[Federal Register Volume 60, Number 21 (Wednesday, February 1, 1995)]
[Notices]
[Pages 6120-6137]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-2381]



=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families
[Program Announcement No. ACYF-HS 93600-951]


A Head Start on Science Demonstration Project; Grant Availability

AGENCY: Administration on Children, Youth and Families (ACYF), 
[[Page 6121]] Administration for Children and Families (ACF), DHHS.

ACTION: Announcement of availability of financial assistance to a two 
year or four year college or university for a Head Start on Science 
demonstration project.

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

SUMMARY: The Head Start Bureau of the Administration on Children, Youth 
and Families announces that applications from colleges or universities 
will be accepted to demonstrate and evaluate a summer institute 
prototype on their campus during the summers 1996 and 1997 on the topic 
of ``A Head Start on Science'', with follow-up assistance to graduates 
as they implement their new skills at their local Head Start programs. 
In year two of the grant period, the successful applicant also will 
recruit, fund and mentor another teacher education college or 
university to implement the ``A Head Start on Science'' approach.

DATES: The closing date for submission of applications is May 2, 1995.

ADDRESSES: Submit applications to: Applications may be mailed to the 
Department of Health and Human Services, Administration for Children 
and Families, Division of Discretionary Grants, 370 L'Enfant Promenade, 
S.W., Aerospace Building, 6th Floor, OFM/DDG, Washington, D.C. 20447.
    Hand delivered applications are accepted during the normal working 
hours of 8:00 a.m. to 4:30 p.m., Monday through Friday, on or prior to 
the established closing date at: Administration for Children and 
Families, Division of Discretionary Grants, 6th Floor OFM/DDG, 901 D 
Street, S.W., Washington D.C. 20447.

FOR FURTHER INFORMATION CONTACT: Any technical assistance calls may be 
forwarded to the ACYF Operations Center Telephone number: 1-800-351-
2293.

SUPPLEMENTARY INFORMATION:

Part I General Information

A. Program Purpose

    Head Start is a national program providing comprehensive 
developmental services primarily to low-income preschool children and 
their families. To help enrolled children achieve their full potential, 
Head Start programs provide comprehensive health, nutritional, 
educational, social, and other services. In addition Head Start 
programs are required to provide for the direct participation of the 
parents of enrolled children in the development, conduct, and direction 
of local programs. Head Start currently serves approximately 713,000 
children through a network of approximately 1,395 grantees.
    While Head Start is targeted primarily toward children whose 
families have incomes at or below the poverty line or who are eligible 
for public assistance, regulations permit up to 10 percent of the Head 
Start children in local programs to be from families which do not meet 
these low-income criteria. Head Start regulations also require that a 
minimum of 10 percent of enrollment opportunities in each program be 
made available to children with disabilities. Such children are 
expected to be enrolled in the full range of Head Start services and 
activities in a mainstream setting with their non-disabled peers, and 
to receive needed special education and related services.

B. Background on Demonstration Project ``A Head Start on Science''

    The report from the Advisory Committee on Head Start Quality and 
Expansion emphasizes that quality services to Head Start families must 
be given priority attention by all Head Start programs. The report 
underscored the need for staff development and training and supports 
initiatives designed to increase staff understanding of concepts and 
principles which will help them become more effective in early 
childhood settings.
    This project is designed to link colleges and universities to Head 
Start programs for the purpose of teaching science to Head Start staff. 
Highly intensive, hands-on instruction will provide teachers, 
assistants, and home visitors with exposure to the principles of 
science and increase their insights and skills regarding how to take 
their college campus experience and create classroom environments which 
invite child exploration and discovery. The staff will also increase 
their understanding of the natural learning environment presented by 
the out-of-doors, and the child's own home. We expect that `` A Head 
Start on Science'' model will be developed and documented in suitable 
printed and visual materials to be used to transmit the concept and 
approaches to other institutions of higher learning and Head Start 
communities. Project funds may also be used to present and distribute 
information at appropriate regional and national Head Start events, and 
to members of the Head Start training and technical assistance network. 
Also, it would be appropriate for the grantee to develop strategies and 
products which will assist other local Head Start programs to negotiate 
with their local college or university for similar staff training.
    We believe that as a result of participating in ``A Head Start on 
Science'' demonstration project, Head Start teachers, teacher 
assistants, and home visitors will be instrumental in creating a 
lifelong interest in science both for themselves and for the children 
and families with whom they work. We believe that staff will be 
impacted by the knowledge that science is found not only in a 
laboratory under a microscope, but in the everyday world in which they 
live. As a result of this experience, teachers, assistants and home 
visitors' concepts of science and their own scientific abilities will 
increase and in turn have a powerful effect on their ability to engage 
in discovery and establish environments in which children and families 
may explore, discover and interpret scientific activities.
    This announcement is soliciting applications from two or four-year 
colleges or universities, i.e., institutions of higher learning that 
grant degrees. Awards, on a competitive basis, will be for a one-year 
budget period, although projects periods may be for two years. 
Applications for continuation grants funded under these awards beyond 
the one-year budget period but within the two year project period will 
be entertained in subsequent years on a non-competitive basis, subject 
to availability of funds, satisfactory progress of the grantee and a 
determination that continued funding would be in the best interest of 
the Government. The Department of Health and Human Services will award 
one grant under this announcement. Up to $550,000 will be available for 
a 24 month project period.
    In the first year of the grant, the grantee institution will use 
these funds to create, demonstrate and evaluate a summer institute 
prototype on their campus during the summer of 1996 with follow-up 
assistance to Head Start staff graduates as they implement their new 
skills at their local programs. Also in year one the grantee will 
recruit another college or university in which to replicate the model 
in year two.
    In the second year of this grant, the grantee institution will 
improve the prototype program based on year-one experiences, and will 
offer the hands-on science program to a new group of Head Start staff 
during the summer 1997. Also during the second year, the ``A Head Start 
on Science'' grantee will fund for one year, and mentor another college 
or university to: (1) Implement the prototype ``A Head Start on 
Science'' model in the summer of 1997 and; (2) provide follow-up 
assistance to the Head Start staff as they plan to 
[[Page 6122]] implement their new skills in their local programs. The 
addition of a second institution will provide the opportunity to 
evaluate the effectiveness and transferability of the concept.
    Throughout the grant period, a third party evaluator must be 
secured by the grantee institution to assess the effectiveness of the 
approach, content and transferability of the ``A Head Start on 
Science'' project. The third party evaluator must not be involved in 
the conduct of the demonstration. The evaluation of the students in 
both institutes in the summer of 1997 will be completed by the end of 
the project period. It should focus on the students' plans for the 
implementation of the program and principles.

Statutory Authority

    The Head Start Act, as amended, 42 U.S.C. 9801 et seq.

D. Project Period and Funding

    A total of approximately $550,000 in ACF funds will be available to 
fund the demonstration project for a 24 month period. Applicants must 
propose how much will be needed for each 12 month period of the 
project.
    The grantee must provide at least 20 percent of the total cost of 
the project. The total approved cost of the project is the sum of the 
ACF share and the non-Federal share. The non-Federal share may be met 
by cash or in-kind contributions, although applicants are encouraged to 
meet their match requirements through cash contributions. Therefore, a 
project requesting $550,000 in Federal funds (based on an award of 
approximately $275,000 per budget period) must provide $137,500 in cash 
or in-kind contributions (20% of total project costs of $687,500).

E. Eligible Applicants

    Applicants must be either two year or four year institutions of 
higher learning which are colleges or universities, private or public, 
having the capability to create, demonstrate and evaluate a summer 
institute prototype.

Part II Special Requirements

    A. Colleges and universities are eligible to apply for these funds. 
The college or university must also be able to award college credit to 
Head Start staff that successfully complete the summer program.
    B. The project should be directed toward Head Start teachers, 
teachers' assistants and/or home visitors.
    C. Funds may be used for university operating expenses and related 
costs. Related costs include such activities as planning and 
development costs, administration, supplies, insurance, university 
staff salaries, training provided at Head Start events and the third 
party evaluation.
    D. The university or college institute teaching team will be 
comprised of individuals with knowledge of science, adult learning, and 
early childhood education.

Part III Specific Responsibilities of the Applicant

    When submitting an application under this announcement, applicants 
should include a maximum of 50 typed, doubled-spaced pages. Applicants 
interested in submitting an application for the training prototype 
must:
    A. Describe the design of the project. Include a description of how 
the summer institutes will address the unique needs of teachers, 
teacher assistants and/or home visitors.
    B. Provide a sample curriculum for the summer institute 
participants based on content and approach which will help increase 
participants' knowledge of science, increase their understanding and 
skills regarding how to create classroom environments, and capitalize 
on the out-of-doors and family settings as areas of scientific 
exploration and learning.
    C. List projected field experiences appropriate to the location of 
the college and Head Start programs. These may include trips to the 
ocean, visiting a quarry, aquarium, desert, nature trail, or wild life 
reserve. Information submitted should include the total number of hours 
of the institute program including a breakout of instruction vs. field 
trip experiences.
    D. Describe a plan for how many participants will be included in 
each summer program and how these participants will be recruited.
    E. Describe what provisions will be made for residential, intensive 
summer institutes for Head Start teachers, teacher assistants, and/or 
home visitors.
    F. Describe provision of materials, lunch and snacks, stipend or 
reimbursement, transportation to field activities, and entry fees.
    G. Describe the college credit to be awarded for work completed 
during the summer institute and for implementing new knowledge and 
practice back at local programs.
    H. Describe the plan for the extension of the summer institute into 
Head Start settings and the provision of on-site feedback and ongoing 
support for adults applying their new skills.
    I. Explain the criteria and the approach to be used to recruit, 
fund, and mentor another college for the second year of the project.
    J. Develop an evaluation of the project to determine the 
effectiveness of the project. Describe the research questions to be 
addressed. Describe the evaluation that would be implemented, including 
the outcomes that would be measured, the evaluation design to be 
employed, and how the data will be analyzed. The evaluation should also 
include an analysis of the second summer institutes. The project and 
the evaluation will be completed by the end of the project period.
    K. Provide a description of the qualifications of each key staff 
member including the third-party evaluator (the evaluator cannot be a 
member of the demonstration project staff). Include copies of their 
curriculum vitae.
    L. Describe a plan to establish a self sustaining project, since 
this will be a prototype other colleges and universities may want to 
adapt. It is expected that the applicant may pay for more activities 
and services during the first year; however, attempts should be made to 
run a more self supporting program by year two. Outside resources or 
Head Start grantees that see these services as a priority can support 
some of the cost of the training.

Part IV Evaluation Criteria

    In consideration of how applicants will meet the requirements and 
responsibilities addressed under Parts II and III of this announcement, 
competing applications from colleges and universities will be reviewed 
and evaluated against the following criteria.
    A. Objectives and Need for Assistance (15 points).
    The extent to which the applicant identifies any relevant economic, 
social, financial institutional or other problems requiring a solution: 
demonstrates the need for the assistance: and states the principal and 
subordinate objectives of the project. Supporting documentation or 
other testimonies from concerned interests other than the applicant on 
the need for assistance may be used.
    Identify the precise location of the project and the area to be 
served by the proposed project. Maps and other geographic aids may be 
attached.
    Information provided in response to the following items under 
``Specific Responsibilities of the Applicant'' will be used to review 
and evaluate applicants on this criterion: Letters A,C,D.
    B. Results or Benefits Expected (15 points).
    The extent to which the applicant identifies the results and 
benefits to be derived which are consistent with the 
[[Page 6123]] objectives of the proposal and indicates the anticipated 
contributions to policy, practice, theory and/or research.
    Information provided in response to the following items under 
``Specific Responsibilities of the Applicant'' will be used to review 
and evaluate applicants on this criterion: Letters A,G,H,J
    C. Approach (40 points).
    The extent to which the applicant outlines an acceptable plan of 
action pertaining to the scope of the project; details how the proposed 
work will be accomplished and lists each organization, consultant, and 
other key individuals who will work on the project, along with resumes 
and a short description of their responsibilities or contribution to 
the applicant's work plan. Describe the evaluation methodology that 
will be used to determine if the needs identified and discussed are 
being met and if the results and benefits identified are being 
achieved.
    Information provided in response to the following items under 
``Specific Responsibilities of the Applicant'' will be used to review 
and evaluate applicants on this criterion: Letters A,B,C,E,F,G,H,I.
    D. Staff Background and Organization's Experience (20 Points).
    Identifies the background of the project director/principal 
investigator and key project staff (including name, address, training, 
most relevant educational background and other qualifying experiences) 
and the experience of the college or university to demonstrate the 
applicant's ability to effectively and efficiently administer this 
project.
    Information provided in response to the following items under 
``Specific Responsibilities of the Applicant'' will be used to review 
and evaluate applicants on this criterion: Letter K.
    E. Budget Appropriateness and Reasonableness (10 Points).
    The extent to which the project's costs are reasonable in view of 
the activities to be carried out and the anticipated outcomes. The 
extent to which assurances are provided that the applicant can and will 
contribute the non-Federal share of the total project.
    The extent to which the amount budgeted for the evaluation is 
sufficient to conduct the evaluation.
    Information provided in response to the following items under 
``Application Requirements'' will be used to review and evaluate 
applicants on this criterion: Letters C,E,F,J,L.

Part V Application Process

A. Availability of Forms

    Eligible applicants interested in applying for funds must submit 
all of the required forms included at the end of this Announcement.
    In order to be considered for a grant under this Announcement, an 
application must be submitted on the Standard Form 424 which has been 
approved by the Office of Management and Budget (OMB) under Control 
Number 0348-0043. A copy has been provided (see Appendix B). Each 
application must be signed by an individual authorized to act for the 
applicant and to assume responsibility for the obligations imposed by 
the terms and conditions of the grant award.
    Applicants requesting financial assistance for a nonconstruction 
project must file the standard Form 424B, ``Assurances: Non-
Construction Programs.'' Applicants must sign and return the Standard 
Form 424B with their applications.
    Applications 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. Applications 
must sign and return the certification with the applications.
    Applications 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.
    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.
    Copies of the certifications and assurance are located at the end 
of this announcement.

B. Application Submission

    One signed original and two copies of the grant application, 
including all attachments, are required. The program announcement 
number [ACYF-HS 93600-951] must be clearly identified on the 
application. Each application must be limited to no more than 50 
double-spaced pages of program narrative (not including the forms which 
make up the SF-424 and resumes) including the one-page project summary. 
If the application is more than 50 double-spaced pages, the other pages 
will be removed from the application and not considered by the 
reviewers.
    The application must be paginated beginning with the Form 424 and 
also contain a table of contents listing each section of the 
application with the respective pages identified. Only one application 
per applicant will be accepted.

C. Application Consideration

    Applicants will be scored against the evaluation criteria described 
above. The review will be conducted in Washington, D.C.
    The results of the competitive review will be taken into 
consideration by the Associate Commissioner, Head Start Bureau, in 
recommending the project to be funded. The Commissioner of ACYF will 
make the final selection of the applicants to be funded. An application 
may be funded in whole or in part, depending on the relative need for 
services, applicant ranking, geographic location and funds available.
    The Commissioner may also elect not to provide funding to 
applicants experiencing problems in providing quality services.
    Successful applicants will be notified through the issuance of a 
Financial Assistance Award which sets forth the amount of funds 
granted, the terms and conditions of the grant, the effective date of 
the grant, the budget period for which support is given, and the total 
project period for which support is provided.

D. Checklist for a Complete Application

    The checklist below is for your use to ensure that your application 
package has been properly prepared.
--One original, signed and dated application plus two copies.
--Application length does not exceed 50 double-spaced pages
--A complete application consists of the following items in this order:
--Application for Federal Assistance (SF 424, REV.4-88); Narrative;
--Staff Resumes;
--A completed SPOC certification with the date of SPOC contact entered 
in line 16, page 1 of the (SF 424, REV.4-88);
--Budget information-Non-Construction Programs (SF 424A REV.88);
--Budget justification for Section B-Budget Categories; including 
subcontract/delegate agency budgets
--Table of Contents;
--Letter from the Internal Revenue Services to prove non-profit status
--Project Summary (not to exceed one page);
--Organization/eligibility information; [[Page 6124]] 
--Assurances Non-Construction Programs;
--Certification Regarding Lobbying.

E. Deadlines

    Applications shall be considered as meeting an announced deadline 
if they are either:
    1. Received on or before the deadline date at a place specified in 
the program announcement, or
    2. Sent on or before the deadline date and received by the granting 
agency in time for the independent review under DHHS GAM Chapter 1-62. 
(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.)
    Late applications: Applications which do not meet the criteria in 
paragraph E of this section are considered late applications. The 
granting agency shall notify each late applicant that its application 
will not be considered in the current competition.
    Extension of deadlines: The granting agency may extend the deadline 
for all applicants because of acts of God such as floods, hurricanes, 
etc., or when there is a widespread 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 applicants.

F. Paperwork Reduction Act of 1980

    Under the Paperwork Reduction Act of 1980, Public Law 96-511, the 
Department is required to submit to OMB for review and approval any 
reporting and record keeping requirements in regulations, including 
program announcements. This program announcement does not contain 
information collection requirements beyond those approved for ACF grant 
applications under OMB Control Number 0348-0043.

G. Executive Order 12372--Notification Process

    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 Executive Order 12372, States may 
design their own processes for reviewing and commenting on proposed 
Federal assistance under covered programs.
    All States and territories except Alabama, Alaska, Connecticut, 
Colorado, 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 jurisdiction areas need 
not take action regarding Executive Order 12372. Applications for 
projects to be administered by Federally-recognized Indian Tribes are 
exempt from the requirements of Executive Order 12372. Otherwise, 
applicants should contact their SPOC as soon as possible to alert them 
to the prospective application and to receive any necessary 
instructions. Applicants must submit any required material to the SPOC 
as early 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 date of contact if no submittal 
is required) on the SF 424, item 16a.
    Under 45 CFR 100.8(a) (2), a SPOC has 60 days from the application 
deadline to comment on proposed new or competing continuation awards.
    SPOCs are encouraged to eliminate the submission of routine 
endorsements as official recommendations.
    Additionally, SPOCs are requested to clearly differentiate between 
mere advisory comments and those official State process recommendations 
which they intend to trigger the ``accommodate or explain'' rule.
    When comments are submitted directly to ACF, they should be 
addressed to: Department of Health and Human Services, Administration 
for Children and Families, Division of Discretionary Grants, 370 
L'Enfant Promenade, S.W., 6th floor, Aerospace Building, Washington, 
D.C. 20447.
    A list of SPOCs for each State and territory is included at 
Appendix A of this announcement.

H. Effective Date

    It is anticipated that successful applications shall be funded no 
later than September 30,1995.

(Catalog of Federal Domestic Assistance Program Number 93.600, 
Project Head Start.)

    Dated: January 23, 1995.
Olivia A. Golden,
Commissioner, Administration on Children, Youth and Families.

Appendix A--Executive Order 12372--State Single Points of Contact

Arizona

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

Arkansas

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

California

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

Delaware

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

District of Columbia

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

Florida

Florida State Clearinghouse, Intergovernmental Affairs Policy Unit, 
Executive Office of the Governor, Office of Planning and Budgeting, The 
Capitol, Tallahassee, Florida 32399-0001, Telephone (904) 488-8441

Georgia

Mr. Charles H. Badger, Administrator, Georgia State Clearinghouse, 254 
Washington Street SW., Atlanta, Georgia 30334, Telephone (404) 656-3855

Illinois

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

Indiana

Jean S. Blackwell, Budget Director, State Budget Agency, 212 State 
House, Indianapolis, Indiana 46204, Telephone (317) 232-
5610 [[Page 6125]] 

Iowa

Mr. Steven R. McCann, Division of Community Progress, Iowa Department 
of Economic Development, 200 East Grand Avenue, Des Moines, Iowa 50309, 
Telephone (515) 281-3725

Kentucky

Ronald W. Cook, Office of the Governor, Department of Local Government, 
1024 Capitol Center Drive, Frankfort, Kentucky 40601, Telephone (502) 
564-2382

Maine

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

Maryland

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

Massachusetts

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

Michigan

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

Mississippi

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

Missouri

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

Nevada

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

New Hampshire

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

New Jersey

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

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

New Mexico

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

New York

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

North Carolina

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

North Dakota

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

Ohio

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

Rhode Island

Mr. Daniel W. Varin, Associate Director, Statewide Planning Program, 
Department of Administration, Division of Planning, 265 Melrose Street, 
Providence, Rhode Island 02907, Telephone (401) 277-2656,
Please direct correspondence and questions to: Review Coordinator, 
Office of Strategic Planning

South Carolina

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

Tennessee

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

Texas

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

Utah

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

Vermont

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

West Virginia

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

Wisconsin

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

Wyoming

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

Guam

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

Northern Mariana Islands

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

Puerto Rico

Norma Burgos/Jose H. Caro, Chairman/Director, Puerto Rico Planning 
Board, Minillas Government Center, P.O. Box 41119, San Juan, Puerto 
Rico 00940-9985, Telephone (809) 727-4444
[[Page 6126]]

Virgin Islands

Jose L. George, Director, Office of Management and Budget, #41 
Norregade Emancipation Garden Station, Second Floor, Saint Thomas, 
Virgin Islands 00802, Please direct correspondence to: Linda Clarke, 
Telephone (809) 774-0750.

                                                 BILLING CODE 4184-01-P
[[Page 6127]]

[GRAPHIC][TIFF OMITTED]TN01FE95.134



BILLING CODE 4184-01-C
[[Page 6128]]

Instructions for the SF 424

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

Item and Entry:

1. Self-explanatory.
2. Date application submitted to Federal agency (or State if 
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing award, 
enter present Federal identifier number. If for a new project, leave 
blank.
5. Legal name of applicant, name of primary organizational unit which 
will undertake the assistance activity, complete address of the 
applicant, and name and telephone number of the person to contact on 
matters related to this application.
6. Enter Employer Identification Number (EIN) as assigned by the 
Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the 
space(s) provided:
    --``New'' means a new assistance award.
    --``Continuation'' means an extension for an additional funding/
budget period for a project with a projected completion date.
    --``Revision'' means any change in the Federal Government's 
financial obligation or contingent liability from an existing 
obligation.
9. Name of Federal agency from which assistance is being requested with 
this application.
10. Use the Catalog of Federal Domestic Assistance number and title of 
the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than one 
program is involved, you should append an explanation on a separate 
sheet. If appropriate (e.g., construction or real property projects), 
attach a map showing project location. For preapplications, use a 
separate sheet to provide a summary description of this project.
12. List only the largest political entities affected (e.g., State, 
counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any District(s) 
affected by the program or project.
15. Amount requested or to be contributed during the first funding/
budget period by each contributor. Value of in-kind contributions 
should be included on appropriate lines as applicable. If the action 
will result in a dollar change to an existing award, indicate only the 
amount of the change. For decreases, enclose the amounts in 
parentheses. If both basic and supplemental amounts are included, show 
breakdown on an attached sheet. For multiple program funding, use 
totals and show breakdown using same categories as item 15.
16. Applicants should contact the State Single Point of Contact (SPOC) 
for Federal Executive Order 12372 to determine whether the application 
is subject to the State intergovernmental review process.
17. This question applies to the applicant organization, not the person 
who signs as the authorized representative. Categories of debt include 
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 6129]]

[GRAPHIC][TIFF OMITTED]TN01FE95.135


[[Page 6130]]

[GRAPHIC][TIFF OMITTED]TN01FE95.136



BILLING CODE 4184-01-C
[[Page 6131]]

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).
Lines 1-4, Columns (c) through (g) (continued)
    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 (b)--Enter the amount of cash and in-kind contributions to 
be made from all other sources.
    Column (e)--Enter totals of Columns (b), (c), and (d).
    Line 12--Enter the total for each of Columns (b)-(e). The amount in 
Column (e) should be equal to the amount on Line 5, Column (f), Section 
A.
Section D Forecasted Cash Needs
    Line 13--Enter the amount of cash needed by quarter from the 
grantor agency during the first year.
    Line 14--Enter the amount of cash from all other sources needed by 
quarter during the first year.
    Line 15--Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed for Balance of the 
Project
    Lines 16-19--Enter in Column (a), the same grant program titles 
shown in Column (a), Section A. A breakdown by function or activity is 
not necessary. For new applications and continuation grant 
applications, enter in the proper columns amounts of Federal funds 
which will be needed to complete the program or project over the 
succeeding funding periods (usually in years). This section need not be 
completed for revisions (amendments, changes, or 
[[Page 6132]] 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.
OMB Approval No. 0348-0040

Assurances--Non-Construction Programs

    Note: Certain of these assurances may not be applicable to your 
project or program. If you have questions, please contact the 
awarding agency. Further, certain Federal awarding agencies may 
require applicants to certify to additional assurances. If such is 
the case, you will be notified.

    As the duly authorized representative of the applicant I certify 
that the applicant:
    1. Has the legal authority to apply for Federal assistance, and the 
institutional, managerial and financial capability (including funds 
sufficient to pay the non-Federal share of project costs) to ensure 
proper planning, management and completion of the project described in 
this application.
    2. Will give the awarding agency, the Comptroller General of the 
United States, and if appropriate, the State, through any authorized 
representative, access to and the right to examine all records, books, 
papers, or documents, related to the award; and will establish a proper 
accounting system in accordance with generally accepted accounting 
standards or agency directives.
    3. Will establish safeguards to prohibit employees from using their 
positions for a purpose that constitutes or presents the appearance of 
personal or organizational conflict of interest, or personal gain.
    4. Will initiate and complete the work within the applicable time 
frame after receipt of approval of the awarding agency.
    5. Will comply with the Intergovernmental Personnel Act of 1970 (42 
U.S.C. Secs. 4728-4763) relating to prescribed standards for merit 
systems for programs funded under one of the nineteen statutes or 
regulations specified in Appendix A of OPM's Standards for a Merit 
System of Personnel Administration (5 C.F.R. 900, Subpart F).
    6. Will comply with all Federal statutes relating to 
nondiscrimination. These include but are not limited to: (a) Title VI 
of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits 
discrimination on the basis of race, color or national origin; (b) 
Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 
Secs. 1681-1683, and 1685-1686), which prohibits discrimination on the 
basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as 
amended (29 U.S.C. Sec. 794), which prohibits discrimination on the 
basis of handicaps; (d) the Age Discrimination Act of 1975, as amended 
(42 U.S.C. Secs. 6101-6107), which prohibits discrimination on the 
basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 
92-255), as amended, relating to nondiscrimination on the basis of drug 
abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, 
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, 
relating to nondiscrimination on the basis of alcohol abuse or 
alcoholism; (g) Secs. 523 and 527 of the Public Health Service Act of 
1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to 
confidentiality of alcohol and drug abuse patient records; (h) Title 
VIII of the Civil Rights Act of 1968 (42 U.S.C. Sec. 3601 et seq.), as 
amended, relating to nondiscrimination in the sale, rental or financing 
of housing; (i) any other nondiscrimination provisions in the specific 
statute(s) under which application for Federal assistance is being 
made; and (j) the requirements of any other nondiscrimination 
statute(s) which may apply to the application.
    7. Will comply, or has already complied, with the requirements of 
Titles II and III of the Uniform Relocation Assistance and Real 
Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide 
for fair and equitable treatment of persons displaced or whose property 
is acquired as a result of Federal or federally assisted programs. 
These requirements apply to all interests in real property acquired for 
project purposes regardless of Federal participation in purchases.
    8. Will comply with the provisions of the Hatch Act (5 U.S.C. 
Secs. 1501-1508 and 7324-7328) which limit the political activities of 
employees whose principal employment activities are funded in whole or 
in part with Federal funds.
    9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. Secs. 276a to 276a-7), the Copeland Act (40 U.S.C. 
Sec. 276c and 18 U.S.C. Secs. 874), and the Contract Work Hours and 
Safety Standards Act (40 U.S.C. Secs. 327-333), regarding labor 
standards for federally assisted construction subagreements.
    10. Will comply, if applicable, with flood insurance purchase 
requirements of Section 102(a) of the Flood Disaster Protection Act of 
1973 (P.L. 93-234) which requires recipients in a special flood hazard 
area to participate in the program and to purchase flood insurance if 
the total cost of insurable construction and acquisition is $10,000 or 
more.
    11. Will comply with environmental standards which may be 
prescribed pursuant to the following: (a) institution of environmental 
quality control measures under the National Environmental Policy Act of 
1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of 
violating facilities pursuant to EO 11738; (c) protection of wetlands 
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in 
accordance with EO 11988; (e) assurance of project consistency with the 
approved State management program developed under the Coastal Zone 
Management Act of 1972 (16 U.S.C. Secs. 1451 et seq.); (f) conformity 
of Federal actions to State (Clear Air) Implementation Plans under 
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 
Sec. 7401 et seq.); (g) protection of underground sources of drinking 
water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered 
Species Act of 1973, as amended, (P.L. 93-205).
    12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 
U.S.C. Secs. 1271 et seq.) related to protecting components or 
potential components of the national wild and scenic rivers system.
    13. Will assist the awarding agency in assuring compliance with 
Section 106 of the National Historic Preservation Act of 1966, as 
amended (16 U.S.C. 470), EO 11593 (identification and protection of 
historic properties), and the Archaeological and Historic Preservation 
Act of 1974 (16 U.S.C. 469a-1et seq.). [[Page 6133]] 
    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 6134]]

[GRAPHIC][TIFF OMITTED]TN01FE95.137


[[Page 6135]]

[GRAPHIC][TIFF OMITTED]TN01FE95.138



BILLING CODE 4184-01-C
[[Page 6136]]

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

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

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

Certification Regarding Lobbying

Certification for Contracts, Grants, Loans, and Cooperative Agreements

    The undersigned certifies, to the best of his or her knowledge and 
belief, that:
    (1) No Federal appropriated funds have been paid or will be paid, 
by or on behalf of the undersigned, or to any person for influencing or 
attempting to fluence 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 act 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 require 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 6137]]

[GRAPHIC][TIFF OMITTED]TN01FE95.139



[FR Doc. 95-2381 Filed 1-31-95; 8:45 am]
BILLING CODE 4184-01-C