applications submitted under General 
Projects and Set-Asides. No eligible organization may receive more than 
$300,000 in the aggregate for a nationwide program.
c. Mobilization of Resources
    OCS would like to mobilize as many resources as possible to enhance 
projects funded under this program. OCS supports and encourages 
applications submitted by applicants whose programs will leverage other 
resources, either cash or third-party in-kind.

3. Project Periods and Budget Periods

    For most projects OCS will grant funds for one year. However, in 
rare instances, depending on the characteristics of any individual 
project and on the justification presented by the applicant in its 
application, a grant may be made for a period of up to 17 months.

4. Administrative Costs/Indirect Costs

    There is no administrative cost limitation for projects funded 
under this program. Indirect costs consistent with approved Indirect 
Cost Rate Agreements are allowable. Applicants should enclose a copy of 
the current approved rate agreement. However, it should be understood 
that indirect costs are part of, and not in addition to, the amount of 
funds awarded in the subject grant.

5. Program Beneficiaries

    Projects proposed for funding under this Announcement must result 
in direct benefits targeted toward low-income people as defined in the 
most recent Annual Update of Poverty Income Guidelines published by 
DHHS. Attachment A to this Announcement is an excerpt from the most 
recently published guidelines. Annual revisions of these guidelines are 
normally published in the Federal Register in February or early March 
of each year and are applicable to projects being implemented at the 
time of publication. Grantees will be required to apply the most recent 
guidelines throughout the project period. The Federal Register may be 
obtained from public libraries, Congressional offices, or by writing 
the Superintendent of Documents, U.S. Government Printing Office, 
Washington, D.C. 20402. They also will be accessible on the OCS 
Electronic Bulletin Board. (See ``For Further Information Contact'' 
section at the beginning of this document.) No other government agency 
or privately defined poverty guidelines are applicable to the 
determination of low-income eligibility for this OCS program.

6. Number of Projects in Application

    An application may contain only one project and this project must 
address the basic criteria found in Part C. Applications which are not 
in compliance with these requirements will be ineligible for funding.

7. Multiple Submittal

    There is no limit to the number of applications that can be 
submitted as long as each application contains a proposal for a 
different project. [[Page 4306]] However, no applicant can receive more 
than one grant.

8. Sub-Contracting or Delegating Projects

    OCS will not fund any project where the role of the eligible 
applicant is primarily to serve as a conduit for funds to other 
organizations.

Part C--Program Priority Areas

1. General Projects--FN

    The application should include a description of the target area and 
population to be served as well as a discussion of the nature and 
extent of the problem to be solved. The application must contain a 
detailed and specific work program that is both sound and feasible. 
Projects funded under this Announcement must produce permanent and 
measurable results that fulfill the purposes of this program as 
described above. The OCS grant funds, in combination with private and/
or other public resources, must be targeted to low-income individuals 
and communities.
    Applicants will certify in their submission that projects will only 
serve the low-income population as stipulated in the DHHS Poverty 
Income Guidelines (Attachment A). Failure to comply with the income 
guidelines may result in the application being ineligible for 
consideration for funding.
    If an applicant is proposing a project which will affect a property 
listed in or eligible for inclusion in the National Register of 
Historic Places, it must identify this property in the narrative and 
explain how it has complied with the provisions of Section 106 of the 
National Historic Preservation Act of 1966 as amended. If there is any 
question as to whether the property is listed in or eligible for 
inclusion in the National Register of Historic Places, applicant should 
consult with the State Historic Preservation Officer. The applicant 
should contact OCS early in the development of its application for 
instructions regarding compliance with the Act and data required to be 
submitted to the Department of Health and Human Services.
    In the case of projects proposed for funding which mobilize or 
improve the coordination of existing public and private food assistance 
resources, the guidelines governing those resources apply. However, in 
the case of projects providing direct assistance to beneficiaries 
through grants funded under this program, beneficiaries must fall 
within the official DHHS Poverty Income Guidelines as set forth in 
Attachment A.
    Applications which propose the use of grant funds for the 
development of any printed or visual materials must contain convincing 
evidence that these materials are not available from other sources. OCS 
will not provide funding for such items if justification is not 
sufficient. Approval of any films or visual presentations proposed by 
applicants approved for funding will be made part of the grant award. 
In cases where material outlays for equipment (audio and visual) are 
requested, specific evidence must be presented that there is a definite 
programmatic connection between the equipment (audio and visual) usage 
and the outreach requirements described in Part A.3.a of this 
Announcement.
    OCS is also interested in projects that address the needs of 
homeless families and welcomes project proposals which seek to develop 
innovative approaches to promote health, and nutritional awareness 
among low-income populations.

2. Set-Asides--SA

    In recognition of the special needs of Indians and Migrant and 
Seasonal Farmworkers, a set-aside will be established to afford 
priority consideration to proposals submitted by agencies serving these 
populations. Proposed Projects must meet the requirements of Part C.1. 
Applications which are not funded within this set-aside will also be 
considered competitively within the larger pool of eligible applicants. 
See Part D, Criteria II and III, for additional guidance on developing 
a work program.

3. Nationwide Programs--NA

    Projects funded must be nationwide in scope and must meet the 
requirements of Part C.1 (General Projects). No eligible organization 
may receive more than $300,000 in the aggregate for a nationwide 
program.

Part D--Review Criteria

    Applications which pass the initial screening and pre-rating review 
(See Part F, Section 5) will be assessed and scored by reviewers. Each 
reviewer will give a numerical score for each application reviewed. 
These numerical scores will be supported by explanatory statements on a 
formal rating form describing major strengths and weaknesses under each 
applicable criterion published in the Announcement.
    The in-depth evaluation and review process will use the following 
criteria coupled with the specific requirements as described in Part F.
    When writing their Project Narrative applicants should respond to 
the review criteria using the same sequential order.

    (Note: The following review criteria reiterate the information 
requirements contained in Part B of this Announcement. These 
requirements are approved under OMB Control Number 0970-0062.)

Criteria for Review and Evaluation of Applications Submitted Under 
This Program Announcement

Criterion I: Analysis of Needs/Priorities (Maximum: 10 Points)

    (a) Target area and population to be served are adequately 
described (0-4 points).
    In addressing the above criterion, the applicant should include the 
following:
    The applicant should include a description of the target area and 
population to be served including specific details on any minority 
population(s) to be served.
    (b) Nature and extent of problem(s) and/or need(s) to be addressed 
are adequately described and documented (0-6 points).
    In addressing the above criterion, the applicant should include the 
following:
    Applicant should discuss the nature and extent of the problem(s) 
and/or need(s), including specific information on minority 
population(s).

Criterion II: Adequacy of Work Program (Maximum: 25 Points)

    (a) Realistic quarterly time targets are set forth by which the 
various work tasks will be completed (0-10 points).
    (b) Activities are adequately described and appear reasonably 
likely to achieve results which will have a desired impact on the 
identified problems and/or needs (0-15 points).
    In addressing the above criterion, the applicant should include the 
following:
    The applicant should address the basic criteria and legislatively-
mandated activities found in Part A.3.a and should include:
    (a) Project priorities and rationale for selecting them which 
relate to the specific nutritional problem(s) and/or need(s) of the 
target population which were identified under Criterion I;
    (b) Goals and objectives which speak to the(se) problem(s) and/or 
need(s); and
    (c) Project activities which if successfully carried out can be 
reasonably expected to result in the achievement of these goals and 
objectives.

Criterion III: Significant and Beneficial Impact (Maximum 30 Points)

    (a) Applicant proposes to significantly improve or increase 
nutrition services to low-income people and such 
[[Page 4307]] improvements or increases are quantified. (0-15 points).
    (b) Project incorporates promotional health and social services 
activities for low-income people, along with nutritional services (0-5 
points).
    (c) Project will significantly leverage or mobilize other community 
resources and such resources are detailed and quantified (0-5 points).
    (d) Proposal addresses (a) problem(s) which can be resolved by one-
time OCS funding or demonstrates that non-Federal funding is available 
to continue the project without Federal support (0-5 points).
    In addressing the above criterion, the applicant must include: 
quantitative data for items (a), (b), and (c), and discuss how the 
beneficial impact relates to the relevant legislatively-mandated 
program activities identified in Part A.3.a. and the Problems and/or 
Needs described under Criterion I.

Criterion IV: Coordination/Services Integration (Maximum 15 Points)

    (a) Proposal shows evidence of coordinated community-based planning 
in its development, including strategies in the Work Program to carry 
on activities in collaboration with other locally funded Federal 
programs (such as HHS health and social services and USDA Food and 
Consumer Service programs) in ways that will eliminate duplication and 
will, for example, 1) unite funding streams at the local level to 
increase program outreach and effectiveness, 2) facilitate access to 
other needed social services by coordinating and simplifying intake and 
eligibility certification processes for clients, or 3) bring project 
participants into direct interaction with holistic family development 
resources in the community where needed. (0-10 points)
    (b) Community Empowerment Consideration--Special consideration will 
be given to applicants who are located in areas which are characterized 
by poverty and other indicators of socio-economic distress such as a 
poverty rate of at least 20%, designation as an Empowerment Zone or 
Enterprise Community, high levels of unemployment, and high levels of 
incidences of violence, gang activity, crime, or drug use. Applicants 
should document that they were involved in the preparation and planned 
implementation of a comprehensive community-based strategic plan to 
achieve both economic and human development in an integrated manner. 
(0-5 points)
    If the applicant is receiving funds from the State for community 
food and nutrition activities, the applicant should address how the 
funds are being utilized, and how they will be coordinated with the 
proposed project to maximize the effectiveness of both. If State funds 
are being used in the project for which OCS funds are being requested, 
their usage should be specifically described.

Criterion V: Organization Experience in Program Area and Staff 
Responsibilities (Maximum 15 Points)

    (a) Organizational experiences in program area (0-5 points). 
Documentation provided indicates that projects previously undertaken 
have been relevant and effective and have provided permanent benefits 
to the low-income population. Organizations which propose providing 
training and technical assistance have detailed competence in the 
specific program priority area and as a deliverer with expertise in the 
fields of training and technical assistance. If applicable, information 
provided by these applicants also addresses related achievements and 
competence of each cooperating or sponsoring organization.
    (b) Management History (0-5 points).
    Applicants must demonstrate their ability to implement sound and 
effective management practices and if they have been recipients of 
other Federal or other governmental grants, they must also document 
that they have consistently complied with financial and program 
progress reporting and audit requirements. Such documentation may be in 
the form of references to any available audit or progress reports and 
should be accompanied by a statement by a Certified or Licensed Public 
Accountant as to the sufficiency of the applicant's financial 
management system to protect adequately any Federal funds awarded under 
the application submitted.
    (c) Staffing skills, Resources and Responsibilities (0-5 points).
    The application adequately describes the experience and skills of 
the proposed project director showing that the individual is not only 
well qualified, but that his/her professional capabilities are relevant 
to the successful implementation of the project. If the key staff 
person has not yet been identified, the application contains a 
comprehensive position description which indicates that the 
responsibilities to be assigned to the project director are relevant to 
the successful implementation of the project. The application must 
indicate that the applicant has adequate facilities and resources (i.e. 
space and equipment) to successfully carry out the work plan.
    In addressing the above criterion, the applicant should include the 
following:
    The applicant must clearly show that sufficient time of the Project 
Director and other senior staff will be budgeted to assure timely 
implementation and oversight of the project and that the assigned 
responsibilities of the staff are appropriate to the tasks identified 
for the project.

Criterion VI: Adequacy of Budget (Maximum: 5 Points)

    (a) Budget is adequate and administrative costs are appropriate in 
relation to the services proposed (0-5 points).

Part E--Instructions for Completing Application Package

(Approved by the OMB under Control Number 0970-0062)

    The standard forms attached to this Announcement shall be used when 
submitting applications for all funds under this Announcement.
    It is recommended that you reproduce single-sided copies of the SF-
424, SF-424A and SF-424B, and type your application on the copies. 
Please prepare your application in accordance with instructions 
provided on the forms as well as with the OCS specific instructions set 
forth below:

1. SF-424--Application for Federal Assistance

    Top of Page. Please enter the single priority area designation 
under which the application is being submitted. An application should 
be submitted under only one priority area.
    Item 1. For the purposes of this announcement, all projects are 
considered Applications; there are no Pre-Applications.
    Item 2. Date Submitted and Applicant Identifier--Date application 
is submitted to ACF and applicant's own internal control number, if 
applicable.
    Item 3. Date Received by State--N/A
    Item 4. Date Received by Federal Agency--Leave blank.
    Items 5 and 6. The legal name of the applicant must match that 
listed as corresponding to the Employer Identification Number. Where 
the applicant is a previous Department of Health and Human Services 
grantee, enter the Central Registry System Employee Identification 
Number (CRS/EIN) and the Payment Identifying Number, if one has been 
assigned, in the Block entitled Federal Identifier located at the top 
right hand corner of the form.
    Item 7. If the applicant is a non-profit corporation, enter N in 
the box and specify non-profit corporation in the space marked Other. 
Proof of non-profit [[Page 4308]] status, such as IRS certification, 
Articles of Incorporation, or By-laws, must be included as an appendix 
to the project narrative.
    Item 8. Type of Application--Please check ``new'' application.
    Item 9. Enter DHHS-ACF/OCS.
    Item 10. The Catalog of Federal Domestic Assistance number for the 
OCS program covered under this announcement is 93.571. The title is 
Community Services Block Grant Discretionary Awards--Community Food and 
Nutrition Program.
    Item 11. In addition to a brief descriptive title of the project, 
indicate the priority area for which funds are being requested. Use the 
following letter designations:

FN--General Projects
SA--Projects where Migrant and Seasonal Farmworker organizations and 
Indian Tribes or Indian organizations are applying specifically for 
set-aside funds described in Part B
NP--Grants to organizations with nationwide programs

    Item 12. Areas Affected by Project--List only the largest unit or 
units affected, such as State, county or city.
    Item 13. Proposed Project--The ending date should be calculated 
based on a 12-month project period.
    Item 14. Congressional District of Applicant/Project--Enter the 
number of the Congressional District where the applicant's principal 
office is located and the number of the Congressional district(s) where 
the project will be located.
    Item 15a. For purposes of this Announcement, this amount should 
reflect the amount requested for the entire project period.
    Item 15b-e. These items should reflect both cash and third-party 
in-kind contributions for the total project period.
    Item 15f. N/A
    Item 15g. Enter the sum of Items 15a-15e.

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

    See Instructions accompanying this page as well as the instructions 
set forth below:
    In completing these sections, the Federal Funds budget entries will 
relate to the requested OCS Community Food and Nutrition Program funds 
only, and Non-Federal will include mobilized funds from all other 
sources--applicants, State, and other. Federal funds other than those 
requested from the Community Food and Nutrition Program should be 
included in Non-Federal entries.
    Sections A and D of SF-424A must contain entries for both Federal 
(OCS) and non-Federal (mobilized funds).

Section A--Budget Summary

Line 1-4
Col. (a):

    Line 1--Enter OCS Community Food and Nutrition Program; Col. (b):
    Line 1--Enter 93.571.

Col. (c) and (d): Not Applicable
Col. (e)-(g):

    For each line 1-4, enter in columns (e), (f) and (g) the 
appropriate amounts needed to support the project for the entire 
project period.
    Line 5--Enter the figures from Line 1 for all columns completed, 
(e), (f), and (g).

Section B--Budget Categories

    This section should contain entries for OCS funds only. For all 
projects, the first budget period of 12 months will be entered in 
Column #1.
    Allocability of costs is governed by applicable cost principles set 
forth in 45 CFR Parts 74 and 92.
    Budget estimates for administrative costs must be supported by 
adequate detail for the grants officer to perform a cost analysis and 
review. Adequately detailed calculations for each budget object class 
are those which reflect estimation methods, quantities, unit costs, 
salaries, and other similar quantitative detail sufficient for the 
calculation to be duplicated. For any additional object class 
categories included under the object class other identify the 
additional object class(es) and provide supporting calculations.
    Supporting narratives and justifications are required for each 
budget category, with emphasis on unique/special initiatives; large 
dollar amounts; local, regional, or other travel; new positions; major 
equipment purchases; and training programs.
    A detailed itemized budget with a separate budget justification for 
each major item should be included as indicated below:
    Line 6a--Personnel: Enter the total costs of salaries and wages.

Justification

    Identify the project director. Specify by title or name the 
percentage of time allocated to the project, the individual annual 
salaries and the cost to the project (both Federal and non-Federal) of 
the organization's staff who will be working on the project.
    Line 6b--Fringe Benefits: Enter the total costs of fringe benefits 
unless treated as part of an approved indirect cost rate which is 
entered on line 6j.

Justification

    Enter the total costs of fringe benefits, unless treated as part of 
an approved indirect cost rate.
    Line 6c--Travel: Enter total cost of all travel by employees of the 
project. Do not enter costs for consultant's travel.

Justification

    Include the name(s) of traveler(s), total number of trips, 
destinations, length of stay, mileage rate, transportation costs and 
subsistence allowances.
    Line 6d--Equipment: Enter the total costs of all non-expendable 
personal property to be acquired by the project. ``Non-expendable 
personal property'', means tangible personal property having a useful 
life of more than one year and an acquisition cost of $5,000 or more 
per unit.

Justification

    Equipment to be purchased with Federal funds must be required to 
conduct the project, and the applicant organization or its subgrantees 
must not already have the equipment or a reasonable facsimile available 
to the project.
    Line 6e--Supplies: Enter the total costs of all tangible personal 
property (surplus) other than that included on line 6d.
    Line 6f--Contractual. Enter the total costs of all contracts, 
including (1) procurement contracts (except those which belong on other 
lines such as equipment, supplies, etc.) and (2) contracts with 
secondary recipient organizations including delegate agencies and 
specific project(s) or businesses to be financed by the applicant.

Justification

    Attach a list of contractors, indicating the names of the 
organizations, the purposes of the contracts, the estimated dollar 
amounts, and selection process of the awards as part of the budget 
justification. Also provide back-up documentation identifying the name 
of contractor, purpose of contract, and major cost elements.

    Note: Whenever the applicant/grantee intends to delegate part of 
the program to another agency, the applicant/grantee must submit 
Sections A and B of this Form SF-424A, completed for each delegate 
agency by agency title, along with the required supporting 
information referenced in the applicable instructions.

    The total costs of all such agencies will be part of the amount 
shown on Line 6f. Provide draft Request for Proposal in accordance with 
45 CFR Part 74, Appendix H. Free and open [[Page 4309]] competition is 
encouraged for any procurement activities planned using ACF grant 
funds, and is required for any procurement that exceeds $25,000.
    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, food, 
medical and dental costs (noncontractual), fees and travel paid 
directly to individual consultants, local transportation (all travel 
which does not require per diem is considered local travel), space and 
equipment rentals, printing and publication, computer use training 
costs including tuition and stipends, training service costs including 
wage payments to individuals and supportive service payments, and staff 
development costs.
    Line 6j--Indirect Charges: Enter the total amount of indirect 
costs. This line should be used only when the applicant currently has 
an indirect cost rate approved by the Department of Health and Human 
Services or other Federal agencies.
    If the applicant organization is in the process of initially 
developing or renegotiating a rate, it should immediately upon 
notification that an award will be made, develop a tentative indirect 
cost rate proposal based on its most recently completed fiscal year in 
accordance with the principles set forth in the pertinent DHHS Guide 
for Establishing Indirect Cost Rates, and submit it to the appropriate 
DHHS Regional Office. It should be noted that when an indirect cost 
rate is requested, those costs included in the indirect cost pool 
cannot be also budgeted or charged as direct costs to the grant. 
Indirect costs consistent with approved Indirect Cost Rate Agreements 
are allowable.
    Line 6k--Totals. Enter the total amounts of Lines 6i and 6j.
    Line 7--Program Income: Enter the estimated amount of income, if 
any, expected to be generated from this project. Separately show 
expected program income generated from OCS support and income generated 
from other mobilized funds. Do not add or subtract this amount from the 
budget total. Show the nature and source of income in the program 
narrative statement.

Justification

    Describe the nature, source and anticipated use of program income 
in the Program Narrative Statement.

Section C--Non-Federal Resources

    This section is to record the amounts of Non-Federal resources that 
will be used to support the project. Non-Federal resources mean other 
than OCS funds for which the applicant has received a commitment. 
Provide a brief explanation, on a separate sheet, showing the type of 
contribution, broken out by Object Class Category, (See Section B.6) 
and whether it is cash or third-party in-kind. The firm commitment of 
these required funds must be documented and submitted with the 
application in order to be given credit in the criterion.
    Except in unusual situations, this documentation must be in the 
form of letters of commitment or letters of intent from the 
organization(s)/individuals from which funds will be received.
Line 8--Grant Program
    Col. (a): Enter the project title.
    Col. (b): Enter the amount of cash or donations to be made by the 
applicant.
    Col. (c): Enter the State contribution.
    Col. (d): Enter the amount of cash and third party in-kind 
contributions to be made from all other sources.
    Col. (e): Enter the total of columns (b), (c), and (d).
    Lines 9, 10, and 11 should be left blank.
    Line 12--Carry the total of each column of Line 8, (b) through (e). 
The amount in Column (e) should be equal to the amount on Section A, 
Line 5, Column (f).

Justification

    Describe third party in-kind contributions, if included.

Section D--Forecasted Cash Needs

    Line 13--Federal: Enter the amount of Federal (OCS) cash needed for 
this grant, by quarter, during the 12 month budget period.
    Line 14--Non-Federal: Enter the amount of cash from all other 
sources needed by quarter during the first year.
    Line 15--Totals: Enter the total of Lines 13 and 14.

Section F--Other Budget Information

    Line 21--Direct Charges: Include narrative justification required 
under Section B for each object class category for the total project 
period.
    Line 22--Indirect Charges: Enter the type of HHS or other Federal 
agency approved indirect cost rate (provisional, predetermined, final 
or fixed) that will be in effect during the funding period, the 
estimated amount of the base to which the rate is applied and the total 
indirect expense. Also, enter the date the rate was approved, where 
applicable. Attach a copy of the approved rate agreement.
    Line 23--Provide any other explanations and continuation sheets 
required or deemed necessary to justify or explain the budget 
information.

3. SF-424B  ``Assurances Non-Construction''

    All applicants must sign and return the ``Assurances'' with the 
application.

4. Project Narrative

    Each narrative should include the following major Sections:

a. Analysis of Need
b. Project Design (Work Programs)
c. Organizational Experience in Program Areas
d. Management History
e. Staffing and Resources
f. Staff Responsibilities

    The project narrative must address the specific purposes mentioned 
in Part A of this Program Announcement. The narrative should provide 
information on how the application meets the evaluation criteria in 
part D of this Program Announcement.

Part F--Application Procedures

1. Availability of Forms

    Applications for awards under this OCS program must be submitted on 
Standard Forms (SF) 424, 424A, and 424B. Part E and attachment B to 
this Program Announcement contain all the instructions and forms 
required for submittal of applications. The forms may be reproduced for 
use in submitting applications. Copies of the Federal Register 
containing this Announcement are available at most local libraries and 
Congressional District Offices for reproduction. They are also 
available for downloading from OCS' Electronic Bulletin Board. If 
copies are not available at these sources they may be obtained by 
writing or telephoning the office listed in the section entitled ``For 
Further Information'' at the beginning of this Announcement.

2. Application Submission

    a. Deadlines. Applications shall be considered as meeting the 
deadline if they are either:
    (1) Received on or before the deadline date at the Department of 
Health and Human Services, Administration for Children and Families, 
Division of Discretionary Grants, 370 L'Enfant Promenade, SW., 6th 
Floor, Washington, DC 20447, or
    (2) Sent on or before the deadline date and received by ACF in time 
for the independent review. Applicants are cautioned to request a 
legibly dated U.S. Postal Service postmark or to obtain a legibly dated 
receipt from a commercial carrier or U.S. Postal Service. Private 
Metered postmarks shall not be acceptable as proof of timely mailing. 
[[Page 4310]] 
    b. Applications submitted by other means. Applications which are 
not submitted in accordance with the above criteria shall be considered 
as meeting the deadline only if they are physically received before the 
close of business on or before the deadline date. Hand delivered 
applications are accepted during the normal working hours of 8:00 a.m. 
to 4:30 p.m., Monday through Friday, on or prior to the established 
closing date at: at the Administration for Children and Families, 
Division of Discretionary Grants, 6th Floor, ACF Guard Station, 901 D 
Street, SW., Washington, DC 20447.
    c. 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.
    d. 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 granting agency 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 four copies are required.

    Note: Applicants should note that the U.S. Postal Service does 
not uniformly provide a dated post mark. Before relying on this 
method, applicants should check with their local post office. In 
some instances packages presented for mailing after a pre-determined 
time are postmarked with the next day's date. In other cases, 
postmarks are not routinely placed on packages. Applicants are 
cautioned to verify that there is a date on the package, and that it 
list the correct date of mailing, before accepting a receipt. 
Private metered postmarks are not acceptable as proof of timely 
mailing.

    Applications which have a postmark later than the closing date, or 
which are hand-delivered after the closing date, will be returned to 
the sender without consideration in the competition.

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, Colorado, 
Connecticut, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Montana, 
Nebraska, Oklahoma, Oregon, Pennsylvania, South Dakota, Virginia, 
Washington, American Samoa and Palau have elected to participate in the 
Executive Order process and have established Single Points of Contact 
(SPOCs). Applicants from these nineteen jurisdictions need take no 
action regarding E.O. 12372. Applicants for projects to be administered 
by Federally-recognized Indian Tribes are also exempt from the 
requirements of E.O. 12372. 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.
    SPOCs are encouraged to eliminate the submission of routine 
endorsements as official recommendations.
    Additionally, SPOCs are requested to clearly differentiate between 
mere advisory comments and those official State process recommendations 
which may trigger the ``accommodate or explain'' rule.
    When comments are submitted directly to ACF, they should be 
addressed to: Department of Health and Human Services, Administration 
for Children and Families, Division of Discretionary Grants, 6th Floor, 
370 L'Enfant Promenade, SW Washington, DC 20447.
    A list of the Single Points of Contact for each State and Territory 
is included as Attachment E of this Announcement.

4. Application Consideration

    Applications which meet the screening requirements in Section 5 
below will be reviewed competitively. Such applications will be 
referred to reviewers for a numerical score and explanatory comments 
based solely on responsiveness to program guidelines and evaluation 
criteria published in this Announcement. Applications will be reviewed 
by persons outside of the OCS unit which would be directly responsible 
for programmatic management of the grant. The results of these reviews 
will assist the Director and OCS program staff in considering competing 
applications. Reviewers' scores will weigh heavily in funding decisions 
but will not be the only factors considered. Applications will 
generally be considered in order of the average scores assigned by 
reviewers. However, highly ranked applications are not guaranteed 
funding since the Director may also consider other factors deemed 
relevant including, but not limited to, the timely and proper 
completion of projects funded with OCS funds granted in the last five 
(5) years: comments of reviewers and government officials; staff 
evaluation and input; geographic distribution; previous program 
performance of applicants; compliance with grant terms under previous 
DHHS grants; audit reports; investigative reports; and applicant's 
progress in resolving any final audit disallowances on OCS or other 
Federal agency grants. OCS reserves the right to discuss applications 
with other Federal or non-Federal funding sources to ascertain the 
applicant's performance record.

5. Criteria for Screening Applications

a. Initial Screening
    All applications that meet the published deadline for submission 
will be screened to determine completeness and conformity to the 
requirements of this Announcement. Only those applications meeting the 
following requirements will be reviewed and evaluated competitively. 
Others will be returned to the applicants with a notation that they 
were unacceptable.
    (1) The application must contain a completed and signed Standard 
Form SF-424.
    (2) The SF-424 must be signed by an official of the organization 
applying for the grant who has authority to obligate the organization 
legally.
b. Pre-rating Review
    Applications which pass the initial screening will be forwarded to 
reviewers for analytical comment and scoring based on the criteria 
detailed in the Section below and the specific requirements contained 
in Part A of this Announcement. Prior to the programmatic review, these 
reviewers and/or OCS staff will verify that the applications comply 
with this program announcement in the following areas:
    (1) Eligibility: Applicant meets the eligibility requirements found 
in Part B.
    (2) Number of Projects: The application contains only one project.
    (3) Target Populations: The application clearly targets the 
specific outcomes and benefits of the project to low-income 
participants and beneficiaries as defined in the DHHS 
[[Page 4311]] Poverty Income Guidelines (Attachment A).
    (4) Grant Amount: The amount of funds requested does not exceed 
$50,000 (except for nationwide programs).
    (5) Program Focus: The application addresses the purposes described 
in Part A of this Announcement.
c. Evaluation Criteria
    Applications which pass the initial screening and pre-rating review 
will be assessed and scored by reviewers. Each reviewer will give a 
numerical score for each application reviewed. These numerical scores 
will be supported by explanatory statements on a formal rating form 
describing major strengths and major weaknesses under each applicable 
criterion published in this Announcement.

Part G--Contents of Application and Receipt Process

(Approved by the OMB under Control Number 0970-0062)

1. Contents of Application

    Each application submission must include:
    A signed original and four additional copies of the application.
    Each copy of the application must contain in the order listed each 
of the following:
    a. Table of Contents with page numbers noted for each major section 
and subsection of the proposal and each section of the appendices. Each 
page in the application, including those in all appendices, must be 
numbered consecutively.
    b. ``A Project Abstract'' (a succinct description of the project in 
200 words or less.)
    c. Standard Form 424. Application for Federal Assistance. The SF-
424 should be completed in accordance with instructions provided with 
the form, as well as OCS specific instructions set forth in Part E of 
this Announcement. The SF-424 must contain an original signature of the 
certifying representative of the applicant organization.
    Applicants must also be aware that the applicant's legal name as 
required in SF-424 (Item 5) must match that listed as corresponding to 
the Employer Identification Number (Item 6).
    d. Standard Form 424A, Budget Information. Pages 1 and 2 should be 
completed.
    e. Standard Form 424B, Assurances--Non-Construction Programs. 
Applicants requesting financial assistance for a non-construction 
project must file the Standard Form 424B, Assurances: ``Non-
Construction Programs.'' Applicants must sign and return the Standard 
Form 424B with their applications.
    f. Restriction on Lobbying Activities--Applicants must provide a 
certification concerning Lobbying. Prior to receiving an award in 
excess of $100,000, applicants shall furnish an executed copy of the 
lobbying certification. Applicants must sign and return the 
certification with their applications.
    g. Disclosure of Lobbying Activities--SF-ILL: Fill out, sign and 
date form found at Attachment F, (required only if lobbying has 
actually taken place or is expected to take place in trying to obtain 
the grant for which the applicant is applying.)
    h. Project Narrative--(See Part E, Section 3.)
    i. Applicants must make the appropriate certification of their 
compliance with the Drug-Free Workplace Act of 1988. By signing and 
submitting the applications, applicants are providing the certification 
and need not mail back the certification with the applications.
    j. Applicants must make the appropriate certification that they are 
not presently debarred, suspended or otherwise ineligible for award. By 
signing and submitting the applications, applicants are providing the 
certification and need not mail back the certification with the 
applications.
    The total number of pages for the narrative portion of the 
application package must not exceed 30 pages in their entirety. 
Applications must be uniform in composition since OCS may find it 
necessary to duplicate them for review purposes. Therefore, 
applications must be submitted on 8\1/2\ x 11 inch paper only. They 
must not include colored, oversized or folded materials, organizational 
brochures, or other promotional materials, slides, films, clips, etc., 
in the proposal. Such materials will be discarded if included.
    Applications should be two-holed punched at the top center and 
fastened separately with a compressor slide paper fastener, such as an 
ACCO clip, or a binder clip.
    While applications must be comprehensive, OCS encourages 
conciseness and brevity in the presentation of materials and cautions 
the applicant to avoid unnecessary duplication of information.

2. Acknowledgement of Receipt

    An acknowledgement postcard will be mailed to all applicants with 
an identification number which will be noted on the acknowledgement. 
This number must be referred to in all subsequent communications with 
OCS concerning the application. If an acknowledgment is not received 
within three weeks after the deadline date, applicants must notify ACF 
by telephone (202) 401-9365. Applicant should also submit a mailing 
label for the acknowledgement card.

Part H--Post Award Information and Reporting Requirements

    Following approval of the applications selected for funding, notice 
of project approval and authority to draw down project funds will be 
made in writing. The official award document is the Financial 
Assistance Award which provides the amount of Federal funds approved 
for use in the project, the budget period for which support is 
provided, and the terms and conditions of the award.
    In addition to the General Conditions and Special Conditions (where 
the latter are warranted) which will be applicable to grants, grantees 
will be subject to the provisions of 45 CFR Parts 74 (non-governmental) 
and 92 (governmental) along with OMB Circular 122 and 87.
    Grantees will be required to submit semi-annual progress and 
financial reports (SF-269) as well as a final progress and financial 
report.
    Grantees are subject to the audit requirements in 45 CFR Parts 74 
and 92.
    Section 319 of Public Law 101-121, signed into law on October 23, 
1989, imposes new prohibitions and requirements for disclosure and 
certification related to lobbying when applicant has engaged in 
lobbying activities or is expected to lobby in trying to obtain the 
grant. It provides limited exemptions for Indian tribes and tribal 
organizations. Current and prospective recipients (and their subtier 
contractors and/or grantees) are prohibited from using appropriated 
funds for lobbying Congress or any Federal agency in connection with 
the award of a contract, grant, cooperative agreement or loan. In 
addition, for each award action in excess of $100,000 (or $150,000 for 
loans) the law requires recipients and their subtier contractors and/or 
subgrantees (1) to certify that they have neither used nor will use any 
appropriated funds for payment to lobbyists, (2) to submit a 
declaration setting forth whether payments to lobbyists have been or 
will be made out of non-appropriated funds and, if so, the name, 
address, payment details, and purpose of any agreements with such 
lobbyists whom recipients or their subtier contractors or subgrantees 
will pay with the nonappropriated funds and (3) to file quarterly up-
dates about the use of lobbyists if any event occurs that materially 
affects the accuracy of the information submitted by way of 
[[Page 4312]] declaration and certification. The law establishes civil 
penalties for noncompliance and is effective with respect to contracts, 
grants, cooperative agreements and loans entered into or made on or 
after December 23, 1989. See Attachment H for certification and 
disclosure forms to be submitted with the applications for this 
program.
    Attachment G indicates the regulations which apply to all 
applicants/grantees under the Discretionary Grants Program.

    Dated: January 13, 1995.
Donald Sykes,
Director, Office of Community Services.

   Attachment A.--1994 Poverty Income Guidelines for All States Except  
             Alaska and Hawaii and the District of Columbia             
------------------------------------------------------------------------
                                                                Poverty 
                     Size of family unit                       guideline
------------------------------------------------------------------------
1............................................................     $7,360
2............................................................      9,840
3............................................................     12,320
4............................................................     14,800
5............................................................     17,280
6............................................................     19,760
7............................................................     22,240
8............................................................     24,720
------------------------------------------------------------------------

    For family units with more than 8 members, add $2,480 for each 
additional member.

                  Poverty Income Guidelines for Alaska                  
------------------------------------------------------------------------
                                                                Poverty 
                     Size of family unit                       Guideline
------------------------------------------------------------------------
1............................................................     $9,200
2............................................................     12,300
3............................................................     15,400
4............................................................     18,500
5............................................................     21,600
6............................................................     24,700
7............................................................     27,800
8............................................................     30,900
------------------------------------------------------------------------

    For family units with more than 8 members, add $3,100 for each 
additional member.

                  Poverty Income Guidelines for Hawaii                  
------------------------------------------------------------------------
                                                                Poverty 
                     Size of family unit                       guideline
------------------------------------------------------------------------
1............................................................     $8,470
2............................................................     11,320
3............................................................     14,170
4............................................................     17,020
5............................................................     19,870
6............................................................     22,720
7............................................................     25,570
8............................................................     28,420
------------------------------------------------------------------------

    For family units with more than 8 members, add $2,850 for each 
additional member. (The same increment applies to smaller family sizes 
also, as can be seen in the figures above.)

                                                 BILLING CODE 4184-01-P
[[Page 4313]]

[GRAPHIC][TIFF OMITTED]TN20JA95.000


BILLING CODE 4184-01-C
[[Page 4314]]

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 
preapplication, use a separate sheet to provide a summary 
description of this project.
    12. List only the largest political entities affected (e.g., 
State, counties, cities).
    13. Self-explanatory.
    14. List the applicant's Congressional District and any 
District(s) affected by the program or project.
    15. Amount requested or to be contributed during the first 
funding/budget period by each contributor. Value of in-kind 
contributions should be included on appropriate lines as applicable. 
If the action will result in a dollar change to an existing award, 
indicate only the amount of the change. For decreases, enclose the 
amounts in parentheses. If both basic and supplemental amounts are 
included, show breakdown on an attached sheet. For multiple program 
funding, use totals and show breakdown using same categories as item 
15.
    16. Applicants should contact the State Single Point of Contact 
(SPOC) for Federal Executive Order 12372 to determine whether the 
application is subject to the State intergovernmental review 
process.
    17. This question applies to the applicant organization, not the 
person who signs as the authorized representative. Categories of 
debt include delinquent audit disallowances, loans and taxes.
    18. To be signed by the authorized representative of the 
applicant. A copy of the governing body's authorization for you to 
sign this application as official representative must be on file in 
the applicant's office. (Certain Federal agencies may require that 
this authorization be submitted as part of the application.)

                                                 BILLING CODE 4184-01-P
[[Page 4315]]

[GRAPHIC][TIFF OMITTED]TN20JA95.001


[[Page 4316]]

[GRAPHIC][TIFF OMITTED]TN20JA95.002


BILLING CODE 4184-01-C [[Page 4317]] 

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 total of Columns (b), (c), and (d).
    Line 12--Enter the total for each 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 
[[Page 4318]] 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. 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. 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.


----------------------------------------------------------------------
Signature of authorized certifying official

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

----------------------------------------------------------------------
Applicant organization

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

                                                 BILLING CODE 4184-01-P
[[Page 4319]]

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[[Page 4320]]

[GRAPHIC][TIFF OMITTED]TN20JA95.004


BILLING CODE 4184-01-C [[Page 4321]] 

Attachment D

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

    By signing and submitting this proposal, the applicant, defined 
as the primary participant in accordance with 45 CFR Part 76, 
certifies to the best of its knowledge and believe that it and its 
principals:
    (a) are not presently debarred, suspended, proposed for 
debarment, declared ineligible, or voluntarily excluded from covered 
transactions by any Federal Department or agency;
    (b) have not within a 3-year period preceding this proposal been 
convicted of or had a civil judgment rendered against them for 
commission of fraud or a criminal offense in connection with 
obtaining, attempting to obtain, or performing a public (Federal, 
State, or local) transaction or contract under a public transaction; 
violation of Federal or State antitrust statutes or commission of 
embezzlement, theft, forgery, bribery, falsification or destruction 
of records, making false statements, or receiving stolen property;
    (c) are not presently indicted or otherwise criminally or 
civilly charged by a governmental entity (Federal, State, or local) 
with commission of any of the offenses enumerated in paragraph 
(1)(b) of this certification; and
    (d) have not within a 3-year period preceding this application/
proposal had one or more public transactions (Federal, State, or 
local) terminated for cause or default.
    The inability of a person to provide the certification required 
above will not necessarily result in denial of participation in this 
covered transaction. If necessary, the prospective participant shall 
submit an explanation of why it cannot provide the certification. 
The certification or explanation will be considered in connection 
with the Department of Health and Human Services (HHS) determination 
whether to enter into this transaction. However, failure of the 
prospective primary participant to furnish a certification or an 
explanation shall disqualify such person from participation in this 
transaction.
    The prospective primary participant agrees that by submitting 
this proposal, it will include the clause entitled ``Certification 
Regarding Debarment, Suspension, Ineligibility, and Voluntary 
Exclusion--Lower Tier Covered Transaction.'' provided below with 
modification in all lower tier covered transactions and in all 
solicitations for lower tier covered transactions.

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

(To Be Supplied to Lower Tier Participants)

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

Attachment E

Executive Order 12372--State Single Points of Contact

Arizona

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

Arkansas

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

California

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

Delaware

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

District of Columbia

Mr. Rodney T. Hallman, State Single Point of Contact, Office of 
Grants Mgmt and Development, 717 14th Street N.W., Suite 500, 
Washington, D.C. 20005, Telephone (202) 727-6551

Florida

Florida State Clearinghouse, Intergovernmental Affairs Policy Unit, 
Executive Office of the Governor, Office of Planning and Budgeting, 
The Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-
8114

Georgia

Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse, 
254 Washington Street, S.W., Room 534A, Atlanta, Georgia 30334, 
Telephone (404) 656-3855

Illinois

Mr. Steve Klokkenga, State Single Point of Contact, Office of the 
Governor, 107 Stratton Building, Springfield, Illinois 62706, 
Telephone (217) 782-1671

Indiana

Ms. 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

Mr. 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

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

Michigan

Mr. 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) 949-2174

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, Attn: Mr. 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

Mr. Gregory W. Adkins, Acting Director, Division of Community 
Resources, New Jersey 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 [[Page 4322]] 

New Mexico

Mr. 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

North Dakota 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

Mr. 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

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

Tennessee

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

Texas

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

Utah

Utah State Clearinghouse, Office of Planning and Budget, ATTN: Ms. 
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, 
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 Office, Wisconsin 
Department of Administration, 101 South Webster Street, P.O. Box 
7864, Milwaukee, Wisconsin 53707, Telephone (608) 266-0267

Wyoming

Ms. Sheryl Jeffries, State Single Point of Contact, Herachler 
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 E. 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, No. 41 
Norregade Emancipation Garden Station, Second Floor, Saint Thomas, 
Virgin Islands 00802

    Please direct correspondence to:

Ms. Linda Clarke, Telephone (809) 774-0750

Attachment F--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.

----------------------------------------------------------------------
Signature

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

----------------------------------------------------------------------
Organization

----------------------------------------------------------------------
Date

                                                 BILLING CODE 4184-01-P
[[Page 4323]]

[GRAPHIC][TIFF OMITTED]TN20JA95.005


BILLING CODE 4184-01-C [[Page 4324]] 

Attachment G--DHHS Regulations Applying to All Applicants/Grantees 
Under the Community Food and Nutrition Program

    Title 45 of the Code of Federal Regulations:

Part 16--Department of Grant Appeals Process
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--Non-discrimination 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

                                                  Attachment H                                                  
               [Optional Checklist (for use of applicant only) to verify contents of application]               
----------------------------------------------------------------------------------------------------------------
                                                                                                        Check   
----------------------------------------------------------------------------------------------------------------
A. Application contains:                                                                                        
    1. Table of Contents..........................................................................       [    ] 
    2. A Project Abstract (no more than 200 words)................................................       [    ] 
    3. Completed SF 424, Application for Federal Assistance.......................................       [    ] 
    4. Completed SF 424A, Budget Information--Non-construction Programs...........................       [    ] 
    5. Signed SF 424B, Assurances--Non-Construction Programs......................................       [    ] 
    6. A project narrative with the following components:                                                       
        a. Analysis of need.......................................................................       [    ] 
        b. Project design.........................................................................       [    ] 
        c. Organizational experience in program...................................................       [    ] 
        d. Management history.....................................................................       [    ] 
        e. Staffing and resources (resume or job description).....................................       [    ] 
        f. Staff responsibilities.................................................................       [    ] 
    7. Relevant portions of the organization's by-laws and articles of incorporation confirming                 
     eligibility..................................................................................       [    ] 
    8. A signed copy of Certification Regarding the Anti-Lobbying Provision.......................       [    ] 
    9. A completed Disclosures of Lobbying Activities form, if appropriate........................       [    ] 
    10. A self-addressed mailing label which can be affixed to a postcard to acknowledge receipt                
     of application...............................................................................       [    ] 
B. Application does not exceed a total of 30 pages................................................       [    ] 
C. Application includes one original and four copies, printed on white 8\1/2\ by 11 inch paper....       [    ] 
D. Applicant is aware that the signing and submitting the application for funds under the CFN                   
 Program, it is certifying that it has read and understood the Federal Guidelines concerning a                  
 drug-free workplace and the debarment regulations set forth in attachments E and F respectively..       [    ] 
----------------------------------------------------------------------------------------------------------------

[FR Doc. 95-1364 Filed 1-19-95; 8:45 am]
BILLING CODE 4184-01-P